In 2004, Dutch physicians from the Groningen University Medical Centre and the public prosecutor jointly set up the Groningen Protocol for Euthanasia in newborns aged 0-1 years. The protocol contains guidelines and criteria that physicians have to follow in order to be exempted from criminal liability when assisting in suicide or performing euthanasia in newborns with hopeless und unbearable suffering. In July 2005, the protocol was adopted by the Dutch Association for Pediatrics.1
In the protocol, a distinction is made between three groups of newborns:
1. The newborn who will die in the near future, despite treatment. This group is also called medically hopeless. There are no scientific methods to keep the child alive. When the child dies, it is therefore called a natural death.
2. The newborn who may survive with maximum treatment, but with bad prospects. Stopping treatment will cause the death of the newborn. Treatment is seen as medically pointless. When the newborn dies, it is called a natural death.
3. The newborn will stay alive without intensive care, but will live a life of severe and hopeless suffering. The suffering cannot be alleviated by pain management or palliative care. The legislation on euthanasia and assisted suicide applies to this group of newborns.
The protocol is a precise guideline for the physician's actions. The physician is obliged to follow the due care criteria at all times. Important criteria are hopeless and unbearable suffering, the parent's understanding of the diagnosis, parent's consenting for end-of-life treatment and consulting at least one other independent physician. Moreover, the protocol contains a list of information that must be provided to the public prosecutor when reporting the case.2
The aim of the protocol is to provide physicians guidelines and procedures during the decision-making process and during the process of euthanasia. Furthermore, the protocol aims to achieve more transparency of physicians regarding end-of-life treatment for newborns. It is suspected that before 2004, only a few end-of-life treatment on newborns were reported, because physicians were unsure about the legal consequences of their actions.3
1. NVK, Zorgvuldigheidseisen rond actieve levensbeëindiging bij pasgeborenen met een ernstige aandoening. Het Gronings protocol, Nederlandse Vereniging voor de Kindergeneeskunde, Utrecht 2005.
2. H.E.G.M. Hermans & M.A.J.M. Buijsen, Recht en gezondheidszorg, Amsterdam: Reed Business 2010, p.441-442.
3. NVK, Zorgvuldigheidseisen rond actieve levensbeëindiging bij pasgeborenen met een ernstige aandoening. Het Gronings protocol, Nederlandse Vereniging voor de Kindergeneeskunde, Utrecht 2005.