In The Netherlands, neonatal euthanasia has become a legal option and the Groningen Protocol contains an approach to identify situations in which neonatal euthanasia might be appropriate. In the 5 years following the publication of the protocol, neither the prediction that this would be the first step on a slippery slope, nor the prediction of complete transparency and legal control became true. Instead, we experienced a transformation of the healthcare system after antenatal screening policy became a part of antenatal care. (...) This resulted in increased terminations of pregnancy and less euthanasia. (shrink)

The Groningen Protocol allows active euthanasia of severely ill newborns with unbearable suffering. Defenders of the protocol insist that the protocol refers to terminally ill infants and that quality of life should not be a factor in the decision to euthanize an infant. They also argue that there should be no ethical difference between active and passive euthanasia of these infants. However, nowhere in the protocol does it refer to terminally ill infants; on the contrary, the developers of the protocol (...) take into account the future quality of life of the infant. We also note how the Nazi Euthanasie Programm started with the premise that there is some life not worthy of living. Therefore, in our opinion, the protocol violates the traditional ethical codes of physicians and the moral values of the overwhelming majority of the citizens of the world. (shrink)

This article articulates and defends a dissolution of the so-called repugnant conclusion, which focuses on the notion of life worth living figuring both in Parfit's formulation of the repugnant conclusion and in most responses to such a conclusion. The proposed dissolution demonstrates that the notion of life worth living is plagued by multiple ambiguities and that these ambiguities, in turn, hamper meaningful debate about both the issue of whether the repugnant conclusion can be avoided and the issue of whether the (...) repugnant conclusion is actually repugnant. This result does not exclude that some modified versions of the repugnant conclusion may yield valuable insights about the value of populations and the tenability of different axiological/ethical theories. Still, if the proposed dissolution is correct, then the repugnant conclusion rests on an ill-defined notion and we lack the information required to assess the merits of the repugnant conclusion. (shrink)

The Groningen Protocol and contemporary defences of the legalisation of infanticide are predicated on actualism and personism. According to these related ideas, human beings achieve their moral status in virtue of the degree to which they are capable of laying value upon their lives or exhibiting certain qualities, like not being in pain or being desirable to third party family members. This article challenges these notions suggesting that both ideas depend on arbitrary and discriminatory notions of human moral status. Our (...) propensity to sleep, fall unconscious, pass out and so on, demonstrates that we very often exhibit our status as “potential persons.” Our abilities can and do fluctuate. The equal dignity principle, distinguished in turn from both the excesses of vitalism and consequentialism, is analyzed in the context of human rights logic and law. The normalization of non-voluntary euthanasia, via such ad hoc practices as the Groningen Protocol is considered. Substituted ‘consent’ to the euthanasia of infants or others, is scrutinized and the implications of institutionalizing non-voluntary euthanasia in the context of financial, research and political interests are considered. The impact on the medical and legal professions, carers, families and coroners, as well as public attitudes more generally, is discussed. It is suggested that eroding the value of human life carries with it significant destructive and hazardous long-term implications for societies. To elevate some long-term implications whilst ignoring others demonstrates the irrational nature of the effort to institutionalize euthanasia. (shrink)

This article argues for the elimination of the concept of life worth living from philosophical vocabulary on three complementary grounds. First, the basic components of this concept suffer from multiple ambiguities, which hamper attempts to ground informative evaluative and classificatory judgments about the worth of life. Second, the criteria proposed to track the extension of the concept of life worth living rest on unsupported axiological assumptions and fail to identify precise and plausible referents for this concept. And third, the concept (...) of life worth living is not shown to serve any major evaluative or classificatory purpose besides those served by already available axiological concepts. By eliminating the concept of life worth living, philosophers will free themselves of the task of addressing ill-posed axiological questions and ground reflection about the worth of life on more rigorous conceptual foundations. (shrink)

The Groningen Protocol, introduced in the Netherlands in 2005 and accompanied by revised guidelines published in a report commissioned by the Royal Dutch Medical Association in 2014, specifies conditions under which the lives of severely ill newborns may be deliberately ended. Its publication came four years after the Netherlands became the first nation to legalize the voluntary active euthanasia of adults, and the Netherlands remains the only country to offer a pathway to protecting physicians who might engage in deliberately ending (...) the life of a newborn. In this paper, I offer two lines of argument. The first is a positive argument for the Protocol, grounded in the good of the newborn as unanimously determined by those in a position to determine it. The second addresses the widely shared belief that the killing of newborns is morally prohibited, where I offer two arguments—one grounded in the fact that the kinds of cases the Protocol is meant to govern are very rare and highly unusual, and the other focused more broadly on the role of pre-theoretical beliefs in moral reasoning—meant to undermine the strong role that the critic of the Protocol affords this belief. I argue that, given this second line of argument, the beliefs underlying my positive argument for the Protocol are in fact more secure than the widely shared belief underlying the critic’s position. (shrink)

The Groningen Protocol aims at providing guidance in end-of-life decision-making for severely impaired newborns. Since its publication in 2005 many bioethicists and health care professionals have written articles in response. However, only very little is known about the opinion among the general population on this subject. The aim of this study was to present the general attitude towards neonatal euthanasia (NE) among the Austrian population and the factors associated with the respondents’ opinion.

Jotkowitz, Glick, and Gesundheit (2008) rightly critique Manninen (2006) for an errant analysis of the Groningen protocol. However, they draw conclusions about the protocol itself that are not justified. Because of the nature of the care of infants, the Groningen protocol doesn't break new ethical ground. We already have to treat infants without direct access to their autonomous preferences or values; therefore, we are already making the decisions that Jotkowitz, Glick, and Gesundheit argue we are beginning to take once active (...) euthanasia of infants is allowed. (shrink)

In this paper, a personalist ethical perspective on end-of-life care of severely ill newborns is presented by posing two questions. (1) Is it ethically justified to decide not to start or to withdraw life-sustaining treatment in severely ill newborns? (2) Is it ethically justified, in exceptional cases, to actively terminate the life of severely ill newborns? Based on five values—respect for life and for the dignity of the human person, quality of life, respect for the process of dying, relational autonomy, (...) and justice—an ethical assessment is conducted that brings us answers to the two ethical questions. (1) Noninitiation or withdrawal of life-sustaining medical treatment in severely ill newborns is ethically acceptable, and might even be a moral duty, when initiation or continuation of medical treatment can be considered futile or even harmful. (2) However, according to the personalist approach, it is not ethically acceptable to actively terminate the life of a severely ill newborn. (shrink)