Skip to comments.Netherland’s Groningen Protocol Gains Acceptance In America
Posted on 08/16/2009 11:50:08 AM PDT by TheWriterTX
Netherlands Groningen Protocol Gains Acceptance In America
By Linda Prussen-Razzano
Former Governor Sarah Palin set off a firestorm when she expressed concern over how her son, Trig (born with Down Syndrome) would be treated in a universal-healthcare system. Posting on Facebook, Palin fretted that children like Trig could potentially face a death panel of bureaucrats determining whether he was fit to live. While the Administration and the majority of the media dismissed her remarks as false, closer examination reveals that Palins alarm was justified.
Everyday, in hospitals across America, panels of doctors and bioethicists deal with the complicated issue of end of life care. This issue is particularly sensitive for parents of newborns, where the question is not how much longer can this person have useful life, but will this person have a useful life? Unlike teenagers or adults, where deterioration or progress may be readily measured against the patients present condition, a newborns family has no collective memory, no mental or physical yardstick to gauge progress. Most new parents are bursting with an overwhelming paternal instinct, and cling fiercely to hope when outsiders would easily turn away.
Ironically, bioethicists are examining the Netherlands model for guidance on implementing guidelines for end of life care in newborns. The Netherlands is one of the few countries that has an active euthanasia law (with government mandated safeguard provisions to avoid abuse). In 1991, the Netherlands government released a detailed report on compliance with the law. The report, commonly known as The Remmelick Report, revealed that 8% (1,040) of the patients were involuntarily euthanized (lethal injection) directly by the doctor without the patients consent, and another 41% (4,941) were deliberately provided overdoses of pain medication with the intent to end their lives again, without the patients consent.
So why would American doctors and hospital boards be examining the process for newborn end of life care from the Netherlands? Quite simply, the Netherlands is very good at reducing demand on the system. With NICU facilities purposefully limited by the government to control costs, there is only so much room for needy newborns.
Under the Netherlands model (known as the Groningen Protocol), a newborn would be subject to end of life decisions if they fall into the following categories:
1. Group One consists of children born with severe cognitive or genetic abnormalities that prevent them from living without technological assistance, or whose prognosis for life is extremely short even with intensive care.
2. Group Two consists of children born severe cognitive or genetic abnormalities that allow them to live for a short period of time without technology, but for whom the prognosis of future quality of life is extremely poor.
3. Group Three consists of children who may not require technology for life, but who may experience substantial pain and suffering, or for whom there is no possibility of a cure.
Although euthanasia of infants is prohibited by law, Doctors in the Netherlands are not accountable if the patient dies as a result of natural causes. To ease parental anxiety over the decision to withdraw or not initiate technological support, Doctors in the Netherlands help transition patients from Group 3 to Group 2 (or even Group 1) by refusing to initiate care or purposefully withholding care. For example, children with Spina Bifida (one of the most common birth defects in the United States) that might otherwise have a strong quality of life are allowed to languish, receiving only nutrition, until they reach the point where cessation of life is imminent or their prognosis for future quality of life declines substantially. Finally, to ease the infants pain and suffering, the doctors dont just simply remove life support, they provide pain medication, which has the secondary benefit of hastening death.
The underlying double effect principle, suggesting that an action that causes a serious harm (death) can be permissible as an adverse effect of promoting some good end (relief of pain and suffering), is accepted in common medical practice of critical care and EoL care, (Physician Medical Decision-making at the End of Life in Newborns: Insight Into Implementation at 2 Dutch Centers, AA Eduard Verhagen, Mark A.H. van der Hoeven, R. Corine van Meerveld, and Pieter JJ Sauer, DOI: 10.1542/peds.2006-2555 Pediatrics 2007;120;e20-e28). Unfortunately, this approach also appears to have a third effect; maintaining the illusion of a peaceful death for the infant, when the potential exists that they are suffering to the end: Some have argued that the desire to comfort the patients family is an important consideration and that initiating neuromuscular blockade can be acceptable when the patients death after the withdrawal of mechanical ventilation is certain..However, others believe that the patients well-being is always more important than family interests. They argue that neuromuscular blockade potentially masks symptoms of pain and suffering and makes proper assessment and adequate treatment impossible.
Americans who presume that such practices cannot possibly happen here are misguided. Peter Singer, Professor of Bioethics at Princeton Universitys Center for Human Values openly advocates allowing parents to abort children up to a month after they are born and calls for rationing of health care to the most productive members of society. Dr. Ezekiel Emanuel (brother of President Obamas White House Chief of Staff) has introduced a complete life chart that allots the majority of healthcare to those between the ages of 15 and 55, while allowing only negligible amounts to those under a year old or over 55. In his defense, Dr. Emanuel has also written a comprehensive review criticizing the current euthanasia system, by showing how most patients requesting doctor-assisted euthanasia are motivated by depression and not the effects of their illness.
The growing popularity towards the Netherland approach (a survey indicated that nearly 60% of American medical students believed in allowing euthanasia, doctor assisted suicide, and withholding care for those deemed to have an unsuitable quality of life) is helping to fuel the promotion of a socialized healthcare system in the United States. In so many different areas of government, human life is given a financial figure, a cost/benefit analysis, with programs adjusted accordingly. And in hospitals across the country, where doctors struggle to determine if a newborn is not just viable but sustainable, parents are faced with a daunting and heartbreaking decision.
Presently, if a hospital chooses to discontinue care, the family has the right to move their loved one to a different facility in the hopes of extending their life.
But in a universal government-run system, with QALYs and DALYs, or cost/benefit analysis driving these decisions, and Washington bureaucrats dictating what hospitals can do, parents may find they have no choice at all.
Ending The Life of The Newborn: The Groningen Protocol, (The Hastings Center Report, Hilde Lindemann and Marion Verkerk, February 1, 2008).
Deliberate Termination of Life of Newborns with Spinal Bifida, a Critical Reappraisal, ( Childs Nervous System, Dutch Pediatric Neurosurgeon T.H. Rob de Jong, January 31, 2008).
The Remmelick Commission Report, Netherlands, 1991
Why We Must Ration Healthcare, (New York Times, Peter Singer, July 15, 2009).
Euthanasia and Physician-Assisted Suicide: A Review of the Empirical Data from the United States (Archives of Internal Medicine, vol. 162, no. 2, January 28, 2002).
Sarah sure hit a nerve. I love this woman. She doesn’t back down from punching right at the solar plexus of the democrats.
This isn’t a shocker. Once killing someone becomes an acceptable “treatment” for any illness it is only natural for whoever pays for care on behalf of another to insist on it as a “final solution” to the costs of health care.
All this from an idiotic right wing conservative hellbent on forcing her values down our throats. </sarcasm>
For an idiot, she does seem to be able to say one thing and get every liberal in the world on the run.
3. Group Three consists of children who may not require technology for life, but who may experience substantial pain and suffering, or for whom there is no possibility of a cure.
So where do you draw the line for illnesses such as juvenile rheumatoid arthritis? What is the definition for substantial?
We must produce a master race. Where have I heard that one before? Hmmmm....must be my imagination. If they can do this with a new born, they can do it with you, your brothers and sisters, your parents and grand parents, your Aunts and Uncles, Nephews, Nieces, and the list goes on and on. I would start questioning the type of people that even put this in the Bill to begin with. These are not the type of people we want in our Government.
deth panel pinger
“If they can do this with a new born, they can do it with you, your brothers and sisters, your parents and grand parents, your Aunts and Uncles, Nephews, Nieces, and the list goes on and on. I would start questioning the type of people that even put this in the Bill to begin with. These are not the type of people we want in our Government.”
Before this kind of thing can be implemented don’t you think they will have to cull the ranks of caregivers and doctors that will refuse to lock step with this program!?
You know, Ethical, moral, caring, people with half a brain and some personal integrity!??
It's time to abort mr. singer too...
My wife is a NICU Clinical Nurse Specialist. Considering the cases she talks about, none of these questions are easy, as a futile treatment often ends up being effectively an act of cruelty, and to that outcome some heed should be given. For people to treat this like these are simple issues is ingenuous at best. We do need better time-sensitive decision making architectures. What we don’t need is government making them.
To anyone who watched obama in Grand Junction last night: did you hear him slip in a positive comment about the Netherlands healthcare system? (I think it was in the middle of one of his rambling answers)
I don’t think I imagined it!
It’s very difficult to listen to his meandering- he’s all over the place.
“Considering the cases she talks about, none of these questions are easy, as a futile treatment often ends up being effectively an act of cruelty, and to that outcome some heed should be given”
I worked as a NICU nurse for a bit, I wasn’t cut out for it because of exactly what you mention. Your wife is very special. I admire her strength.
And you’re right - we don’t need the government making these decisions.
For those of you without a medical back ground.. Neuromuscular blockade is a drug that prevents the neurotransmitter from initiating a muscular movement.
It is typically used during surgery and on patients that are intubated and being ventilated.
The particular evil in this little procedure is that you may be totally conscious but unable to move.
With intubated patients you always use blockade with some sort of sedation because it is horror itself to be awake, alert and unable to move or blink.
Imagine they are giving blockade to these children to prevent their movement under the presence of a peaceful death while the infant is aware that they are suffocating.
It would be kinder and more honest to hold a pillow over their faces.
This is straight out of hell.
Spinal Bifida is a spinal cord defect.. It comes in degree..Mild to severe.
Mentation is usually completely normal and they usually have higher functioning bodies than Stephen Hawkings.
Professor of anti-Bioethics
That's NOTHING in terms of the total cost of medical care nationwide. It's a false ethical question because the number of children in such dire condition is really very small.
My brother had down's syndrome. He only died because he had leukemia and it was uncurable at the time (1960).In these modern times I ear he would have been euthanized. I really, really don't like where society is headed.
Just have a seat at the top of that slippery slope, give a little push, and see where you end up.
There’s nothing surprising about this. But Sarah seems to be one of the few politicians with enough guts to say anything about it.
The stupid party doesn’t seem to realize that she is not only taking the moral position by saying this, she is taking the winning position. Most Americans don’t really favor killing babies, or old people, or handicapped people. But the left has all sorts of ways of hiding what they are doing, and the Republicans let them control the language. If the Republicans would only speak out, they would have a political winner. But again and again, they remain silent.
Why, for instance, is Kathleen Sebelius sitting in her current job? If the REpublicans had made her an issue, they might have blocked her appointment AND made political gains while doing so. Instead, they just folded.
“Keep in mind, finally — and this is the last point that I’ll make — that you have a bunch of countries that have systems in which government is involved but you still have a thriving private insurance market — The Netherlands being a good example.”
The way the plan works will be to isolate actual moral authority such as the pope or the Scriptures as narrowly sectarian. We simply MUST be inclusive, don't you know? Then we will have university accredited, allegedly edumacated thoroughgoing atheists and enemies of mankind callng themselves "bio-ethicists." They will play at "make-believe morals" as though we actually needed their rationalizations for murder. When the pope and the various churches still loyal to Western Civilization object to their "bio-ethics", they will assume exclusivism rather than their former play act of inclusivism and explain that all that pope or bible stuff is obsolete and that modern man needs a new and more sensible ethics (faux pragmatism) for a new and more sensible age. Then those who persist in religion will be declared heretics by the new religion of the state and persecuted accordingly.
Zen ve vill haff our master race!!!! Heil Obama! Hail, Rosemary!
This is almost the exact wording used by 'progressive' ethicists in America and around the world, before they were discredited by their German colleagues. Jonah Goldberg's Liberal Fascism once again shows what is happening.
Now they’re getting close to home. My perfectly beautiful grandson was born a year ago with spina bifida. His spine was visible, as his back didn’t properly close over it. Not treating him would have meant death from infection, if not starvation/dehydration. He had successful surgery at 22 hrs. of age, and at 5 weeks had a shunt put in his brain to alleviate hydrocephalus. All of us prayed hard for his survival. Can you imagine the horror to his parents if “society” deemed him too defective to live?
At age one, he loves life, laughs all day, enjoys the love and attention of family and friends. He is mentally normal, and will require foot/ankle orthotics to walk. It will take him awhile. He will lead a slightly different life, but there are no barriers to what he can achieve in life as a productive citizen. Keep their ghouls away from my grandson!
Your beautiful grandson has such a loving and wonderful family to back him up that he will have a happy life. That’s all we can ask for, love and some happiness.
Every one of us has some disability, whither it be of the body, the heart or the mind. We all lack in something as no one is perfect. Those who think they are are the real handicapped.
I’ve taken care of several kids with spinal bifida..
For the most part, spunky, bright delightful kids.
Prayers for your grandson in this increasingly wicked world.
Why? The Groningen Protocol.
Grab a copy of the medical article referenced at the bottom of this article. Chilling!
Thank you for your kind reply. Our little guy brings such joy to our lives.
Thank you for your prayers and encouraging words. What happened to the notion of diversity? Didn’t Eunice Shriver become so honored because she helped make a place for handicapped children? This regime seriously reminds me of Nazi Germany.
I’m surprised the mortality rate is 54% in the US. I guess we were lucky. There’s never been a moment when we haven’t thanked God for this precious boy’s life. The nurses in the hospital where he was born thought he should have been aborted. My daughter didn’t know of the defect until the day he was born, but she wouldn’t have aborted had she known. The nurses and doctors at the NICU in a large city hospital where he was transported were angels. Groningen is clearly the opposite of an angel.
Indeed it is reminiscent of Germany.
One of the most delightful and gentle souls that I ever had the blessing to take care of was a middle aged woman that had had MS for 20 years.
Her condition had deteriorated to the point that her only voluntary movement was turning her head side to side.
She still had the heart of a teacher, so she did.
Her care givers were primarily nurses aids throught home health and she taught them.
Every individual is valuable in the eyes of God.. It doesn’t matter the package that individual is in.
God frequently chooses imperfect vessels.. Moses, David, Abraham were very far from perfect but they were instrumental pivot points in salvation history.
Blessings on your family.
Great article highlighting the disgraceful practice which takes place in the Netherlands. It gives me shivers to read what goes on in some other countries.
Gov. Palin was right on with her “death panel” comments. We need to hit that meme over and over.