Posted on 08/16/2009 11:50:08 AM PDT by TheWriterTX
Netherland’s 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 Palin’s 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 patient’s present condition, a newborn’s 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 Netherland’s 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 Netherland’s 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 patient’s consent, and another 41% (4,941) were deliberately provided overdoses of pain medication with the intent to end their lives – again, without the patient’s 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 Netherland’s 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 infant’s pain and suffering, the doctors don’t 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 patient’s family is an important consideration and that initiating neuromuscular blockade can be acceptable when the patient’s death after the withdrawal of mechanical ventilation is certain..However, others believe that the patient’s 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 University’s 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 Obama’s 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.
Resources:
“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.
Bookmark!
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.
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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.
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