Euthanizing terminally ill newborns, while still very rare, is more common in the Netherlands than was believed when the startling practice was reported a few months ago - and experts say it also occurs, quietly, in other countries.
Dutch doctors estimate that at least five newborn mercy killings occur for every one reported in that country, which has allowed euthanasia for competent adults since 1985.
In 2002, doctors at University Medical Center Groningen helped create the so-called Groningen protocol, a list of standards for performing and reporting euthanasia of newborns with serious, incurable deformities. The aim was to encourage more reporting and discussion.
Two pediatricians at the hospital, Drs. Pieter J.J. Sauer and Eduard Verhagen, report in Thursday's New England Journal of Medicine that 22 mercy killings of newborns who otherwise would have lingered in intensive care for years were reported to authorities from 1997 to 2004, about three each year. But national surveys of Dutch doctors have found 15 to 20 such cases a year, out of about 200,000 births.
Verhagen, who supports such euthanasia, said in an interview the doctors were allowed to review district attorneys' records on the 22 reported cases. None was prosecuted.
"These were all very clear and very extreme cases," he said, where the newborns were suffering from severe, untreatable spina bifida, with major brain and spinal cord deformities and sometimes other birth defects. "Do we have them continue life in suffering or do we end the life and end the suffering?"
Euthanasia opponents and others have been highly critical of that viewpoint.
"During the past few months, the international press has been full of blood-chilling accounts and misunderstandings concerning this protocol," the doctors wrote in the journal.
The Groningen protocol requires being sure that the newborn is suffering greatly with no hope of improvement, that the prognosis is certain and confirmed by at least one independent doctor, and that both parents give informed consent. Details of the newborn's condition and the euthanasia procedure, usually an infusion of lethal drugs, must be reported to local district attorneys under the protocol, so they can assess each case without interrogating physicians.
"We believe that all cases must be reported if the country is to prevent uncontrolled and unjustified euthanasia," the doctors wrote.
Dutch medical groups since 1997 have asked the government to set up a panel of medical, legal and ethical experts to which doctors would be more comfortable reporting cases. The Dutch government has promised to create the panel but repeatedly has delayed doing so, Verhagen said.
"Every country has to find a way how they want to deal with this difficult dilemma," he said. "Do they want the doctors to be silent?"
Other research, he said, shows that is often the case in other countries.
In France, 73 percent of doctors in one study reported using drugs to end a newborn's life, but those cases aren't reported to authorities. Meanwhile, 43 percent of Dutch doctors surveyed and between 2 percent and 4 percent of doctors in the United Kingdom, Italy, Spain, Germany and Sweden reported doing so.
In the United States, some doctors and ethicists - both supporters and opponents of euthanasia - say newborn euthanasia has happened occasionally for decades, although it is much more common, and accepted, to withhold or stop intensive treatment and let the baby die. Experts said the new Dutch report will generate discussion but won't change American public opinion or practices.
Princeton University bioethics professor Peter Singer, who believes euthanasia is acceptable when a baby's suffering cannot be relieved, said U.S. neonatologists tell him it does happen occasionally.
"This is never reported or publicly discussed, for fear of prosecution," he wrote in an e-mail interview from Australia, where he is on leave. "In the present political climate, it is difficult to see doctors being more open about these issues."
Carrie Gordon Earll, bioethics policy analyst at Focus on the Family, said she thinks the U.S. medical community strongly opposes newborn euthanasia but that some cases have occurred.
"If they're done under cover and secret ... they should be prosecuted," she said. "This is not the Netherlands and we should not be on a slippery slope to baby infanticide."
Rita Marker, executive director of the International Task Force on Euthanasia and Assisted Suicide, which opposes both, said newborn euthanasia happens "under the radar" in the United States, but there's no way to quantify it.
"If we transferred the Netherlands experience to the United States, we would see even more abuses" of patients' rights because of the health system's emphasis on cost control, Marker said.
By Linda A. Johnson