“ROTTERDAM, the Netherlands, Sept. 6 – Doctors in Holland, where euthanasia for adults is permitted, have hastened the deaths of children as well, researchers have found.
In a four-month period in 2001, 36% of all deaths of children in Holland between the ages of one and 17 were preceded by what is called an “end-of-life decision,” according to Astrid Vrakking, M.Sc., of Erasmus Medical Center here.
Such decisions range from withholding life-sustaining treatment, to administering drugs to relieve pain or other symptoms, even though with a possible life-shortening effect, or – in the most extreme cases – to using drugs with the aim of ending life, Vrakking and colleagues wrote in the September issue of the Archives of Pediatrics & Adolescent Medicine.
The finding comes as the debate over euthanasia heats up: The U.S. Supreme Court is expected to consider this fall whether Oregon’s doctor-assisted-suicide law – the only one in the U.S. – is legal.
Between Aug. 1 and Dec. 1, Vrakking and colleagues found from an analysis of death certificates, 129 children died in Holland. Of those, physicians and families decided to withhold treatment from 17 and to administer drugs with possible life-shortening effects to another 21.
One child – a 16-year-old with an autoimmune disease, for which there were no treatment options – asked for euthanasia. And in three cases, physicians administered drugs to hasten death – without the consent of the child, but with the agreement of the parents.
Details of the cases came from questionnaires sent to the doctors who signed the death certificates.
The researchers also conducted in-depth interviews – up to as long as five hours in some cases — with 63 pediatricians in Holland’s eight university medical centers.
Half of all the doctors interviewed had at some point been asked by parents to end their child’s life and 15% had been asked by a child under their care; 14 of the 63 had granted a parental request and one had granted a child’s request.
Under Dutch law, physicians can grant requests for euthanasia or physician-assisted suicide from minors aged 12 to 16 with parents’ consent and from minors aged 16 or 17 years if parents are informed.
Neither euthanasia nor physician-assisted suicide is legal for children under the age of 12.
But last year, the university medical center in the northern city of Groningen disclosed that it had created a protocol to govern when an infant might receive euthanasia from a doctor. Among other things, the baby’s condition must be incurable illness and its suffering extreme. Also, both parents must give consent.
But the hospital became the center of a storm when it also disclosed that under the protocol, it had already ended the lives of four babies.
The debate over euthanasia and physician-assisted suicide has so far been restricted largely to the adult case, but the current Dutch study and the Groningen protocol suggest that the discussion is going to become broader, said Harold Siden, M.D., of the University of British Columbia in Vancouver.
“The genie is out of the bottle, and families will want information about what is increasingly discussed,” Dr. Siden said in an editorial accompanying the Dutch study. “The message is that euthanasia does occur, and we need to understand it better in pediatrics.”
While the debate over end-of-life decisions for children is likely to be bitter, “there is a broad consensus about many fundamental aspects,” argue Jeffrey Burns, M.D., and Christine Burns, R.N., of Harvard Medical School.
The “core principles” are almost universal, they commented in the journal. Parents and families should be encouraged to be present and to comfort the dying child, they wrote. Children should not experience preventable suffering, and not all children must stay connected to machines intended to support vital signs as they die.”
Primary source: Archives of Pediatrics & Adolescent Medicine
Vrakking AM et al. Medical End-of-Life Decisions for Children in the Netherlands. Arch Pediatr Adolesc Med. 2005;159:802-809.
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