Dutch doctors pushed on to 'slippery slope' over euthanasia: Relaxation of legislation on medical codes of practice has led to controversy about disabled newborn children being put to death, writes Leonard Doyle

BEARING a hypodermic syringe filled with a lethal dose of potassium chloride, a Dutch doctor walks into a paediatric ward and quickly administers an injection to relieve a young family of the burden of raising a severely handicapped newborn child.

In another case, a male child born with deformed genitalia is put to death because the doctors and his parents concur that he will have a poor quality of life.

In the Netherlands there are at least 10 such cases a year of active euthanasia of newborn infants and at least 100 cases of passive euthanasia in which life support treatment is switched off, according to official figures provided by the Dutch Paediatric Association.

Following the adoption of a new euthanasia code of practice by the Dutch parliament last week, physicians will have even more liberty than they already had to dispatch their patients. 'Newborn euthanasia' is now gaining acceptability in the Netherlands and, like euthanasia for older patients, the practice is expected to become more common as the legal barriers against it are torn down.

'Only a physician can commit homicide with impunity,' Pliny the Elder said. Some 2,000 years later in the Netherlands, 'mercy killings' are routine.

Professor Zier Versluys, of the University of Utrecht, is an advocate of 'newborn euthanasia' in circumstances in which the child's quality of life will be severely impeded.

He describes a case history: 'A baby was born with severe spina bifida and three other congenital diseases. We decided not to operate because we hoped the child would die, but it did not. The child could drink and be handled in its cot. After much discussion between the parents, the doctors and a priest it was decided that the best thing was that the child should die. This was done with sedatives.'

Mr Versluys has written a report for the Dutch Paediatric Association's panel on neo-natal ethics asking the government to permit euthanasia for infants who are so incapacitated that their quality of life will be impeded. Under the new Dutch guidelines on euthanasia, the patient has to ask to be killed to be put out of pain.

In the case of 'newborn euthanasia' it is left to the parents and the doctors to decide, and a report is then made to the coroner who can decide whether a crime (in theory punishable by up to 12 years in jail) has been committed.

Critics say the Dutch have become carried away with their ethos of Protestant pragmatism. 'I find the rationalisation that the child will be a burden to its parents to be obscene,' said Carlos Gomez of the University of Virginia, author of Regulating Death: Euthanasia and the case of the Netherlands. 'We should have learnt something from the history of the 20th century,' he added, referring to the Nazi practice of euthanasia on deformed children and psychiatric patients.

Ever pragmatic, if somewhat confusing, the Dutch legislation will ensure that doctors will not be prosecuted provided they follow 28-point guidelines. They provide, for example, that the patient has repeatedly requested to die and is undergoing unacceptable suffering, and has no hope of recovery.

The request for euthanasia must be repeated over a period of time and another experienced physician must support the decision.

In theory, the guidelines are strict and simply codify what is already widespread practice - but in practice, as Dutch critics such as Henk Ten Have, professor of medical ethics at Nymejen University point out, the new system has pushed the country on to a 'slippery slope' that begins with active euthanasia for the terminally ill in intractable pain; Aids patients, for example.

Ending the life of infants whose 'quality of life' will be poor because of congenital disease is the next stage and doctors will face increasing dilemmas; under the Nazis psychiatric wards were cleared by means of euthanasia. Once the country's moral compass is so disabled, the argument goes, it will not be long before patients with Alzheimer's disease, schizophrenics and the mentally ill are being dispatched because they are a burden on society.

The problem Mr Ten Have finds with the new Dutch law is that it leaves it up to doctors to notify the coroner of any life they have deliberately ended and to justify the actions against the checklist. In practice, Mr Ten Have says, the suffering of the patient 'overrides the issues (of whether there are) repeated requests for euthanasia' and Dutch doctors increasingly make the decision by themselves to end their patients' lives. It is farcical to suggest that a doctor who has illegally killed a patient will then volunteer that information to the coroner, he says.

The Dutch government's Remmelink Report on euthanasia put the number of patient-requested euthanasia cases at 2,300 in 1990 and said there were around 400 cases of suicides assisted by a physician. However, the report also stated that there were about 1,000 cases a year in which patients were being killed by their doctor without requesting euthanasia.

Mr Ten Have cites independent figures that suggest the numbers are far higher and says there are about 8,000 cases of active euthanasia in the Netherlands each year.

'Indeed, it could be as many as 10,000 or 8 per cent of all deaths,' Mr Ten Have says.