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Child euthanasia is a controversial form of non-voluntary euthanasia that is applied to children who are gravely ill or suffer from significant birth defects. In this regard, neonates and infants are euthanized by either active or passive means. Because children at these early stages of mental development are incapable of providing explicit consent to these terminal procedures, it has become a hot-button issue for ethical debates. Furthermore, child euthanasia recently broadening its scope to incorporate voluntary euthanasia for minors has generated both great applause and heavy criticism. Today, Belgium is the only country with legalized euthanasia without any age limit, while the Netherlands has decriminalized infant euthanasia falling within strict guidelines.
First major child euthanasia case in November 1915. Chicago. Surgeon on-call that evening. Dr. Haiselden believed it is "our duty to defend ourselves and future generations against the mentally defective." Five days after foregoing surgery, Baby Bollinger died. Haisdelden made two arguments in defense of the Bollinger case: first, a merciful death is more humane than a life of suffering, and second, it is our responsibility to protect our society from the burden of certain disabilities.[1]
On April 9, 1982 in Bloomington, IN, "Baby Doe" was born with Down syndrome and a tracheo-esophogeal fistula (TEF). While knowing surgical intervention to resolve the TEF is a relatively standard procedure and essential to live, the baby's parents and obstetrician chose against it. This decision, met with resistance from other attending physicians, ultimately led to a court trial. The court determined that the parents were free to decline the surgery their baby needed because of mixed expert opinions of the hospital doctors. Baby Doe died six days later. This case quickly became a nation-wide debate and garnered the attention from then U.S. Surgeon General, Dr. C. Everett Koop. Koop, a pro-life proponent and retired pediatric surgeon, condemned the court ruling.[2]
One year later, the Reagan administration orchestrated new regulation creating the notorious "Baby Doe Squads" and toll-free hotline to answer any complaint concerning potential abuse of a disabled infant. Known as the Baby Doe regulations, these were eventually overturned. In 1984, Congress legislated additional amendments to the Child Abuse Protection and Treatment Act (CAPTA) outlawing the withholding of necessity-based medical care, specifically noting "appropriate nutrition, hydration, and medication,"[2] from disabled neonates unless "(A) the infant is chronically and irreversibly comatose; (B) the provision of such treatment would (i) merely prolong dying, (ii) not be effective in ameliorating or correcting all of the infant's life-threatening conditions, or (iii) otherwise be futile in terms of the survival of the infant; or (C) the provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane."[2]
Bente Hindriks, born in 2001 at Groningen University Medical Center in the Netherlands, was immediately diagnosed at birth with the rare genetic disorder, Hallopeau-Siemens syndrome. The disease features chronic blistering and peeling of the epidermis and mucous membranes. There is no effective treatment, while the damage on the top layer of the skin comes with severe, unmitigated pain. Bente's diagnosis was impossible to treat and her prognosis of skin cancer would take her life in five to six years. Her pediatrician, Dr. Eduard Verhagen, could do nothing to help. Though illegal at the time, Bente's parents wished to end her suffering with active euthanasia. Ultimately, it is believed that the high dose of morphine that Dr. Verhagen administered to ease her pain killed Bente.[3]
Four years after Bente Hindriks' death, Dr. Verhagen began campaigning for policy change that called for permitting infant euthanasia under specifically strict guidelines. While he continued on this pursuit, Dr. Verhagen publicly stated that he terminated the lives of four more infants, all with severe cases of spina bifida. Called "Dr. Death"[3] and "a second Hitler"[3] by some, Verhagen continued along with his hope for a "nationwide protocol that allows each pediatrician this delicate question with due care, knowing he followed the criteria,"[3] to end his patients' lives simply out of compassion. Verhagen felt that strict regulations on infant euthanasia would prevent uncontrolled and unjustified instances of euthanasia. In 2005, Dr. Verhagen and Dr. Sauer with a team of prosecutors formalized the Groningen Protocol.[3]
The agreement follows that no charges shall be pressed against physicians who perform end-of-life procedures on infants who meet the following five criteria:[3]
Furthermore, neonates and infants who might be considered candidates for end-of-life decisions are divided into three categories:[3]
Belgium legalized euthanasia for terminally-ill adults in 2002. As it stood then, euthanasia could only be applied to citizens over eighteen years of age or, in rare accounts, a category of individuals called "emancipated minors."[4] In years to follow, the debate on euthanasia opened up to the idea of this same law being extended to minors. In 2014, an amendment to the 2002 Euthanasia Act made it legally permissible for minors, regardless of age, to pursue euthanasia as long as they fit a few specific criteria. The amendment states that minors who request euthanasia must exhibit the ability to judge their current state of affairs when in a "medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will, within a short period of time, result in death, and results from serious and incurable disorder caused by illness or accdient."[5]
The provisions of this amendment to the 2002 Euthanasia Act have distinguishable differences between the act applied to adults and minors. First, the law establishes that only physical suffering may be valid for minors, while physical and psychological suffering is plausible reasoning for adults and the emancipated minors to pursue end-of-life care by euthanasia. Second, the amendment says that the presumed death of a minor should result within a short period of time, whereas no timeframe of expected death is needed for adult cases. Finally, this extension to minors requires that multiple physicians and legal representatives sign-off on the mental capacity of the patient, reinforcing that the minor is competent of his or her condition and decision to die.[4]
Dr. Eduard Verhagen, who developed the Groningen Protocol, has made clear his stance in endorsing the motivation for the protocol. Verhagen clarifies that his protocol does not include infants with ordinary, and otherwise, treatable conditions. Rather, the protocol was created to relieve the burden that both the infant and its parents would face in a "life of agonizing pain."[3] Dr. Alan Jotkowitz, Professor of Medicine at Ben-Gurion University, argues strongly against the Groningen Protocol. Jotkowitz defends his argument on the basis that idea of a "life not worth living" does not exist. Continuing, he claims that nowhere in the protocol does it mention only pertaining to terminally-ill infants and the developers of the protocol value the future quality of life more than the current being of the infant. Jotkowitz also draws comparisons to the the practice of child euthanasia employed by the Nazi rule through the 1940s.[6]
Dr. Alexander A. Kon, a national leader in pediatric critical care medicine and bioethics at University of California San Diego School of Medicine, outlines that the ethical implications for neonatal euthanasia lies in the lack of "self-determination" for infants compared to adults.[2] Kon states, therefore, justification must solely be on the basis of the patient's well-being. Though not asserting his position on the Groningen Protocol, Kon's concerns center around the the use of paralytic agents in Verhagen's infants. As reported by Verhagen, "neuromuscular blockers were added shortly before death in 5 cases to prevent gasping, mostly on parental request."[7] According to Kon, the practice of making euthanasia more palatable with these agents is something that cannot be justified. Kon concludes with his belief that those in support of neonatal euthanasia have motivations to genuinely help infants the best they can.[2]
Dr. Douglas S. Diekema, most known for his role in the Ashley Treatment, argues that in cases where parents act against the best interests of their child, that the state should have ability to intervene. Diekema continues on his support of the Harm Principle being the basis for state intervention, which would allow physicians of the state to override the decisions made my parents if it is determined that their position does not represent the best interests of their child, and rather, is the more harmful procedure.[8]
Extension of the 2002 Euthanasia Act to Belgian minors received both heavy criticism and large applause, ultimately launching another ethical debate centered around child euthanasia.[4] Luc Bovens, professor of philosophy at the London School of Economics, explains the three fields of thought opposing this amendment to the 2002 Euthanasia Act. First, some believe that euthanasia is morally impermissible in general. Second, some believe the law was sufficient as is and that hospital ethics boards should deal with the "emancipated minors" on a case-by-case event. Third, some believe euthanasia for minors is more impermissible than adults. Bovens outlines the five most used arguments in favor of this third point:[9]
Bovens shows these five arguments do not carry much weight in the debate; however, does support arguments defending the wish to retain age restriction and ownership of hospital ethics boards in dealing with discrete requests from minors.[9]
Proponents of the new law argue this amendment helps avoid discrimination, clarifies legal matters and improves consistency in medical practice and decision-making. Previously, euthanasia could be performed for "emancipated minors," but not for minors deemed non-emancipated though otherwise competent. Those favoring child euthanasia viewed this to be unfair, stating that the non-emancipated minors may be similar in levels of competence to emancipated minors, and thus, suffering to the same extent.[4] Dr. Verhagen supports this stance with the claim that an age restriction of a certain number of years is arbitrary in nature, and that "self-determination knows no age limit."[10] Furthermore, proponents believe the extension will clarify the legality of the matter for physicians who are treating terminally-ill minors, resulting in less unlawful behavior and more consistency in medical decision-making.[4]
Buddhist views are not in favor of the intentional ending of one's life. The Dalai Lama claims all life of having "precious" value, with human life being the most valuable. According to the Dalai Lama, abortion is an act of killing within traditional Buddhist views yet we must judge each instance on a case-by-case basis. He cites an example where a woman with pregnancy complications could result in two deaths rather than just the baby's if no intervention is done. The Dalai Lama expands the idea of "exceptional circumstances" to a case where a person is a coma with no chance of recovering his or her pre-coma condition.[11]
In 1995, Pope John Paul II spoke on matters concerning the moral evaluation of prenatal diagnostic techniques which allow for the early detection of abnormalities in the unborn fetus, siding with traditional Catholic views on life. Pope John Paul II continued by stating foregoing extraordinary means to save one's life is not the equivalent of euthanasia, but rather an acceptance of the delicate balance of human life. He summarizes, "human life, as a gift from God, is sacred and inviolable. For this reason, procured abortion and euthanasia are absolutely unacceptable."[12] Pope Francis shared his stance on euthanasia in 2017. He called for more thought into balancing medical efforts to prolong life and withholding those same efforts when death seems inevitable. Pope Francis echoed Pope John Paul II's remarks on suspending medical procedures beyond conventional means and reaffirmed that euthanasia is always wrong, being that it's intention is to end life.[13]
Hinduism allows for multiple interpretations on the concept of euthanasia. The majority of Hindus believe doctors should not fulfill requests for euthanasia, as it will damage the karma of both parties. Others say that performing euthanasia procedures goes against the teaching of ahimsa - to do no harm. Yet, some Hindus believe that the act of ending a painful life is rather a good deed.[14] In a 2012 study centered around Hindu college students and their views on ending the lives of severely disabled neonates, it was found that 38% had no firm opinion on the acceptability of terminating these lives.[15]
Islam forbids any form of euthanasia, as it is determined by God how long a person lives. Life is a sacred thing bestowed upon humans by God.[16]. The aforementioned 2012 study involving Hindu university students also analyzed the same measures of 150 Muslim students. The study found that, in accordance with the teachings of Islam, the Muslim students were more likely to oppose the purposeful termination of the damaged neonates.[15]
Yoel Jakobovits, a devout Orthodox Jewish physician who holds academic positions at Johns Hopkins University School of Medicine and at Sinai Hospital of Baltimore, summarizes the religious Jewish attitudes that appear to govern the topic of neonatal euthanasia. Jakobovits states that all human life is valuable, irrespective of potential disabilities or impairments and actively forfeiting life by any means would constitute murder. He continues that pain reducing agents are permissible for terminally ill patients, and it is the right of a terminally-ill person to refuse a medical procedure that may extend his or her life. Lastly, withholding of nutrition, oxygen and blood is forbidden in Judaism.[17]
A major challenge for physicians tasked with the medical decision-making of babies born very premature or severely disabled with neurological damage and poor quality of life for the future presents another side to the bioethics topic of child euthanasia.[18] A recent study performed in 2017 looked into the end-of-life decisions made by neonatologists in Argentina. The questionnaire investigated the method of their actions in response to critical neonates. The results showed that more than 75% of the neonatologists would initiate treatment in premature infants of unknown prognosis, based on newborn viability. It followed that more than 80% of physicians withdrew treatment which yielded no positive outcomes. Silberberg and Gallo's analysis showed the current sentiment of physicians with respect to infant euthanasia apply some variation of therapeutic activism, yet the large majority of those same doctors will withdraw life-preserving treatments when no advancements are made.[19]
After deliberating on the potential topics discussed in previous weeks, I have decided to move forward with child euthanasia and letting die. Both of these topics are that are highly debatable in the social world. With each of these having views that stem from both a philosophical and moral approach, I will need to find sources and learn more about philosophical ideology behind euthanasia as well as how different religious views shape the moral canvas of these discussions. I have spent many hours on finding sources, and it seems like finding religious sources specifically about child euthanasia and letting die will be difficult. Both of these articles have been chosen because there are existing content gaps with respect to our class focus - religion - and could be improved with better organization of the ethical debates of different philosophical views.
I would like to reorganize the format of this article to shadow other related pages (Euthanasia) more closely. To do this, I recommend splitting "Ethical considerations" into several different headings: Age-Specific euthanasia, Current debate, Religious views, and Physician sentiment. Details to follow in subheadings below. Ideally, I would enhance the "By country" section and "Notable examples", however, I am not sure that my time will allow for those additions.
The lead section is only one sentence long, and yet I still feel like there is a need to clarify the meaning. In addition to modifying the brief definition of what child euthanasia is, I think it could be useful to distinguish the difference between this term and others like infanticide, child murder, etc. There are a few sentences from the current "Ethical considerations" tab that I think should be moved up to the lead (first three sentences to be precise).
Exact name of subheading to be decided later. It is an easy argument to be made that the type of child euthanasia is very different depending on age. There could be euthanasia of an unborn baby (is this even considered euthanasia), euthanasia of an infant/toddler due to birth defect, and euthanasia to a developing minor (adolescence to adulthood) for several reasons. I think there will be enough sources that this difference should be distinguished. Note to self: neonates, young children and minors.
Still cannot decide how this would best be formatted. But I am thinking that this should be broken down into the for/against arguments. Where the different input of philosophical contributions would be categorized. I believe that I will keep religious input separate and have that information specifically in its own heading, though much of the current debate stems from morals derived from religious faith. I am thinking Ethical debate may be a better heading for this section since it will be philosophical ideals on ethics.
This will be broken down into subheadings by religion. Again, I am unsure which would be the best layout for presenting each side of the child euthanasia debate and where religion should fall. As of now, I am sticking to sourcing the philosophical views in the "Current debate" heading and keeping religious views in this separate heading.
Again, the difficult part is deciding whether physician sentiment should be its own heading or included as a subheading in the Current debate heading.
Researching for sources of letting die is even more difficult the child euthanasia article. This article is severely underdeveloped with only a brief lead, which defines what the term "letting die" means, and some links to a specific case and related terms. I would like to add in the lead the distinction between passive euthanasia and letting die (withdrawing v withholding). Also, I would like to add headings within the article of Philosophical debate and Religious views.
I have re-evaluated the Wikipedia article page related to the topics in this course and have decided I want to move forward with child euthanasia, as opposed to my initial investigation in martyrdom in Judaism. This feeling comes from perspective that I wish to practice in the Pediatrics field, so ultimately, I have more interest in this ethical debate. Below, I am posting questions and answers that pertain to my review evaluation of the child euthanasia page, as I wish to not completely re-do last week's assignment, yet revisit the purpose and intentions of what I plan to do with this page.
The article seems to contain information that is both relevant to the topic and neutral in its position. The authors of the page have done a great job providing both sides to the ethics debate, while not including their own voice.
It's time to think critically about Wikipedia articles. You'll evaluate a Wikipedia article related to the course and leave suggestions for improving it on the article's Talk page.
Complete the "Evaluating Articles and Sources" training (linked below). Create a section in your sandbox titled "Article evaluation" where you'll leave notes about your observations and learnings. Choose an article on Wikipedia related to your course to read and evaluate. As you read, consider the following questions (but don't feel limited to these)
Choose at least 1 question relevant to the article you're evaluating and leave your evaluation on the article's Talk page. Be sure to sign your feedback with four tildes — Garrettspindell (talk) 04:02, 12 February 2018 (UTC).
@Garrettspindell: An okay job, Garrett, but remember that this is a writing-intensive course. Make sure to always answer your questions for assignments in full answers, not responses that seem rushed and short. I like the idea of adding to the Martyrdom in Judaism page. It looks perfect. Make sure to consider options in case there aren't many martyrs in Judaism OR if there is just not a lot out there. I do think, however, that you will find much to work with. Alfgarciamora (talk) 22:51, 12 February 2018 (UTC)
@Garrettspindell: The topic you have chosen is really interesting and could definitely use more content. In your sandbox I don't see the exact content you want to add but I do see you work from week 6 about ideas for the article. For that section, you clearly have a good idea of what you would like to add to the child euthanasia article and how you would change it. Your ideas about all of the new sections would be really beneficial for this article due to the fact that there are really on 2 full sections in this stub article. I don't have too many comments because I don't see the real edits you are going to make but feel free to ping me when you have more done for this article and I'll be happy to come back and give more suggestions! Emilyrd98 (talk) 01:06, 19 March 2018 (UTC)
Hey @Garrettspindell: I am on the same page as Emily and don’t see any specific section to be edited. From what you have so far I think you are off to a good start. I think having a section on religious views for both articles is a good idea since it will focus in you research on what is relevant for our class. I think you can add moral and philosophical views for background information, but staying on the topic of religion is important. I think if you found any notable examples or case studies related to religion they could be a good addition to have. The current lead sections for both articles can definitely be expanded upon, so I look forward to reviewing what you add there. I’m interested to see what you find and let me know if you need any help! Kvraffy (talk) 03:46, 19 March 2018 (UTC)
Bio moved over to actual userpage.Garrettspindell (talk) 03:59, 12 February 2018 (UTC)
@Garrettspindell: Great work with finding an article on child euthanasia and linking it appropriately. I fear that the topic may not have a lot of academic research on it since it is pretty much illegal in the USA. Do you think you will be able to find good stuff on the topic? Alfgarciamora (talk) 15:57, 19 February 2018 (UTC)
@Alfgarciamora: Hi Prof. Garcia, I apologize for the tardiness in my completion of the Week 5 assignment. I did not schedule the work from my prior week well, and did not want to rush submission of this assignment last night so I am submitting to you late. I will not make this mistake moving forward. Please review the "Possible Topics" tab whenever you have the free time to do so. Would love feedback before moving forward in our project timeline. Thank you, Garrettspindell (talk) 21:27, 26 February 2018 (UTC)
Week 5 @Garrettspindell: I think that you will have enough to research with child euthanasia and letting die. You have to be very careful to distinguish your work with other euthanasia pages and be very specific about your additions. You will delve into philosophy for sure, but don't forget that you'll have to write about religion as well. Looking forward to seeing what you produce here. Alfgarciamora (talk) 22:48, 26 February 2018 (UTC)
Week 6 @Garrettspindell: Great work this week. You are beginning to think clearly about how the page will look, which is excellent, and have begun to allocate some sources to the content. Moving forward, pay special attention to identifying key phrases, quotes, or other data that you will be pulling from your sources. Your organization in the sandbox is superb - keep that up. Remember that the goal is encyclopedic writing, not argumentation. I believe you're off to a solid start. Alfgarciamora (talk) 22:05, 5 March 2018 (UTC)
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