Blog by Neil FrancisPosted on Tuesday 24th September 2024 at 11:54pm
The Dutch LZA-LP has just published its latest annual report.
Nearily two decades ago...
It seems like such a long time.
The Groningen Protocol
Back in 2005, the Dutch Paediatric Association (NVK) ratified what is known as the Groningen Protocol. It was adopted into the nation's regulations in 2006. It allows for the termination of a neonate's life in very particular circumstances, via strict processes, and reported to the regulating authority, the LZA-LP.
Only the most grave, extremis circumstances are eligible, for example Herlitz type epidermolysis bullosa, an untreatable condition that causes extreme internal and external blistering, and then death.
Then in 2013, the Dutch medical association (KNMG) released a medical media statement saying that each year, some 650 of 175,000 Dutch neonates will die not long after birth.
VAD opponents become enraged
Opponents of voluntary assisted dying (VAD) immediately became enraged, joining dots that didn't exist.
"After a decade of legalized assisted dying in the Netherlands, it is estimated that as many as 1 in 3 deaths in the country are from euthanasia [itself false] – including 650 babies each year." — Anti-VAD correspondent
The flood of false associations continued at least until 2016. It was then that I conducted a scholarly, forensic and exhaustive investigation into the Groningen Protocol, its history and its use, as well as documenting the trail of religious institutions running the "650 babies" association story up the media flagpole. I published a paper on it.
What's happened since then?
For appropriate reference, in the nine years immediately preceding the Protocol, there were 22 cases of neonatal euthanasia in the Netherlands.
That's not per year. It's the total over nine years. An average of a bit over two a year. Not 650.
And since regulation?
The LZA-LP has just released its 2022-23 report on neonatal euthanasia cases, so we're now up to date. And the figures are:
That is, in 9 years prior to the Groningen Protocol there were 22 cases, while in twice the period after its introduction (18 years), there were 3.
The findings show that shining a light on practice helps improve it. And that VAD, whose numbers have increased in the Netherlands, is not associated with a concomitant rise (but rather a major drop) in the small number of neonatal euthanasia cases.
I've yet to see any of the sources who spread "650 babies euthanised every year" misinformation publish a correction or refer to the LZA-LP annual reports. I wouldn't hold my breath, either.
More of the same
The "650 babies" caper is still doing the rounds.
Take Lord Alton of Liverpool for example. Last year he gave an address to a Catholic Social Thought forum, in which, after invoking Nazi Germany, he said:
"For those who would contend that infant euthanasia in the Netherlands is only permitted for rare and exceptional, cases, a Dutch commission on euthanasia argued in 2013 that as many as 650 infants should be eligible for the practice in the country each year." — Lord Aston of Liverpool
Actually, it was the Dutch medical association, not the Dutch euthanasia commission. It was 650 babies die, not "should be eligible for euthanasia". And the already small numbers have radically dropped, not risen.
But let's not let the facts get in the way of a good story.
Blog by Neil FrancisPosted on Saturday 24th September 2016 at 11:31pm
St Patrick's Cathedral, Melbourne, Australia. Photo: Donaldytong
Against current moves to legalise assisted dying, Australian Catholic Father John George invokes Nazi Germany, resorts to ad hominem attacks to dismiss those who disagree with him, and demands that the Pope’s edicts are binding on everyone regardless of their own faith or world view.
On 24th September 2016, Journalists Greg Brown and Rick Morton published an article in The Australian, Victorian coroner credited with turning tide on euthanasia, summarising recent Australian moves to legalise assisted dying choice.
Catholic Father John George commented on the article online, quoting four sections of the Catholic Church’s catechism that prohibit assisted dying (sections 2276–9).
Pushback
Other readers of The Australian remarked that they respected his view for himself but they had no interest in the Pope’s views given the readers were not Catholic. In fact, repeated polls in Australia have shown that even the great majority of Catholics (three out of four) do not agree with the Vatican on the matter of assisted dying, a matter which Fr George dismisses merely as ‘fickle votes and polls.’
I would remind Fr George that these are not fickle: Australian public opinion in favour of assisted dying choice has been consistently in the majority for now more than four decades.
Fr George further quoted Catholic sources, for example the LJ Goody Bioethics Centre in Perth, Australia, which he failed to mention is, literally, an agency of the Catholic Archdiocese of Perth. He also selectively quoted Palliative Care Australia, failing to mention that they have acknowledged that not all pain and suffering can be eliminated at the end of life, even with the best palliative care.
Ad hominem attack
In response to a rising tide of objections to his musings, including from Mr Ian Wood, a fellow Christian and co-founder of Christians for Voluntary Euthanasia Choice, Fr George resorted to the ad hominem attack: to attack the person (or persons) rather than the arguments. He said:
“The pro euthanasia claque here make professional Nazi propaganda expert Goebbels look like a 5th rate amateur.” — Father John George.
For anyone in the dark, a claque is a group of sycophants hired to applaud a performer or public speaker. How rude. Fr George seems to have neglected to reflect that it is he who is hired to promote the performance of the Vatican. I applaud his right to do so, and I do not compare him to a treacherous propagandist in a murderous wartime regime in order to dismiss his arguments: I address the arguments themselves.
Nazi Germany
Fr George makes repeated mentions of Nazi Germany as a core reason to deny assisted dying choice.
In contrast, several years ago I was chatting at a conference with the pleasant and engaging Peter McArdle, then Research Director of the Australian Catholic Bishop’s Conference. He volunteered that he very much disliked the “Nazi Germany” argument so often used in religious circles, and wished it would stop because in so doing it meant they’d already lost the debate.
I agree. It’s a lazy and indefensible argument: that rational people in a functioning democracy must be denied choice for themselves on the basis of what some murderous regime did against others at the point of a gun.
Indeed, to rely on such a standard would be to equally argue against the right to religious practice, because the Catholic Church, through its inquisition practices (medieval C12th, papal C13th, Spanish C15th, Roman and Portuguese C16th) relied on torture and resulted in confiscation of property and at least tens (if not hundreds) of thousands of executions for witchcraft and heresy.
Ultimate hubris
But the real crux is that Fr George then unequivocally demands that:
“Principles elaborated by the pope are universally applicable.” — Father John George.
This ultimate hubris reveals a profound lack of self-reflection, both personally and organisationally. Even entertaining for a moment the premise that one individual (or even organisation) can tell everyone on the planet how they must live their lives, how would we choose that person or organisation? Why is it less valid for the head of any other branch of Christianity, of Judaism, Islam, Hinduism, Buddhism (or any other religion) or an agnostic (which I am) or an atheist, to set such rules for everyone, overriding other deeply-held beliefs and values?
A keener example of ‘blinded by faith’ would be hard to find.
Conclusion
I argue that Fr John George displays some of the gravest hubris of some members of the Catholic church. I respect and applaud his world views for himself and those who wish to subscribe. But using canonincal arguments (that is, religious arguments demanded as universally true by virtue of the supposed authority that dispensed them) is probably a major contributor to the current flight of people away from organised religion.
More happily, such an attitude is also contributing to accelerating the legalisation of assisted dying choice because folks can see these arguments for what they are. For that I doff my hat to Fr George.
The F filesPosted on Tuesday 22nd March 2016 at 12:00am
One of the articles wrongly claiming 650 Dutch babies euthanized
Opponents of assisted dying have fallen prey to misinformation contagion about the Dutch Groningen Protocol, claiming that 650 babies would be or are euthanized every year. The claim is comprehensively and evidentially false.
Starting in 2013 and increasing in shrillness in 2015, numerous opponents of assisted dying law reform—many of whom are connected to conservative (Christian) sources—published online articles making false claims about the Dutch Groningen Protocol, wrongly claiming that up to 650 babies could be, would be or actually are ‘euthanized,’ ‘killed’ or ‘murdered’ every year under the Protocol’s provisions.
A national Dutch Regulation (not statute) effective since late 2006 whose current name is so long that it remains convenient to use its old name, ‘Groningen Protocol,’ even though it has changed.
Permits, only as a last resort and with a number of strict conditions, the intentional ending of a newborn’s life when the newborn is in current (not merely anticipated) untreatable and unrelievable extremis.
Mandatory reporting of intentionally hastened deaths to a national Commission and the Board of Prosecutors General at The Hague.
Physician is not cleared until the case is deemed acceptable by the Commission and the Board and the Minister of Security and Justice.
The Regulation is entirely separate from and unrelated to the Dutch Euthanasia Act for competent adults.
Where did the '650 babies euthanized' claim come from?
In 2013 the Royal Dutch Medical Association (KNMG) published a media release that launched a major policy paper about end-of-life decisions for neonates. The media release stated that of the approximately 175,000 births in the Netherlands each year, around 650 newborns will die as a result of severe congenital defects.
Some of these babies die soon after birth, in the delivery room. Others die later in neonatal intensive care despite the best interventions attempting to keep them alive. Yet others die after futile treatment is withdrawn and palliative (comfort) care is administered to minimize suffering prior to death.
Only in a tiny minority of cases is there a medical intervention with an explicit intention to hasten the death of the newborn, who is in untreatable and unrelievable extremis.
Despite this clarity, opponents—mostly linked to conservative religious sources—jumped on the misinformation bandwagon and trumpeted that 650 babies either could be or would be or are actually ‘euthanized,’ ‘killed’ or ‘murdered’ every year in the Netherlands.
What's the actual evidence?
Neonatal euthanasia occurs around the world regardless of prohibition and is not caused by a protocol or regulation
For example, the rate in France, with no regulation, is much higher than the Netherlands.
Intentional hastening of neonatal death in the Netherlands is rare
Most neonatal deaths occur either quickly with no medical intervention, or intensive treatment proves futile and palliative (comfort) care is administered until death.
The (Groningen) Regulation has been further restricted since it was first formulated
It has not been 'relaxed' as claimed by some opponents.
The Regulation is separate from and completely unrelated to the Netherlands' Euthanasia Act
The Euthanasia Act is only for mentally competent adults (and 12-16 year olds with parental agreement).
Physicians do not receive black-letter law protection as they do under the Euthanasia Act
Reporting, investigation and acceptance requirements are even more rigorous than under the Euthanasia Act.
The rate of intention to hasten neonatal death has decreased since the Regulation came into effect
In eight years prior to Regulation there were twenty two reported cases, and only two in eight years since Regulation.
The rate of medical end-of-life decisions with an explicit intention to hasten death was 8–9% prior to Regulation, dropping to 1% after Regulation.
The use of neuromuscular blockers has decreased.
Physicians report improved communication with parents
Shared decision-making and better opportunities for parents to grieve the loss of their child.
There are clear explanations for the decrease in neonatal euthanasia in the Netherlands:
Physicians report they are fearful of prosecution under the Regulation, so they now more often administer palliative care not intended to hasten death.
A folate supplementation program for pregnant females has resulted in a substantial drop in the rate of spina bifida and related disorders.
An antenatal screening program at 20 weeks has resulted in a higher rate of pregnancy terminations for major congenital disorders.
In conclusion
Despite all these facts, in an epidemic of 'confirmation bias' that drove misinformation contagion, many anti-euthanasia commentators have published false claims about '650 babies euthanized' under the Dutch Groningen Protocol. I provide a forensic examination of the issue in the latest edition of the Journal of Assisted Dying.
This is not the first example of how opponents of assisted dying widely circulate information that is untrue (e.g. check out the Council of Europe Declaration 1859 case), and it won't be the last. However, for opponents of assisted dying to avoid egg on face, I'd recommend:
Neonatal deaths under Dutch Groningen Protocol very rare despite misinformation contagion
Author(s)
Neil Francis
Journal
Journal of Assisted Dying, vol. 1, no. 1, pp. 7–19.
Abstract
The Groningen Protocol specifies criteria for the potential termination of life in severely ill newborns in extremis with untreatable and unrelievable conditions. In September 2006 the Netherlands formally adopted a Regulation incorporating the Protocol. Despite the Regulation’s development through extensive professional consultation, endorsement by the Dutch Paediatric Association, empirical data showing a decrease rather than increase in use, and research showing that neonatal euthanasia occurs around the world in the absence of regulation, the Dutch Regulation has sparked controversy. More recently it has been claimed that hundreds of babies a year are killed under its provisions. Forensic analysis reveals the claim to be comprehensively and evidentially false. Wide online dissemination of the claim by mostly religious sources demonstrates confirmation bias and misinformation contagion.
Francis, N 2016, 'Neonatal deaths under Dutch Groningen Protocol very rare despite misinformation contagion', Journal of Assisted Dying, vol. 1, no. 1, pp. 7-19.
