AMSTERDAM, Netherlands -- A hospital in the Netherlands -- the first nation to permit euthanasia -- recently proposed guidelines for "mercy killings" of terminally ill newborns and then made a startling revelation: It has already begun carrying out such procedures, which include administering a lethal dose of sedatives.
The announcement by the Groningen Academic Hospital came amid a growing discussion in Holland on whether to legalize euthanasia on people incapable of deciding for themselves whether they want to end their lives -- a prospect viewed with horror by euthanasia opponents and as a natural evolution by advocates.
In August, the main Dutch doctors' association KNMG urged the Health Ministry to create an independent board to review euthanasia cases for terminally ill people "with no free will," including children, the severely mentally retarded and people left in an irreversible coma after an accident.
The Health Ministry is preparing its response, which could come as soon as this month, a spokesman said.
Three years ago, the Dutch parliament made it legal for doctors to inject a sedative and a lethal dose of muscle relaxant at the request of adult patients suffering great pain with no hope of relief.
The Groningen Protocol, as the hospital's guidelines have come to be known, would create a legal framework for permitting doctors to actively end the life of newborns deemed to be in similar pain from incurable disease or extreme deformities.
The guideline says euthanasia is acceptable when the child's medical team and independent doctors agree the pain cannot be eased and there is no prospect for improvement, and when parents think it's best.
Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions; and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida and epidermosis bullosa, a rare blistering illness.
The hospital revealed it carried out four such mercy killings in 2003 and reported all cases to government prosecutors. There have been no legal proceedings against the hospital or the doctors.
Roman Catholic organizations and the Vatican have reacted with outrage to the announcement, and U.S. euthanasia opponents contend the proposal shows the Dutch have lost their moral compass.
"The slippery slope in the Netherlands has descended already into a vertical cliff," said Wesley J. Smith, a prominent California-based critic, in an e-mail to The Associated Press.
Child euthanasia remains illegal everywhere. Experts say doctors outside Holland do not report cases for fear of prosecution.
"As things are, people are doing this secretly and that's wrong," said Eduard Verhagen, head of Groningen's children's clinic. "In the Netherlands we want to expose everything, to let everything be subjected to vetting."
According to the Justice Ministry, four cases of child euthanasia were reported to prosecutors in 2003. Two were reported in 2002, seven in 2001 and five in 2000. All the cases in 2003 were reported by Groningen, but some of the cases in other years were from other hospitals.
Groningen estimated the protocol would be applicable in about 10 cases per year in the Netherlands, a country of 16 million people.
Since the introduction of the Dutch law, Belgium has also legalized euthanasia, while in France, legislation to allow doctor-assisted suicide is currently under debate. In the United States, the state of Oregon is alone in allowing physician-assisted suicide, but this is under constant legal challenge.
However, experts acknowledge that doctors euthanize routinely in the United States and elsewhere, but that the practice is hidden.
"Measures that might marginally extend a child's life by minutes or hours or days or weeks are stopped. This happens routinely, namely, every day," said Lance Stell, professor of medical ethics at Davidson College in Davidson, N.C., and staff ethicist at Carolinas Medical Center in Charlotte, N.C. "Everybody knows that it happens, but there's a lot of hypocrisy. Instead, people talk about things they're not going to do."
More than half of all deaths occur under medical supervision, so it's really about management and method of death, Stell said.