Belgium: Euthanasia of Newborns Practiced Outside the Law

This article was published by the European Institute of Bioethics on June 6, 2021.

10% of newborn deaths in Flanders Belgium are euthanasia.

A recent study has brought to light the practice of deliberate euthanasia to newborns for whom the medical team considered that there was "no hope of a bearable future". These practices concerned 10% of the neonates (0-1 year) who died in Flanders, between September 2016 and December 2017 (i. e., 24 babies).

This practice is illegal in Belgium, yet no authority seems to take offense. The law only allows the euthanasia of a minor if he or she is capable of discernment and conscious at the time of the request for euthanasia.

In her thesis, which served as the basis for the study in question, Laure Dombrecht, researcher at the Vrije Universiteit Brussel (VUB), refers to a similar study conducted in 1999-2000. The proportion of euthanasia to new-borns by injection of lethal substances has increased from 7 to 10% since this previous survey.

Among what is considered as "end-of-life medical decisions" involving 61% of these babies, the study distinguishes between decisions not to start or to stop "life-sustaining treatment" (e.g. ventilator), on the one hand, and the administration of certain substances to the baby, on the other hand. Note that the term euthanasia does not appear anywhere in the article.

In terms of the physician's intentions, the study distinguishes three situations. 

In the first scenario, the physician does not intend to cause or hasten the baby's death, but considers the potential effect of hastening death (e.g., decision not to administer antibiotics, administration of morphine or sedatives). 

The second scenario consists in the situation where the potential effect of hastening death is not the primary goal but is partly aimed at by the physician. 

The third scenario is that in which the physician explicitly intends to cause death (e.g., injection of a lethal muscle relaxant).

While the ethical considerations on the medical decision differ substantively depending on whether it refers to the first or second scenario (death not intended vs. intended death), the study classifies the cases neither according to these two categories of intention, nor referring to the withholding/withdrawing distinction, nor underlining the relevant moral factor actively administering substances. The criterion of proportionality (in withdrawing treatment or in the dosage of substances) is not mentioned either, even though it is decisive for judging the physician's intention.

Doctors who euthanized newborns with lethal injection indicated in 91% of the cases that the main reason for their action was that there was no hope of a "bearable future" for the child. In other words, these children had a real chance of survival, but the medical team - no doubt in agreement with their parents - considered that their lives were not worth living to the end.

Why do practitioners deviate from the legal framework when it comes to children who are unable to express themselves?

The authors of the study raise the question of the need for a framework for this "practice", similar to the paralegal framework established in the Netherlands through the Gröningen Protocol. Such a "framework" would in fact mean conditional authorization of physician infanticide.