Good afternoon, my name is Karla… (AQUÍ VA TU INTRODUCCIÓN) and I will talk about the issue of

euthanasia, specifically, euthanasia applied to children.

First of all, we need to know what euthanasia is.

Euthanasia is the act of causing death for the benefit of the person. The etymological meaning of
the word is: "good death".

Traditionally, the problem of euthanasia has been raised as a conflict between life as a value in itself
or as a value subordinated to certain minimum conditions of well-being, that is, quality of life. Also,
it has been raised as a conflict between the right to life and the right to free decision.

In this sense, in order to identify a possible solution to the ethical problems involved in euthanasia,
the different ways in which euthanasia can occur are distinguished, namely:

1. Voluntary euthanasia, which implies an explicit manifestation of the patient's desire to die.

2. Involuntary euthanasia, where there is no explicit manifestation of the patient's desire to die.

3. Active euthanasia, where death is caused by the agent.

4. Passive euthanasia, that is, let the patient die.

It is worth mentioning that in passive and active euthanasia there is an intention to end life, so
regarding our subject, I will talk about who is empowered to make the decision to apply it to children
or newborns and what are the bases legal to carry it out.

In April 2002, a law that allows doctors to practice euthanasia or collaborate in the suicide of
patients older than 18 who request it was approved in the Netherlands.

Since euthanasia was legalized in the Netherlands, the new step has been to extend it to newborns
suffering from serious diseases. It has also been applied to patients who can’t decide for
themselves, however, the application of euthanasia to these patients like newborns was not
regulated.

Recently, a group of Dutch pediatricians, led by Eduard Verhagen, who are in favor of euthanasia,
have explained in the New England Journal of Medicine a list of situations in which the doctor could
end the life of a child with the consent of his parents and that it is an accepted medical practice. The
requirements are very simple: there has to be an uncontrollable and desperate suffering, a certain
diagnosis and prognosis, the confirmation by another doctor, the consent of the parents and that it
is an accepted medical practice.

The authors of this publication have made several media appearances in which they recognize their
active participation in the death of newborns with severe forms of spina bifida and in those media
appearances they intend to promote the acceptance of euthanasia, which is also starting to be
considered as a common practice in many countries of the world.
However, these considerations lead to a dangerous debate. The arguments that the authors who
are in favor of euthanasia are based on a utilitarian criterion that considers pain or suffering as the
greatest possible evil. The treatment of pain and suffering is an unavoidable duty of any doctor.
There are plenty of studies over the last 15 years that show that anesthesia and sedation can be
safely and safely administered to newborns and infants, provided that it is done properly adjusting
the dose to the age and the clinical situation. In addition, the development of palliative care has
made it possible to improve the quality of life, maintain dignity and reduce the suffering of seriously
ill children and their families in accordance with their values, education and beliefs.

Doctors base their decisions "on the presence of intense suffering without the possibility of relief"
even if the characteristics of this situation are never detailed, neither from a physiological nor
psychological point of view. In this way, the same clinical situation can be considered as "unbearable
suffering", while for others it can be understood as part of the process of becoming ill. This position
was clearly seen in the correspondence published in the magazine following the original article.

Well, the only persons legally authorized to make the decision are the parents of the minor,
however, recently there have been situations in which doctors take the decision without consulting
them, this because as we said, they consider pain or suffering as the greatest possible evil and they
feel the need to end it. It is a difficult decision, but these doctors say you can not let a child live in
inhuman conditions, even if the parents want it. Only the doctor can objectively determine what is
best for the patient.

The loss of a child is one of the most shocking situations in the life of an individual and comes to
produce a true crisis for parents. The presence of the doctor in these circumstances is crucial and
can contribute to alleviating the grief.

However, the easy solutions like euthanasia are far from both the values of medicine and the
scientific challenges that the professional doctors face in complex situations. Directly causing death
by administering lethal doses of drugs is an ethically unacceptable practice. It seems necessary to
have great caution and sensitivity to initiatives such as the "Protocol of Groningen".

Now, I will talk about the regulation of the euthanasia applied to newborns: the Protocol of
Groningen, proposed by pediatricians of a university hospital, establishes the legal bases for these
cases.

The protocol, developed jointly with the Office of the Prosecutor (Fiscalía de los Países Bajos),
regulates the procedure to be followed when applying euthanasia to newborns within the legal
margins that consider it acceptable.

The protocol recognizes that the acceptable quality of life to justify euthanasia is a subjective
criterion that depends on different options of parents and doctors. The criterions for assessing
situations that imply the application of euthanasia were proposed by the Professional Medical
Group of the Dutch Pediatric Association. These criteria are the following:

 The degree of dependence on the medical care the patient will have in the future.
 The possibility of having an autonomous life.
 The ability to communicate.
 The level of suffering and the average life expectancy of the patient.

Despite the fact that the intentional death of newborns is a very sensitive issue ethically speaking,
the Protocol of Groningen aims to adequately regulate the procedure to be followed. This is because
there are cases of newborns who died by euthanasia without the consent of their parents, therefore,
the Protocol recognizes that the decision must be taken jointly by both parents and doctors, seeking
the most appropriate solution to the health problems suffered by some newborns.