The Groningen Protocol for neonatal euthanasia - Our perspective




ethics, neonatal euthanasia, Groningen Protocol


Introduction: The Netherlands has pioneered the implementation of recommendations and laws regulating voluntary active euthanasia. Since 2002 it has allowed active euthanasia in children aged 12 and over. The Groningen Protocol, established in 2005, introduced the possibility of ending the life of newborns who fulfill certain specific criteria. It was drafted by Verhagen and Sauer at the University Medical Centre in Groningen and was granted authorization for national implementation from the Dutch Association of Pediatric Care.
Methods: A literature search was conducted to analyze the Groningen Protocol and arguments supporting and opposing it.
Results: Seemingly competing tenets of principalism – respect for autonomy, beneficence, nonmaleficence, and justice – are invoked as core arguments both for and against the protocol. The scale hangs in the sense of opposition to the protocol, essentially because of the weight of some of the arguments presented.
Conclusion: From our perspective, the Groningen Protocol seems to have been built primarily to allow deliberately ending the life of a newborn baby without fear of criminal prosecution. In addition, included criteria are prone to subjectivity and may lead to abuse. The protocol’s proposal to regulate a very rare practice such as the anticipation of death in a seriously ill newborn promotes acceptance of active euthanasia for those who are most vulnerable and cannot express their own will.


Download data is not yet available.

Author Biography

Daniela Alves, West Lisbon Hospital Centre - Santa Cruz Hospital




1. Verhagen E. End-of-Life Decisions in Newborns: An Approach From the Netherlands. Pediatrics. 2005; 116:736–9.

2. Verhagen E. End of life decisions in newborns in The Netherlands: medical and legal aspects of the Groningen protocol. Med Law. 2006; 25:399–407.

3. Barry S. Quality of Life and Myelomeningocele: An Ethical and Evidence-Based Analysis of the Groningen Protocol. Pediatr Neurosurg. 2010; 46:409–14.

4. Chervenak FA, Mccullough LBLB, Arabin B. Why the Groningen Protocol should be rejected. Hastings Cent Rep . 2006; 36:30–3.

5. Verhagen E, Sauer PJJPJJ. The Groningen Protocol — Euthanasia in Severely Ill Newborns. N Engl J Med. 2005; 352:959–62.

6. Martín Hortigüela ME. Analysis of the Debate on Neonatal Euthanasia Using Present Bioethical Literature. Cuad Bioet. 2015; 26:223–39.

7. Martens WHJ. Recommendation of the Groningen Protocol for euthanasia of newborns with unbearable suffering and unacceptable quality of life. Med Law. 2008; 27:925–8.

8. Lindemann H, Verkerk M. Ending the life of a newborn: the Groningen Protocol. Hastings Cent Rep. 2008; 38:42–51.

9. Manninen BAA. A case for justified non-voluntary active euthanasia: exploring the ethics of the Groningen Protocol. J Med Ethics. 2006; 32:643–51.

10. Hanson S. Pediatric Euthanasia and Palliative Care Can Work Together. Am J Hosp Palliat Med. 2016; 33:421–4.

11. Appel J. Neonatal Euthanasia: Why Require Parental Consent? J Bioeth Inq. 2009; 6:477–82.

12. Tedesco M. Dutch Protocols for Deliberately Ending the Life of Newborns: A Defence. J Bioeth Inq. 2017; 14:251–9.

13. Eijnden S Vanden, Martinovici D. Neonatal euthanasia: A claim for an immoral law. Clin Ethics. 2013; 8:75–84.

14. De Vries MCMC, Verhagen AAEAE. A Case Against Something That Is Not the Case: The Groningen Protocol and the Moral Principle of Non-Maleficence. Am J Bioeth. 2008; 8:29–31.

15. Verhagen E. Decisions About Periviable Babies in Dutch Neonatal Intensive Care Units; Quality-of-Life and Quality-of-Death Concerns. Curr Pediatr Rev. 2013; 9:40–5.

16. Verhagen E. The Groningen Protocol for newborn euthanasia; which way did the slippery slope tilt? J Med Ethics. 2013; 39:293–5.

17. Verhagen E. Neonatal euthanasia: Lessons from the Groningen Protocol. Semin Fetal Neonatal Med. 2014; 19:296–9.

18. Gastmans C, Naulaers G, Vanhole C, Denier Y. From Birth to Death? A Personalist Approach to End-of-Life Care of Severely Ill Newborns. Christ Bioeth. 2013; 19:7–24.

19. Wilkinson DJ. A Life Worth Giving? The Threshold for Permissible Withdrawal of Life Support From Disabled Newborn Infants. Am J Bioeth. 2011; 11:20–32.

20. Voultsos P, Chatzinikolaou F. Involuntary euthanasia of severely ill newborns: is the Groningen Protocol really dangerous? Hippokratia. 2014; 18:193–203.

21. de Vos MA, van der Heide A, Maurice-Stam H, Brouwer OF, Plotz FB, Schouten-van Meeteren AYN, et al. The Process of End-of-Life Decision-Making in Pediatrics: A National Survey in the Netherlands. Pediatrics. 2011; 127:e1004–12.

22. Goldnagl L, Freidl W, Stronegger WJWJ. Attitudes among the general Austrian population towards neonatal euthanasia: a survey. BMC Med Ethics. 2014; 15:74.

23. Halac J, Halac E, Moya MP, Olmas JM, Dopazo SL, Dolagaray N. Perinatal bioethics: Euthanasia or end-of-life decisions? Analysis of the Groningen Protocol | Bioética perinatal: ¿Eutanasia o decisiones sobre terminación de la vida? Ańalisis del Protocolo de Groningen. Arch Argent Pediatr. 2009; 107:520–6.

24. Jotkowitz ABB, Glick S. The Groningen protocol: another perspective. J Med Ethics. 2006; 32:157–8.

25. Gordijn B, Janssens R. The prevention of euthanasia through palliative care: New developments in The Netherlands. Patient Educ Couns. 2000; 41:35–46.

26. Liao L, Chan D. Physician-hastened death in young children: Getting to underlying assumptions. Paediatr Child Health. 2016; 21:181–2.

27. Jotkowitz A, Glick S, Gesundheit B. A Case Against Justified Non-Voluntary Active Euthanasia (The Groningen Protocol). Am J Bioeth. 2008; 8:23–6.

28. Chervenak FA, McCullough LB, Arabin B. The Groningen Protocol: Is it necessary? Is it scientific? Is it ethical? J Perinat Med. 2009; 37:199-205.

29. Kon A. We cannot accurately predict the extent of an infant’s future suffering: the Groningen Protocol is too dangerous to support. Am J Bioeth. 2008; 8:27-9.

30. Koper JF, Bos AF, Janvier A, Verhagen AAE. Dutch neonatologists have adopted a more interventionist approach to neonatal care. Acta Paediatr. 2015; 104:888–93.

31. Aronin PA, George TM. Commentary on ‘Quality of Life and Myelomeningocele: An Ethical and Evidence-Based Analysis of the Groningen Protocol’ by Sean Barry. Pediatr Neurosurg. 2010; 46:415-6.

32. Kon A. Neonatal Euthanasia Is Unsupportable: The Groningen Protocol Should Be Abandoned. Theor Med Bioeth. 2007; 28:453–63.

33. Kodish E. Paediatric ethics: a repudiation of the Groningen protocol. Lancet. 2008; 371:892–3.




How to Cite

Alves D, Dias-Costa E. The Groningen Protocol for neonatal euthanasia - Our perspective. REVNEC [Internet]. 2019Dec.16 [cited 2023Jan.29];28(4):185-90. Available from:



Original Articles