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At long last, Dutch doctors draw a line in the sand

November 25th, 2011

Disturbing on so many levels….

by Michael Cook

Euthanasia is OK, but circumcising male babies is a bridge too far.

There seems to be no end to the creative energy of the right-to-die movement in the Netherlands. The latest innovation is a proposal for a euthanasia flying squad. The lobby group Right To Die wants mobile vans to buzz around the streets so that patients can die at home, not in hospital.

At the moment this is no more than a proposal, but proposals have a way of becoming policy in the first country in the world to legalise euthanasia.

Unlike most other countries, where euthanasia is still taboo, in the Netherlands doctors are constantly expanding the circle of eligibility for a lethal injection. A recent position paper from the Royal Dutch Medical Association (KNMG) reminded its members that they are obliged to take seriously all requests for euthanasia, even if patients are demented, mentally ill, suicidal, or merely tired of living.

Perhaps in response to this encouragement, registered euthanasia deaths rose by 12 percent in 2010 to 3,136 — and this figure does not include the numerous deaths for which harried doctors did not do the paperwork or deaths by terminal sedation — slow euthanasia by withdrawing food and water from heavily sedated patients.

It is commonly thought that euthanasia is just for the elderly. Not so. If Dutch babies are seriously ill doctors are permitted to euthanase them. This has even been codified in an agreement between paediatricians and the government called the Groningen Protocol. Since the baby cannot consent to his own death, his parents are allowed to consent for him. Involuntary euthanasia is regarded as a caring response to severe disabilities.

Dutch doctors have been accused of abandoning all ethics. The falsity of this was displayed earlier this month in another position paper. There is a line beyond which no Dutch doctor is supposed to go, a medical procedure so barbarous and morally repugnant that the KNMG has condemned it as completely unethical. This is the ancient practice of circumcising male babies.

The KNMG takes a highly principled stand. It says that “minors may only be exposed to medical treatments if illness or abnormalities are present, or if it can be convincingly demonstrated that the medical intervention is in the interest of the child, as in the case of vaccinations. Non-therapeutic circumcision of male minors conflicts with the child’s right to autonomy and physical integrity.”

The KNMG says that there is even a good case for outlawing circumcision despite its “deep religious, symbolic and cultural feelings”, but that a ban would drive the practice underground and might do more harm than good. About 15,000 boys are circumcised in the Netherlands every year. Most of them are Muslims and Jews.

A KNMG medical ethicist, Gert van Dijk, explains: “We feel circumcision is a medically unnecessary form of surgery. The patient has to give consent, but children can’t give consent and we feel that is wrong and a violation of the child’s rights. In our code of medical ethics, it states that you must not do harm to the patient, but with this procedure this is exactly what you’re doing.”

Does anyone else detect something dark, dangerous and loopy about these explanations?

Male circumcision is the world’s most common surgical procedure. There is a low incidence of gruesome complications — but death is not one of them. How can it be unethical to circumcise babies but ethical to kill them? How can parents offer surrogate consent to euthanase their children but not to circumcise them? Aren’t Dutch medical ethicists straining out the gnat and swallowing the camel?

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