Unlike most pro-infanticide journal articles, this one was published online and noticed by the popular media—leading to the rare case when a major bioethics article received widespread public scrutiny, sparking a firestorm of popular outrage. Indeed, the criticism became so intense that the Journal of Medical Ethics took it offline and the authors wrote a public non-apology apology—not recanting anything they wrote, mind you, but claiming to be harmless philosophers merely chewing intellectual cud: “When we decided to write this article about after-birth abortion we had no idea that our paper would raise such a heated debate. ‘Why not? You should have known!’ people keep on repeating everywhere on the web. The answer is very simple: the article was supposed to be read by other fellow bioethicists who were already familiar with this topic and our arguments [as] . . . this debate has been going on for 40 years.”82
But that is precisely why it was important that the public reacted so viscerally. As I described in the last chapter, bioethics is not a mere debating society. Rather, the field is—and has been since its inception—about changing societal values and public policies. Moreover, bioethicists haven’t discoursed about infanticide for forty years because they enjoy exploring novel concepts, but rather because it isn’t easy to convince people—not even bioethicists—that killing babies is acceptable. Should infanticide ever become “unexceptional,” in Richard John Neuhaus’s formula, killing babies would become the launching pad for the next radical proposal.
Giubilini and Minerva disingenuously pretend they are not part of that process of persuasion: “We never meant to suggest that after-birth abortion should become legal. This was not made clear enough in the paper. Laws are not just about rational ethical arguments, because there are many practical, emotional, social aspects that are relevant in policy making (such as respecting the plurality of ethical views, people’s emotional reactions etc.). But we are not policy makers, we are philosophers, and we deal with concepts, not with legal policy.”83
Whatever. That which we don’t condemn we may ultimately allow. Thus the strong public pushback against Giubilini and Minerva’s philosophical apology for infanticide was not only justifiable but absolutely necessary. Indeed, the fact that bioethicists deem promotion of infanticide debatable—even those who “respectfully disagree” with permitting it—speaks volumes about the danger posed by the contemporary bioethics movement.
Killing Babies in Holland: Peter Singer and Udo Schuklenk’s infanticide-friendly philosophy has been turned into lethal practice in the Netherlands, where seriously disabled and terminally ill babies are killed in their cribs by pediatricians and neonatologists. According to a 1997 study published in the British medical journal The Lancet, approximately 8 percent of Dutch infants who died in 1995 were killed by doctors who administered drugs “with the explicit aim of hastening death.”84 If the study, which looked into the deaths of 338 infants between August and November 1995 is accurate, and with approximately 1,000 infants dying in the Netherlands each year (1,041 in 1995), approximately 80 babies are murdered each year by their doctors without legal consequence. A follow-up investigation in the same journal in 2005 came to a nearly identical conclusion.85 According to the 1995 study, 45 percent of surveyed neonatologists and 31 percent of surveyed pediatricians had “given drugs explicitly to end life.”86
Most of the babies were killed because the doctors believed they would not survive, but 18 percent of the killings were due to “a poor prognosis,”87 meaning disabilities. Life was shortened by more than five years in 16 percent of the cases. Some of the killed babies didn’t even need life support to survive: “… a drug was given to hasten death to neonates not dependent on life-sustaining treatment in 1 percent of all death cases,” which “represents 10–15 deaths of this type per year in the Netherlands.”88 Most—but not all—of the killings were at the request of parents, as per the Peter Singer and Udo Schuklenk formulas.89 Despite legal requirements that euthanasia deaths be disclosed to the coroner’s office for review, “physician-assisted deaths for neonates is . . . virtually never reported.”90
Few cases of infanticide have been prosecuted in the Netherlands; those that have been have not been attempts to punish doctors but rather to establish a “precedent.” (Dutch prosecutions are not necessarily adversarial in nature, particularly as they involve physicians involved in euthanasia. As Dutch lawyer and euthanasia proponent Eugene Sutorius told me, “The public prosecution, as a body, sees that this is not criminality in the normal sense. . . . So, even the prosecutor, while bringing the case, he’s more interested in making sure that we have strict definitions and order than he is in punishing the professional. He’s trying to create a precedent.”91)
The first Dutch infanticide precedent that essentially decriminalized infant euthanasia involved a Dutch gynecologist named Henk Prins who killed a three-day-old infant who was born with spina bifida, hydrocephalus, and leg deformities. When prosecuted (in order to create a precedent), Dr. Prins testified that he killed the child with her parents’ permission because of the infant’s poor prognosis and because the baby screamed in pain when touched. Yet the child was in agony because she was neglected medically. The open wound in her back, the primary characteristic of spina bifida, had not been closed; the fluid had not been drained from her head either, even though these treatments are standard in spina bifida cases and would have substantially reduced the infant’s pain.
The trial court refused to punish the doctor for killing the baby. Indeed, the judge praised Dr. Prins for “his integrity and courage” and wished him well in any further legal proceedings he might face.92
The Royal Dutch Medical Association (KNMG) published a report in 1990 that set forth guidelines for killing incompetent patients, including infants. The standard for pediatric euthanasia is what is called “a livable life,”93 a more tactful way of expressing the Binding and Hoche idea of a life unworthy of life. According to Dutch medical ethics, and echoing Fletcher’s “humanhood” concept described in the last chapter, the “livableness” of an infant’s life depends on a combination of factors, including the following:
• The expected measure of suffering (not only physical but emotional);
• The expected potential for communication and human relations, independence (ability to move, to care for oneself, to live independently);
• The child’s life expectancy.94
If the infant’s prospects don’t measure up to what the doctor and parents believe is a life worth living, the child can be medically neglected to death, or if that doesn’t work, killed by the doctor via lethal injection.
Dutch infanticide came completely out of the shadows—albeit remaining technically illegal, for what that might be worth—in 2004 with the publication of the “Groningen Protocol for Euthanasia in Newborns” by the Groningen University. The protocol was drawn up by doctors at the Groningen Academic Hospital, led by Dr. Eduard Verhagen, head of the hospital’s pediatric department. Infanticide is a clear violation of the existing euthanasia law, which requires competent patients to voluntarily request death.
No matter. Verhagen explained, “It’s time to be honest about the unbearable suffering endured by newborns with no hope of a future,” adding that he hoped the Groningen protocol would serve as a nationwide guide to the killing of seriously ill or disabled infants.95
Even more alarmingly, some of the world’s most respected bioethical and medical journals embraced the Groningen protocol as a respectable approach. It was published, for example, with all due respect in the New England Journal of Medicine.96 The bureaucratic infanticide checklist was even applauded in the Hastings Center Report—in which, reminiscent of Binding and Hoche—bioethicists Hilde Lindermann and Marian Verkerk lauded the protocol because it allows the infanticide of babies who aren’t dying: “Critics charge that the protocol does not successfully identify which babies will die. But it is precisely those babies who could continue to