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参考
オランダでの乳幼児安楽死の議論（BBC）【成人の安楽死についての議論も再燃】
http://www.asyura2.com/0406/health9/msg/465.html
http://www.iht.com/articles/2005/03/18/news/doctor.html
Infant euthanasia: A doctor explains
By Gregory Crouch The New York Times
Saturday, March 19, 2005
GRONINGEN, Netherlands Bounding down a spiral staircase that resembles a sawed-off strand of DNA, Dr. Eduard Verhagen is wrapping up a tour of what is surely the world's most controversial pediatric ward.
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In the past two years, Verhagen, the clinical director of pediatrics at the University Medical Center, Groningen, has presided over the medically induced deaths of four extraordinarily ill newborns.
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For his efforts to end what he calls their unbearable and incurable suffering, he has been called "Dr. Death," a second Hitler and worse, mostly by American opponents of euthanasia. Slowing down to introduce a visitor to a few colleagues, Verhagen acknowledges his notoriety with a bit of black humor.
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"He's here to see what the mercy killer is really like," he jokes.
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His stab at self-deprecation hangs awkwardly in the air. His co-workers are not quite sure how to react - just about the only people around who are not voicing an opinion of Verhagen or his cause celebre.
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The pope has condemned infant euthanasia and Verhagen, indirectly, for advocating it. Hate mail from the United States bombards the hospital with comparisons to the Holocaust.
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"My first reaction to most of the criticism is: ridiculous, uninformed," Verhagen said. "Then the question arises in me: How is it possible that people themselves feel free to say such horrible things about other people they don't know?"
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Verhagen is asking people to recognize something many would prefer not to even think about: A few babies are born with conditions so horrific, so excruciatingly painful, that their doctors and even their parents think they would be better off dead.
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His push for an open and detailed discussion of such cases could one day, some hope and others fear, lead to the formal legalization of infant euthanasia in the Netherlands.
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Euthanasia is legal here except for children younger than 12. But Verhagen has documented 22 cases of reported infant euthanasia in the past seven years.
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Those include the four in his own hospital, and there may be more. On the basis of past court decisions, in which doctors were acquitted on murder charges, prosecutors have chosen in recent years not to pursue similar cases.
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Verhagen, 42, wants a team of physicians, together with the baby's parents, to decide openly, in what are very rare, extraordinary cases, whether or not to end a child's life.
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Better that, he said, than a lone pediatrician behind a hospital curtain armed with too much pain reliever.
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"If you do this, the most important decision man can take, you must do it in a spotlight, you must do it with the curtains opened instead of closed, because it's extremely difficult and you can't be wrong," he said.
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A father of three who spent years tending to sick children in underdeveloped countries, Verhagen became a pediatrician with the sole intention of saving lives, not ending them. And that is exactly what he did until Sanne was born on his ward four years ago with a severe form of Hallopeau-Siemens syndrome, a rare skin condition.
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In the best-case scenario, she would live until her 9th or 10th birthday and then die of skin cancer.
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Her skin would literally come off if anyone touched her, leaving painful scar tissue in its place.
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The top layers of mucous membranes inside her mouth and esophagus fell away any time she was fed, which was done by tube.
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Verhagen tried to evoke the kind of pain he says Sanne was in. He clenched his fists and mimicked the way she balled her tiny hands. Her cry was not that of a normal, healthy baby but the shriek of an extraordinarily sick one.
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And her vital signs - heartbeat, blood pressure and respiration - reflected those of a child in extreme stress, Verhagen said.
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Pain relievers seemed to be useless.
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Making matters worse, Verhagen and his colleagues had to bandage Sanne's scar tissue knowing they were contributing to a vicious circle: Every time they replaced the bandages, a little more skin fell off. Before long, Verhagen said, Sanne resembled a mummy.
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Her parents demanded an end to her suffering, which moved Verhagen to consider euthanasia.
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Fearing criminal prosecution, Verhagen and hospital officials refused and eventually sent Sanne home, where she died of pneumonia half a year later.
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Verhagen felt he had failed Sanne and her parents, believing all three had suffered longer than necessary. "We were very unhappy," he said.
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He and his colleagues started familiarizing prosecutors with difficult cases, even including them on daily rounds.
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And they developed a protocol, published this month in the New England Journal of Medicine, that is both a checklist and a how-to-guide for Dutch doctors who are considering ending a baby's life and still want to stay out of jail.
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Now, he is suddenly in demand as an expert in the medical and ethical issues surrounding infant euthanasia and not exactly sure what to make of all the fuss. "It's weird," he said. "I want to be a normal pediatrician, not Dr. Death."
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The decision to end a child's life is obviously an emotional one, Verhagen said, and not just for the parents.
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Once everyone - doctors, parents and social workers - agrees there is nothing more to be done for a child medically, a time is fixed to start administering a deadly intravenous drip of morphine and midazolam, a sleeping agent.
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Advance notice of a couple of days is important, Verhagen said, so consenting parents have enough time to say goodbye and, in at least the instance of two devoutly religious families, to pray.
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Verhagen says he has watched one child die and was there moments later for the other three. All had severe forms of spinal bifida.
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"The child goes to sleep. It stops breathing," he said. "I mean it's difficult to give the right emotion there, but it's beautiful in a way," he said, somewhat aware of how this might sound to a layman. "They are children who are severely ill and in great pain. It is after they die that you see them relaxed for the first time. You see their faces in a way they should be for the first time. In that sense, but this is delicate, this is difficult, in that sense, it's beautiful."
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Verhagen does not admit to doubts about whether he is doing the right thing. It is what he would want for his own children, he said. "If my child would be so ill that it would fall into this category, I would ask someone else to end its life," he said, emphasizing that he could never do it himself. "At that moment, I would be a father and not a doctor."
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