A 2-Year-Old Was Euthanized in the Netherlands. Two Doctors Said No. A Third Said Yes.

In December 2025, a nearly two-year-old Dutch child died after doctors injected sedatives. It was the first publicly reviewed case after the Netherlands extended its “active termination of life” rules to children aged 1 to 12 in 2024.

In September 2026, the review committee published its report. It found that the attending physician had acted “prudently and responsibly.” Four prosecutors reviewed the case and concluded that the physician had not broken the law.

The paperwork was clean. The ethics were not.

A child with a developmental age of six weeks

The report described the case: birth at 26 weeks and 3 days, extensive brain damage, cerebral visual impairment, and severe developmental delay. At nearly two years old, the child functioned at roughly the level of a six-week-old infant. He had no language. He could communicate only in a very limited way.

At eight months, he was diagnosed with infantile epileptic spasms syndrome. He had repeated seizures daily. During seizures he cried, arched his body, and struggled to breathe. He also had severe insomnia, swallowing problems, and trouble clearing secretions. Anti-epileptic drugs did not work. Some caused marked agitation, crying, and insomnia.

His parents applied for termination of life. Two independent physicians examined him. They confirmed the condition was irreversible. Both agreed that at that time the child was not continuously suffering unbearable pain. “The epilepsy caused clear discomfort, but the seizures were not continuous,” the report said. Both recommended palliative measures and medication to control symptoms.

Doctors tried medication. The side effects were bad enough that they stopped it.

What the parents refused was continuous palliative sedation: keeping the child deeply sedated long term, stopping artificial fluids and nutrition, and waiting for natural death. The parents believed the dying process would drag on too long. The attending physician also considered this unreasonable.

Afterward, the attending physician invited an outside physician to conduct another independent assessment. This physician concluded that, apart from occasional brief better periods, the child had long been in obvious discomfort. He had frequent seizures and breathing and swallowing difficulties. The suffering could not be relieved by other reasonable means.

The termination of life was carried out.

Who decides for someone who cannot speak?

The four classic principles of modern bioethics are respect for autonomy, beneficence, nonmaleficence, and justice. All four matter here. The first one collapses.

The core ethical justification for euthanasia rests on respect for the patient’s autonomous will. An adult can, while lucid, say whether to continue enduring suffering or choose to end life. A child under two cannot say “I can’t bear it anymore,” nor “I want to keep living.”

The decision can only be made on his behalf by parents and doctors. They are guided by the “best interests of the child” principle in pediatric medicine.

The problem is what counts as this child’s “best interests.”

Repeated seizures, breathing difficulties, swallowing disorders, and chronic insomnia prove he was suffering obvious pain. But between “he is suffering” and “death is more in his interests than continued life” lies a gap that no objective test can measure.

The first two physicians and the physician who ultimately acted disagreed at the root. The first two believed the suffering had not reached “continuous and unbearable.” The last believed it had. The disagreement itself shows that this is not only a medical judgment. It is also a value judgment.

As bioethical commentary has noted, the argument from “respect for the patient’s will,” on which euthanasia advocates rely, collapses entirely in patients who cannot give informed consent.

Palliative care: reasonable alternative or abandoned option?

Dutch law requires that no other reasonable and sustained means of relieving the child’s suffering exist, including palliative care.

Medication was tried and stopped because of side effects. Continuous palliative sedation became the focus of controversy.

Medically, continuous sedation can make the child unconscious or greatly reduce consciousness. That lessens the perception of suffering from seizures, breathing difficulties, and similar problems. But this is not cure or reversal. It trades reduced suffering for reduced wakefulness. The dying process may last weeks or longer.

The parents and attending physician considered this unreasonable. The first two independent physicians believed doctors should still try palliative care.

Does a plan that can relieve suffering but prolongs the dying process count as a “reasonable alternative”?

Pediatric palliative sedation is clinically complex and ethically sensitive. It lacks a strong evidence base and pediatric-specific guidelines. Practice varies widely among physicians. In this case, the answer to “whether other reasonable options exist” depended largely on who was answering and by what standard.

Does severe disability equal life as suffering?

In addition to medical suffering such as epilepsy and breathing and swallowing difficulties, the official report noted that the child had “virtually no prospect of future development, could not live independently, and had very limited positive life experiences.”

These descriptions help convey the severity of the condition. But can they automatically justify ending a life?

Being unable to speak, unable to walk, and needing lifelong care does not automatically mean a person’s life has no value. It does not mean being alive is itself suffering.

Healthy adults easily imagine by their own standards: “If I could never walk, communicate, or care for myself, I wouldn’t want to live.” Such imagination cannot replace judgment about a concrete, living child who experiences the world in his own way.

The basis for judgment should be “this child is suffering uncontrollable medical pain.” It should not slide toward “this child will only live as a severely disabled person.”

If the latter logic holds, the implicit premise is that life below a certain quality is not worth living. Once accepted, that premise extends far beyond this case, to all people with severe disabilities.

The Dutch review committee ultimately found that the physician met the due-care standard. A decision that is legal and passes review is not the same as a morally uncontested decision. This case has provoked wide discussion because it exposes the gray zones in the current system at two key points: judging suffering and assessing alternatives.

Institutional evolution and internal tensions

The Netherlands was the first country to legalize euthanasia, with legislation opening the door in 2002. Before this, there was a “blank zone.” Newborns could undergo euthanasia under the Groningen Protocol. Minors over 12 could apply under law. Children aged 1 to 12 had no institutional arrangement at all. Seriously ill children in this age group previously could only receive palliative sedation, or have nutrition and fluids withdrawn, and be left to die naturally over weeks.

The Groningen Protocol emerged after two neonatal euthanasia cases in 1995 sparked national debate. It aimed to provide standardized criteria and transparency for neonatal euthanasia. Many international physicians criticized the protocol as vague, overly permissive, and even tinged with disability discrimination.

The 2024 amendment, in a sense, extended the logic of the Groningen Protocol to the 1-to-12 age group.

The Dutch government estimated at the time that about 5 to 10 children nationwide would meet the criteria each year. Legislators framed it as an “extreme exception.” Once an exception is institutionalized, it faces a question: where the boundary of the standard lies, who judges whether suffering is “unbearable,” and how the system responds when physicians disagree.

In this case, the answer was obtained by bringing in another assessing physician. The attending physician invited an outside doctor for a new round of independent assessment, which is permitted within the legal framework. But it exposes a structural problem. When the safeguard of “independent physician opinion” depends on the subjective judgment of particular doctors, how much constraint does it provide?

The irreversible decision

The Netherlands was the first country to legalize euthanasia. Belgium removed age limits for euthanasia in 2014 and carried out the world’s first minor euthanasia in 2016. The Dutch amendment in 2024 filled an institutional gap in comparative-law terms.

Filling an institutional gap is not the same as filling an ethical gap.

The difficult question in this case is not “Was the Netherlands right to do this?” The more precise question is: when a person cannot express his will at all, to what extent may others judge on his behalf what counts as “unbearable”? How much certainty is required before making a wholly irreversible decision for him?

The Dutch review committee’s answer was that in this case, the certainty had been reached. Four prosecutors confirmed this on review.

The voices of the first physicians who believed “the suffering had not yet reached unbearable” and critics’ questions that “the parents gave up the very palliative care that could have relieved suffering” will not disappear because the procedure was compliant.

This case matters as an ethical event because it forces everyone who attends to it to confront an unavoidable question. At the beginning of a life, when suffering cannot be spoken and will cannot be expressed, on what grounds do we make the final, irrevocable decision for a life?