CHICAGO -- Researchers in the Netherlands, the first country to legalize euthanasia for terminally ill people, have found that doctors are helping hasten the deaths of sick children in a variety of ways, sometimes at the edges of what the law allows.
The study adds to an international debate expected to increase in the United States this fall when the US Supreme Court considers whether Oregon doctors can prescribe federally controlled drugs to help patients die. Oregon has the nation's only doctor-assisted suicide law.
The Dutch euthanasia law took effect in 2002. Before that, the Netherlands's highest court ruled in 1984 that euthanasia could be legal in limited circumstances.
The study looked at 64 deaths of ill children during a four-month period. Of those, 42 cases involved medical decisions that could hasten death.
Doctors received immunity against prosecution and their responses were kept anonymous in the government-sponsored study.
The decisions ranged from withholding life support, a practice accepted in the United States, to administering drugs such as morphine with the intention of ending suffering and hastening death.
Only one case involved euthanasia in its strictest definition: doctor-assisted death at the patient's request.
Some of the cases described in the study ''take place at the boundaries of what is legally allowed," its co-author Astrid Vrakking of Erasmus Medical Center in Rotterdam said in an e-mail. ''Whether or not these boundaries are supportive or rightful is, of course, a matter of debate."
The study, funded by the health and justice arms of the Dutch government, was published yesterday in Archives of Pediatrics & Adolescent Medicine.
The Dutch law allows euthanasia and doctor-assisted suicide for terminal patients suffering unbearable pain with no hope of improvement, and who request death when they are of sound mind.
The law bars euthanasia for children younger than 12. However, officials at Groningen Academic Hospital have proposed guidelines for mercy killings of newborns deemed to be in great pain from incurable disease or extreme deformities -- and in November, they revealed they had already begun carrying out such procedures, euthanizing four newborns in 2003.