The Dutch government, the first to legalize euthanasia (search) for some terminally ill people, will tackle an even thornier ethical dilemma: what to do when doctors say it is best to end the lives of infants, the mentally handicapped or the demented.

Euthanasia opponents view the idea with horror, but The Royal Dutch Medical Association (search) believes guidelines and a panel of experts should be created to vet such cases.

Health Secretary Clemence Ross, who has opposed expanding the current euthanasia rules, will send an opinion to Parliament in three or four weeks, said her spokesman, Richard Lancee.

If Ross approves, doctors acting with the families' permission would not be punished for administering lethal sedatives to "people with no free will," in cases that pass review.

Under current law, euthanasia is restricted to terminal patients suffering unbearable pain with no hope of improvement, and who request to die when they are of sound mind. Each case is reviewed by a panel of medical experts.

The new proposal calls for a similar panel for patients who cannot express themselves, with the addition of a judge or court official, giving a legal veneer to a practice that technically would remain illegal.

For advocates, the issue is one of transparency: Past studies have shown that doctors already carry out a handful of such euthanasia cases each year.

In the best known example, the Groningen Medical Center (search) announced last year it euthanized four severely ill newborns in 2004, under guidelines known as "the Groningen Protocol" — a list of standards for performing and reporting euthanasia of newborns with serious, incurable deformities.

Examples include extremely premature births, where children suffer brain damage from bleeding and convulsions, and diseases where a child could only survive on life support for the rest of its life, such as severe cases of spina bifida.

Euthanasia opponents say formalizing such practice would be another step in the Netherlands' slide down an ethical slope. Bert P. Dorenbos, director of Cry for Life (search), said the move would be a preliminary step to legalizing involuntary euthanasia.

"This is the most important moment, when we can still fight it," he said.

A similar proposal was stricken from the euthanasia bill that was passed in 2001 and took effect in 2002, making the Netherlands the first country to legalize a practice it says is common but unstated in most Western countries.

Since then, Belgium has also legalized euthanasia, while in France, legislation to allow doctor-assisted suicide is currently under debate. In the United States, the state of Oregon is alone in allowing physician-assisted suicide, but its law is under constant challenge.

The Terri Schiavo (search) case would not fall under Dutch euthanasia law, because courts have held that withdrawing life support or a feeding tube is a decision left up to doctors.

Peter Holland, the director of The Royal Dutch Medical Association, said doctors support the creation of a vetting panel for "extreme cases." The Dutch Society for Voluntary Euthanasia (search) has no official position on the latest proposal, but Chief Executive Rob Jonquiere said the organization generally supports it.

"The best argument for the review boards is the success of the existing system" in the Netherlands, he said.

There were 1,815 euthanasia cases reported to regional review boards in 2003, a slight decline from previous years. In eight cases, doctors were deemed not to have followed the rules properly and were referred to prosecutors.

According to a study published in the Netherlands Journal of Medicine in January, 22 cases of newborns being euthanized were reported to prosecutors since 1997. Prosecutors found that the Groningen guidelines were followed in all of them, so they recommended to superiors the cases not be pursued further though they were technically murder.