Once a month on average somewhere in the Netherlands a doctor injects a newborn baby with a lethal cocktail of morphine and sedatives. Within a few hours, the baby is dead. The agonizing decision is taken, invariably at the pleading of distraught parents, because the infant is born into excruciating pain with life-threatening illness or disability and with little or no prospect of recovery or successful treatment.
Routinely, the killings are car-ried out in secret. The reasons for the deaths are covered up. The death certificates the doctors are obliged to fill out are falsified in order to render the doctors immune to prosecution for murder.
"We know these cases are happening every year. There's a kind of consensus that it is justifiable," says Johan Legemaape, legal adviser to the Royal Dutch Medical Association. "But it's still a very sensitive subject and it raises a strong reaction."
The moral, psychological and emotional pressures raised by the topic of killing infants are daunting, and in Holland, which has allowed strictly controlled euthanasia for 10 years, doctors are now demanding new rules governing the practice.
"It's time to be honest about the unbearable suffering endured by newborns with no hope of a future," said Dr Eduard Verhagen, head of pediatrics at Groningen hospital, in a statement last week. "All over the world doctors end lives discreetly out of compassion without any kind of regulation ... This is a subject that nobody likes to acknowledge, let alone discuss."
Behind the scenes pediatricians in the Netherlands have been making tacit deals with local prosecutors' offices for years, promising to report cases of "life-ending treatment for newborns" in return for guarantees that the doctors will not find themselves hauled into the dock facing charges of murder.
Last year Verhagen's clinic in Groningen carried out three terminations of newborns and reported the cases to the prosecutor's office, which decided not to bring charges.
Leendert De Lange, an official at the national prosecutor's office in The Hague, says there have been 18 such cases of "neo-natal" deaths reported to the judicial authorities in the past four years, none of them resulting in prosecution.
The doctors say this is around one-third of the total number of such cases, with most cases going unreported because of doctors' fears.
Two test cases in the mid-90s set the precedent. Two doctors, one a neurologist, the other a GP, reported the killing of two new-borns and were tried for murder. They were acquitted and appeal courts in both cases confirmed the acquittals. Since then there have been no more trials.
"In fact the prosecutors are not prosecuting these cases," said John Griffiths, an expert in euthanasia law at the university of Gronignen, in the north-east of the country.
Such a situation is not good enough for Dr Louis Kollee, the head of pediatrics at the Radboud University Medical Centre in the eastern Dutch town of Nijmegen.
Along with a bunch of likeminded colleagues from children's and maternity wards across the Netherlands, Kollee is campaigning for new rules surrounding the killing at birth of babies whose condition is so serious that they cannot be expected to survive for long.
Kollee and his colleagues argue that they want neither to legalize nor to decriminalize the lethal injections administered by doctors into newborns. But they want a new system of government-endorsed regulation that will minimize the chances of prosecution.