As Belgium becomes the first country in the world to remove all age restrictions to euthanasia, health care experts and ethicists are debating whether or not terminally ill children should ever be allowed access to life-ending drugs.
Under amendments to the country’s 2002 euthanasia law, a child of any age may be helped to die under strict conditions: the child must be terminally ill, close to death and suffering a great amount of pain. Counseling by doctors and a psychiatrist or psychologist is required, as is approval by parents or guardians. The child must possess the “capacity of discernment and be conscious” of requesting death.
But the law– expected to soon be signed by King Philippe– has faced strong opposition from both religious conservatives and physicians who argue that euthanasia is unnecessary, because modern medical technologies help minimize suffering.
“The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they’ve become able to decide that someone should make them die,” Brussels Archbishop Andre-Joseph Leonard said at a prayer vigil, according to the BBC.
I don’t think euthanasia is for every society and every place in the world, but I’m not willing to say it is always wrong.
Craig M. Klugman, a professor of bioethics at DePaul University in Chicago, said discussions about euthanasia are emotional because they touch upon an individual’s religious, political or medical beliefs. “The sanctity of life argument is a very personal one. Different religions have different views on what makes a life sacred, and in some cultures, a child is not a born human being until a month after its birth, because the infant mortality rates are so high. In others, life starts at the moment of conception,” he said.
But Klugman points to the sickest of children, whose entire existence is pain. “Some people might say we can control pain, but it is really difficult for an infant or newborn to tell us what they want, all they can do is scream and cry. But, they also cannot provide consent.”
Loving parents who choose to end the life of their suffering child could be viewed as morally courageous, while others would call them cowardly, Klugman said. “I don’t think euthanasia is for every society and every place in the world, but I’m not willing to say it is always wrong. If the parents determine in conjunction with the physician that it is a life whose quality is so poor that it is not worth living, then yes, I would support their freedom to make this decision.”
According to Klugman, the argument that legalized euthanasia will lead to “death panels” or eugenics is false. “Slippery slope arguments are considered a fallacy, because they assume we don’t have the ability to say ‘when,’” he said. “They assume that we don’t have any critical thinking or acting skills, and they have not often been proven true.”
Eric Price, M.Div., a pediatric care chaplain, argues that some seriously ill children should be granted equal access to euthanasia if they are suffering. “I don’t think we need to parse children into a different category,” he said. “It will always feel worse when we are talking about sick or terminally ill children. The suffering of a 7-year-old is no different than the suffering of a 70-year-old.”
However, Jean Kosova, a registered nurse and ethicist practicing in Chicago, said she believes palliative medicine should be viewed as a practical alternative to euthanasia. “We should be focusing on pain relief, and not allowing people to get to the point where they feel any comfort is hopeless,” she said. “But, working as a nurse, I have seen a lot of people in pain, even with the best medicines.”
Kosova’s concerns are with those children under 12. “It would be difficult to say that a child under 12 would be able to decide in the ways that we would hope an adult making these kind of decisions would be able to,” she said.
Similarly, Dr. Andrew Bonwit, an assistant professor of pediatrics with Loyola University, maintains euthanasia is an unnecessary practice. “Let’s redirect the goals of care when patients are terminal and help families come to terms,” he said. “We should make good use of every pain control measure available, including terminal sedation.”
Bonwit’s experiences have led him to conclude that young children are incapable of making difficult end of life decisions for themselves. “I would be very leery of letting children under 12 years of age choose euthanasia, just as I would be very leery of letting children under 12 choose for their goals of care to be redirected,” he said. “Asking a child to make this decision is something I would have difficulty with, but I also don’t practice in Belgium.”
Belgium is one of a handful of European countries where euthanasia is legal. The Netherlands legalized euthanasia in 2002, even allowing it in some cases for seriously ill minors 12 and older. Luxembourg allows euthanasia for adults; Switzerland allows doctors to help patients die in some circumstances. The practice is banned in the U.S., but physician-assisted suicide, or “Death with Dignity,” is legal in four states: Oregon, Washington, Vermont and Montana.
“Euthanasia will never come to the U.S., hands down,” Klugman said, citing history. “A lot of World War II was about euthanasia, the Nazi experiments, the Japanese experiments, even the U.S. experiments that were done without consent. A lot of our medical ethics and social norms are based on those experiences.”