Late last week, the Belgian parliament passed laws that granted children access to euthanasia. The laws have been controversial and attracted significant discussion internationally.
Opponents of reform in Australia might argue that the Belgian experience is evidence of the so-called “slippery slope” – that once assisted dying is legalised for competent adults, the criteria would inevitably expand over time to include other cohorts of people, such as children. And this is precisely what happened in Belgium.
But is this concern well-founded? Has Belgium really transformed its euthanasia law? And, if so, what are the implications for the euthanasia debate that has been occurring in Australia over the previous decades?
What are the changes to Belgian law?
There is no official English translation of the proposed laws. But, relying on media reports that describe the law, we can discern some of the key aspects of the legislation.
First, Belgium has removed the age limits to access its assisted dying regime and this has been reported as a world first. This is true, but it is also important to note that the scheme in the Netherlands permits access for children as young as 12, provided various conditions are met.
So, the key difference in Belgium is that access to euthanasia is not limited by age. Instead, a child will only be eligible to access the legislation if all of the following conditions are satisfied:
The child must be “conscious” and display “a capacity of discernment”. This refers to a child who is competent to decide for themselves. To use the language usually adopted in Australia, this would mean the child had the understanding and intelligence necessary to fully understand the decision to seek assistance to die.
The child must “be in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short-term”.
The child must be counselled by doctors and a psychiatrist or psychologist, and the child’s decision must be approved by his or her parents.
What is apparent is that the cohort of children who may access euthanasia in Belgium is narrow: terminally ill children who cannot otherwise be helped and who are capable of making a considered decision about seeking assistance to die. The capacity aspect serves as an indirect limit related to age, as only older, mature children would be able to satisfy that criterion.
Claims that there are no age limits to access euthanasia need to be tempered by a wider look at the requirements of the relevant law.
But are concerns about a slippery slope well-founded?
There are different types of slippery slope arguments and corresponding critiques of their soundness, both generally and in the setting of assisted dying. Let’s focus on the more practical question of whether this is a plausible concern from what we know about how Australian parliaments have engaged with this issue to date.
With the exception of a single act in the Northern Territory, parliaments have been persistent in their refusal to enact legislation that would legalise voluntary euthanasia and/or assisted suicide. Dozens of attempts have been made but only one (in the Northern Territory, and for a limited time) has succeeded.
This suggests that should assisted dying become lawful in Australia, a cautious and careful approach would be taken to arguments about widening criteria for who can access the scheme.
Further, any such decision-making would invariably be informed by the extensive empirical data that is routinely collected alongside such regimes (assuming such systems were also set up in Australia).
So, it seems that further reform would be slow and evidence-based. There would be points along the way down the “slope” to carefully consider what has happened to date and whether a change in law is justified.
And the very effective opposition to euthanasia – that has prevented reform in Australia – would be instrumental in ensuring any further steps were considered carefully and that important considerations, such as protecting the vulnerable, were taken into account by legislators.
The Australian debate
But these are hypothetical discussions because in the debate to date, the issue of children seeking to access voluntary euthanasia or assisted suicide has not been canvassed in proposed Australian reforms. The focus of legislative activity has been on competent adults and, generally, only those with a terminal illness.
Belgium is literally on the other side of the world in terms of this issue, due in part to a different culture and history in this field. Australia is in a different place and asking different questions.
So while those interested in the issue in Australia should be aware of what’s happening abroad, caution is needed in applying the Belgian experience here – and particularly without careful regard to the scope of those amendments.