The first child to die by euthanasia in Belgium took place in September 2016 after the country introduced an unprecedented law that allows for the voluntary euthanasia of children.
Voluntary euthanasia is intentionally ending a life at the request of the patient. It is lawful, on various differing grounds, in several jurisdictions, including Belgium, the Netherlands and Luxembourg.
In Belgium, the patient must be in a condition of constant and unbearable physical or psychological suffering resulting from a serious and incurable disorder caused by illness or accident, for which medical treatment is futile, and there must be no possibility of improvement. The patient must also be an adult.
But extending this to children was a bad proposal because of misconceptions about voluntary euthanasia. Here are four of them:
Euthanasia’s the only way to end suffering
This is untrue. Given modern palliative care (which is likely to be available in any European jurisdiction in which active euthanasia is proposed), there is simply no need for euthanasia. Pain and much-feared symptoms such as choking can all be controlled effectively.
Pro-euthanasists love stories about people going screaming to their deaths. The stories are out of date, and it is disingenuous or ignorant, as well as alarmist and unkind, to let people believe it’s inevitable.
In the vanishingly rare cases of suffering that cannot be palliated using orthodox techniques, it is always possible to sedate the patient to unconsciousness and withdraw food and fluids (sometimes referred to as “passive euthanasia”). This leads to a painless death in a few days.
You could say that it is intellectually dishonest to cause death in this way and deny a quick death by lethal injection, but many feel that there is a distinction of great moral weight between causing death by an act (for example an injection) and causing death by omission. That distinction has proved its worth in the law of murder.
Children can make informed decisions
Let’s suppose, for the sake of argument, that there are no good reasons why the law shouldn’t permit the euthanasia of a fully capacitous adult. (In fact there are some very good reasons: I touch on some of them below). And if that is so, why children shouldn’t be the beneficiaries of a similar compassionate law.
Death, so far as we know, is terribly final. And if you’re opting for death, you need to be sure that you’ve got it right. This demands an understanding of many complex facts (such as prognosis – how your disease or condition is going to pan out – and your therapeutic and palliative options), and an evaluation of their significance. It’s hard for anyone; it’s likely to be impossible for children.
There’s lots of evidence to show that when we find ourselves in the situations we have most feared (for instance severe disability), we find that those situations are nothing like as unbearable as we anticipated. When we are stripped of much, we value all the more what is left. Try explaining that to a child.
If children can’t make an informed decision, perhaps also because they’re simply too young or too ill, they can’t be autonomous. Of course the decision-makers will usually be well-meaning, and will do their best to be well-informed and objective, but it is hard to be honest about one’s own motives.
Children won’t be pressurised into death
The argument that someone might be pressurised to choose to die is commonly used when talking about older people or those with dementia (also being considered in Belgium) who might be seen as a “burden”. For children, you might argue that they are less likely to be seen in this way. But children could easily think, or be actively or unconsciously persuaded, that they should opt for death because their illness causes trouble for their parents.
A child is the only relevant decision-maker
The autonomy argument for adults goes: “It’s my life and no-one has the right to tell me what to do with it.” This philosophy permeates and corrodes law and ethics because it doesn’t accurately reflect the way the world is. We’re relational entities. Everything I do affects someone. And in the context of the euthanasia of children, the following problems arise:
First, the death of a child (obviously) affects families, friends, carers and clinicians in many complex ways. The effects on others of my death ought to be factored into my decision to end my own life. Children won’t be able to do that when deciding whether or not to end their own lives. This again falls into the idea of informed consent.
Second, someone’s got to do the killing. That probably means doctors. If the law allows professional carers to become professional executioners, the medical profession will also be dangerously and irrevocably changed.
The headline and introduction text of this article were updated on September 23 2016 to reflect the introduction and first use of the law in Belgium.