by Dr. Patricia Mayer, Bioethics Program Alumna (2009)
Belgium just became the first country in the world to extend the option of voluntary euthanasia to children under the age of 12. Voluntary euthanasia of adults has been legal in that country since 2002, but the Belgian parliament has now decided to remove age restrictions from the current law.
This decision raises both ethical and medical questions. For a patient to qualify, the current law in Belgium requires the patient to make the request, be in unbearable pain, be assessed by two doctors and a psychiatrist or psychologist, and have consent from their legal representative (usually the parents in cases involving children).
Medically, the phrase “unbearable pain” makes little sense in this context. Physical pain can be controlled with current medical therapy. It is true that sedation to unconsciousness might be required to achieve complete pain relief in rare cases, but it is not true that physical suffering cannot be controlled. From a physical standpoint, the phrase “unbearable pain” is ambiguous and inapplicable.
Unbearable mental pain or suffering is different, and palliative care cannot guarantee relief from that kind of suffering in all cases. However, the determination that a patient is experiencing unbearable mental suffering must be made by a patient with decision-making capacity. As a society, however, we do not believe children, particularly those under the age of 12 have complete decision making-capacity. Their brains are not developed enough, nor do they have the life experience to always make rational choices.
This underdeveloped decision-making capacity is why we have laws stipulating how old children must be before they can engage in certain tasks or consent to specific acts, such as driving, drinking, voting, and serving in the military. We rate movies to prevent children from attending those that we deem inappropriate because of extreme violence or sexual content. We have statutory rape laws under which a child cannot legally consent to sexual intercourse under any circumstances (except marriage) until a specified age is reached. We also do not allow children the right of refusal; they cannot refuse to be vaccinated, to go to school, to live with parents or guardians, or to accept needed medical treatment except in rare situations..
These laws exist because we believe underage children are not capable of making decisions of great magnitude, or decisions that might later prove harmful to them. They are not capable of making autonomous decisions the way adults are, so we limit the autonomy of children in all kinds of ways. Thus it makes little sense to allow a child, who cannot even choose what movie to watch, to request death.
This does not mean that we should not listen to children. The terminally ill child who has “had enough” should certainly be involved in decisions to forgo further aggressive or life-prolonging treatments. Such a request should be carefully considered and a decision reached in conjunction with loved ones and the medical team. Terminally ill children, like all terminally ill persons, should have access to effective palliative care.
Grandma got it right: Johnny doesn’t (always) know what’s best. Killing him at his request, no matter how ill he is, is surely not the right course of action.
[The contents of this blog are solely the responsibility of the author and do not represent the views of the Bioethics Program or Union Graduate College.]