Should Pediatric Euthanasia be Legalized?

Abstract

Voluntary active euthanasia for adults at their explicit request has been legal in Belgium and the Netherlands since 2002. In those countries, acceptance of the practice for adults has been followed by acceptance of the practice for children. Opponents of euthanasia see this as a dangerous slippery slope. Proponents argue that euthanasia is sometimes ethically appropriate for minors and that, with proper safeguards, it should be legally available in appropriate circumstances for patients at any age. In this Ethics Rounds, we asked philosophers from the United States and the Netherlands, and a Dutch pediatrician, to discuss the ethics of legalizing euthanasia for children.

Proposal for the extension of rights to medical assistance in dying (MAiD) to mature minors in Canada.

“…From the medical perspective, the goal of terminal sedation in palliative care is to keep the patient comfortable until their death. It is argued that as long as terminal sedation exists as an option, physician-assisted death is not justifiable as the only option to relieve suffering (Brouwer et al, 2018). Whereas this argument is valid, ethical considerations that may trump this point of view lie in patient autonomy.…”

Why Do Neonatologists in Scandinavian Countries and the Netherlands Make Life-and-death Decisions So Different?

“…35 Important principles and values that serve as the moral justification of neonatal euthanasia are beneficence, parental determination, responsibility, and compassion or care. 35,36 An important step toward legalization was the publication and nationwide adoption of the Groningen Protocol (GP) in 2005. 37 One of the main goals in the GP was to make the existing practice of neonatal euthanasia transparent and subject to public review.…”

Ethics of Paediatric Medical Assistance in Dying

“…In the Netherlands, only mature minors aged 12 to 18 or infants under 1 year old (Groningen Protocol) are eligible. 5 Such strict age limits fail to consider vast differences in maturity uncorrelated with biological age and undermine case-based evaluation, an approach more thoroughly considerate of complex situational factors. Opponents of paediatric MAID argue that minors should not be trusted with such decisions, citing immaturity.…”

“…One can even argue that they grasp the gravitas of their choice moreso than adult patients, as many paediatric patients with lifelong conditions have grown used to confronting their mortality, while adult patients often face shocking lifestyle changes overnight, potentially skewing their perspective. 5 In the case of incompetent minors where parental determination comes into play, there is a societal right for parents to raise offspring as they see fit. Compared to hours of doctors' visits, a parent's experience with their child extends into months and years.…”