By Luke J Davies. Follow Luke on Twitter.
Last week the upper house of the Belgian Federal Parliament voted (50 to 17) that euthanasia should be legal for children suffering from a terminal illness that is causing severe physical pain. [1] The bill legalizing the practice requires that the child understand what euthanasia is, and that parents provide their written consent. Unlike the Netherlands, which allows euthanasia for children over the age of 12, there will be no minimum age in Belgium. (Find the story here, here, here, and here.)
The passing of this bill, which has yet to be turned into a law [2], has been met with severe criticism in Belgium and abroad, mostly from religious and conservative groups. From what I have read, there are three main lines of argument against allowing euthanasia for children. The first maintains that allowing euthanasia for children is the first in a long series of steps that will lead to some Third Reich-like eugenics program. The second maintains that children do not have the capacity to make a decision to be euthanized. The third maintains that the legalization of euthanasia for children would lead to parents or health care professionals putting pressure on children to opt for that choice. I believe that each of these arguments fails to demonstrate that the bill should not pass, and will spend the remainder of this post explaining why.
First, the worry that euthanasia being allowed for children will lead to a eugenics program is the result of the first draft of the bill, which included cases of depression, anorexia and other mental illnesses as valid reasons for the child’s decision to die. The belief seems to be that the state should not be able to determine what makes a life worth living (and thus ending); for if it did, then it might begin to withhold lifesaving treatment from some in pursuit of an ethically indefensible ideal—i.e., one in which only those who fit a certain mold are allowed to live. Put simply, it is a ‘slippery slope’ style argument: If we allow doctors help children die, this will lead to doctors choosing who gets to live.
There are two things (at least) to say in response to this. First, the bill has changed from its original form. As I have already mentioned, only physical pain that is constant, severe, and the result of an untreatable illness will be sufficient for a child’s being considered for euthanasia—assuming that he or she has met the other criteria. This means that there will be a narrower set of criteria for children than there is for adults. Second, the choice to make it legal for a medical professional to help someone who is suffers end his or her life, no matter the age of that person, is simply not the same as giving that professional the power to determine who receives lifesaving treatment.
Second, some believe that a child does not possess the capacity to make a decision to end his or her own life. Given that the choice to die must be the patient’s own, the truth of that statement would constitute grounds for dismissing the bill.
I believe that this objection to the bill wrongly assumes that all children develop their critical and emotional capacities at the same rate, which is simply not true. It may be the case that the vast majority of children who are suffering from a terminal illness will be incapable to make the decision to die because they are unable to satisfy the criteria for understanding and appreciating the choice. Is this a reason for denying all children the right to make a choice? I think not. There will always be worries when we allow euthanasia that someone gets euthanised who didn’t satisfy the criteria. This is no different with adults or children. However, I don’t believe that this is an argument against the practice; it is merely an argument for making the criteria as clear as possible, and providing adequate training for the health care professionals who will be charged with carrying out the assessments. It is not clear to me that the criteria ought to include a minimum age requirement if what is required conceptually and emotionally from the person—child or adult—is sufficiently clear.
Finally, and most pressingly I believe, is the worry that undue pressure will befall any child who is, if consenting, a candidate for euthanasia. This worry is a result of the fact that doctors will be permitted to suggest euthanasia as an option for a child who suffers from a condition that qualifies them for the procedure. It is not difficult to believe that the child to whom this is suggested might feel some form of obligation to consent. Similar pressures, it is thought, might come from the parents. This is also a problem for euthanasia in general, not just for children. There can be a huge emotional and financial burden caused by prolonged and untreatable illness. If the family or doctor suggests euthanasia, the ill person may feel pressured to consent.
But, again, I believe this isn’t an argument against the practice on the whole, but an argument for being careful. If it turned out that there was no way to avoid allowing people to die who didn’t actually meet the criteria, then I would concede that euthanasia should not be permitted. However, I don’t believe that the risk is that great, especially given that the practice has been legal in Belgium for the last 12 years.
In the end, we are discussing people’s lives when we discuss euthanasia. But the lives in question are ones in which there is much suffering. At least in Belgium, adults are permitted to choose to end their life when that suffering is being caused by a condition that cannot be treated. I clearly side with those who believe that euthanasia is permissible—and might go further in thinking that its provision should be obligatory for those who want it. But the question in the Belgian case is not, ‘Should we allow euthanasia?” That has already been settled. The question is, “If it is allowed for adults deemed to be competent to make the decision, why should it not be permitted for children who are also competent?” I for one cannot see a reason, but would be interested to hear more arguments to the contrary.
Notes:
[1] Euthanasia has been legal for adults since 2002. However, unlike adults, children will not be permitted to opt for euthanasia when the condition afflicting them is mental.
[2] Voting for this is expected to happen in May.
Regarding the second objection, if we are to accept that the emotional and critical faculties of certain children are more highly developed than those of other children of a similar age, and we allow them the right to seek euthanasia because of this, do we not then have to do away with a number of societal laws?
If we deem certain children of a sufficient mental capacity as to end their own lives, surely we must then view them as competent enough to drive, vote, join the military, sign contracts and so on, until essentially, we afford them the legal status of an adult.
I am not saying this should not be the case, but do you agree that passing this euthanasia would set a precedent in regards to all these areas?
While some children may indeed be capable of deciding on their own livelihood and indeed all the other areas listed, surely the legalisation of these rights to children would bring a whole host of problems, particularly in regulating who is allowed to do what.
Perhaps we should undertake a general rethink of children’s rights. If an individual can demonstrate capacity, should that not be sufficient grounds to confer the right in question?
One possibility would be to maintain a general age of capacity together with a mechanism for individuals to demonstrate capacity earlier than the general age. There is provision along these lines in relation to marriage. While the consent of a parent is needed for 16/17yr olds to marry the young person can petition a court to allow them to marry, they need to convince the court that they understand the commitment and have realistic plans for married life.
Speaking from the perspective of the UK, I think we still have a long way to go in recognising children as persons entitled to the same rights of persons as adults, taking into account developing capacity.
I would foreground the failure to provide children with the same legal protection against physical assault that adults enjoy. Husbands could, at one time, legally beat their wives. We have consigned that to history yet parents can still legally physically assault their children.
“If it turned out that there was no way to avoid allowing people to die who didn’t actually meet the criteria, then I would concede that euthanasia should not be permitted.”
I would not concede that so quickly.
If 1000 people who would have suffered unspeakable suffering were enabled to end their lives and one person who wanted to live out the last couple of weeks despite all was to mistakenly be euthanised, would that be sufficient to concede that euthanasia should not be permitted.
I think this is a question that needs more thought. Heuristically applying a utilitarian calculation the outcome, in my example above, seems to favour permitting euthanasia.
Thanks J and Bill.
Two comments in response to your worry, J, that allowing euthanasia might set a dangerous precedent in other areas of social life:
First, I think that there might be something to be said for giving certain children more rights than they are currently afforded. However, given that we generally assume children to lack capacity when it comes to marriage, voting, etc., an assessment would be necessary in each case. That is, it’s not the case that conferral of the one right would entail capacity in distinct areas.
Second, and relatedly, I think that the right to be euthanised is different in some respect because there is a general presumption of incapacity even for adults. That is, any person who wants to euthanised must demonstrate that they are capable to make the decision. If that is the case, why shouldn’t children at least have the chance to demonstrate their capacity?
Bill, I tend to be skeptical of utilitarian calculations of the sort you described, but, like you say, the question needs much more thought. Thanks again for your interesting comments.
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