Child euthanasia - The year they did the unthinkable.

This article was written by Paul Russell and published on the HOPE Australia website on September 20, 2016.

Paul Russell

Paul Russell is the director of HOPE Australia.

Hot upon the heels of the news that the first reported case of euthanasia for a minor took place recently in Belgium, comes the news from Holland that a 'centre for euthanasia in children' is expected to open in that country within 12 months. Dutch Health Minister, Edith Schippers earmarked 400,000 Euros in May this year for a study on the matter.

What is it they say about an inquiry? Never start one unless you know the answer beforehand?

The case in Belgium was announced to the world by Wim Distelmans who is head of the Belgian Euthanasia Evaluation Commission. Distelmans seems to be involved in all of the 'ground breaking' cases and is certainly something of a rockstar in his own country.

The initial reports did not mention the age of the minor concerned. Later reports said that the person was 17 years of age. Not that far from reaching his or her majority, one might say. But, prior to the law change in 2014, this euthanasia would have been entirely verbotten.

But even at that time, the initial wedge was beginning to widen further with at least one Dutch pediatric oncologist admitting that the pending changes would simply legalise what was 'already happening informally'.

There's a little more to the history of the question of child euthanasia that is sobering and worth considering.

Trudo Lemmens

Canadian Belgium-born Professor, Trudo Lemmens, notes that consideration was given in Belgium to the inclusion of euthanasia for children in the initial legislation in 2002. He says that, ‘children were explicitly excluded from the ambit of the original law because “it was deemed so controversial that including it may have threatened approval of the Euthanasia Bill.”’ He follows by noting that even the amendment to allow euthanasia for children that passed in 2014 was considered so controversial that it was amended at the last minute to also require parental approval so that its passage into law could be secured.

Loading even more, euthanasia for dementia cases was also mooted along with the 2014 Child Euthanasia discussion but also dropped, presumably because the debate in that area had not been sufficiently explored or, like in 2002, its inclusion may have jeopardised child euthanasia becoming law.

But wait! There's more. The Dutch have also been engaging in a public debate about extending euthanasia to people who consider themselves to have 'completed life'. Frustratingly, the debate has not been so much about whether or not this kind of category of people is acceptable for the lethal dose, but, rather about where the line should be drawn. Should it be at 80, 75 or 70 years of age? If any of this euthanasia history is anything to go by, those who write the bill will err on the side of caution for the sake of gaining the numbers on the floor of the parliament.

And so, any child in Belgium can request euthanasia - no age restriction, only parental consent required. One wonders, as many dissenting pediatricians and oncologists in Belgium also did, what that consent looks like and whether a small child can really understand the gravity of such a decision.

It remains to be seen what formula the Dutch will adopt. They already have a tiered approach with children over the age of 12 able to die by lethal injection with parental consent and children over the age of 16 with parental notification.

Neonates are also covered under the Groningen Protocol which allows for newborns with a disability to be euthanased. To my knowledge, this protocol has never been formally approved by the Dutch lawmakers and, in recent years, the number of children being killed this way has fallen significantly - mostly due, one suspects, to the advent of universal prenatal screening.

I wrote at the time of the Belgian child euthanasia debate about what I saw as the insurmountable difficulties inherent in a conversation with a child about euthanasia. If the Dutch media report is correct and the new approach will be accompanied by the creation of a 'centre for euthanasia in children', this adds significant difficulty, in my view, to any child's ability to process the idea of being made dead and to express his or her reservations.

Are we talking about what we would call a 'walk up' clinic where a sick child can be brought by his or her parents for a consultation? Are we talking about a facility with beds that a child may be moved to ahead of the 'procedure'? Who knows. Either way informed consent without coercion - implicit or explicit - cannot be guaranteed and, I believe, is not actually possible at all.

But consent has not been a primary concern in recent years in either country. It really is all about the elimination of suffering by eliminating the sufferer.