Laying the groundwork for child euthanasia in Canada.

The following article was published by BioEdge on September 22, 2018.

Michael Cook

By Michael Cook:
 
Euthanasia, or “medical aid in dying”, was authorised by Canada’s Supreme Court in June 2016. It was a controversial decision and the controversy is far from over. Three issues were left hanging: euthanasia for “mature minors”, euthanasia for people with mental illness, and advance directives for euthanasia. The government asked the Council of Canadian Academies to produce a report on these issues by December this year.

Euthanasia for mature minors is a particularly sticky issue. In the Journal of Medical Ethics, several Canadian paediatricians and bioethicists construct an argument supporting it.

First of all, they frame euthanasia (MAID) a part of a continuum of palliative care.

it is wrong to force a person to live in circumstances of unendurable and irremediable suffering and ... the wishes of capable patients should be respected within legal limits, especially in such an intimate matter as how they choose to die. Persons, in other words, have a right to life, not a duty to live ...

If MAID is essentially a normal medical procedure, it follows that there is no need for “special procedures for managing communication, confidentiality and capacity assessment”.

One consequence of this is that doctors should be proactive in suggesting euthanasia to children for they have an obligation to inform patients of their healthcare options.

What about a young person’s capacity for consent? In Ontario, “young people can be and are found capable of making their own medical decisions, even when those decisions may result in their death”. This is not universally accepted in Canada, so it may be necessary to tweak the law.

How about the role of parents? What if a young person requests MAID but their parents object? The authors argue that if a young person is capable of making their own medical decisions, there is no reason why parents have to be informed. “If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way.”

How should hospitals manage their public relations? Permitting child euthanasia is sure to be extremely controversial so they need to reduce the social stigma. The authors propose HIV/AIDS as a model:

If we take the HIV model as our strategy for publicly messaging MAID, we would proceed by providing MAID in a matter-of-fact way that may, over time, reduce the social burden both on patients seeking this procedure and clinicians providing it.

• Paediatric Palliative Care Symposium and child euthanasia.