Monday, 23 December 2013

Insane Conversations – talking to children about euthanasia

If Belgium continues on its reckless path towards child euthanasia, as seems likely, what will the conversations look like that precedes the killing of a child?

Let’s assume for the sake of this exploration that the protocols and so-called safeguards will always be adhered to. There’s plenty of evidence to doubt that this will occur; that observance will deteriorate over time. But, initially at least (and at least because of initial public scrutiny), we can assume proper regard for the new law.

So, how does the conversation begin? We know that the child must ask for euthanasia and that an assessment of the child’s ability to comprehend what he or she is asking for must be tested and attested to. So what is it that would prompt a child to ask?


There would be some need here for an exchange of information. Perhaps there’s a leaflet outlining the child’s rights. Perhaps it’s part of an informal discussion with the child about his or her prognosis and medical treatment options. Whichever, it would not be a matter of an ‘unknown, unknown’. By some method at some time the child would have need to be made aware of the euthanasia option.

So the edict that ‘the child must ask for it’, which suggests initiative on the part of the child, is likely never to be entirely the case. Not convinced? Think about why it would be that the specialist medical practitioner or the parents would come to a point where they thought it necessary to tell the child (or to remind the child) about euthanasia as an option. The very act of saying as much is ‘loading the gun’.

Such information is loaded with any number of possible undercurrents of thought which, even if explained away by the doctor or parent, may have the reverse effect of actually highlighting them.

The inferences abound - all leading to any number of further subtexts – real or imagined:

·         Are they saying that I should take the euthanasia option?
·         Are they saying that my life is hopeless and not worth the living?
·         Are they saying that they (the parents) just can’t take it anymore?
·         Are they telling me that euthanasia is a heroic option?
·         Are they saying that there’s no point to my life?
·         Are they telling me that I've suffered enough?

How else is a child to interpret this information? If the parents didn't want the euthanasia option and wouldn't agree to co-sign any request, why would they add to the anguish by telling the child? But they may be forced to do so under some sort of quasi-rights protocol. After all, if it is a legal and legitimate option, could they deny such information?

And what about the doctor? He or she may also be bound by some protocol to advise the patient. Is he or she, in doing so, making a preliminary judgement about the child’s capacity to make such a decision? Would he or she be likely to have to first ask the parents if he or she can inform the child patient?

This is not a values-neutral option, like choosing dessert or a movie. All of us, even if we sought a second medical opinion on a diagnosis or possible treatments, take a doctor’s suggestions as considered professional opinion. This will be no different. Such advice is loaded with moral considerations.

In all of the above we would be considering a situation where a child was probably already in a hospital or hospice situation and at an advanced stage of progression of his or her condition. But there’s no reason to expect that this will be the stage at which the euthanasia discussion is introduced.

In The Netherlands, and likely in Belgium also, we know that, for adults, the discussion about euthanasia is not seen as a ‘last resort’ option when all else fails, but, rather, is often introduced at or shortly after diagnosis in a manner that some have called an ‘early intervention’. There’s no reason to suppose it would be any different for a child.

We know also that ‘suffering’ is broadly interpreted to include existential suffering – even in anticipation of later difficulties as the disease or condition progresses. It has been observed that the suffering of the parents is also a consideration. Could this also be interpreted as ‘suffering in anticipation of suffering’? No parent wants to see their child suffer.

Consider also the pressure that may be put upon parents to agree in circumstances where their child has decided for euthanasia and where they are against it or at least undecided. We do not know yet whether the protocols will see the necessary professional attestations as to the child’s capacity to decide occur before parental endorsement or afterwards. Should the parental agreement come as the last box to be ticked, imagine the pressure upon those parents to conform?  The child has asked for it, the doctors have agreed that he or she has capacity to ask for it, will the parents have the strength and internal resources to stand against it?

Even if the child’s request to die was thwarted by the parents, there’s nothing to stop the child thereafter rejecting the dominion of his or her parents and claiming status as an ‘emancipated minor’ – a provision for an ‘emancipated minor’ to request euthanasia without reference to his or her parents already exists in Belgian law.

Even if the parental consent were to occur before the capacity tests, one can still imagine the difficulty parents would face. It would be the unspoken subtext of the entire treatment process.

And all of this is a situation where the same child is otherwise under the care and direction of the parents; where he or she can’t yet vote; probably can’t yet marry, drive a motor vehicle or consume alcohol.

It is certainly true that some young people develop the capacity for reason and sound judgment before they reach their majority. It is also likely that a young person who has endured a long and difficult illness will have, in some ways, matured more quickly for the experience. But the question still remains: whose choice ultimately would it be for death by euthanasia?

It will never be the child’s choice. Nor will it be the parents’ choice. It will remain a decision by the doctor who loads and delivers the lethal dose. That’s the inescapable reality.

And what of the role of the doctors and nurses?  What conversations happen in the quiet moments when no-one else is around? Will letting a child patent know that they can always request euthanasia become a matter of duty? Will a perverse sense of compassion see subtle reminders conveyed to the child in the wee hours when he or she can’t find sleep?

No matter what the child’s capacity for reason, there is never going to be a situation where subtle pressure, real or perceived, won’t be part and parcel of the contract. It’s just the way it is.
It’s merely academic now; but one wonders if, with the benefit of 20-20 hindsight, whether the Belgians would have taken the first precarious step towards killing its citizens back in 2002 if the concept of child euthanasia had been foreseen as inevitable.

Is this the end of the depravity or are there other extensions possible and perhaps as yet unseen? Child euthanasia where the child lacks capacity to make a decision seems to me to be the logical next step. This would extend to any minor of any age. After all, parents retain decision making capacity for minors in all other circumstances relating to medical interventions, so why are the Belgians pretending that child capacity and request is necessary at all?


The logical end of this spiral is death on demand without reason or restraint. The pretense of necessity, in this case, is simply a sham. The Belgians, like to frog in the pot, are being brought to a simmer in incremental stages.

2 comments:

  1. The list of inferences you give in response to a child being made aware of the option of euthanasia reflects your biases rather than the published evidence on the topic. While it is certainly possible that children may feel despondent, abandoned or pressured to accept euthanasia, it is also possible that they may feel empowered or relieved to know options exist in the event that palliative care is inadequate. There is evidence that adolescents wish to be involved in end of life decision making (http://pediatrics.aappublications.org/content/124/6/e1142.full). To disallow their participation would be to practise an outdated, patriarchal, doctor-knows-best approach which is no longer in favour. 

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    1. Yours is a Utopian view, Malcolm. But at least you confirm the reality that euthanasia law is really not about limited people in limited circumstances. The pro-euthanasia brigade is not being honest if it says otherwise.

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