This article is a rendering (using Google translate) of an article that appeared on the Belgian website LaLibre.
Is it desirable to extend the law on euthanasia for minors if a large number of experienced caregivers, who, day after day, are caring for seriously ill children and are able to relieve their pain? This letter is an appeal by paediatricians working in daily practice.
It is not an attempt to set in the fridge euthanasia of minors, but a plea for the suspension of a bill that may be passed in haste. Far from being a political or ideological pamphlet, this open letter offers a serene reflection from the caregiving field.
1 - This law does not meet any real demand. Most medical teams taking care of terminally ill children at home or in hospital must recognize that they have never faced in their practice a request for spontaneous and voluntary euthanasia expressed by a minor. Even the most complex medical cases can be solved in the current legal framework, with the means and expertise at our disposal. For whom is this legislation therefore designed?
Abroad, there are no other claims for a similar legal framework. A recent survey of paediatricians from 19 countries showed that neither their citizens nor their paediatricians perceive the need for a legal framework in Austria, Czech Republic, Denmark, Hungary, Ireland, Israel, Italy, Norway, Portugal, Slovenia and Sweden. Palliative care in respect of the sick child removes any demand for deliberate death. Only a very small number of paediatricians in Australia, France, Germany, Spain, United Kingdom and some states of the United States demand, today the creation of a legal framework on the grounds that palliative care would be inadequate in exceptional cases.
2 - In the present state of medicine, means to alleviate the suffering are widely available in our country, more than in most other countries. It is clear today that no patient and therefore no child should suffer. It must also be given to any form of medical determination, through a timely and progressive therapeutic escalation, so not to prolong life in difficult circumstances. In addition, we are now able to fully control the physical pain, choking, or anxiety as they approach death. The palliative care teams for children are perfectly capable of recognized pain relief, both in hospital and at home.
The draft law on the extension of euthanasia was discussed too quickly in the Senate and in the House recently all requests in the House to conduct new hearings of experts in paediatrics were rejected. We can hardly speak of a peaceful debate and duly informed. This policy precipitation creates the impression that the situation is dramatic in our country and that we must act urgently. We categorically deny this false impression and say that the situation in our country is far from dramatic. Insufficient attention is paid to the efficient and commendable initiatives of many caregivers. Their work can never be appreciated at its true value!
3 - The management of critically ill children is already complex enough. In such circumstances, it is even more difficult for the medical staff and the family to be further faced with a particularly difficult ethical choice: are we going or not, use active euthanasia? Paediatric caregivers are witnessing the indescribable pain of the parents of a sick child terminally ill. The extension of the law to children will only increase their distress and stress.
In the proposed law, parental consent appears as a safety lock, which occurs after the request for euthanasia expressed by the child. In practice, things can appear very differently: the request of the child may be suggested by parents who are beginning to hope that the pain does not persist too long and, consciously or unconsciously, encourage the child to ask for 'finish’. It is not incongruous that a child endowed with a particular sensitivity to perceive the option of euthanasia as a solution or a duty, especially if he feels that his parents can no longer bear to see him suffer.
4 - According to the current draft law, the ability of the minor to discern is a condition of admissibility of the request for euthanasia. However, in practice, there is no objective method for determining whether a child is gifted with the ability of discernment and judgment. So this is actually largely subjective and subject to other influences. Because, today, thanks to the development of effective palliative care for children, it does not appear objectively necessary to adapt the legislation, because it is contradictory to assert the autonomy of the minor child, found fit to make a request for euthanasia, while requiring parental consent, finally, because there is no objective measure of the ability of discernment children, we believe that the issue deserves further consideration. We believe that there is no urgency to pass this bill in the current legislature.
For the list of signatories, go to the original text: