Guest Post by Luc Bovens

In 2014 Belgium passed a law that extends its euthanasia legislation to minors.  There were strong parliamentary majorities in favour of this law but nonetheless a scream of “Murderers!” was heard in the public galleries of the Chamber of Representatives.  What is the opposition like in Belgium?

Euthanasia for adults has been legal in Belgium since 2002.  Many opponents of this legislation, including the Catholic Church, abhor the decision to further extend this legislation to minors.  I do not engage with the legalisation of euthanasia in general.  What I am asking is whether, considering that euthanasia is legal, it is or is not reasonable to limit the legislation to adults only.  This is a separate moral question.  One may be an opponent of a particular practice, yet at the same time believe that, if the practice is legalised, then it would be wrong to restrict the legalisation to a particular subgroup.   (Likewise, one may be an opponent of, say, legislation permitting abortion, and yet, if abortion is legalised, oppose a restriction that would make it accessible to only certain sectors of society.)  I distinguish between two lines of opposition that focus on the extension of the euthanasia legislation to minors in the Belgian debate.

First, there is an Open Letter signed by (mostly) paediatricians and there are various arguments in the press against the extension of the legislation: We should never grant euthanasia requests to minors, because such decisions are too weighty for minors, minors are not capable of discernment, the pressure on minors is too great, minors are particularly sensitive to such pressure, and there is sufficient palliative care for minors.

The Open Letter is less open than one might expect.  Professor Dr Willem Lemmens, a Professor of Ethics in Antwerp University, is one of the signatories.  Upon my request he kindly sent me the letter with a list of 185 signatories.  The French Press published an early version signed by 38 people, mostly paediatricians.  I found a Dutch and French version of the text on ‘De Specialist/ Le Spécialiste’, a web site restricted to medical personnel, though the actual text in Dutch and French with a list of 160 signatories is freely accessible.  A more obvious source is a web site of a ‘Collective of Paediatricians’ which mentions 182 signatories, but the signatories are not attached.

I find arguments to the effect that there are special problems for honouring euthanasia requests for minors wanting.  They fail to make clear why the concerns in question are more acute for minors than for adults and on a proper understanding of capability of discernment there is no reason why at least some adolescents would not be able to exercise this capability.

Second, Dr Marleen Renard, an Oncologist in the University of Hospital in Leuven also opposes the Law but is not listed as a signatory of the Open Letter.  She argues that the law is unnecessary for two reasons: because young adolescents simply do not ask for euthanasia; and, even without a law in place, minors could file a request for euthanasia to ethics committees who may give permission.  In the local press she is quoted: “Do you really think that people care about what is or is not stated in the law? The whole discussion about euthanasia for children is a non-issue that irritates us” [my translation].  This position is also found in an Opinion Text of the University Hospital of Leuven.

This line of argumentation is quite curious.  The goal is to keep the legislation blocking euthanasia for minors on the books, place power in the hand of ethics committees to exercise discretion, and not to have any legal directives detailing conditions under which euthanasia would be permissible.  Hence, euthanasia for minors would be practiced outside the confines of the law.  Why is it that some doctors would actually favour this position?

I interpret this position on the background of Velleman’s ‘Against the Right to Die’.  Velleman does not want to legalise euthanasia because some patients may prefer palliative care as long as they do not have the option of euthanasia.  If a patient genuinely wants euthanasia then this request could be honoured within the trusting relationship between patient and physician.  I add that, as a safeguard against abuse, hospital ethics boards may exercise oversight and discretion in dealing with such requests.  The position has many drawbacks for euthanasia in general—foremost legal uncertainty and lack of transparent standards.  I am not convinced that it is ultimately defensible as a position on euthanasia for minors, but there are reasons why it is more attractive for minors than for adults, in particular because there are few euthanasia requests and there is acceptance of fiduciary decision-making by minors.

Read the full paper in the JME here.