{"id":2905,"date":"2015-05-12T20:21:41","date_gmt":"2015-05-12T19:21:41","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=2905"},"modified":"2015-05-12T20:21:41","modified_gmt":"2015-05-12T19:21:41","slug":"child-euthanasia-should-we-just-not-talk-about-it","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/12\/child-euthanasia-should-we-just-not-talk-about-it\/","title":{"rendered":"Child Euthanasia: Should We Just not Talk about It?"},"content":{"rendered":"<p><em><strong>Guest Post by Luc Bovens<\/strong><\/em><\/p>\n<p>In 2014 Belgium passed a law that extends its euthanasia legislation to minors. \u00a0There were strong parliamentary majorities in favour of this law but nonetheless a scream of \u201cMurderers!&#8221;\u00a0was heard in the public galleries of the Chamber of Representatives. \u00a0What is the opposition like in Belgium?<\/p>\n<p>Euthanasia for adults has been legal in Belgium since 2002. \u00a0Many opponents of this legislation, including the Catholic Church, abhor the decision to further extend this legislation to minors. \u00a0I do not engage with the legalisation of euthanasia in general. \u00a0What I am asking is whether, considering that euthanasia is legal, it is or is not reasonable to limit the legislation to adults only. \u00a0This is a separate moral question. \u00a0One 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. \u00a0 (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.) \u00a0I distinguish between two lines of opposition that focus on the extension of the euthanasia legislation to minors in the Belgian debate.<\/p>\n<p>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.<\/p>\n<p><span style=\"line-height: 1.5\"><!--more-->The Open Letter is less open than one might expect. \u00a0Professor Dr Willem Lemmens, a Professor of Ethics in Antwerp University, is one of the signatories. \u00a0Upon my request he kindly sent me the letter with a list of 185 signatories. \u00a0The French Press published <\/span><span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"line-height: 1.5;color: #0000ff;text-decoration: underline\" href=\"http:\/\/www.lalibre.be\/debats\/opinions\/fin-de-vie-des-enfants-une-loi-inutile-et-precipitee-52e93c5b3570e5b8eeea1a00\">an early version<\/a><\/span><\/span><span style=\"line-height: 1.5\"> signed by 38 people, mostly paediatricians. \u00a0I found a Dutch and French version of the text on \u2018De Specialist\/ Le Sp\u00e9cialiste\u2019, a web site restricted to medical personnel, though <\/span><span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"line-height: 1.5;color: #0000ff;text-decoration: underline\" href=\"http:\/\/www.lespecialiste-despecialist.be\/sites\/default\/files\/uploads\/medisphere\/2014\/actuality\/wms00094_nl_een_open_brief_van_kinderartsen_nl.pdf\">the actual text<\/a><\/span><\/span><span style=\"line-height: 1.5\"> in Dutch and French with a list of 160 signatories is freely accessible. \u00a0A more obvious source is a web site of a \u2018Collective of Paediatricians\u2019 which mentions 182 signatories, but the signatories are not attached.<\/span><\/p>\n<p>I find arguments to the effect that there are special problems for honouring euthanasia requests for minors wanting. \u00a0They 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.<\/p>\n<p>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. \u00a0She argues that the law is <em>unnecessary<\/em> for two reasons:\u00a0because 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. \u00a0In the local press she is quoted: \u201c<span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/www.zol.be\/internet\/uploadedFiles\/E-flash\/2013\/HBvL%20-%20Euthanasie%20bij%20kinderen.pdf\">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<\/a><\/span><\/span>\u201d [my translation]. \u00a0This position is also found in <span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"https:\/\/www.kuleuven.be\/metaforum\/docs\/pdf\/wg_9_n.pdf\">an Opinion Text<\/a><\/span><\/span> of the University Hospital of Leuven.<\/p>\n<p>This line of argumentation is quite curious. \u00a0The 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. \u00a0Hence, euthanasia for minors would be practiced outside the confines of the law. \u00a0Why is it that some doctors would actually favour this position?<\/p>\n<p>I interpret this position on the background of Velleman\u2019s \u2018Against the Right to Die\u2019. \u00a0Velleman does not want to legalise euthanasia because some patients may prefer palliative care as long as they do not have the option of euthanasia. \u00a0If a patient genuinely wants euthanasia then this request could be honoured within the trusting relationship between patient and physician. \u00a0I add that, as a safeguard against abuse, hospital ethics boards may exercise oversight and discretion in dealing with such requests. \u00a0The position has many drawbacks for euthanasia in general\u2014foremost legal uncertainty and lack of transparent standards. \u00a0I 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.<\/p>\n<p><em>Read the full paper in the JME <span style=\"text-decoration: underline\"><span style=\"color: #0000ff\"><a style=\"color: #0000ff;text-decoration: underline\" href=\"http:\/\/jme.bmj.com\/content\/early\/2015\/03\/10\/medethics-2014-102329.abstract\">here<\/a><\/span><\/span>.<\/em><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Guest Post by Luc Bovens In 2014 Belgium passed a law that extends its euthanasia legislation to minors. \u00a0There were strong parliamentary majorities in favour of this law but nonetheless a scream of \u201cMurderers!&#8221;\u00a0was heard in the public galleries of the Chamber of Representatives. \u00a0What is the opposition like in Belgium? Euthanasia for adults has [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/12\/child-euthanasia-should-we-just-not-talk-about-it\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2153,511,443,591],"tags":[],"class_list":["post-2905","post","type-post","status-publish","format-standard","hentry","category-guest-post","category-in-the-news","category-jme","category-life-and-death"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Child Euthanasia: Should We Just not Talk about It? - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2015\/05\/12\/child-euthanasia-should-we-just-not-talk-about-it\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Child Euthanasia: Should We Just not Talk about It? - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"Guest Post by Luc Bovens In 2014 Belgium passed a law that extends its euthanasia legislation to minors. \u00a0There were strong parliamentary majorities in favour of this law but nonetheless a scream of \u201cMurderers!&#8221;\u00a0was heard in the public galleries of the Chamber of Representatives. \u00a0What is the opposition like in Belgium? 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