Pediatricians divided over medically assisted deaths
A group that represents pediatric doctors is weighing into the thorny issue of whether terminally ill children and youth should be permitted medical assistance to end their lives.
Nearly a year and a half after federal legislation enshrined the right of eligible adults to medical aid in dying, the Canadian Paediatric Society says some young patients and their parents are now asking about the service.
The finding comes from new surveys of the society’s members, which also found pediatricians are highly divided on the question of whether to extend the ultimate choice to Canadians not yet old enough to vote.
Results of the surveys were published late Wednesday.
“It showed a lot of polarization,” said Dr. Dawn Davies, a pediatric palliative care specialist at the Stollery Children Hospital who also served as first author of the report.
“Really it’s a reflection of larger society, where there is a huge spectrum of viewpoints.”
In one survey, pediatricians were asked how often they had been approached about medical aid in dying.
Of the 1,050 respondents, 118 pediatricians reported having “exploratory discussions” about the service with parents of sick children, while 35 said they had discussed the subject with minors directly.
As for explicit requests for medical assistance to die, 45 said they had received at least one plea from a parent. Just nine said they had received a request directly from an underage patient.
“It’s about a five-to-one ratio that parents are coming forward with these questions and requests more than the minors themselves,” Davies said.
Of the explicit requests that originated from parents, more than half were on behalf of a sick newborn or infant less than a year old.
The survey comes as the Council of Canadian Academies conducts research for Parliament on the potential for extending medical aid in dying to groups not included in the current legislation.
Davies is chairing the panel looking at the question of mature minors.
While a report is due to be submitted by December 2018, that more young patients and their parents are inquiring about the service suggests Ottawa can’t drag its feet on the issue.
Davies noted there is also the potential for a legal challenge, in which a young patient may argue they are being discriminated against or a parent claims their right to make decisions for their child is being unfairly denied.
Davies said the pediatric society is calling for a large-scale consultation effort and safeguards before anything is decided. In part, that’s because the concept remains highly controversial in Canada — including among pediatricians.
A second survey by the society found 46 per cent of respondents supported medical aid in dying for mature minors with a progressive or terminal illnesses, or intractable pain. There was less support for offering the service to minors with intolerable disabilities or mental illnesses.
A third of respondents said medical aid in dying should never be granted minors under any circumstances.
As for the even trickier question of whether parents should be allowed to seek the service for very young “non-competent” children, 32 per cent said access could be offered in very rare cases as long as the process had robust oversight.
Just 19 per cent of respondents said they would be personally willing to assist a minor patient to end their life.
Davies noted the second survey had a response rate of 29 per cent, which it means it may not be a good representation of the profession’s attitude.
Belgium and the Netherlands are the only countries that currently offer medical aid in dying for minors, though Davies said few patients have used the freedom — one in Belgium and five in the Netherlands.
Shanaaz Gokool, CEO of the advocacy group Dying with Dignity Canada, agreed more study is needed, but said she hoped to eventually see medical aid in dying for mature minors.
“This is fundamentally an issue about discrimination,” she said.