Don’t deny children euthanasia, panel urges
Some 12-year-olds mature enough to decide: co-chair
Terminally ill children as young as 12 should be given the option of physician-assisted death, an expert panel advising the provinces says in a report expected to shift the euthanasia debate into a whole new realm.
The nine-member committee argues there should be no “arbitrary age limits” for assisted death, and that eligibility should be based on maturity and mental competence, not age.
“A five- year- old? A sevenyear-old? They would never be seen as having the capacity or competence for making these decisions,” said co-chair Maureen Taylor, widow of Dr. Donald Low, whose posthumous video plea for legalized assisted death was shot just days before his death in 2013 from a brain tumour.
However, Taylor, a physician assistant, said, theoretically, a 12- year- old could have the maturity to make such life- and- death decisions. “I could definitely see 12- yearolds having that capacity, and I could see 16- year- olds not have that capacity.” Decisions would have to be made on an individual basis, she said.
In its landmark and unanimous decision last February known as Carter vs. Canada, the Supreme Court of Canada granted mentally competent adults suffering from a “grievous and irremediable” condition the right to a doctor-assisted death. It gave the federal government a year to draft a law.
But the advisory panel, struck to assist the provinces and territories as they grapple with legalized doctor- hastened death, argues in its report released Monday that the court didn’t define “adult.” In most provinces, the age of majority is 18.
“We just didn’t feel that to make an arbitrary decision that, at 17 years and 364 days you wouldn’t meet the criteria, but the next day you would. We felt that wasn’t the way to go,” Taylor said.
The basis for the panel’s argument is the “mature minor” doctrine, which holds that minors can make their own medical decisions — including a decision to discontinue life support — if they understand the nature of their illness and the repercussions of their decisions.
“That’s already well established in our system,” said ethicist and panel member Arthur Schafer, director of the Centre for Professional and Applied Ethics at the University of Manitoba.
“The idea of an arbitrary age limit, and people suffering intolerably and waiting days, weeks or months to die because they haven’t reached that limit, seems morally unacceptable,” he said.
There’s no age restriction to come off a respirator or venti- lator, he said, or to refuse an antibiotic or stop kidney dialysis. “End- of- life decisions are being made every day in Canada by mature minors,” Schafer said. “Doctors make decisions about competence and capacity all the time.
“I’m asking readers to imagine a patient with metastatic cancer that has spread throughout her body, who has received the best possible care but who is suffering intolerably and is almost certain to be dead in two weeks, and who requests assistance to hasten her dying,” Schafer said.
“Setting an arbitrary age limit seems cruel and unfair.”
The Supreme Court, in a 2009 case involving a 15-yearold Jehovah Witness, ruled that children under 16 who demonstrate sufficient maturity should have their treatment wishes respected.
Schafer said parents couldn’t make the decisions for mature minors; they would have to make the decisions for themselves.
The advisory panel spent three months consulting experts and organizations across Canada. Its final report lists 43 recommendations, from criteria to qualify for a lethal injection or doctor-prescribed drug overdose, to the obliga- tion of doctors who object on moral or religious grounds to refer the patient to another doctor or a third body that can arrange assisted death for them.
And while the Supreme Court said the patient requesting assisted death has to be competent, “it didn’t say when,” Schafer said.
The panel is recommending that if a person is diagnosed with, for example, dementia that he be allowed to make his death wishes known in an advance directive, or living will, before he loses mental competence.
“It seemed to us wrong and against the spirit of the Supreme Court ruling that you would have to be competent at the very instant,” Schafer said.
“You can already specify in an advance directive when you want life support withheld or withdrawn.”
The group also offered a definition of “grievous and irremediable,” recommending it be defined as any “very severe” or serious illness that can’t be alleviated by any means acceptable to t he person suffering.
Taylor and other panel members rejected suggestions that this means “anything goes.”
The Supreme Court, in Carter vs. Canada, “already said it didn’t have to be a terminal illness; they already said the suffering could be psychological ( and) they already said it could be a disability,” she said.
“We heard form stakehold- ers on both sides who agreed with each other that there shouldn’t be a list of conditions set out — ‘don’t list cancer and don’t list Lou Gehrig’s disease’ — because that list will always change.” What is incurable today might become curable tomorrow, she said. “Everybody said don’t come up with a list, it wouldn’t be workable.”
A three- member federal advisory panel is to release its own report tomorrow.
Justin Trudeau’s Liberals are seeking a six-month extension of the Supreme Court’s ruling, which is scheduled to come into effect in February. Quebec, meanwhile, has enacted its own euthanasia law, pending an appeal to be heard Friday.