Proposal to let children opt to die is ultimate slippery slope, ethicist says
Opens door to euthanizing victims of dementia, stroke
One of the world’s foremost medical ethicists says a proposal to grant terminally ill children the right to die by euthanasia could put some of Canada’s most vulnerable at risk.
“Setting the precedent that the state is going to tolerate killing children, even mature minors, is very, very dangerous,” Arthur Caplan, head of medical ethics at New York University’s Langone Medical Center, said Tuesday in response to a Canadian expert panel’s suggestion age should not be an issue when determining eligibility for doctorassisted death.
“It’s the slippery slope argument, and this is a slope I worry about. Sometimes I don’t, but this one I do.”
On Monday, a provincial- territorial advisory panel opened a door to the once- unmentionable by recommending access to doctor- assisted dying should not be impeded “by the imposition of arbitrary age limits.”
Instead, the federal government should amend the Criminal Code so eligibility is based on “competence” and not age.
Last summer, the law in Belgium was changed to allow terminally ill children of any age to request euthanasia, with their parents’ consent, if they are in constant and unbearable suffering and near death. Three doctors have to agree to the request.
The change sparked outrage from religious groups and even a video plea from then- four- year- old Jessica Saba of Quebec, born with a heart defect, who asked the king of Belgium to refuse to sign the new bill into law.
In the Netherlands, where children aged 12 and older can ask to die, the Dutch Pediatric Association is pushing for the age cut- off to be scrapped, arguing doctors feel “powerless” when they must deny euthanasia to a younger child. Five children have been euthanized in the Netherlands since it became legal in 2002, The Daily Telegraph reported this summer. The youngest was 12.
In an article in the Journal of the American Medical Association, Caplan says while the euthanasia practices in the Netherlands and Belgium are unlikely to gain a foothold in the U. S. or Canada, there are reasons to be concerned.
In striking down the Criminal Code prohibitions against doctorassisted death, the Supreme Court of Canada granted competent, consenting adults the constitutional right to “termination of life.”
But, in its 61- page report, the expert advisory panel says the high court did not define “adult,” and in some provinces, “age is irrelevant” as to whether someone has the legal right to make decisions about his or her treatment. This is known as the “mature minor doctrine.”
“If you’re within days or weeks of death, and you’re suffering intolerably, I don’t know that you would need to have super- subtle reasoning and maturity and life experience … to make that decision,” said Arthur Schafer, a panel member and University of Manitoba ethicist. “The issue really is competence: Are you able and capable of making that decision for yourself ? And if you are, then for that purpose, you’re an adult,” he said.
But Caplan argues when the Su- preme Court said “adult,” it’s clear it meant 18 and older. Euthanasia isn’t like deciding to take birth control, he says.
“When the ultimate stakes are ‘ We’re going to help you die,’ I just don’t trust the doctrine alone for such a momentous decision,” he said, adding having 12- and 13- yearolds involved in end-of-life decisions “makes me very, very nervous.”
“It opens the door to helping people die who really have questionable competence,” he said, including people cognitively disabled by stroke or dementia, the severely depressed or those who have simply “lost their zest for living.”
“When you’re talking about killing children — killing them — we need independent confirmation,” Caplan added.
“I’m not saying no kid could do it. But I am saying I would want a court review — case by case by case.”
Dr. Rob Jonquiere, who was an architect of the Netherlands euthanasia law, said the few children who have died by lethal injection in the Netherlands involved mostly those with leukemia or severe malignant diseases.
The request comes after “their second or third ( round) of chemotherapy, and they are suffering immensely,” said Jonquiere of the World Federation of Right to Die Societies.
“They’re nauseated. They don’t want to go through with the third or fourth chemotherapy. They say, ‘I just want to stop; this is no life for me anymore.’
“I, thank God, have never been confronted myself with a child like that, but I have heard it from pediatricians. It is horrific to see a child of 11 ½ or 12 suffering enormously.
“The children know what they are asking.”