To tie into Jackie Glodener’s post about autonomy and children, an extreme case about this topic became reality last week when Belgium granted the right to euthanasia for minors. The Parliament passed the law 86 to 44 with 12 abstentions. Back in 2002, the country legalized euthanasia for those in “constant and unbearable physical or mental suffering that cannot be alleviated” for adults and have since extended the law to include children.
The new bill gives the right only under strict conditions, which seem to fulfill Miller’s four senses of autonomy. A child psychologist or psychiatrist will examine the child’s capability of decision-making, which matches Miller’s idea that the patient is fully competent and aware of his or her decision and addresses previous apprehensions about autonomous decisions in children. The child must receive adequate information from the doctor and his or her parents about death itself. The parents also must give consent for the child’s decision. In addition, the bill protects the doctor’s opinion by stating that no doctor would be forced to carry out the act against his or her will. In all cases the child would have the option of palliative treatment.
While the law’s guidelines seem to adhere to the principle of respect for autonomy, there still seems to be something morally wrong and complex about the issue at hand.
An article about the bill can be found here: http://www.cnn.com/2014/02/13/world/europe/belgium-euthanasia-law-children/
Placing such a large decision on the shoulders of a child simply seems unreasonable to me. I understand that they law will affect a small number of children – but stating that if a child is of rational mind to make such a decision raises many questions. To begin with, this will only apply to teenagers and to be frank, should a teenager be responsible for such a large decision?
Is a teenager in a place to make a life changing choice? If they are suffering from a life-long illness, who is to judge if they are of rational mind. It just does not seem right to me. There is a deep ethical dilemma at hand while expecting young people to make this choice.
Furthermore in the example given of Mother Linda Van Roy, from my understanding even with the new law she would not be able choose the fate of her daughter. If this is true, the examples to support the law become event weaker.
Finally, teenagers especially suffer from extreme guilt. As do the parents and family members of those who are terminally ill. Placing the physician as the final judgement call is a great addition to the bill, however I envision a certain scenario occurring.
A young person falls terminally ill and fits within the new law to qualify for euthanasia. Having seen the effects of his/her illness on her surrounding family, the young person feels an overwhelming guilt knowing the option of choosing death is available. This choice now becomes the more important decision of their lives. This can result in parents additionally choosing to follow the child’s wish, simply to do what is best. But is this really the best choice? Does giving families the option change the situation all together?
This scenario above may be completely autonomous. I am honestly not sure. If that is what the young person whats, and they now have the option of receiving such treatment then maybe it is as close to autonomy as possible. I still however cannot shake the feeling that it is morally and ethically wrong.
I really can’t see any good resulting passage of this law. In my opinion, minors’ brains have not developed to place where they can make such a tremendous decision. Teenager’s especially are very emotion driven and in the majority of cases I don’t feel as though a person may have a different outlook on life later down the road. I do not think physician-assisted suicide for minors is morally permissible let alone an option. I’m having trouble imaging any set of clear-headed parents allowing their child to be euthanized willingly unless in some extreme case of terminal illness.
I have to disagree with the comments about this being immoral. There has always been a negative connotation surrounding the topic of euthanasia. In the US it is only legal is one or two state, I believe Oregon is one of them. We require such stringent measures including a verbal request from the doctor, a written request, an analysis by a psychiatrist, and another written request, and only then is the prescription for the fatal medication provided. Then it is still up to the patient to fill the prescription and TAKE the pills. This is a lot of work and a very time consuming process. The patient would undoubtedly question themselves, have moments of hesitation, and other feelings. This is not a decision that one could make instantaneously, emotionally, or based on others.
Now to take this in terms of the new Belgium law that allowed children to be euthanize. There are once again numerous rule and regulations that must be followed even more so when considering a child. In terms of the question of age, teenagers are in a different subcategory. While they are very emotional people, this is why a child psychiatrist meets with them. Also you would be saying that an 18yo has the right to euthanasia, but a 17yo does not. Lastly, in terms of the guilt argument, you are forgetting that the parents have to consent to allow their child to request euthanasia. I find it impossible to imagine that a parent would want their child DEAD just to easy the financial or emotional burden. No parent wants their child sick, much less dying.
I also agree that placing such a big responsibility on a child seems quite unreasonable. Majority of children are mentally undeveloped so it makes sense to have some weak paternalism involved in the decision making. They might not know what is most beneficial to them. However, if you’re talking about teenagers, I think that makes things more complicated. Simone brings up a good point about the difference between age 18 and 17. What makes the 18 year-old more mentally developed to make decisions by him/herself? Can a 16 year-old be more mature than an 18-year old? It’s possible, depending on people’s life experiences. Therefore, I think it’s also important to consider how mentally developed the child is rather than just the age.
I also agree that letting a child make this large of a decision seems unreasonable. The decision making part of the brain – the one that weighs the consequences of actions – is not fully developed until the mid-20s. I think there needs to be a line drawn to limit autonomy in this situation. While it is a great idea to give terminally ill people this option, it is not feasible to have children that are fully competent and aware of the consequences of a decision like this. This also puts the family in such an odd and uncomfortable position. What if the family opposes euthanasia but the child wants it? Since the parents are legally in charge of a child under 18 who is given the choice? Not to mention the serious psychological issues those left behind would have following a decision like this.
The part of the article that bothered me had to do with the letter from the 175 pediatricians. It is all well and good for them to have a stance against the bill, but one of the things that was stated in the letter was: “Extending the “right to die” to minors will only add to the stress and pain of families at a difficult time”. This implies that the euthanization of a child should not be legal because of the stress and pain it causes for the family, not how it affects the child who is in physical pain. The decision to euthanize will inevitably affect the family, the act cannot even be carried out without parental consent. However, I think that the argument against euthanasia should be focused solely on the child, and what the child is going through. After all, it is the families responsibility to do what is best for the child, regardless of how it will affect them. I think that complete selflessness of being a parent is the willingness to suffer (emotionally) in order to end their child’s physical suffering when there is no other way out.
With regards to passing the law. I think that it will not change much. In the 12 years that the law has been in place in the Netherlands, only 5 children have gone through with the option. It seems like there are very few cases the law would apply to, and even fewer people who would consider it at all. Making a choice to end your own life, or your child’s life, is not something many people choose in any situation even if it is a legal option.