On January 13, Belgium legalized euthanasia for children, regardless of age. The legislation is aimed at relieving terminally ill minors who are nearing death and are experiencing “constant and unbearable suffering.” Historically, the Low Countries have led the way in progressive social policies, such as the legalization of euthanasia for adults, which occurred in 2002 in both the Netherlands and Belgium. While the right to euthanasia in the Netherlands only extends to children over the age of 12, Belgium has taken an extra step and provided children of all ages with autonomy over their own lives. This has spurred strong emotional debate and backlash. Opponents ranging from conservative religious leaders to Belgian pediatricians have contended that modern medicine is sufficient to alleviate suffering and that providing euthanasia as an option in these cases is unnecessary. The law has come under international scrutiny as well; a column in the German daily Die Welt proclaimed that “Belgium has allowed the killing on demand of terminally ill children and has headed for ethical abyss.” The law does include measures to help ensure that these ethical decisions are made thoughtfully and, above all, voluntarily. These caveats include: the patient must be conscious of his or her decision and understand the meaning of euthanasia; the request must be approved by the child’s parents and medical team; the illness must be terminal; and the patient must be in grave pain with no available treatment to alleviate distress.
However, these stipulations are broad and thereby subject to interpretation by third parties. The first caveat, to “understand the meaning of euthanasia,” leaves significant loopholes in the policy, as the meaning of euthanasia is highly subjective and can easily be distorted by both doctors and parents. Sonja Develter, a nurse specializing in end-of-life care for children, told CNN that providing children with a choice may influence them to opt for euthanasia in order to alleviate the burden on their families. If the family is solely responsible for the decision, however, they may be more hesitant to euthanize their child.
By stating that patients must be conscious of their decisions, the first caveat places a large amount of responsibility on children who are enduring a great amount of suffering. This may obscure their long-term decision-making skills due to the intensity of their short-term pain. Additionally, excessive use of euthanasia may discourage medical professionals from developing new medication for the terminally ill, limiting the alternatives for those who might consider euthanasia down the line. This is particularly worrisome when a young patient may have a chance of survival, but relinquishes it due to extreme suffering or discomfort.
Last month, American publishing executive Steve Forbes wrote, “[The West is] on the malignantly slippery slope to becoming a society like that envisioned by Nazi Germany, one in which ‘undesirables’ are disposed of like used tissue.” Belgium’s stance on euthanasia for children could perpetuate this danger, making death a convenience as opposed to a last resort. However, much of this foreign criticism was met with surprise from the local Belgian media. According to the Belgian daily De Morgen, Belgium’s citizens have advanced “to being ethically progressive leaders” since the country’s founding in 1830. The fact that the newspaper said it was “quite proud” of such a stance indicates a subtle competition between Belgium and its fellow liberal Low Country neighbors regarding socially progressive policies.
The chief editor of De Standaard, one of Belgium’s largest daily newspapers, stated that he is “annoyed at hearing ‘you’ll kill the children’ in the foreign media,” because Belgium’s decision is a “very different debate on a very different level.” Belgians are typically unafraid of speaking out against contentious government policies, yet the decision regarding euthanasia has not sparked widespread domestic debate. According to Reuters, the implication of new highway tolls has incited more public response than the new euthanasia policy.
Several of those backing the law are mothers who have seen their children dying of terminal illnesses and lacked the ability to mitigate their pain. Take the case of Ella-Louise van Roy, a 10-month-old baby from Schilde, Belgium, who suffered from Krabbe disease, a rare and terminal genetic mutation that destroys the nervous system. Before the current law, Ella-Louise would not have qualified for euthanasia. Her mother, Linda, watched as her baby gradually passed away under palliative sedation. Philippe Mahoux, a Belgian Socialist Party senator, argued that granting euthanasia for children is an “act of humanity that allows the doctor to take the most humane course of action for his patient.” Mahoux addressed the debate of whether sick children are able to make such drastic decisions by stating that “suffering from a terminal illness endows young people with a maturity sometimes lacking in many adults.” Although this argument is not universally applicable and may not extend to very young children (who are still conscious of their decision and to some extent understand the meaning of it, putting them in accordance with the law’s first caveat), it is certainly more humane to prevent inevitable suffering in certain instances. But the child is also giving up the possibility of recovery due to new pharmaceutical innovations that may be developed during their lifespan. In some cases, that potential is so slight that it may not be worth the agony. As such, assigning arbitrary age limits undermines the efficacy of euthanasia altogether.
Although Europe is generally perceived to be more socially liberal than the United States, only the Netherlands, Switzerland, Belgium, Luxembourg and Albania have legalized euthanasia in any form. Germany has recently begun considering the option, while several other European nations remain opposed to the morally contentious policy. Belgium’s stance on euthanasia takes its social liberalism to a new extreme, placing an unparalleled level of trust in the nation’s citizens and medical institutions. Such an approach can either encourage responsible moral autonomy or allow for the premature end of sensitive lives. It is the Belgian government’s responsibility to educate patients on the nature of euthanasia and to cultivate an informed youth that is able to make independent moral decisions.
Art by Julia Ladics