Should a Sick Child Be Allowed to Choose Death? Belgians Think So

Belgian lawmakers are set to let children decide whether they should die for their own good. Sebastian Rose/Getty Images

Jutte van den Werff Ten Bosch has already had the talk with her 10-year-old son. Several times, in fact. No, not the sex talk. The euthanasia talk.

"Even if he said, 'I want to die', I'd support him," she explained. "I didn't put my children in the world for me. It's their life and their death. The best parents are the ones who let their children go."

Professor van den Werff Ten Bosch's dinner-table conversations with her son and her three other children are far from hypothetical: They live in Belgium, where a law allowing child euthanasia is on track to be passed early next year.

The law, which follows a 2002 law making euthanasia legal for consenting adults, will allow terminally children of any age to request that their lives be terminated.

"Children are not tiny humans that we can boss around," said van den Werff Ten Bosch, a pediatric oncologist who works at Brussels University Hospital and has spoken out in favor of the proposed law.

"Children with terminal diseases like cancer mature much faster than other children. They think a lot about their life and death and how they'd like their death to be. And sometimes they're more courageous than their parents," she said.

The child euthanasia bill, which has just passed the committee stage in the legislature's upper house, the Senate, and is expected to be adopted by the full Senate later this month followed by the lower house, the Chamber of Representatives, in January or February, stipulates that doctors can suggest to terminally ill minors that they should be euthanized.

After the child decides in favor of death, the parents have to consent, though the law makes no provision for what will happen if the parents disagree. Euthanasia is usually performed by a doctor, who gives the patient an overdose of muscle relaxants or sedatives. This causes a coma followed by death.

Since Belgium passed its adult euthanasia law, the number of patients who have asked to be killed has grown to over 1,400 per year. It conjures up a Soylent Green world where a neatly ordered state routinely euthanizes its older population to maintain the right population balance.

One Belgian who took advantage of the euthanasia law was Nathan Verhelst, a woman-turned-man whose body rejected his new penis. In a newspaper interview, Verhelst explained he didn't want to become a monster, and this year his doctor gave him a lethal injection. Today, Belgium, Luxembourg, and the Netherlands are the only countries in the world permitting euthanasia administered by a second person.

But the laws have raised a number of ethical, moral, and legal dilemmas. Such as, is it right for a parent to propose the legal killing of their child in any circumstances? And, as children don't have the same reasoning skills as adults, are they equipped to make a terminal decision about their lives that will also deeply affect the lives of others?

Like most animals, humans have an innate instinct to protect their young. As the 20th century German theologian Dietrich Bonhoeffer wrote: "The test of the morality of a society is what it does for its children."

Have the Belgians gone completely mad in allowing doctors to help children die? Or are they, by contrast, on track to become Earth's most compassionate society because they'll end children's suffering?

"Of course, I had a long debate with myself before deciding to support this law. Every senator did," said Philippe Mahoux, Senate group leader for Prime Minister Elio Di Rupo's Socialist Party, who introduced the bill. "But it isn't always possible to alleviate these children's pain. That's the main point."

The issue has divided Belgians in a radically new way: not along political lines but according to personal morality. "I don't know what to think," said Sébastien Petit, 34, a movie industry worker in Liège. "On the one hand, I think it's wrong to kill children. But on the other, I realize these children are suffering."

His wife, Marie, 28, an occupational therapist, said she thinks the adult euthanasia law works well, so she sees no problem in extending it to children. According to a poll byLa Libre newspaper, 74 percent of Belgians are in favor the law.

Yet faith groups from the Roman Catholic Church to Muslims and Jews remain firmly opposed, as do many doctors and nurses. "It's always possible to control pain and terminal anxiety with medication," said Dr. Benoit Beuselinck, a medical oncologist at the University of Leuven Hospitals.

"If that's not enough, a palliative sedation can induce the child into a deep sleep, and it won't suffer any more. The patient will then usually die within several days and during this period the family can stay with the child and start the mourning," he said. "The process of dying is a natural process, and we have to respect this natural process as much as possible."

Proponents of the law, however, consider such arguments outdated. Peter Deconinck, emeritus professor of pediatric surgery at the Free University of Brussels, said it's high time to break the taboo surrounding child euthanasia.

"It's our duty. Children today are not like they were 50 years ago. They have mature minds," he said. "It's not like terminally ill children go to the doctor and say, 'I'd like to die.' But terminally ill children spend a lot of time on oncology wards. It's a doctor's duty to speak to such a child in a plain manner, perhaps not saying everything the first time, but little by little."

Besides, say supporters of the bill, child euthanasia is already happening in Belgium. "In reality, pediatricians are compelled by compassion to end the lives of quite a few children with the agreement of their parents," said Jan Bernheim, professor of medicine at the Free University of Brussels and a pioneer in palliative care.

"They've had to do it clandestinely, with the risk of being charged by prosecutors," he said. "Now they'll be able to do it the legal way."

Before they give the full weight of the law to child euthanasia, Belgian politicians will have to address other implications: for example, how to handle the likely rise of euthanasia tourism.

Of course, death won't just be a matter of the child uttering his fiat mortem. The law requires statements by psychologists and doctors confirming the child's ability to make the decision. The child's doctors must also inform him about medical options that may ease his suffering and maintain a dialogue about his preferences.

Even so, the fact that the word euthanasia can now be uttered to gravely ill children may put pressure on them to end their lives.

"I don't think we should be proud of killing our children when we have good palliative care," said Carine Brochier of the European Institute of Bioethics in Brussels. "We're becoming the world's euthanasia laboratory. Euthanasia is becoming a Belgian trademark, just like waffles."

She warned that the child euthanasia law would open an ethically dangerous door. "What's next? Euthanasia for people with dementia? Then for handicapped people?" she said.

"Becoming fully human is a gradual process that's completed when the fetus becomes viable and has finished acquiring all the potentials to become a person," said Bernheim. "Similarly, the end of life with dementia is a gradual process of involution in which most attributes of personhood end up being lost.

"Already now, almost everywhere, such patients are not resuscitated or given antibiotics, treatments that are considered futile when they only prolong suffering. Their blighted life is not considered deserving of the degree of protection that is given to other human life."

According to this school, euthanasia for the demented would be better than simply waiting for a lethal bout of pneumonia. But where to draw the line? "Recently an elderly couple was euthanized, just because they were 'tired of living,' " said Beuselinck.

Indeed, deciding who qualifies for life comes close to playing God, and that power has been taken to extremes before. In the Third Reich, German doctors killed more than 10,000 handicapped or incurably ill children. Unlike Belgium's children, the German children were never asked whether they wanted to die. But if the law were to pass in Belgium, doctors would be allowed to suggest to children that they agree to be killed.

"Of course, it's a difficult conversation," said van den Werff Ten Bosch. "Usually the parents ask, 'What can we do now?' Now we'll be able to give them not just the various medical options, but also say, 'There's the option of choosing to die.' "

Passing the new law permitting children to agree to the end of their life will reflect on Belgian society, its morals and duties. "What does child euthanasia mean for our life together in Belgium?" asked Brochier. "The answer to terminally ill children's suffering is more solidarity, and that includes more financial support for palliative care."

The third part of this new death trinity, complementing the doctors and the child, are the parents. According to van der Werff Ten Bosch, most parents don't want their child to suffer, and "if the child says, 'I really want to die,' 90 percent of parents will let him."

Still, the choice between consenting to one's child's death wish and prolonging his painful life presents parents with an agonizing spectrum of emotions. Some doctors argue that it places parents in such an excruciating position that it would be more compassionate to leave them out of the decision altogether.

Sébastien and Marie Petit try to visualize what it would be like if they had a terminally ill child who said he wanted to die. "I'd listen to as many opinions as possible," said Sébastien. "I'm not a medical professional, so I'd go with what the majority told me."

A majority vote on a child's life or death? Belgium is indeed entering a chilling new world.

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