A Dutch newspaper, de Volkskorant, reports that after intense discussion and consideration, the Dutch Paediatrics Association (NVK) have stated their position that a child between 1 and 12 years who is mentally competent should be allowed to request euthanasia from their parents. They propose doctors take ‘real mental competence’ as a benchmark for a child’s decision making rather than chronological age.
The position statement also recommends that for children between 1 and 12 years not deemed mentally competent, parents should have the choice to consult with their physician who may then decide to terminate the child’s life.
The parliament and Minister Edith Schippers of Public Health (VVD) have been waiting for over a year for this decision, which would require legislative amendments, should it be adopted. Minister Schippers asked the NVK to consider their position after a law was passed in Belgium in February 2014 allowing for euthanasia of children of all ages under very specific circumstances. These circumstances include a child’s constant and unbearable physical suffering, and the knowledge that the child will die ‘within the foreseeable future’.
More research needed
Under Dutch law, a child of 12 years or over, if competent, can ask their parents to give permission for the termination of their life. As far as is known, five such requests have been made and honoured in The Netherlands between 2002 and 2012 for one child of 12 years and four aged between 16 and 17 years.
Until now there has been little research into how children aged 1 to 12 years and older children who are not mentally competent have died. The pediatricians therefore want to do more research into issues around the end of life for these children before there are calls to amend the law. Until then, the NVK proposes a ‘commission of expertise’ made up of experienced pediatricians to advise on euthanasia decisions.
The situation in Belgium
A related article from de Volkskorant published in February 2015 looked at how the law in Belgium has impacted on children with life limiting conditions and their families. An interview with members of the Kites Children’s Palliative Care Team from University Hospitals Leuven reveal that since the ruling many parents ‘react in terror’ when doctors propose to increase morphine dosages to keep a child comfortable as they see this as a kind of ‘slow euthanasia’.
Doctor Marleen Renard who has worked for the Kites team for fifteen years finds that the ‘media hype’ surrounding the extension of the euthanasia law to include all children has hampered their work. The discussion with parents to administer powerful drugs is even more delicate. “Parents now associate morphine with the intentional euthanasia of their child, while the medication is needed to provide comfort for the child in the palliative setting.”
Relating their concerns about children asking for euthanasia, Kites Team members say that parents who may not want their children to suffer any longer may unwittingly influence the decision made by the child, who feels a sense of loyalty to their parents. However, they report that in their experience, both parents and children fight to hold on to life, no matter how tenuous the thread, for as long as it is possible and that even in the worst situations, children can still manage to experience ‘some beautiful, happy moments’ and some quality of life.
ICPCN Position paper
The International Children’s Palliative Care Network (ICPCN) has published a Position Paper on euthanasia in children which states:
- Many requests for euthanasia or assisted suicide are made in order to draw attention to specific causes of emotional distress and despair. Those can often be reversed with appropriate support. Such requests should be acknowledged with respect and be extensively explored in order to understand, appropriately address and, if possible, remedy the underlying difficulties that gave rise to the request.
- In the face of a request for euthanasia or assisted suicide, provision of effective symptom control becomes particularly important, especially with respect to symptoms associated with a serious and sustained “desire for death” such as depressive disorders and poorly controlled pain. In such situations, early referral to an appropriate specialist should be considered.
The position paper also recommends that all governments
- integrate children’s palliative care into their country’s healthcare system
- ensure training for health care workers in communication skills, bioethics and children’s palliative care
- encourage Advance Care Planning and discussion of preferences for end-of-life care.
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