It never made any sense. The assurance that active euthanasia would always be limited to terminally ill, competent adults just never made any sense. Here’s the problem: Once a society widely supports eliminating suffering by eliminating the sufferer and redefines as a “medical treatment” the act whereby doctors kill seriously ill patients, there is no logical argument for limiting euthanasia to adults with legal decision-making capacity. After all, children suffer too, so how can they be logically refused “medical aid in dying” — or MAID, the current euphemism for euthanasia and assisted suicide — only because of their age?
The short answer, of course, is that they can’t and they won’t be, once a society generally embraces euthanasia consciousness, as is demonstrated by the three countries where lethal-jab euthanasia has been legalized and now has popular support. Belgium legalized euthanasia in 2002 for anyone age twelve and older. In 2014, it eliminated all age restrictions. A recent report published by Belgian authorities reveals that three children were euthanized legally in 2016–17 — the youngest at age nine — with the two others at ages eleven and 17, respectively. Their maladies? Cystic fibrosis, muscular dystrophy, and a brain tumor.
Euthanasia has popular support in the Netherlands as well. There children down to age twelve are permitted to be euthanized, with parental permission required until age 17. Infanticide is also practiced openly by Dutch doctors, even though it is technically illegal. Indeed, the “Groningen Protocol,” a bureaucratic checklist published by Dutch pediatricians, describes which terminally ill and seriously disabled babies can be put down.
When these horrors are brought up in euthanasia debates in the United States, assisted-suicide advocates wave off the concern as mere slippery-slope advocacy and sniff that whatever policies Belgium and Netherlands have adopted, those countries are very different culturally from the United States. Now that blithe assurance is poised to become inoperable, as Canada appears on the verge of allowing children to be euthanized.
The Canadian Supreme Court in 2015 created a right to be euthanized, followed by enabling legislation in the national and provincial parliaments. The law basically guarantees the availability of euthanasia to adults experiencing intractable suffering — as defined by the patient — in circumstances where death is reasonably foreseeable. Serious discussions are now underway to expand that license to children. That development is especially alarming for the United States, given that Canada is our closest cultural cousin.
The Canadian medical establishment has clearly signaled its acquiescence. Earlier this year, the Canadian Paediatric Society issued a position paper entitled “Medical Assistance in Dying: A Paediatric Perspective.” The paper is entirely uncritical of expanding the euthanasia law to include minors. More than that, the statement makes recommendations about how to implement pediatric euthanasia once the law permits. In refusing to oppose legalization or, indeed, to make even one substantive argument against its moral propriety, the society implicitly endorses a policy that would allow sick and disabled children to be killed.
Member pediatricians were polled about the question. Only one-third of respondents opposed expanding Canada’s euthanasia law to children in all circumstances. Almost half (46 percent) were in favor of extending the MAID option to “mature minors experiencing progressive illness or intractable pain.” (According to the report, “the mature minor doctrine recognizes that a patient’s comprehension of the nature and consequences of a treatment has determinants beyond age, and that children’s wishes should be granted degrees of deference that reflect their evolving maturity.”) There’s more: Twenty-nine percent of answering respondents believe in making euthanasia available to mature minors experiencing “intolerable disability,” while 8 percent would even extend the killing to mature minors with “intolerable mental illness as the sole indication”!
Some parents are already open to having their sick children killed. A startling 11.2 percent of those responding to questionnaires reported having already held “exploratory discussions” with parents about killing their seriously ill mature children — and that’s while child euthanasia remains illegal in Canada.
What about euthanasia for “never competent children”? Forty-five respondents reported having received explicit parental requests to euthanize their children. One-half of the requests were for babies under the age of one. Netherlands-style infanticide, here we come. Thirty-two percent of responding doctors said they approved of allowing euthanasia for immature children “in rare situations involving terminal illness or intractable pain, provided that the process was accompanied by significant oversight.”
While the paper did not take an explicit position on legalizing child euthanasia, it is not reticent about forcing doctors’ participation once it becomes legal. Even though only 19 percent — still a startling figure — of responding doctors stated they would personally euthanize children, the society argued that, on legalization, dissenting doctors would have the ethical obligation to “inform” patients about the euthanasia option and to “refer requesting patients or families appropriately” to doctors known to be willing to do the deed. (In Canada, this is known as an “effective referral.” An Ontario judge has even ruled that Catholic and other dissenting doctors morally and religiously opposed to euthanasia must so participate in adult euthanasia or get out of medicine. One presumes that the same coercion would apply to pediatricians should pediatric euthanasia become legal.)
In contrast to the society’s supportive neutrality (let’s call it) to child euthanasia, in “Medically Assisted Dying in a Paediatric Hospital,” an article in the Journal of Medical Ethics, doctors and bioethicists associated with a children’s hospital in Toronto are positively enthusiastic about expanding the law. Indeed, the authors report, some doctors at the Hospital for Sick Children have already volunteered to euthanize children once that lethal act becomes legal.
The authors assume that pediatric euthanasia will be soon legalized in Canada, at least for mature minors — a good bet, as the government has planned legalization as a two-step process, starting with competent adults and then potentially expanding to the legally incompetent. Accordingly, the paper describes the bureaucratic process the hospital plans to implement once minors can be given lethal jabs.
I found this point particularly startling: Doctors will be allowed to euthanize “capable minors” — akin to a “mature minor,” as previously described — without parental consent or even their notification (my italics):
If . . . a capable [legally underage] patient explicitly indicates that they do not want their family members involved in their decision-making, although healthcare providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected. If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way.
The paper was not as explicit about doctors euthanizing children who do not have the perceived mental capacity to decide for themselves. But the paper does state that lethal jabs should be considered “practically and ethically equivalent to other medical practices that result in the end of life.” That means parents would be able to request pediatric euthanasia in the same way they can now order the removal of life support in an ICU.
The members of the working group are also intent on doing what they can to normalize pediatric euthanasia as a standard part of medical practice, stating, “We will . . . as an institution, publicly discuss the provision of MAID in an effort to normalise this procedure and reduce social stigma for everyone involved.” Good grief. Sometimes “social stigma” serves a positive social purpose by preventing immoral acts regardless of legality.
Here’s the bottom line: Countries such as the Netherlands, Belgium, and now our most culturally aligned nation, Canada, demonstrate that once a society popularly accepts euthanasia, there are no brakes to prevent the steady expansion of the killing license, to include eventually even children and babies — acts that, until very recently, were universally condemned in the civilized world. Those with eyes to see, let them see.
Editor’s note: In an earlier version of this article, the percentage of respondents to a questionnaire who reported that they had held exploratory discussions with parents about medical aid in dying for their seriously ill mature children was misstated. The correct figure is 11.2 percent.