An ethicist in Antwerp expresses alarm that the practice of terminating the lives of seriously ill minors is going mainstream.A recent report in Belgium noted that legal euthanasia there has claimed the lives of three children in the past two years.
The response in Belgium? A big yawn.
“The report of the control commision has provoked not one article in the press, and no comments at all,” said Willem Lemmens, Professor of Modern Philosophy and Ethics at the University of Antwerp.
Lemmens was referring to a July 17 report from the commission that regulates euthanasia in Belgium, which noted that between January 1, 2016, and December 31, 2017, Belgian physicians gave lethal injections to three children under 18. Belgium in 2014 amended its already permissive euthanasia law to all children of any age to request the procedure.
Euthanasia deaths in Belgium have risen from 2,021 in 2015 to 2,309 in 2017.
Charles Lane, writing in the Washington Post, reported that the three euthanasias of children included an 11-year-old who had cystic fibrosis.
“This congenital respiratory disease is incurable and fatal, but modern treatments enable many patients to enjoy high quality of life well into their 30s or even beyond,” Lane wrote. “Median life expectancy for new CF cases in the United States is now 43 years, according to the Cystic Fibrosis Foundation.”
The others were a 17-year-old with Duchenne muscular dystrophy and a 9-year-old with a brain tumor.
“Doctors must verify that a child is ‘in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term.’ After a child makes his or her wish for euthanasia known, in writing, child psychiatrists conduct examinations, including … intelligence tests, to determine that the youngster is capable and ‘not influenced by a third party.’ Parents can, however, prevent the request from being carried out.”
But Lane was unconvinced. “What, exactly, convinced doctors that these children’s cases were hopeless, that their deaths were imminent — and that the kids fully understood not only euthanasia but also the treatment options that might have alleviated their condition?” he asked.
“These questions are no longer asked in the Belgian press,” Lemmens said.
In an interview Friday, Lemmens said he sees a process of normalization going on in Belgium. “On the one hand, people take it more and more for granted for somatic diseases like cancer, or terminal diseases of neurological origin. … And there’s discussion going on whether the law be enlarged for people with dementia or for elderly who are not terminal but are just tired of living.”
Most of Belgium’s 4,337 euthanasias in 2016-2017 involved adults with cancer.
And yet, Lemmens reports, doctors overall are “very concerned and very eager to address needless suffering at the end of life, and some doctors really try to avoid euthanasia. They don’t like the procedures for it. If they apply palliative sedation they don’t need to go through all these procedures that the law requires.”
Palliative sedation is the use of narcotics to the point of suppressing the body’s respiratory system. The controversial practice relieves pain, but usually hastens death.
“There’s a discussion about the proper way to do palliative sedation,” he said. “The pro-euthanasia doctors will say that palliative sedation is always a means to hasten death in a way that is not so much different from euthanasia. The only difference is that with palliative sedation the doctors avoid external control and act, according to pro-euthanasia doctors, in a paternalistic way. These discussions are going on between doctors, and I think the discussions prove there has been an increase in what I would call a gray zone in end of life practices.”
But Lemmens rejects the idea that the overall care for dying patients in Belgium is decreasing. “Overall, Belgium has quite a good health system,” he said.
He affirmed that there is pressure on Catholic hospitals to cooperate with euthanasia requests, partly due to the mergers between Catholic and secular institutions in recent years and the secularization of Belgian culture. The euthanasia law does allow an objecting physician to opt out, but it’s generally expected for such a physician to refer a patient to another doctor, even though the law does not require it.
For Alex Schadenberg, Executive Director of the London, Ontario-based Euthanasia Prevention Coalition, the mass media has been complicit in the advance of Belgium’s euthanasia laws. “The more cases that get promoted through the media the worse it will become, he said. “Recently there was the case in the Netherlands of Aurelia Brouwers, who was 29, who died by euthanasia, who was physically healthy but was going through psychiatric issues. She intentionally went to the media, she became a media darling before she died in January this year. And the reason was the more we hear about it, the more it becomes considered acceptable. What someone would never think of doing in the past, once we hear of others doing it, suddenly it becomes acceptable for somebody to do this.”
What troubles Schadenberg about Belgium’s euthanasia law is that even a 9-year-old’s “consent” to a doctor euthanizing him is accepted. “I don’t know how capable my nine-year-old was about consent, and now we’re talking about death,” he said. “In law we recognize there’s limits to consent, for these very reasons, that there’s a certain level of ability, and yet we’re allowing death to be done in these cases.”
Schadenberg said child euthanasia is being talking about it in Canada right now. He said that the government in 2016 instituted committees to look at child euthanasia, euthanasia for people with dementia, and euthanasia for people with psychiatric conditions alone. “We’re expecting the reports in December,” he said. “I’m assuming that euthanasia for children will be considered very seriously.”
