Euthanasia And Children

The lower house of the Belgian parliament recently voted to extend a 2002 law, which legalized euthanasia, to minors. Under the proposed legislation, the former age limit, which had been set at 18, would be removed entirely. The bill is awaiting approval from the Belgian king, who is expected to sign it into law amid considerable support from the populace.

The new measure would enable terminally ill children who experience “constant and intolerable” suffering to procure euthanasia. The child would have to demonstrate a capacity for discernment-which would be assessed via a psychological evaluation-and would still require the written consent of one parent. While the Netherlands has allowed euthanasia for children above the age of 12 under exceptional circumstances, the proposed bill would make Belgium the first country in the world to remove all age restrictions.

Naturally, the proposed measure has met resistance and has been the cause of a heated debate in the small country. Arguments made public on either side of the controversy, however, have been unhelpful at best. Those protesting the amended law argue that the measure is tantamount to “playing God,” and that we have no right to assume authority over the length of a human life-regardless of quality of life. In doing so, they overlook the point made by the philosopher David Hume nearly 300 years ago in an essay titled “On Suicide.” Hume argued quite simply that, since medical services have already interfered with “divine Providence” by lengthening lives, surely “interference” should not be grounds for the prohibition of shortening them?

Proponents of the measure, on the other hand, point out that we relieve the suffering of animals by euthanizing them and should therefore extend the service to children. In a twisted a fortiori argument, they hold that it is downright inhumane to provide such a “mercy” to animals and not to children. This very loose appeal to “mercy” seems to make no allowance for the distinction that has traditionally always been made between human beings and animals-a distinction that I believe most would agree is paramount to preserving human dignity. Logically speaking, the fallacy is a weak analogy. Putting down your dog and putting down your son are two substantially different actions. The reason euthanasia is such a contested issue is precisely because we want to prevent people from being slaughtered like cattle, as they were in recent history under the banner of “humane” German medicine.
Thus, on both sides, we see rhetoric that is less than helpful. The problem is that Belgians are much more likely to respond to appeals for “mercy” than to the less secular appeal to refrain from “playing God.” Indeed, the proposed measure is supported by almost 75 percent of the population according to polls. Clearly, in a country where medical professionals receive very little ethical training during their medical education, it is the responsibility of intellectuals to intervene in the debate by advancing sound considerations instead of emotionally loaded maxims.

The most obvious reason for concern is the potential for abuse. Daniel Callahan, founder of the Hastings Center-a bioethics research institution based in the United States-has argued that the motives for euthanasia contain in themselves the ingredients for abuse. The two main motives for euthanasia usually advanced by its proponents are self-determination and mercy. Self-determination requires the patient to be competent (in order to self-determine), and mercy requires some form of “intolerable suffering” to be present. Both motives are usually presented together under a single justification for euthanasia. Yet, they are not intrinsically linked to one another, and a separate analysis of each raises significant ethical problems. Why must a competent person be suffering in order to choose death? Isn’t that an arbitrary stipulation that limits the all-too-loved principle of self-determination? Why must a person’s motives, regardless of suffering, be questioned? Conversely, why are only the competent granted the “mercy” of an easy death? What of the mentally incompetent-must they languish in pain while the competent receive relief? Surely it is a capricious cruelty to deny “mercy” to the incompetent who cannot self-determine properly?

Callahan’s point is that there appears to be no good moral reason to limit euthanasia once taking a life for the purposes of self-determination and mercy has been legitimated. That is a serious danger that should cause any proponent of euthanasia to pause and reconsider. Indeed, Belgium seems to have started down the path of limitless euthanasia-the dividing line between “competent” and “incompetent” is blurred significantly in the case of euthanasia of children. What will count as “reasonable discernment”? What guarantee do we have that a mumbled assent-in the midst of despair and physical anguish-will not be abused for the sake of convenience? These are not problems hypothesized for the sake of a polemical attack on euthanasia. These are real grounds for concern. All legislation is subject to abuse-this is part of the reason why euthanasia is illegal in all 50 U.S. states.

Another obvious consideration is the pressure on children. Proponents of the measure argue that the choice will only be available to them upon request. It seems unlikely, however, that a child battling cancer for over a year will not have become aware of this “avenue of escape.” Already under physical and psychicological stress, such children are unreasonably haunted by feelings of guilt over the burden they pose to their parents and caregivers. Who is to say that some children-and one would be too many-will not feel the pressure to choose? If the option is there, how can one not consider it? In a way, not to choose is to have made a choice already.

Finally, the future of the medical profession itself is at stake. Primum non nocere, “first, do no harm,” is one of the principal precepts in bioethics. To cause death is very different from to let die. The first is to violate human dignity, while the second-in cases where medication or treatment becomes futile-is to uphold it. Physicians must first and foremost remain advocates for their patients, not the agents of their death. There remains a sacred inviolability of human life-and the prohibition of taking such a life must remain firmly in place if we are to prevent abuse, especially in the case of terminally ill children.

Editor’s Note: The views presented in this column are those of the author alone and do not represent the views of The Heights.