In September, a 17-year old became the first child to be euthanised under Belgian law.
Euthanasia became legal for Belgian adults in 2002, and for competent minors in 2014.
The Netherlands permits euthanasia for minors from the age of 12. But is a child ever really capable of choosing euthanasia?
Euthanasia is a contentious issue in and of itself. The idea of it being an option for children is, for some, unthinkable. There are warnings of a slippery slope towards children being pressurised into requesting euthanasia by the adults around them. Some question whether minors can ever have the capacity to make such a significant judgement, particularly during their vulnerable teenage years.
In reality, the laws in Belgium and the Netherlands only allow for euthanasia in a very narrow and controlled set of circumstances. The vast majority of cases in both countries involve patients with terminal cancer.
In the Netherlands the law stipulates that any request must come directly from the patient, and can only be countenanced in the case of suffering that is both unbearable and hopeless.
Dr Rob Jonquière from the World Federation of Right to Die Societies explains that “only the patient can decide whether the suffering is unbearable, and it is the doctor who decides whether the situation is hopeless”.
An experienced second opinion is always required, and only then can the procedure can go ahead. The decision then stands automatically referred to a review committee. If a finding is made that the procedure was “uncareful”, then the doctor concerned risks prosecution for murder.
The process for Dutch minors above the age of 12 is identical to that for adults, except that, between the ages of 12 and 16, their parents must also consent, and between 16 and 18 their parents must be informed.
Dr Eduard Verhagen of the University Medical Centre in Groningen says that “so far there have been no cases of the parents disagreeing with their child’s decision”. There have been approximately five requests made by minors in the past ten years.
Whilst in the Netherlands limits on child euthanasia are determined by calendar age, in Belgium they are based on the competence of the child, which is assessed by a child psychologist, who will take into account any pressure being put on the child by those close to them.
Competence is a difficult concept because, in one case, a ten-year-old may be deemed competent, where in the next, a fourteen-year-old may not be.
Can someone under the age of 18 ever be a reasonable judge of whether or not their suffering is unbearable? Dr Jonquière is adamant that they can.
“These are children who have experienced and suffered more than most adults,” he says. “They have endured terrible and distressing treatments. They are perfectly lucid and rational. They do not particularly want to die, they just do not want to endure another treatment.”
Where a minor has a terminal disease, has been deemed mentally competent, and has the consent of their parents and doctors, there is no reason why society should treat them any differently from adults in the same position, he argues.
Thus the question should not be whether a child can choose euthanasia, but whether a person can do so. And therein lies a far thornier issue.