After watching three close relatives die slow and painful deaths at the undiscriminating, brutal hand of cancer, euthanasia to me is a human right – the right to die with dignity at a time of your own choosing, without the law determining how much more pain you ought to endure. 

But to extend that right to a child, a minor, without the fully formed adult faculty of reason seems shocking. At least, at first glance.

Is the pain of an incurably ill child any less worthy of ending than that of an adult?

Last week, Belgium became the first country in the world to legalise euthanasia for a person of any age, an extension of a law it passed in 2002 permitting an adult to end their life.  

Pediatrician, Dr. Gerlant van Berlaer was one of 16 doctors asking the Belgium Parliament to sign off on the new law.

“We are not playing God – these are lives that will end anyway,” said Dr. Van Berlaer.

“Their natural end might be miserable or very painful or horrifying, and they might have seen a lot of friends in institutions or hospitals die of the same disease. And if they say, ‘I don’t want to die this way, I want to do it my way,’ and that is the only thing we can do for them as doctors, I think we should be able to do it.”

Of the 142 lawmakers who were given the chance to play God, 86 said “yes”, 44 said “no” and 12 abstained. It was perhaps a reflection of the public mood: 75 percent of the Belgium population supported the extension of the euthanasia law which goes beyond even that of the very liberal Netherlands where euthanasia is available to anyone over the age of 12.

There are checks and balances in place. A child would need to be terminally ill, suffering unbearable physical and psychological pain to use the law. He or she would need to show that they are “capable of discernment” – of making the decision – and a psychologist would check this to ensure the child understands that their life will end. And, of course, the child’s parents must consent.

mother caressing her child with cancer

The arguments of those opposed to the law are familiar.  

It’s a slippery slope: children could be pressured by their desperate and distressed parents into making a decision just as, they argue, adults can be pressured into the decision.

It’s normalising euthanasia so that people will begin to see it as a way out when either more time or more treatment might save them: self-determination taken to its outer limits. It’s giving children the responsibility for the most critical of decisions when the right to make others is denied them until they reach the age of 18.

One oncologist argued that the law wasn’t needed because there were other ways to end a child’s suffering – sedation or, if and when that failed, going to the country’s Ethics Committee for permission to end the child’s life.

Even the law’s supporters have been concerned by a few cases in which the prerequisite for unbearable psychological suffering was the trigger for the adult law being used (an adult need not be suffering a terminal illness and it doesn’t need to be physical).

In one case, a female-to-male transsexual used the law when hormone therapy, a mastectomy and a penis construction failed. Nathan Verhelst said when he looked in the mirror “I was disgusted with myself. My new breasts did not match my expectations and my new penis had symptoms of rejection. I do not want to be… a monster. ” He met the psychological criteria for euthanasia.

In another, doctors sanctioned the use of euthanasia for a 64-year-old woman suffering depression.  She had lived her life with depression and wanted to die.

Both are difficult cases, which have left many asking whether the country’s euthanasia laws are simply too broad.

Supporters, predictably, argue the law as it applies to children is significantly tighter and that children who are terminally ill and spend a lot of time around adults, are more mature than others of the same age and can make this kind of decision. Giving children the right to choose when to die spares them the anxiety of dying a slow and painful death.

But perhaps the most convincing and poignant argument was put by oncologist and palliative care specialist Dr. Jan Bernheim, especially for those of us who have watched a human being die of cancer (and in 80 percent of cases where euthanasia has been used, cancer is the culprit).

“Suffering trumps all other considerations. And the way these people die is very ceremonial, and often has some emotional beauty. Whereas, the patient who dies after two or three days of rattling, twitching and grunting, that’s terrible…”

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