The Jahi McMath legal battle at Children’s Hospital Oakland over a brain-dead 13-year-old provides a stark contrast to a law passed across the Atlantic in Belgium that allows terminally ill minors to choose physician-assisted suicide. California judges have allowed the mother of young Ms. McMath to uphold her wish to keep her daughter on life support despite multiple pediatric neurologists declaring her dead. Meanwhile, the nation of Belgium presses forward its dismal euthanasia policies on terminally ill minors, with the bill expected to pass in the Chamber of Representatives after passing in the Senate 50-17.
Euthanasia is certainly not new to Belgium. In 2002, it became the second country to pass sweeping legislation legalizing physician-assisted suicide. Unlike in the United States, where states such as Oregon only allow a physician to prescribe but not administer lethal drugs, Belgium both allows this passive euthanasia available to American doctors and also permits medical providers to hasten death by administering lethal drugs or otherwise actively allowing patients to die (by depriving them of food and water, for example).Since that time, Belgium and its neighbor, the Netherlands, have become the globe’s case-studies for all that is wrong with legal euthanasia. Recently, a colleague of mine shared a story of his friend, a middle-aged Belgian man whose father had terminal cancer. The physician shared with this patient his options: to continue aggressive treatment or end his pain and suffering with life-ending drugs. The wife and daughter of the patient were adamant that their father end his life to save them pain and trouble. The son of the patient wanted his father to fight the cancer, but because the patient’s wife and daughter supported expediting the end of his life, the patient chose suicide. Yes, each patient has “autonomy” when making these decisions, but the opinions of loved ones bears much weight. When it comes to children making decisions about abbreviating their lives, it is hard to imagine they could actually make an informed, autonomous decision.
Since 2002, the percentage of citizens choosing euthanasia has skyrocketed, with now up to 2 percent of Belgian deaths caused by euthanasia. With roughly 75 percent of Belgium’s citizens supporting the policy, the amendment extending physician-assisted suicide to children comes as no surprise, yet allowing children to choose euthanasia is tragic for several reasons.
First, the amendment gives no stipulations about the age of a minor, stating only that the child must have the capacity of discernment in making the decision. (Proponents of the bill claim that euthanasia on minors is already taking place and that physicians need a legal framework.) Second, supporters claim terminally ill children are psychologically more mature than their healthy peers. Minimal medical knowledge regarding the nature of metastatic, terminal cancers proves this completely untrue. Often, cancer’s effects on the body cause mental regression, which results in an inability to make informed decisions.
Fourth, the law opens doors for families with children with medical complications to encourage their children to end their lives. Last, expansion of the law’s scope is possible. It became clear soon after the original legislation in 2002 that the strict caveats of the law were being disregarded to allow those with unbearable psychological suffering and pain, as well as those whose mental state made them burdensome to others, to be euthanized instead of only the terminally ill. Essentially, the severely depressed have elected to die by physician-prescribed, and often physician-administered, lethal drugs. Also, those with severe dementia have been euthanized since 2002. This slippery slope of not valuing human life has only bleak outcomes ahead.
As a healthcare provider, I wondered about the actual prescribing and implementation of euthanasia on future pediatric candidates. Is the current mindset of healthcare providers open to these policies? A retrospective study asked 141 Belgian PICU nurses in 2005 to complete a questionnaire to assess the nurse’s attitude toward and role in pediatric end-of-life decisions. Seventy-two percent said they had administered drugs to hasten death and 88 percent said laws should be adapted to allow terminally ill patients to end their lives. A 2011 study surveyed Belgian physicians with results showing only 5 percent of euthanasia requests were ever denied. The medical community of Belgium does not stand in the way of legalized death.
The world will be watching closely as Belgium implements its new policy, and with good reason. The United States already has three states, Oregon, Vermont, and Washington, with legalized physician-assisted suicide for adults and nearly gained a fourth in 2012 when Massachusetts’s citizens narrowly voted down a euthanasia law. The medical community in the United States is trending towards its European counterparts in its liberal policies, and Belgium provides a chilling example of what we will inevitably become if life continues to be undervalued in the name of patient autonomy and medical cost saving. No longer do we have to look back to Nazi Germany for an example of the medical community blindly implementing life-ending practices on children. Rather, we can look to a small nation that less than a century ago was at odds with the regime that began the modern euthanasia movement.
Caroline Pilgrim is a Physician Assistant (PA-C) who passionately believes in the value of every human life and encourages her medical colleagues to believe the same.
1. Alex Schadenberg, “Euthanasia Deaths Increase by 25 percent in Belgium,” LifeSiteNews, March 1, 2013, available at http://www.lifesitenews.com/blog/euthanasia-deaths-increase-by-25-percent-in-belgium.
2. Cohen, I. Marcoux, J. Bilsen, P. Deboosere, G. van der Wal, and L. Deliens. “European Public Acceptance of Euthanasia: Socio-demographic and Cultural Factors Associated with the Acceptance of Euthanasia in 33 European Countries.” Social Science & Medicine 63 (3): 743-56.
3. E. Inghelbrecht, J. Bilsen, H. Pereth, J. Ramet, and L. Deliens. “Medical End-of-life Decisions: Experiences and Attitudes of Belgian Pediatric Intensive Care Nurses.” American Journal of Critical Care 18 (2): 160-168.
4. Y. Van Wesemael , J. Cohen, J. Bilsen, T. Smets, B. Onwuteaka-Philipsen, and L. Deliens. “Process and Outcomes of Euthanasia Requests under the Belgian Act on Euthanasia: A Nationwide Survey.” Journal of Pain and Symptom Management 42 (5):721-733.
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