In the United States’ most culturally aligned nation, a race toward the once-unthinkable accelerates.It never made any sense. The assurance that active euthanasia would always be limited to terminally ill, competent adults just never made any sense. Here’s the problem: Once a society widely supports eliminating suffering by eliminating the sufferer and redefines as a “medical treatment” the act whereby doctors kill seriously ill patients, there is no logical argument for limiting euthanasia to adults with legal decision-making capacity. After all, children suffer too, so how can they be logically refused “medical aid in dying” — or MAID, the current euphemism for euthanasia and assisted suicide — only because of their age?
Euthanasia has popular support in the Netherlands as well. There children down to age twelve are permitted to be euthanized, with parental permission required until age 17. Infanticide is also practiced openly by Dutch doctors, even though it is technically illegal. Indeed, the “Groningen Protocol,” a bureaucratic checklist published by Dutch pediatricians, describes which terminally ill and seriously disabled babies can be put down.
The Canadian Supreme Court in 2015 created a right to be euthanized, followed by enabling legislation in the national and provincial parliaments. The law basically guarantees the availability of euthanasia to adults experiencing intractable suffering — as defined by the patient — in circumstances where death is reasonably foreseeable. Serious discussions are now underway to expand that license to children. That development is especially alarming for the United States, given that Canada is our closest cultural cousin.
Member pediatricians were polled about the question. Only one-third of respondents opposed expanding Canada’s euthanasia law to children in all circumstances. Almost half (46 percent) were in favor of extending the MAID option to “mature minors experiencing progressive illness or intractable pain.” (According to the report, “the mature minor doctrine recognizes that a patient’s comprehension of the nature and consequences of a treatment has determinants beyond age, and that children’s wishes should be granted degrees of deference that reflect their evolving maturity.”) There’s more: Twenty-nine percent of answering respondents believe in making euthanasia available to mature minors experiencing “intolerable disability,” while 8 percent would even extend the killing to mature minors with “intolerable mental illness as the sole indication”!
Some parents are already open to having their sick children killed. A startling 40 percent of those responding to questionnaires reported having already held “exploratory discussions” with parents about killing their seriously ill mature children — and that’s while child euthanasia remains illegal in Canada.
While the paper did not take an explicit position on legalizing child euthanasia, it is not reticent about forcing doctors’ participation once it becomes legal. Even though only 19 percent — still a startling figure — of responding doctors stated they would personally euthanize children, the society argued that, on legalization, dissenting doctors would have the ethical obligation to “inform” patients about the euthanasia option and to “refer requesting patients or families appropriately” to doctors known to be willing to do the deed. (In Canada, this is known as an “effective referral.” An Ontario judge has even ruled that Catholic and other dissenting doctors morally and religiously opposed to euthanasia must so participate in adult euthanasia or get out of medicine. One presumes that the same coercion would apply to pediatricians should pediatric euthanasia become legal.)
The authors assume that pediatric euthanasia will be soon legalized in Canada, at least for mature minors — a good bet, as the government has planned legalization as a two-step process, starting with competent adults and then potentially expanding to the legally incompetent. Accordingly, the paper describes the bureaucratic process the hospital plans to implement once minors can be given lethal jabs.
I found this point particularly startling: Doctors will be allowed to euthanize “capable minors” — akin to a “mature minor,” as previously described — without parental consent or even their notification (my italics):
If . . . a capable [legally underage] patient explicitly indicates that they do not want their family members involved in their decision-making, although healthcare providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected. If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way.
The paper was not as explicit about doctors euthanizing children who do not have the perceived mental capacity to decide for themselves. But the paper does state that lethal jabs should be considered “practically and ethically equivalent to other medical practices that result in the end of life.” That means parents would be able to request pediatric euthanasia in the same way they can now order the removal of life support in an ICU.
The members of the working group are also intent on doing what they can to normalize pediatric euthanasia as a standard part of medical practice, stating, “We will . . . as an institution, publicly discuss the provision of MAID in an effort to normalise this procedure and reduce social stigma for everyone involved.” Good grief. Sometimes “social stigma” serves a positive social purpose by preventing immoral acts regardless of legality.
Here’s the bottom line: Countries such as the Netherlands, Belgium, and now our most culturally aligned nation, Canada, demonstrate that once a society popularly accepts euthanasia, there are no brakes to prevent the steady expansion of the killing license, to include eventually even children and babies — acts that, until very recently, were universally condemned in the civilized world. Those with eyes to see, let them see.