Euthanasia/Assisted Suicide/Right to Die and or Live/Death with Dignity Part I: The Belgian Euthanasia Debate: Should it be Kid Stuff?
Demetra M. Pappas, JD, MSc, PhD, Crimcast Correspondent
As the title suggests, this is Part I of a two-part commentary on the rights (and burdens) of children pertaining to medical euthanasia, physician assisted suicide, life and death with dignity, and (tangentially) the concept of medical futility. Taken together, they juxtapose debate in Belgium (regarding the potential for legally permitted euthanasia of children) and debate in America (regarding the question of medically prolonging life in the alleged face of medical futility).
As anyone who has read my recent book (which took a pointedly neutral stance on physician prosecutions for medical euthanasia and assisted suicide of consenting adults with terminal illnesses, focusing rather upon how civil and/or criminal liability for such actions moved the debate further) and as anyone who has sat in one of my classes, conference presentations or honorarium talks would know, I am extremely cagey about stating whether I am pro or con, other than to say that there are compelling arguments on both (or indeed, a multitude of) sides.
In this commentary, I am pointedly departing from the judicious stance (no doubt learned as a law student and enhanced by time as an appellate judicial clerk, as well as a fair amount of reading, trial/hearing attendance, listening to interviewees and conference participants, etc.). So, here is the first spoiler alert: I am not in favor of the Belgian proposal.
In December 2013, Belgium’s Senate passed a “child euthanasia” bill by a large majority, and the bill is facing debate in the Chamber of Representatives as early as January 2014. If passed and signed into law, this would allow for legal euthanas
ia of terminally ill children (euthanasia for adults is already legal, and has been since 2002). The bill requires “constant and unbearable suffering” and also allows for decision making by what are called minors who have “a capacity of discernment.”
I have some serious concerns about legally permitting (albeit with, or perhaps because of, a provision for parental consent) children to elect to end their lives. I have even more concerns about a lawful provision allowing for doctors, with all of their professional credentials, to be empowered to suggest this as an option to minor children who are terminally ill or who are experiencing what may be “constant and unbearable suffering.” Physicians have higher social status by virtue of their professional authority, and, when dealing with children, have the additional social status of being adults, whom children world-wide are generally taught to respect (if not outright obey and capitulate to). I find myself worrying for the terminally ill children who will almost certainly be literally looking up at a doctor, male or female, who also has the professional schooling, credentials and trappings of authority, whether white (or any other color) coat, stethoscope, badge, title.
It is true that terminally ill children, by necessity, have to sustain and undergo more adult problems. They live more adult lives and are confronted by far more adult issues than those more ordinarily faced by children, tweens and teenagers being socialized at school and at the playground, while these young people are not adults. However, their lives are more, not less complicated, by the issues and death trajectories they face. Consider that in American society, an 18-year old can legally sign a contract, can lawfully enter into marriage (but not lawfully drink a champagne toast at their wedding party), are permitted (sometimes legally encouraged) to enter the military (but not permitted by law to have a beer after a battle won or lost until the age of 21). As a society, we only first trust our children to vote in a municipal, state or national electoral process after the 18th birthday.
My fear here is that underage patients will be subtly (or unsubtly) coerced, whether by doctors or parents (or even worse, a combination of the two). The euthanasia debate, which is to say the debate regarding putting end-of-life control into the hands of doctors, is fraught with complications all around. Adding the complication of underage children/tweens/teens compounds the potential for error – not of misdiagnosis, but of overzealousness on the part of the doctor (in either direction of over treating or of giving up on a child). Also, while we all hope that parents will act in accord with biological instinct (and hopefully socialization) and protect a sick child, there is no guarantee of such. I have fear that terminally ill children may be subtly (or less-than-subtly) coerced into euthanasia, for sake of “surviving children,” for sake of family finances, for sake of social worlds of the parents or the other children of the parents.
In other words, my worry for the children is more about the adults in the euthanasia scenarios that may play out in Belgium. My fear is not about the Belgians, it is about adults impinging upon the human rights of children, even assuming the best of intentions and taking as a given that a Belgian child euthanasia program will not turn into anything resembling the Nazi child euthanasia program (PS some would more immediately go to the slippery slopes argument, and that is a fair argument to make). The potential for erosion of the trust relationship between doctor and patient is tremendous, leaving aside the legal and moral issues (and frankly setting aside any theological issues). And, I hasten to add, there may be social, fiscal and other forces that may well undermine – in unanticipated ways – the parent/child relationship.
As an aside, there is concern that if euthanasia for children becomes lawful in Belgium, there will be a burst of death tourism. This is not an unreasonable concern: in my doctoral work on Michigan’s Jack “Dr. Death” Kevorkian, there was great interest in death tourism, and I was shown binders of letters way beyond the 137 cases Kevorkian participated in assisting in suicide/administering euthanasia. An interesting, though unfortunate, opportunity for a future study will be to see whether there is a spike in Belgian euthanasias of people from other jurisdictions, and to compare to the Swiss Dignitas program (which has seen some death tourism, subject to both litigation and reportage) and to Washington State (which, after patients had difficulty making the Oregon residency requirements, pointedly removed the residency provisions from its ballot initiative and enabling legislation).
In the vernacular, I am not saying I do not trust or believe or respect the kids and their wishes here; what I am saying is that I do not trust the so-called adults here, whose duty, whether as physician or parent, is to protect the child (for the record, I am not even sure that I would be comfortable relying upon a guardian ad litem, who would be charged with protecting the rights and best interests of the child patient). Such adults may have conflicting duties (such as protecting assets for other children or themselves, which may go to care of the child who is ill during his/her lifetime). While I do not believe in prolonging suffering by fruitless and medically futile treatment (a whole other discussion, which I plan to address in Part II of this pair, which will regard the case of 13-year-old Jahi McMath, who has been declared brain dead following a tonsillectomy gone awry; at the time of this writing, her parents are seeking to have her moved to a long-term care facility and are meeting with resistance from the hospital), the lawyer in me cannot at this time endorse a process which will end the life of children/tweens/teens who, by definition, are overwhelmingly not deemed to have the legal capacity to be able to consent, short of a proceeding (and additional protections) to ascertain a level of knowledge, competency and informed voluntary consent.
Demetra M. Pappas, JD, MSc, PhD was named the 2011/2012 SGA Faculty Member of the Year at St. Francis College for her work in the Department of Sociology and Criminal Justice. Her first book, The Euthanasia/Assisted Suicide Debate, (Greenwood Press: 2012) has been nominated and short listed for the 2013 British Society of Criminology Book Prize and most recently nominated for the 2014 International Qualitative Inquiry Book Prize. Her doctoral dissertation for the London School of Economics and Political Science (Department of Law, co-supervised by the Department of Sociology), was entitled, The Politics of Euthanasia and Assisted Suicide: A Comparative Case Study of Emerging Criminal Law and the Criminal Trials of Jack ‘Dr. Death’ Kevorkian.. She also writes about dramaturgy, culinary culture, visual sociology and criminal justice issues. She may be reached at DemetraPappas@yahoo.com and followed on Twitter @DemetraPappas.