By Dave Andrusko

The American College of Pediatricians vigorously criticized the new Belgian law making it legal to euthanize children.
Earlier today we posted a short article by Michael Cook, whose analyses are always worth reading, summarizing a piece that ran this month in the Journal of the American Medical Association (“US bioethicists take Belgian child euthanasia to task”).
I take a slightly dimmer view of “Pediatric Euthanasia in Belgium Disturbing Developments,” and I would like to a few minutes to explain why.
The context is the ghastly decision by Belgium to extend euthanasia to children. The legislation (which amended the 2002 Belgium Act on Euthanasia) is wrong on so many scores, it’s hard to know where to start.
My objection to Siegel, Sisti, and Caplan is that not only do they start in the wrong place, they do not go far enough in their condemnation.
Having said that, however, even if the argument is flawed, it’s important that something negative is said about euthanizing children and that it appears in JAMA. So, first the good stuff.
The three, who are all associated with the University of Pennsylvania, are clearly correct when they write “Children and adolescents lack the experiential knowledge and sense of self that adults often invoke—rightly or wrongly—at the end of their lives.”
The law supposedly applies only for “terminally ill children who are close to death, experiencing constant and unbearable suffering.” So they are also spot on when they insist “That suffering of such magnitude exists in modern pediatrics is an inexcusable tragedy. But the solution need not and should not be euthanasia.”
Finally, it is good and proper that they should conclude, “The goal of reducing suffering in children at the end of life is a laudable one. However, the ethical way to achieve this goal should be expanded education and clinical guidance around the provision of aggressive palliative care.”
But because Siegel, Sisti, and Caplan take on face value assurances that have not proved to be true (and likely could not be true), their focus, as important as it is, is limited to pain management and the [in]ability of children to give meaningful consent.
For example, one of the four supposed requirements that goes without comment is that parents need to consent. But how “meaningful” can their consent be when doctors paint the grimmest possible scenario? On the other hand, ”the Royal Dutch Medical Association (KNMG), which represents doctors in the Netherlands, has said that distress felt by parents can justify euthanasia of a dying newborn,” according to Dr. Peter Saunders.
Another “requirement” is that the “termination procedures” comport with “medical standards.” Belgium—along with the Netherlands and Luxemburg–is racing headlong down the slipperiest slope in the world. Those standards are in a race to the bottom.
To return quickly to the obvious fact that children lack the wherewithal to give assent “to life-ending interventions.” The trio implicitly (in my opinion) approve of euthanasia for adults for reasons beyond pain; for example, out of a fear of a loss of control or of “not wanting to burden others.”
But whether or not they approve of this for adults, children can’t choose euthanasia for those reasons because (Siegel, Sisti, and Caplan tell us) they “lack the intellectual capacity to develop a sophisticated preference against palliative interventions of last resort. … Although a child can surely feel pain, concepts like loss of dignity or the fear of losing self-determination are outside the realm of young children’s capacities.” Two thoughts:
#1. When the reasons offered have nothing to do with physical pain, they are inherently expansionary. People nowadays choose assisted suicide for a range of reasons that would have made most people gasp in bewilderment only 5 years ago. And “chosen” death has rapidly become death chosen for people in these countries.
#2. Lack of “intellectual capacity’ is a thin, thin reed to lean on. If we’ve learned nothing else over the past thirty years, it’s that once a “right” is won for a competent adult, anti-life types will demand that this “right” be extended to those who cannot (or will not) give assent.
Otherwise, we’re told, we are practicing discrimination. And note that prior to passage of the law to euthanize children in Belgium, proponents were not the least bit shy about waving the discrimination flag.
To be clear, it is no small thing that JAMA would print “Pediatric Euthanasia in Belgium Disturbing Developments.” But as welcome as any second thoughts are on the new law, it is crucial that all the other reasons the law is dangerous not be missed.