Euthanizing Children

The death of a terminally ill seventeen-year-old boy made headlines recently, as Belgium’s first case of child euthanasia. I don’t understand the sudden fuss. The Netherlands has long allowed minors to request and receive euthanasia: Dutch children down to age sixteen can receive euthanasia without their parents’ consent, and children can be killed by doctors with parental consent starting at age twelve.

Perhaps Belgium’s euthanasia law has received this recent media attention because it has no age limits, instead requiring that a minor demonstrate a capacity to make autonomous decisions before receiving assisted suicide.

Think about this: Children who can’t enter into legal contracts, get tattooed, or be licensed to drive a car may request – and receive – death.

The healthcare system doesn’t dole out death only to teens and preteens. In the Netherlands, doctors commit infanticide against babies born with serious disabilities or terminal illnesses with impunity, even though the practice remains technically illegal. Indeed, doctors at the Groningen University Medical Center felt so safe committing infanticide that they published the Groningen Protocol, a bureaucratic checklist to help determine whether a baby is killable.

The protocol permits doctors to administer lethal injections to infants under three scenarios:

–the baby has no chance of survival (a circumstance that is sometimes misdiagnosed);

–the baby “may survive after a period of intensive treatment but expectations for their future are very grim”;

–the baby does “not depend on technology for physiologic stability” but has “suffering [that] is severe, sustained, and cannot be alleviated.”

This means that doctors are lethally injecting not only babies who are dying, but also babies with serious disabilities who do not need intensive care – those who are living what is sometimes called an “unlivable life” by Dutch infanticide apologists.The Groningen Protocol was published without criticism in the New England Journal of Medicine.

But babies don’t have decisional capacity. Thus, in order to maintain the pretense that euthanasia is about “choice,” the protocol requires parental consent. That, however, opens the door to all kinds of horrors. One can easily envision parents deciding that they would be better off without a disabled child for whom they would have to provide ongoing care. After all, such decisions are ubiquitous involving later-term abortions of fetuses diagnosed with Down syndrome and other disabilities. Moreover, according to a study published in The Lancet in 1997 – admittedly, before the protocol was crafted – some 21 percent of babies killed by doctors responding to the authors’ questionnaires had been euthanized without parental consent.

I guess we should be pleased that the euthanasia death of a seventeen-year-old remains at least mildly controversial. But it is clear that the culture of death, if allowed to progress further, will eventually consider such deaths routine. That is why I was completely unsurprised that Princeton University’s Peter Singer, who believes it should be acceptable to kill babies because (in his view) they are not “persons,” came to the Belgian law’s defense.

Singer assures us that the law “effectively excludes very small children.” But why would the age of the euthanized be of any significance to Singer, given that he supports not only infanticide but also the non-voluntary euthanasia of adults who have lost decisional capacity? Moreover, Singer believes that children do not attain “full moral status” until “after two years” of age – implying they too could be killed, although he is too politically savvy to support such a public policy.

Singer also grapples – poorly – with the fact that children he thinks should be allowed to choose to die can’t make other adult decisions:

Age limits are always to some extent arbitrary. Chronological age and mental age can diverge. For some activities for which a mental age limit may be relevant, the number of people engaging in the activity is very large: voting, obtaining a driving license, and having sex, for example. But it would be very costly to scrutinize whether every person interested in those activities has the capacity to understand what is involved in voting, driving responsibly, or giving informed consent to sex. That is why we rely on chronological age as a rough indication of the relevant mental capacity.

This is not true of minors requesting euthanasia. If the number of those who meet the requirements of the law is so small that Belgium has had only one case over the past two years, it is not difficult to carry out a thorough examination of these patients’ capacities to make such a request.

Please. There are plenty of minors who could be shown in court to have the decision-making capacity that allows Belgian youngsters to receive death, and yet who are still considered rape victims when they have consensual sex with an adult. The issue isn’t the cost or difficulty of measuring maturity, but the definitional need to protect all minors from harmful choices.

Here’s the bottom line. Euthanasia consciousness isn’t really about “choice.” Nor is it about terminal illness. Rather, euthanasia proponents see killing and suicide as acceptable answers to human suffering and acceptable means of reducing costs of care. Publicizing the euthanasia of a seventeen-year-old marks the beginning of a campaign to normalize putting dying (and eventually disabled) children to sleep.