The topic of death is one that makes even the strongest
uncomfortable, especially when it is in regards to a loved one
or close friend. What can make this situation even more difficult
is when that loved one has to decide, or must have his
relatives decide for him, whether it is worth prolonging life, in
spite of the agony and suffering. In several countries, patients
and/or their families are given a particularly controversial
option: to end life and suffering through means of euthanasia.
In recent news, Belgium has swept international headlines
and has sparked international debates by signing into
legislation the option of euthanasia for terminally ill children.
The best place to start a conversation about euthanasia
is to properly define it. Euthanasia is the action taken by a
medical physician “that intentionally ends the life of a person
at his or her request.”1 In contrast,
although often confused
with euthanasia, physicianassisted
suicide requires no
direct action from the physician.
A common practice for
physician-assisted suicide has
the physician prescribe the
lethal dose of a drug, and the
afflicted self-administers the
dosage. The Netherlands, Luxemborg,
and Belgium have legalized euthanasia; the United
States still holds the practice as illegal. However, states such as
Washington and Oregon currently permit physician-assisted
suicide.1
In the countries that have legalized euthanasia, physicians
can choose to practice either active or passive euthanasia;
the distinction is derived from the physician’s actions in
the process. Active euthanasia is whereby a physician actively
administers medication to the patient with the intent of causing
death.2 Passive euthanasia, on the other hand, is when a
physician withdraws all food, water and medical treatments
from the patient and allows the patient to pass at a natural
rate.3 The majority of this article will deal with active euthanasia,
not passive euthanasia.
Ever since Dr. Jack Kevorkian put his Suicide Machine
into practice and aided the first physician-assisted death (this
was euthanasia, not physician-assisted suicide) in 1990, there
have been stark divisions between those who support euthanasia
and those who oppose it.4 Two of the more universal
supporting arguments of euthanasia are that it keeps the best
interest of the person who is suffering in mind and that people,
in good mental capacity, have an innate right to die. Proponents
of the former posit that no one should be forced to
suffer excessively when steps can be taken to mitigate his suffering.
Although for terminal patients the option of palliative
care is available, it is not always successful in curbing pain and
may cause the afflicted to suffer more than necessary. With
regard to the latter, advocates especially in the United States
believe that there is an inherent right to die embedded in the
Declaration of Independence.5 Essentially, this group believes
the right to life, one of the inalienable rights, also implies that
one automatically inherits the right to die. Finally, supporters
justify euthanasia by employing the Doctrine of Double
Effect. This basically states that if an action has a positive side
effect and a negative side effect, the action is morally right if
the intention of the action was not the negative side effect.6
Opponent of euthanasia rally around the points that
legalizing euthanasia would place unfair pressure on vulnerable,
sick people in the hospital and that it would put
the country on a slippery
slope, which would end with
the practice of involuntary
euthanasia becoming a commonplace
practice.7 Patients
in a terminal state may feel
as though they are being
a burden to their families
emotionally and financially,
especially if the illness has
been prolonged. Feeling
depressed considering what their family is enduring for them
may make them want to take an easy exit.
There does not seem to be an end in sight to the debate of
whether or not to give patients the decision to die. Belgium’s
latest legislation to legalize euthanasia for minors seems to
have polarized groups even further. The bill, signed into law
by King Philippe, provides children who are in severe pain
the option to request euthanasia, and would require the consent
of the child’s parents, physicians and a psychiatrist who
would evaluate the mental capacity of the child.8 The bill is
receiving heavy objection from Christian Democratic and
Flemish political groups, as well as a conservative Spanish
lobby that petitioned to veto the bill. In addition, a group of
175 physicians drafted a letter asking the legislature to reflect
on the bill longer before making a final decision.9 The main
point of the letter was that currently in Belgium there is no
pressing medical need for such a revolutionary bill and the
measure was unnecessary. Despite these forces, the bill passed
86-44, with 12 abstentions, in the Belgian House of Representatives
and was consequently approved in the Senate.8 However,
it is expected that in the upcoming months, the European
Court of Human Rights may become involved in the
Author Contact: Rohan Rao is a Junior at Tufts University. Address
correspondence to [email protected].
Spring 2012 • Volume 11, Issue II ⏐ TuftScope 2
matter as the debates persist.
In my opinion, this bill is a myopic piece of legislation
that was forced through the Belgian legislature without truly
examining future ramifications. Primarily, it is incredibly difficult
for children, especially younger children, to grasp the
concept of death and its finality. Without this understanding,
it is hard to expect children to be able to make an informed
decision regarding their own lives. The trouble arises when
children begin to think of euthanasia as a one-step way to stop
the pain they have been enduring for months or even years.
“We want for those children to be able to talk about euthanasia
and to ask those questions and if they really want to say,
‘Stop, this is it, I don’t want it anymore,’ that they can have a
choice,” says Mother Linda von Roy, a proponent of the bill.9
While a valid point, this requires a level of comprehension
that cannot be expected from children who are in pain.
A second point that legislators seemingly overlooked
is how impressionable and vulnerable children are when it
comes to dealing with uncomfortable situations. It is characteristic
of children to aim to please their parents or say what
they believe their parents would like to hear. If a terminally ill
child is aware of the financial burden his parents are undergoing
to keep him in the hospital, along with medications and
surgical procedures, the child may feel dejected and tell his
parents that he would like to opt for euthanasia, seeing this
as doing right by his parents. Similarly, the reality of having a
young child who may not live more than a year can also put
an incredible amount of strain on familial relationships, especially
between two parents doing their best to deal with the
situation at hand. If a child encounters fighting between the
parents, he may quickly assume that he is the root of all this
fighting and push for euthanasia to make his parents happy,
even if he does not necessarily need the treatment.
Finally, a large group of physicians in Belgium agreed, saying
that there is no urgent need for a bill like this. Passing such
ground-breaking legislation incorrectly implies that there is
some immediacy for children to be able to decide for themselves
whether euthanasia in the right step for them. While
proponents say this bill is more about principle than urgency,
it seems as though a gradual process with more foresight and
open discussions with professionals would have been the
more logical route to take for legislation of this magnitude.
Dealing with terminal illness in the family can be both
an emotionally and physically taxing process. In an attempt
to create an open discussion and facilitate this whole process,
it feels as though the Belgian legislature has produced more
woes than cheers. In short, it seems overly optimistic that children
are mentally capable of making decisions regarding the
permanence of their own lives. The bill also created a feigned
sense of urgency, and may not have taken into account how
easily children will blindly follow an idea when they think
it will make their parents’ lives easier. I hope to see this bill
modified and regulated in the future, with measures to prevent
abuse and protect terminal children who already have
enough strain.