Self-request euthanasia in minors: an act of compassion. Analyzing arguments during public debate in Belgium

Friedel, Marie [UCL] Clément de Cléty, Stéphan [UCL] Jacquemin, Dominique [UCL]

The arguments that led to the depenalisation of self-requested euthanasia in children in Belgium in 2014 were: 1.Unbearable and unrelievable physical pain justifies euthanasia. 2.Suffering is not correlated to age. 3.Self-determination plays a major role during end of life (EOL) decisions. 4.The competence of a child can be assessed. These arguments are underlying the main moral argument that accepting euthanasia for children, under strict conditions, would be an act of compassion. In fact, the majority of politicians were convinced. Surprisingly, few professionals involved in care of children opposed the bill. Furthermore, it is possible that the majority of the Belgian population did not correctly make the difference between all types of EOL decisions. The questions that we can ask are: 1. How is unbearable and unrelievable pain circumscribed and tackled by different teams involved in paediatric palliative care (PPC)? 2. Which are the current limits of paediatric palliative care when faced with unbearable and unrelievable pain? 3. Can such pain be reduced to its physical dimension, regardless of psychological, social and spiritual dimensions of suffering? 4. Can self-requested euthanasia nowadays be the only compassionate response to unbearable and unrelievable physical pain? My own clinical practice in PPC and my review of the literature prompt me to try to give some answers to these questions and to invite medical teams to quietly debate about the difficult subject of self-requested euthanasia in minors. The word euthanasia has not the same meaning for everyone ; il should be clarified. Many aspects should be considered by the teams involved in EOL decisions in order to offer the best care to the children; pain relief is an important one and requires a multidisciplinary approach. We also need to understand why a child can ask for euthanasia. The following concepts, on which the analysis is based, will help us in our thoughts: relational autonomy versus self-determination, holistic family centred care versus reductionism, vulnerability and mutual dependence versus individualism.