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===Belgium=== |
===Belgium=== |
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Belgium legalized euthanasia for terminally-ill adults in 2002. As it stood then, euthanasia could only be applied to citizens over eighteen years of age or, in rare accounts, a category of individuals called "emancipated minors."<ref name ="Raus">{{cite journal|last1=Raus|first1=Kasper|title=The Extension of Belgium’s Euthanasia Law to Include Competent Minors|journal=Journal of Bioethical Inquiry|date=1 June 2016|volume=13|issue=2|pages=305–315|doi=10.1007/s11673-016-9705-5|url=https://doi.org/10.1007/s11673-016-9705-5|language=en|issn=1176-7529}}</ref> In years to follow, the debate on euthanasia opened up to the idea of this same law being extended to minors. On February 13, 2014, an amendment to the 2002 Euthanasia Act made it legally permissible for minors, regardless of age, to pursue euthanasia as long as they fit a few specific criteria. The amendment states that minors who request euthanasia must exhibit the ability to judge their current state of affairs when in a "medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will, within a short period of time, result in death, and results from serious and incurable disorder caused by illness or accdient."<ref>{{cite journal|title=Act amending the Act of 28 May 2002 on euthanasia, sanctioning euthanasia for minors|journal=Belgian Official Gazette|date=2014|volume=2014009093: 21053}}</ref> |
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On February 13, 2014, Belgium became the first country to allow ''voluntary'' child euthanasia without any age limit.<ref>{{cite news |url=http://www.bbc.co.uk/news/world-europe-26181615 |title=Belgium's parliament votes through child euthanasia |date=2014-02-13 |newspaper=BBC News |accessdate=2014-03-05}}</ref> |
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The provisions of this amendment to the 2002 Euthanasia Act have distinguishable differences between the act applied to adults and minors. First, the law establishes that only physical suffering may be valid for minors, while physical and psychological suffering is plausible reasoning for adults and the emancipated minors to pursue end-of-life care by euthanasia. Second, the amendment says that the presumed death of a minor should result within a short period of time, whereas no timeframe of expected death is needed for adult cases. Finally, this extension to minors requires that multiple physicians and legal representatives sign-off on the mental capacity of the patient, reinforcing that the minor is competent of his or her condition and decision to die.<ref name="Raus" /> |
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==Ethical considerations== |
==Ethical considerations== |
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Revision as of 15:34, 6 May 2018
 | The examples and perspective in this article may not represent a worldwide view of the subject. (September 2017) |
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Child euthanasia is a controversial form of non-voluntary euthanasia that is applied to children who are gravely ill or suffer from significant birth defects. In this regard, neonates and infants are euthanized by either active or passive means. Because children at these early stages of mental development are incapable of providing explicit consent to these terminal procedures, it has become a hot-button issue for ethical debates. Furthermore, child euthanasia recently broadening its scope to incorporate voluntary euthanasia for minors has generated both great applause and heavy criticism. Today, Belgium is the only country with legalized euthanasia without any age limit, while the Netherlands has decriminalized infant euthanasia falling within strict guidelines.
Modern history
Dr. Haiselden and Baby Bollinger
Baby Bollinger was born in 1915 at the German-American Hospital in Chicago, IL.[1] Characterized by various physical abnormalities, surgeon Harry J. Haiselden advised the Bollinger parents to forgo the surgery that could have saved the baby’s life. Dr. Haiselden believed it is "our duty to defend ourselves and future generations against the mentally defective." Five days after foregoing surgery, Baby Bollinger died.
Haiselden, then, brought this case to the public through a press conference and argued in defense of the Bollinger case: first, a merciful death is more humane than a life of suffering, and second, it is our responsibility to protect our society from the burden of certain disabilities.[2] Haiselden drew supporters and critics alike through his support for euthanasia in the United States. Unlike Jack Kevorkian, Haiselden did not assist patients who wished to be euthanized. Instead, Haiselden chose to euthanize babies who were born with deformities and began advocating aggresively.[3] Following the Bollinger case, Haiselden began withholding life-saving treatment from other disabled babies, in addition to campaigning for the euthanizing of the terminally ill.[2]
Baby Doe regulations
On April 9, 1982 in Bloomington, IN, "Baby Doe" was born with Down syndrome and a tracheo-esophogeal fistula (TEF). While knowing surgical intervention to resolve the TEF is a relatively standard procedure and essential to live, the baby's parents and obstetrician chose against it. This decision, met with resistance from other attending physicians, ultimately led to a court trial. The court determined that the parents were free to decline the surgery their baby needed because of mixed expert opinions of the hospital doctors. Baby Doe died six days later. This case quickly became a nation-wide debate and garnered the attention from then U.S. Surgeon General, Dr. C. Everett Koop. Koop, a pro-life proponent and retired pediatric surgeon, condemned the court ruling.[4]
One year later, the Reagan administration orchestrated new regulation creating the notorious "Baby Doe Squads" and toll-free hotline to answer any complaint concerning potential abuse of a disabled infant. Known as the Baby Doe regulations, these were eventually overturned. In 1984, Congress legislated additional amendments to the Child Abuse Protection and Treatment Act (CAPTA) outlawing the withholding of necessity-based medical care, specifically noting "appropriate nutrition, hydration, and medication,"[4] from disabled neonates unless "(A) the infant is chronically and irreversibly comatose; (B) the provision of such treatment would (i) merely prolong dying, (ii) not be effective in ameliorating or correcting all of the infant's life-threatening conditions, or (iii) otherwise be futile in terms of the survival of the infant; or (C) the provision of such treatment would be virtually futile in terms of the survival of the infant and the treatment itself under such circumstances would be inhumane."[4]
Groningen Protocol
Bente Hindriks, born in 2001 at Groningen University Medical Center in the Netherlands, was immediately diagnosed at birth with the rare genetic disorder, Hallopeau-Siemens syndrome. The disease features chronic blistering and peeling of the epidermis and mucous membranes. There is no effective treatment, while the damage on the top layer of the skin comes with severe, unmitigated pain. Bente's diagnosis was impossible to treat and her prognosis of skin cancer would take her life in five to six years. Her pediatrician, Dr. Eduard Verhagen, could do nothing to help. Though illegal at the time, Bente's parents wished to end her suffering with active euthanasia. Ultimately, it is believed that the high dose of morphine that Dr. Verhagen administered to ease her pain killed Bente.[5]
Four years after Bente Hindriks' death, Dr. Verhagen began campaigning for policy change that called for permitting infant euthanasia under specifically strict guidelines. While he continued on this pursuit, Dr. Verhagen publicly stated that he terminated the lives of four more infants, all with severe cases of spina bifida. Called "Dr. Death"[5] and "a second Hitler"[5] by some, Verhagen continued along with his hope for a "nationwide protocol that allows each pediatrician this delicate question with due care, knowing he followed the criteria,"[5] to end his patients' lives simply out of compassion. Dr. Verhagen felt that strict regulations on infant euthanasia would prevent uncontrolled and unjustified instances of euthanasia. In 2005, Dr. Verhagen and Dr. Sauer with a team of prosecutors formalized the Groningen Protocol.[5]
The agreement follows that no charges shall be pressed against physicians who perform end-of-life procedures on infants who meet the following five criteria:[5]
- The infant's diagnosis and prognosis must be certain.
- The infant must be experiencing hopeless and unbearable suffering.
- At least one independent physician must confirm that the first two conditions are met.
- Both parents must give their consent.
- The termination procedure must be performed in accord with the accepted medical standard.
Furthermore, neonates and infants who might be considered candidates for end-of-life decisions are divided into three categories:[5]
- Infants with no chance of survival who are likely to die soon after birth, even if they receive the best medical and surgical care available.
- Infants who are sustained by intensive care but have a bleak prognosis.
- Infants who have a hopeless prognosis and experience unbearable suffering.
Belgium
Belgium legalized euthanasia for terminally-ill adults in 2002. As it stood then, euthanasia could only be applied to citizens over eighteen years of age or, in rare accounts, a category of individuals called "emancipated minors."[6] In years to follow, the debate on euthanasia opened up to the idea of this same law being extended to minors. On February 13, 2014, an amendment to the 2002 Euthanasia Act made it legally permissible for minors, regardless of age, to pursue euthanasia as long as they fit a few specific criteria. The amendment states that minors who request euthanasia must exhibit the ability to judge their current state of affairs when in a "medically futile condition of constant and unbearable physical suffering that cannot be alleviated and that will, within a short period of time, result in death, and results from serious and incurable disorder caused by illness or accdient."[7]
The provisions of this amendment to the 2002 Euthanasia Act have distinguishable differences between the act applied to adults and minors. First, the law establishes that only physical suffering may be valid for minors, while physical and psychological suffering is plausible reasoning for adults and the emancipated minors to pursue end-of-life care by euthanasia. Second, the amendment says that the presumed death of a minor should result within a short period of time, whereas no timeframe of expected death is needed for adult cases. Finally, this extension to minors requires that multiple physicians and legal representatives sign-off on the mental capacity of the patient, reinforcing that the minor is competent of his or her condition and decision to die.[6]
Ethical considerations
Generally, when a newborn's life is contested, the parents are the ones who determine their child’s future. The parents and the doctor both take part in making the decision. When there is persistent disagreement, the case may be taken to court where the decision is made. Considerations include the cost of treatment and the newborn's quality of life. The cost of the treatment includes medical resources and their availability.[8] The newborn’s quality of life will depend on whether the treatment is applied, continued or ceased (which can result in passive euthanasia). This can also be classified as a crime under certain laws without the approval of parents. There are ongoing debates about parents' roles in choosing euthanasia for their children, and whether this can be considered voluntary euthanasia. Specifically, if considered voluntary euthanasia it is because the parents authorized it and they have a say in the life of their children.[9]
The concept of child euthanasia has sparked heavy debate. For example, Eric Kodish and Daniel A Beals[10] have compared child euthanasia to infanticide. Kodish says "the very notion that there is an “accepted medical standard” for infanticide calls for resistance in the form of civil disobedience".[11] Others, such as Joseph Fletcher, founder of situational ethics and a euthanasia proponent, proposed that infanticide be permitted in cases of severe birth defects. Fletcher says that unlike the sort of infanticide perpetrated by very disturbed people, in such cases child euthanasia could be considered humane; a logical and acceptable extension of abortion.[12] American bioethicist Jacob M. Appel goes one step further, arguing that pediatric euthanasia may be ethical even in the absence of parental consent.[13] Bioethicists Alberto Giubilini and Francesca Minerva argue that killing a newborn "should be permissible in all the cases where abortion is, including cases where the newborn is not disabled".[14] A recent psychological study in Belgium showed that people who disapprove the legalization of child euthanasia tend to be religious, have low flexibility in existential issues, endorse collectivistic morality (values of loyalty and purity), and/or express ingroup-oriented prosocial inclinations.[15]
Religious views
Buddhism
Catholicism
Hinduism
Islam
Judaism
Physician sentiment
Child euthanasia by country
Belgium
On February 13, 2014, Belgium became the first country to allow voluntary child euthanasia without any age limit.[16]
Netherlands
In the Netherlands, euthanasia remains illegal for patients under the age of 12. However, Eduard Verhagen has documented several cases of infant euthanasia. Together with colleagues and prosecutors, he has developed a protocol to be followed in those cases. Prosecutors will refrain from pressing charges if this "Groningen Protocol" is followed.[17][18]
This Protocol prompted a very critical response from Elio Sgreccia, the head of the Pontifical Academy for Life.[19]
United Kingdom
The Nuffield Council on Bioethics launched an enquiry in 2006 into critical care in fetal and neonatal medicine, looking at the ethical, social and legal issues which may arise when making decisions surrounding treating extremely premature babies.
The Royal College of Obstetricians and Gynaecologists, in its submission, recommended that a public debate be started around the options of "non-resuscitation, withdrawal of treatment decisions, the best interests test and active euthanasia" for "the sickest of newborns".[20] The College stated that there should be discussion over whether "deliberate intervention" to cause death in severely disabled newborn babies should be legalised; it stated that while it was not necessarily in favour of the move, it felt the issues should be debated. The College stated in this submission that having these options would save some families from years of emotional and financial suffering; it might also reduce the number of late abortions, "as some parents would be more confident about continuing a pregnancy and taking a risk on outcome".[20] In response to this proposal, Pieter Sauer, a senior paediatrician in the Netherlands, argued that British neonatologists already perform "mercy killings" and should be allowed to do so openly.[20]
The Church of England submission to the enquiry supported the view that doctors should be given the right to withhold treatment from seriously disabled newborn babies in exceptional circumstances, and the Christian Medical Fellowship stated that when treatment would be "a burden" this was not euthanasia.[20][21][22]
United States
In the United States, euthanasia remains illegal for children under the age of 18.[23]
See also
- Non-voluntary euthanasia
- Child euthanasia in Nazi Germany
- Joseph Maraachli case
- Robert Latimer
- The Giver
- infanticide
- neonaticide.
References
- ^ "Dr. Haiselden of Chicago Refuses to Operate to Save a Day-Old Infant. Physician, Who Acted Similarly in the Bollinger Case, Suspects Pre-Natal Influence". New York Times. July 25, 1917. Retrieved 2008-12-28.
{{cite news}}: Cite has empty unknown parameter:|coauthors=(help) - ^ a b Gerdtz, John. "Disability and Euthanasia: The Case of Helen Keller and the Bollinger Baby" (PDF). Life and Learning. 16: 491–500.
- ^ Cheyfitz, Kirk (1999–2000). "Who Decides? The Connecting Thread of Euthanasia, Eugenics, and Doctor-Assisted Suicide". Omega. 40 (1): 5–16. doi:10.2190/djfu-aawp-m3l4-4alp.
- ^ a b c "Neonatal Euthanasia". doi:10.1053/j.semperi.2009.07.005.
{{cite journal}}: Cite journal requires|journal=(help) - ^ a b c d e f g Munson, [edited by] Ronald (2014). Intervention and reflection : basic issues in bioethics in bioethics (Concise ed. ed.). Boston, MA: Wadsworth/Cengage Learning. p. 524-527. ISBN 978-1285071381.
{{cite book}}:|edition=has extra text (help);|first1=has generic name (help) - ^ a b Raus, Kasper (1 June 2016). "The Extension of Belgium's Euthanasia Law to Include Competent Minors". Journal of Bioethical Inquiry. 13 (2): 305–315. doi:10.1007/s11673-016-9705-5. ISSN 1176-7529.
- ^ "Act amending the Act of 28 May 2002 on euthanasia, sanctioning euthanasia for minors". Belgian Official Gazette. 2014009093: 21053. 2014.
- ^ Slansky, Mark (2007). "Neonatal euthanasia: moral considerations and criminal liability". Journal of Medical Ethics. 27 (1): 5–11. doi:10.1136/jme.27.1.5.
- ^ Cohen-Almagor, Raphael (2002). "Non-voluntary and involuntary euthanasia in The Netherlands: Dutch perspectives". Croatian Journal of Philosophy. 5: 162–163.
- ^ Daniel A. Beals (2005). "The Groningen Protocol: Making Infanticide Legal Does Not Make It Moral" (2 ed.). The Center for Bioethics & Human Dignity. Trinity International University.
- ^ Kodish, Erick (2008). "Paediatric ethics: a repudiation of the Groningen protocol". The Lancet. 371 (9616): 892–893. doi:10.1016/S0140-6736(08)60402-X.
{{cite journal}}: Invalid|ref=harv(help) - ^ Fletcher, Joseph (1978). "Infanticide and the ethics of loving concern". In Kohl, Marvin (ed.). Infanticide and the Value of Life. NY: Prometheus Books. pp. 13–22. ISBN 978-0-87975-100-5.
- ^ Appel JM (May 2009). "Neonatal Euthanasia: Why Require Parental Consent?". Journal of Bioethical Inquiry. 6 (4): 477–482. doi:10.1007/s11673-009-9156-3.
- ^ Giubilini, A.; Minerva, F. (2012). "After-birth abortion: Why should the baby live?". Journal of Medical Ethics. 39 (5): 261–263. doi:10.1136/medethics-2011-100411. PMID 22361296.
- ^ Deak, C. & Saroglou, V. (2017). Terminating a child’s life? Religious, moral, cognitive, and emotional factors underlying non-acceptance of child euthanasia. Psychologica Belgica, 57(1), pp. 59–76. http://doi.org/10.5334/pb.341
- ^ "Belgium's parliament votes through child euthanasia". BBC News. 2014-02-13. Retrieved 2014-03-05.
- ^ Verhagen, Eduard; Sauer, Pieter J.J. (2005). "The Groningen Protocol — Euthanasia in Severely Ill Newborns". The New England Journal of Medicine. Vol. 352, no. 10. pp. 959–962. doi:10.1056/NEJMp058026. PMID 15758003.
- ^ "Outrage from Churches over Euthanasia on Newborns". December 1, 2004. Retrieved 2007-05-22.
- ^ Statement by Mgr Elio Sgreccia Archived October 20, 2012, at the Wayback Machine
- ^ a b c d Templeton, Sarah-Kate."Doctors: let us kill disabled babies", Sunday Times, 2006-11-05 (retrieved 11-2011).
- ^ "Church supports baby euthanasia - Times Online". The Times. London. November 12, 2006. Retrieved 2007-10-19.
{{cite news}}: Cite has empty unknown parameter:|coauthors=(help) - ^ "Church enters euthanasia debate". BBC News. 12 November 2006. Retrieved 2007-10-19.
- ^ Brouwer, Marije; Kaczor, Christopher; Battin, Margaret P.; Maeckelberghe, Els; Lantos, John D.; Verhagen, Eduard (9 January 2018). "Should Pediatric Euthanasia be Legalized?". Pediatrics. pp. e20171343. doi:10.1542/peds.2017-1343.
