In the Netherlands, Health Minister Ernst Kuipers wants to approve the administration of euthanasia to children aged between 1 and 12 who suffer from a terminal illness, through a legal reform. He has announced that he intends to extend the Groningen Protocol, adopted in 2005, to include children under the age of 12.

The initiative is very likely to be supported by a parliamentary majority. At present, euthanasia in the Netherlands is only allowed for children over 12 years of age who are experiencing “unbearable and endless suffering” and for children under one year of age with the consent of their parents.

The proposed protocol contains seven criteria:

  1. The doctor must be convinced, on the basis of «prevailing medical knowledge», that the child’s suffering is unbearable and hopeless.
  2. The opinion of an independent expert will be required.
  3. The doctor must be convinced that euthanasia is «the only possible option to alleviate suffering».
  4. The diagnosis will have to be shared «in its entirety» with the parents, but it must also be talked about it with the child «in a manner adapted to their level of understanding».
  5. Both parents must give their consent.
  6. The doctor must ensure that the child is not subjected to euthanasia “against his or her will”.
  7. Finally, the euthanasia process must be carried out with «medical care».

Bioethical assessment

The new Dutch proposal to further extend the application of euthanasia to children under 12 years of age confirms the “slippery slope” experienced by countries with a longer history  in terms of legally ending the lives of their patients.

Although the proposal reveals the most sinister side of euthanasia — which is unacceptable in any case in terms of respect for dignity and human rights — three particularly worrying aspects should be highlighted.

The first of these is the proposal to end the lives of completely immature patients, who as such are unable to make decisions of this magnitude, and who cannot in any way properly evaluate nor reasonably assume their consequences. This is yet another example of the expansion of the principle of autonomy that seeks to extend it to the making of harmful and irreversible decisions by people who are unequipped to make a free choice.

The second is the current extension of involuntary euthanasia, i.e., homicide, or rather murder, in the case of parents who decide to end the life of their child under the age of 1. Now it can also be done at any age. The existence of involuntary euthanasia — actual murder — is already well-known in the Netherlands and Belgium and has been applied to elderly people for some years, as several studies show.

Finally, the advance of palliative medicine, which consists of caring for patients with an incurable illness, avoids resorting to euthanasia as a means of alleviating patient suffering.

The use of “unbearable suffering” as an argument often wielded by advocates of ending patients’ lives in order to justify euthanasia is an unacceptable manipulation, because the implementation of quality palliative care, even in children, today allows reasonably good control of so-called “refractory symptoms”, symptoms that are difficult to control by conventional means.

We are once again faced with the greatest and most retrogressive failure of medicine, culture and the defense of human rights in caring for the most disadvantaged and needy. Any civilization that ends the life of these people, its weakest members, shows nothing but worrying signs of decline.

Julio Tudela

Bioethics Observatory – Institute of Life Sciences

Catholic University of Valencia

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