Catholic Communications, Sydney Archdiocese report:
14 Feb 2014
For terminally ill children life may well still be worth living
Shockwaves have been felt across the world following the decision by Belgium to legalise euthanasia for on terminally ill children.
Belgium has now become the first country in the world to remove any age restriction on euthanasia or the killing of terminally ill children.
Twelve years after legalising voluntary euthanasia for consenting adults, this radical extension of euthanasia law was passed by Belgium's Parliament early this morning Australian time and gives children "the right to die."
Twelve years after legalising voluntary euthanasia for consenting adults, this radical extension of euthanasia law was passed by Belgium's Parliament early this morning Australian time and gives children "the right to die."
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Under the plan passed by the Belgium Parliament with an overwhelming majority of 86 to 44 there is no age limit to minors suffering from a terminal illness who can seek a lethal injection.
Claiming that there are strict provisos to the new law, the Bill insists that the child must be "in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term."
Claiming that there are strict provisos to the new law, the Bill insists that the child must be "in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term."
A psychologist must also determine if the young patients who wish to die are in full possession of their mental faculties. Parents are also required to give consent.
"It is a terribly tragic outcome when the best we can offer a suffering child is to kill them," says Chris Meney, Director of the Archdiocese of Sydney's Life Marriage and Family Centre. "It also reveals where such a distorted understanding of compassion can lead us and proves that once the euthanasia line is crossed, there is no limit."
Dr Richard Chye Director of Sacred Heart Palliative Care
As Dr Colin Patterson, Senior Lecturer in Moral Theology at the John Paul II Institute in Melbourne, and a former child and family psychologist points out children have incomplete ego development and maturity of the brain to be able to make such an overwhelming decision as to whether they wish to live or die.
"The case against children having the option of euthanasia is in essence the same as that for adults and infringes on one of the most fundamental moral laws - don't take innocent human life - in order to relieve the suffering of a person," says Dr Patterson calling this a "profoundly anti-social way of thinking."
Dr Patterson finds it difficult to fathom the reasoning or thinking behind Belgium's move.
"I suspect, underlying this bill, an increasingly persvasive mode of thought in Western societies that holds that life is really not worth living, and that options for escaping it must be continually expanded," he says.
"I suspect, underlying this bill, an increasingly persvasive mode of thought in Western societies that holds that life is really not worth living, and that options for escaping it must be continually expanded," he says.
One of the arguments against Belgium's new law is that the majority of teenagers and certainly most children under the age of 12 are too immature to grasp the implications of such a momentous and final decision. Also in many cases for those who are terminally ill their ability to reason and weigh all the consequences of such a decision, will be affected by medication as well as other factors such as metastasis of the brain or a lack of oxygen.
Dr Richard Chye, Director of Sacred Heart Palliative Care, Darlinghurst agrees that medication and other factors may affect a person's judgement but he says many of the children he sees, especially those who have been very sick over prolonged periods, such as those with leukaemia, are often wise and more mature than the average 10 or 12 year old.
He has no doubt many of these youngsters have a good understanding of their situation. But although these children frequently have a sense of foreboding that things are not going in the "right direction" before their doctors or parents are aware of this, it does not mean that they wish to end their lives. Instead while they may decide it is inappropriate to undergo more treatments to extend their lives, they do no express any desire to shorten what time they have left," he says.
Children unlikely to understand full implications of euthanasia
Dr Chye says that while the quality of life in the eyes of parents or doctors for a child who is extremely ill may seem poor, from the child's point of view the quality may still be okay.
"In terms of the Belgium law to allow children and minors to be euthanised this could be a real problem with adults imposing their own idea about what is or isn't quality of life."
He also has concerns about how such a law would determine what is a life threatening or life limiting illness.
"In one case overseas a severely depressed patient requested and received euthanasia. He had found life not worth living. But while depression is a very serious illness and accompanied by much suffering, does it qualify as life threatening? Where does this legislation draw the line and what illnesses come under the Act?"
Another leading palliative care specialist, Dr Frank Brennan asks a similar question and he also wants to know what the Bill means by "when suffering cannot be alleviated."
"What is the threshold for suffering under Belgium's new law? And what definition of suffering is being used?" he wants to know.
A consultant at Calvary and St George Hospital and a senior lecturer at the University of NSW's School of Public Health & Community Medicine, Dr Brennan is also concerned if any of Belgium's terminally ill children have the capacity to meet consent conditions for any procedure let alone a life or death decision.
Dr Frank Brennan of UNSW and Palliative Care Consultant at Calvary and St George Hospital
"Without having seen the wording of the Bill and only having read newspaper reports about giving minors 'the right to die,' I would say that the issue of competency to make such a decision is critical," he says.
To be considered competent as an adult to make a voluntary decision over one's health - even for normal everyday procedures - a patient must have a full understanding of the nature of the risk of any treatment, he says.
"The second is that they are able to retain the information and the third is that they must also be able to reason and weigh this information. Any flaw in any one of these three criteria may be make the consent invalid," he explains.
For children under Belgium's controversial euthanasia laws there is also the danger of "undue influence" Dr Brennan believes and points out that although it is unlikely this would to come from the child's parents, it is possible it may come from a medical practitioner or some other person involved with the child.
"Throughout human existence and throughout all cultures there has been a general ethos that children are one of the most vulnerable groups in the community. Any aspect and behaviour, either legal or illegal that may impact on this vulnerability, has always been and should always be of great concern," he says.
Dr Brennan is also concerned that permitting children to be euthanised will lead to a loss of trust in doctors.
"I understand that 16 paediatricians signed a petition advocating that the age of 18 be removed and that euthanasia to have no age limit. But what will the effect be on parents if the doctors they trust to save lives, are now advocating taking the life of a child," he says.
The Executive Director of Family Life International, Paul Hanrahan is another who is shocked by the new law and warns that the decision by Belgium's Parliament shows the inevitability of what begins as "voluntary euthanasia" results in the "voluntariness" being removed.
Protesters against decision to allow terminally ill children to choose euthanasia
"Nothing highlights this more than what occurred in Belgium this morning," he says pointing out that more and more cases of "involuntary" deaths by lethal injection are being documented in the Netherlands which was the first nation that legalised euthanasia.
In the Netherlands teenagers are able to seek death by lethal injection but unlike Belgium, there is no euthanasia offered to minors under the age of 12.
"I am deeply saddened by yesterday's development. I cannot believe that a country that has been so Christian can believe that children can make such informed life and death decisions for themselves," says Sister of Charity, Sr Annette Cunliffe, former Chair of Catholic Health Australia and current President of Catholic Religious Australia.
A spokesperson for the Little Company of Mary Health Care (Calvary) describes euthanasia as a public act with adverse consequences for society.
"One person aiding the death of another is a significant public act and worthy of public concern. It can lead to abuse, exploitation and attrition of care for the most vulnerable in our society, including children. Even when fully consented, the 'choice' to euthansia opens a society to believe that a life is not worth living. This concept can easily be transferred to vulnerable and sick children, elderly, disabled or mentally suffering people in similar circumstances. We understand that people may feel their life is not worth living but it is very dangerous for us as a society to develop policy and clinical practices that require that we agree with them," the spokesperson says.
The Little Company of Mary Health Care, a national healthcare organisation and well known for the Calvary private and public hospitals across Australia is one of the leaders in palliative care.
Chris Meney, Director of Life, Marriage and Family Centre
"Palliative care and pain management is better today than it was yesterday and through an investment in people and research will continue to provide comfort to dying children and adults tomorrow," the spokesperson says.
At Palliative Care Australia, CEO Yvonne Loxford makes it clear that euthanasia is not part of palliative care practice.
"Palliative care offers a holistic multi-disciplined approach and when we talk about children who are terminally ill, the entire family is involved in this care. Social workers and pastoral carers are an incredibly important part of palliative care particularly in helping support the family of terminally ill adults as well as children, and caring for these loved ones after the child or adult has died," she says.
Although palliative care for children in Australia is still somewhat limited, particularly for peri natal palliative care despite 1200 infants dying before their first birthday each year, Yvonne says this is beginning to change.
"What we need is more money going into palliative care, more positions in paediatric palliative care and more doctors and nurses training in this field," she says. "There is still very little research in peri natal palliative care and there is certainly a need to encourage scholars to do more research in this area and as well as encourage doctors and nurses to specialise in this type of care."
To find out more about palliative care which not only treats pain but also depression, emotions and helps support families and loved ones as well as the terminally ill log on to www.palliativecare.org.au
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