Euthanasia: A child’s choice?

Rev Dr Gerard Aynsley

It is difficult to imagine a more painful reality than that faced by parents of a terminally ill child. Is child euthanasia the answer? In Belgium politicians have voted overwhelmingly ‘yes’.

Chris Cleave, in his 2012 novel, ‘Gold’, takes the reader into the mind of seven-year-old Sophie who is receiving treatment for Leukaemia. The author gives a powerful portrayal of the sort of angst a child may experience when seriously ill and the ways the child will, quite naturally, be concerned for her parents. Sophie is forever attempting to protect her parents from knowing how sick she is, and, in doing so, unwittingly prevents her parents from being involved in her care. I was reminded of the character, Sophie, when reading in Saturday’s Otago Daily Times (15.02.14) that members of the Belgium Parliament had voted 86 to 44 in favour of lifting restrictions to their present Euthanasia law so that terminally ill children could request the assistance of a physician to end their life. The Belgium proposal takes into account that a child’s “legal age isn’t the same as mental age” and that a child can have “a capacity for discernment”. I concur that a child has the capacity to make important choices, but the vulnerability of the child and the possibility that, like Sophie, a child may inadequately understand a situation must be kept in mind.

It was as a member of the Otago Ethics Committee some years ago that I saw some of the practical ways in which a child’s capacity to choose could be honoured. As a committee we held strongly to the view that children should, where possible, be included in the consent process and in discussions about their own health. Inasmuch as it was possible our committee would insist that researchers involve the children in the decision-making and that they explore ways of conveying information that was accessible to the particular age of the child. We also encouraged researchers to have an agreement form for the child to complete additional to the legal consent signed by the child’s parent or guardian. While there was a deep respect for the child’s choosing capacity, forefront in our minds was the fact that children are vulnerable, and a sick child is particularly vulnerable. A child needs others to stand up for them; to ensure there are proper safeguards; to consider the more complex possibilities. The vulnerability of the child needed to be taken into account and the most important way this was addressed was by ensuring the child’s choosing didn’t occur in isolation.

Choosing doesn’t occur in a vacuum, but rather in a complex web involving the lives of others who are also making choices that intersect and overlap with our own. As human beings we make choices, not only with our own needs in mind, but also for the sake of an ‘other’: we choose to spend time with them; to help out; to forgive; to show kindness; to bear with the other in their difficulties. Children are indeed capable of making choices to do with their own wellness, but they especially need the choices of adults to overlap and intersect with their own choosing. The Belgium proposal may appear on the surface to show respect for children and their capacity to choose, but it fails to sufficiently take into account the child’s vulnerability and the child’s need for adults who are called upon to make good choices for their sake.

One of the things that makes a child particularly vulnerable when it comes to making choices is the simple fact that she or he has limited experience. This can impact on how they form an understanding of the situation requiring a decision. A child may not see the whole picture or may not understand fully the various options available to them. A child may be confused in their summing up of a situation. Think, for example, of the child who imagines he is responsible for his parents’ choice to separate. Similarly, a child who is seriously ill may see herself as the cause of her parent’s suffering and think that if she were no longer around her parent’s suffering would be lessened or alleviated. Sophie, in the novel, ‘Gold’, was looking at things in this way. The legal age is set for a very important reason. Children need the protection and care of adults. Children, whose minds are developing and whose experiences are limited need to be protected from the burden of thinking they have both the power and responsibility to make things better for their families.

In fact, all people living with a life-limiting illness need to be protected from this burden. It goes to the heart of why euthanasia is a bad idea for adults as well as children. The claim that an earlier death will somehow make everything alright is a spurious one that is not resolved by a simple appeal to ‘choice’ or the capacity to choose.

Rev Dr Gerard Aynsley is a parish priest in the diocese of Dunedin. He holds a PhD in philosophy from Monash University in Australia