LSR Visiting Facutly Fellow‚ Luc Bovens‚ discusses child euthanasia at an Ira W. DeCamp Bioethics Seminar.

Dec. 18, 2015

UCHV Graduate Prize Fellow‚ Madison Kilbride‚ recounts the event.

Child Euthanasia: Shall we Just Not Talk About It?
Laurance S. Rockefeller Visiting Faculty Fellow, Professor Luc Bovens gave a talk at an Ira W. DeCamp Bioethics Seminar in November titled “Child Euthanasia—Shall We Just Not Talk About It?” Bovens is head of the Department of Philosophy, Logic, and Scientific Method and Coordinator of the MSc Programme in Philosophy and Public Policy at the London School of Economics.

In February 2014, Belgium became the first country in the world to lift an age restriction on euthanasia. Under the law, a child of any age can receive euthanasia, so long as certain conditions are met, which are stricter than those imposed on adults.  In order to be eligible for euthanasia, a minor must request it; have a physical condition resulting from illness or accident; be terminally ill, have a short-term life expectancy; experience constant and unbearable physical pain that cannot be relieved; and be capable of understanding and appreciating the nature and significance of euthanasia. Additionally, the child’s legal representatives must provide consent.

Bovens raises a number of questions about the extension of euthanasia to minors.  While adults may consider euthanasia for both physical and psychological conditions as well as for terminal and non-terminal illness, minors cannot receive euthanasia for anything other than physical and terminal conditions. Bovens recognizes that it is appropriate to prevent minors from receiving euthanasia for psychological disorders like anorexia or depression or when they are faced with the prospect of living with a disability.  However, he asks whether it is reasonable to prevent a child from receiving euthanasia during the non-terminal stage of her terminal disease because she suffers despair due to her bleak prospects. Bovens also points out that as mature minors are legally allowed to make many weighty decisions about their health care autonomously—including whether to refuse life-saving treatment—it is difficult to justify requiring parental consent for euthanasia.Finally, he asks whether and under what conditions advance directives should be available for euthanasia and whether they would also be appropriate for minors in certain situations.

Bovens then considers—and ultimately rejects—arguments which propose that child euthanasia is morally worse than adult euthanasia. Opponents of child euthanasia maintain that children are incapable of requesting it. In response to this, Bovens points out that if we think minors are capable of refusing life-saving medical treatment, then it is difficult to argue that they are incapable of requesting euthanasia. In fact, refusing life-saving treatment may be the weightier decision. After all, a minor who refuses life-saving treatment could have a full life ahead of her, but for the terminally-ill minor who seeks euthanasia, untimely death is a foregone conclusion.

Opponents of child euthanasia have also argued that children may be pressured into euthanasia by parents and guardians, or that they are more inclined to choose euthanasia because they are especially sensitive to parental pressure and thus motivated by a desire to meet their family’s expectations. Bovens maintains that neither of these arguments are convincing.  Finally, some opponents of child euthanasia have held that euthanasia is only permissible when suffering cannot be relieved. They argue that since palliative care can always alleviate physical suffering, euthanasia for minors is unnecessary. In response, Bovens asks how we evaluate whether an individual’s suffering can be alleviated: Should we make the determination based on whether pain relief and sedation is sufficient to relieve an individual’s physical suffering? What if a patient refuses palliative measures? Should we base our assessment of whether an individual’s pain can be alleviated by considering his willingness to receive palliative care? Ultimately, Bovens grapples with the question: should children be treated differently than adults?

In response to Bovens’ talk, David Velleman, Professor of Philosophy at New York University, argued that euthanasia should not be a legal option for either adults or children. There are certain situations, he said, in which it is preferable to not have a choice. He provided the following example of an “unwanted invitation” to illustrate this point: Imagine that you have an acquaintance who is throwing a party that you do not want to attend. If the acquaintance does not invite you, you do not have to decide whether to go. Not being invited is therefore the preferred outcome.  But if the acquaintance sends an invitation, you are placed in the uncomfortable position of having to either (a) go to the party or (b) make up an excuse to avoid going. Both of these choices are worse than not having been invited in the first place.

Velleman draws an analogy between the unwanted invitation and euthanasia. He explains that when euthanasia is not a legal option, a patient can only choose palliative care. However, when euthanasia is a choice, a patient must decide between the two. Absent a choice, the patient may actually prefer the available option: palliative care over the unavailable option: euthanasia. But when a patient has a choice between palliative care and euthanasia, she may prefer euthanasia since she now feels that she has to provide a justification for her continued existence. Velleman argues that by making euthanasia a legally available option, patient welfare may be reduced because one can no longer pursue her preferred option, which is to have palliative care without a choice: however, Velleman does think that sometimes it is appropriate for ethics boards to grant euthanasia requests on an individual, unpublicized basis.