Facing Assisted Suicide and Euthanasia in Children and Adolescents
REGULATING HOW WE DIE: THE ETHICAL, MEDICAL, AND LEGAL ISSUES SURROUNDING PHYSICIAN-ASSISTED SUICIDE, pp. 92-119, 274-294, Linda L. Emanuel, ed., Harvard University Press, 1998
51 Pages Posted: 22 Jan 2011
Date Written: 1998
Advocacy for legitimating physician-assisted suicide and euthanasia in the United States has largely ignored children and adolescents. Instead, advocates have concentrated on competent adults. Support for assisted suicide and euthanasia thus rests on the assertion of competent patients’ rights and physicians’ duties of beneficence. By limiting proposals to competent adults, advocates brandish the sword of patient self-determination, while using voluntary choice as a shield against charges of abuse.
Relegating pediatric assisted suicide and euthanasia to the margins is reassuring. The intentional killing of children and adolescents, or assistance in their suicides, is surely more disquieting than the same practices among competent adult patients. But conducting the debate over assisted suicide and euthanasia without examining the consequences for minors ignores too much. It ignores reported cases of pediatric euthanasia in this country. It also ignores the Dutch experience of initially permitting only adult euthanasia but then discovering pediatric cases. The Dutch pediatric and medical associations now actually advocate pediatric euthanasia and assisted suicide, and courts are excusing it. Avoiding the pediatric issues ignores, too, the fact that minors may be more vulnerable to euthanasia and more apt to request assisted suicide than many others in the United States because of inferior pain relief, the large numbers who are poor, the substantial number who are uninsured, the complex dynamics of parental decision making for ill or disabled minors, and psychological differences between adults and those who are younger. Finally, it ignores the difficulty of confining any right to these practices to adults, as rights to termination of life-sustaining treatment and abortion - the roots, many argue, of rights to assisted suicide and euthanasia - have already been extended to minors.
This chapter argues that avoiding the pediatric issues is a mistake. It risks having the practices occur among children and adolescents with no applicable justification, no consideration of the special dangers, and no specific safeguards. This minimizes the rights and interests of minors and fails to reach the question of how far legitimation of assisted suicide and euthanasia should go. The chapter explores the current neglect of pediatric issues in the United States and then the cautionary tale of the Dutch experience. Building on the empirical data and normative arguments, the author argues that pediatric application of euthanasia and assisted suicide should be rejected.
Keywords: Physician-assisted suicide, euthanasia, termination of life-sustaining treatment, end-of-life care, infants, newborns, children, adolescents, Dutch euthanasia, euthanasia in the Netherlands, health law, constitutional law, bioethics
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