Recently in Belgium the Parliament has approved a modification of the law regulating assisted death, and consequently has decriminalized euthanasia in minors; It is not the first country to include such an amendment in its laws, since it is also allowed in the Netherlands (under strict conditions). The Belgians however, have preferred not to place a minimum age to be able to decide on this matter, but are based on the mental maturity of the child.
This is a non-controversial issue, although the authors of the legal text have not ceased to explain that it will be up to the doctor in charge in each case, to evaluate (after consulting with a child psychiatrist) if the minor who wishes to be admitted is able to adopt the decision. The possibility is limited to minors suffering from a terminal illness that causes them to suffer "impossible to alleviate"; and the legal representatives of the child must consent.
It should be clarified that the project must still be ratified by King Felipe of BelgiumThe vote after which the law was modified was preceded by positions found: on the one hand it seems that 74 percent of the population (according to a survey conducted by "La libre Belgique") was in favor of the minors also being able to take advantage of this possibility; on the other, the detractors of the measure, considered that there was not enough consensus, and that the effort to modify the law was perhaps too hasty. Certain political sectors, and a good number of pediatricians positioned themselves against.
Among the questions asked by opponents is "Can a child under 10 years of age really make such a decision by understanding what he is facing?". And meanwhile, on the side of those who supported the modification, it was alleged (among other things) the difficulty of some doctors to make decisions in terminal cases without violating the law.
It is such a complex and painful issue that, indeed, it is difficult even to expose, however, I bring the position of the Spanish Society of Outpatient Pediatrics (SEPEAP), a medical entity that has expressed the need for debate and ethical reflection about “How the care of children should be at the end of their life, and what their role in making clinical and vital decisions should be”.
It is explained that although the attention to children's diseases has improved, the suffering related to the disease has not been eliminated. But even in cases like some types of cancers, or certain trauma, the fact that patients are not curable occurs, but It does not mean that they cannot benefit from what is understood by “palliative care” (In fact "relieving" is one of the purposes of Medicine).
“All pediatricians should be involved, in one way or another according to our training and dedication, in the care of children suffering from chronic, incurable diseases, but for whose associated sufferings (in particular, pain) we have effective and safe resources in the most cases ”.
Sometimes, and despite the resources, the suffering is not controllable, or the disease is progressive (or perhaps present exacerbations), with a bad quality of life. For many years, the option of limiting therapeutic effort has been used (always by agreement between professionals and family members, and if possible, the child).
In the same way that palliative care must be performed at home, to allow the child to integrate into their socio-family environment, the death of chronic patients should occur at home, being cared for and accompanied by their loved ones in the last moments of life. Pediatricians should take advantage of this option and do everything possible so that the death of a child does not occur in the cold, technical and often lacking in privacy of the hospital.
When the conflict arises (keeping life in unworthy conditions / the patient's request to end his life), All aspects should be analyzed by the parties involved, and with the help of professionals with experience in healthcare ethics.
The bioethics committee of the Spanish Association of Pediatrics states that the group of health professionals, cannot ignore the pending dialogue about euthanasia; even when they clearly bet on life, and for the help to die without pain, with dignity and with the appropriate palliative care.
In Belgium the debate was sour, and it was accompanied by protests and also demonstrations in favor. With little training (if not null) in these matters, and from outside it is really difficult to analyze this legislative change; however I agree with the SEPEAP in that This is one of the topics that requires a broad social debate, which includes all possible positions, and the need to reflect on this.
