Articoli, saggi, Fine vita -  Redazione P&D - 2014-04-23

PEDIATRIC EUTHANASIA IN BELGIUM - Andrew M. SIEGEL

On February 13, 2014, Belgium"s Parliament approved an amendment of the 2002 Belgium Act on Euthanasia to allow euthanasia for chronically ill children. The amendment, supported by a majority of Belgians and recently signed into law by King Philippe, permits euthanasia for children who are experiencing "constant and unbearable suffering." In addition to requiring the child"s own voluntary and explicit request for euthanasia, the new law requires parental consent, excludes children with an intellectual disability or mental illness, and mandates a multidisciplinary team carefully examine the child"s capacity for discernment.

The passage of this law marks the culmination of years of increasing acceptance of euthanasia in the Benelux region. To date, the Netherlands, Belgium, and Luxembourg are the only member states in the European Union in which euthanasia is legal. In Belgium, euthanasia for adults has been lawful since May 2002. A study examining the attitudes of physicians involved in the care of Belgian children under the age of 18 years who died between June 2007 and November 2008 revealed that the majority (69%) favored extending the Belgian law on euthanasia to include minors. Those physicians favoring extending the law were more likely to engage in practices intended to shorten their patient"s life.

In March 2005, recognizing the rising incidence of pediatric euthanasia without any legal sanction, physicians at the University Medical Center of Groningen, in the Netherlands, published practice guidelines for the ethical implementation of euthanasia for severely disabled newborns. The Groningen protocol stipulates that the provision of active euthanasia is justifiable for a class of infants "with a hopeless prognosis who experience what parents and medical experts deem to be unbearable suffering." The protocol specifies that the termination of a child"s life is acceptable if 4 requirements are met: the presence of hopeless and unbearable suffering, the consent of both parents, consultation with physicians, and the termination procedures comport with "medical standards."

In contrast to the Belgium law, the Groningen protocol represents a form of nonvoluntary active euthanasia, in which the patient—a neonate—never possessed the capacity to develop preferences.

Meanwhile, US support for physician aid in dying for adult patients is slowly evolving, as evidenced by legislation legalizing the practice in the states of Washington, Oregon, and Vermont and favorable court opinions in Montana and New Mexico. Although US laws only apply to competent adult patients, developments in Belgium and the Netherlands may stoke the debate about the ethical permissibility of pediatric euthanasia in the European Union and in the United States.[...]

Tratto da JAMA. Published online April 17, 2014. doi:10.1001/jama.2014.4257

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