Health Minister Ernst Kuipers said that children aged five to 12 years can obtain lethal injections if "life termination is the only viable option to end the child's hopeless and unbearable suffering".

The country already allows the euthanasia of gravely ill newborn children under the infamous Groningen Protocol.

According to the NLTimes, Mr Kuipers said he expects the regulations to be implemented within the year.

He said he also expected up to 10 primary school-age children a year to die by lethal injection as a result.

The regulations will work by exempting doctors from prosecution if they perform an approved child euthanasia.

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It was a controversial decision and the controversy is far from over.

Three issues were left hanging: euthanasia for "mature minors", euthanasia for people with mental illness, and advance directives for euthanasia.

The government asked the Council of Canadian Academies to produce a report on these issues by December this year.

Euthanasia for mature minors is a particularly sticky issue.

In the Journal of Medical Ethics, several Canadian paediatricians and bioethicists construct an argument supporting it.

First of all, they frame euthanasia (MAID) a part of a continuum of palliative care.

it is wrong to force a person to live in circumstances of unendurable and irremediable suffering and ... the wishes of capable patients should be respected within legal limits, especially in such an intimate matter as how they choose to die. Persons, in other words, have a right to life, not a duty to live ...

If MAID is essentially a normal medical procedure, it follows that there is no need for "special procedures for managing communication, confidentiality and capacity assessment".

One consequence of this is that doctors should be proactive in suggesting euthanasia to children for they have an obligation to inform patients of their healthcare options.

What about a young person's capacity for consent?

In Ontario, "young people can be and are found capable of making their own medical decisions, even when those decisions may result in their death".

This is not universally accepted in Canada, so it may be necessary to tweak the law.

How about the role of parents?

What if a young person requests MAID but their parents object?

The authors argue that if a young person is capable of making their own medical decisions, there is no reason why parents have to be informed.

"If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way." Continue reading

The article by Sick Children's doctors, administrators and ethicists and backed by the University of Toronto's Joint Centre for Bioethics was published last month in British Medical Journal's J Med Ethics.

In December this year, The Canadian Council of Academies is due to report to Parliament and to the public on the medical consensus about extending voluntary euthanasia in circumstances currently forbidden by law.

The main question the Canadian Council of Academies is specifically looking at is:

"What is the available evidence on, and how does it inform our understanding of, ... MAID in the case of mature minors, advance requests and where mental illness is the sole underlying medical condition, given the clinical, legal, cultural, ethical and historical context in Canada?"

In a flowchart that outlines how a medically induced death would occur at Sick Kids, the authors don't mention discussing with family or parents how the child dies until after the death occurs in the "reflection period."

The authors say patient confidentiality is the deciding factor in whether to include parents in assisted death choices.

In general, the authors say families are involved in end-of-life decisions.

"If, however, a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although health care providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected."

The Sick Kids' proposed policy and procedures argue there is no meaningful ethical distinction between a patient choosing to refuse burdensome treatment and accepting an inevitable death versus patients who choose to die by chemical injection before the disease brings on death.

The authors point out that legally, the state of Ontario (and therefore its provincial capital Toronto) does not require parents to be involved in a capable minor's decision to refuse further treatment.

This being the case, they say there is no legal reason to require parent involvement in an assisted death.

Source

• Catholic Herald
• Crux Now
• Catholic Register
• Image: CTV News