Innocuous MAID, Finality of Euthanasia

"[An extension draft policy on the legal age restrictions for] medical-aid in dying: MAID [was developed] with an eye to a future when MAID may well become accessible to capable minors."
"Thus, this paper is intended as a road map through the still-emerging legal and ethical landscape of paediatric MAID."
"[There are doubts a difference of any meaning exists for the patient] between being consensually assisted in dying [in the case of MAID] and being consensually allowed to die [in the case of refusing life-sustaining interventions]."
"[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."
"How should health-care providers respond if a capable patient requests MAID but their parents clearly oppose this request? Are there situations in which MAID requests and administration would be kept secret from parents and other family members, for example, if a capable patient were to indicate that they do not want family members involved?"
Hospital for Sick Children, Toronto, draft policy team

Doctors from Toronto’s Sick Kids Hospital have outlined policies and procedures for medically assisted death for children. Photo from Wikipedia

"A young person experiencing grievous and irremediable suffering is unimaginably tragic."
"[However, assisted dying requests from minors would be certain to relate to] very, very small numbers [such that any changes to the law] would, of course, require corresponding changes to hospital policy."
Randi Zlotnik Shaul, director, bioethics, Hospital for Sick Children

"I have no doubt that a child might ask for it, but whether they could really fulfill that competency test for such a major life-shattering decision, the U.S. says no."
"[Legalization of euthanasia for children under 18 would be] enormously controversial."
Arthur Caplan, bioethicist, New York University

"I'm worried about how far people may be pushing this. [When the Supreme Court of Canada struck down the Criminal Code prohibitions in 2015, it] clearly did not equate medical assistance in dying with just any other form of medical care."
"We do put limits on individual choices of mature minors that expose them to harm. I think we have to carefully reflect on what it would mean to allow this particular practice without involvement of the parents."
Trudo Lemmens, professor in health law and policy, University of Toronto

The only two jurisdictions in the world which have legislated for assisted suicide for minors are the Netherlands and Belgium. Belgium permits terminally ill children whatever their age to request euthanasia, as long as they have secured their parents' consent, while the Netherlands has enacted a law requiring parental consent for 12- to 15-year-olds while permitting 16- and 17-year-olds to request a doctor-assisted death.

Now it is the largest children's hospital in Canada where a policy has been drafted foreseeing the time when children could be entitled by law to be euthanized on their own initiative. The Sick Kids' team was comprised of bioethicists, palliative care doctors and health professionals in related fields, the report published in the Journal of Medical Ethics. The working group within the hospital points out that there are willing doctors who could "safely and effectively" perform euthanasia for terminally ill youth 18 and older, meeting criteria as set out in federal law.

It would be "antithetical" to the hospital's philosophy of care should age of patient kick in to force a transfer of young patients to an unfamiliar adult hospital, stated in support of the hospital's willingness to have such permissive legislation put into effect. Mature minors in most provinces are now permitted by law to make decisions relating to their medical care, including the withdrawal or withholding of life support. A minor is considered "capable" of providing consent in Ontario, if possessed of the maturity and intelligence to make decision on treatment, able to appreciate "reasonably foreseeable consequences" of their decision.

Generally, families are involved in such decisions, with every effort spent in encouraging youth to involve their family; however, "ultimately the wishes of capable patients with respect to confidentiality must be respected", the report emphasizes. As it does that the same rules should apply to MAID since no meaningful ethical or practical distinction exists between assisted dying and procedures effectively resulting in ending life such as palliative sedation (drugged to sleep until death arrives) or withholding or withdrawing life-sustaining treatments.

An expert panel report struck to present the Liberal government with the reasoning leading to exploring euthanasia being extended to mature minors in December coincides with this Sick Kids' report, where the Canadian Council of Academies was requested to examine cases where mental illness represents the sole underlying medical condition, along with "advance requests" to end life, in the future. For the purpose of protecting staff from "potential violence and social harassment", the names of doctors who volunteer to provide MAID are not to be made public, according to the draft.

Some doctors whose work brings them into direct care for terminally ill children express outright horror at the very idea of euthanasia provided for children, arguing that when all hope for a cure is exhausted, pain and other symptoms are manageable in minimizing suffering. And in those rare instances where suffering is clearly not to be borne, a child can be sedated to sleep until death occurs. An injection of barbiturates in assisted dying, ends life immediately.

Toronto’s Hospital for Sick Children has developed a draft policy on doctor-assisted dying that applies exclusively to youth aged 18 and older, but it could one day apply to minors.   Getty Images