It's an idea that, in the death-squeamish U.S., is probably too disturbing for the edgiest TV hospital drama, let alone real life and real legislation. Last week, the Belgian Parliament passed a law allowing terminally ill children to request aid in dying. Adults there have been able to do that since 2002, and a few other European countries have similar measures. But last Thursday's action, which is expected to be signed into law by King Philippe, will make Belgium the first to extend the right to minors faced with "constant and unbearable suffering."
International headlines ensued, including some rather aggrieved ones in the U.S. on the order of "Belgium on Verge of OK to Kill Sick Children." Commentators chalked up the law to cold European secularism, even trotting out comparisons to Kinder-Euthanasie in Nazi Germany, an initiative that systematically killed severely disabled children.
But amid the consternation, several details were overlooked. For starters, Belgians are overwhelmingly in favor of the new law. Despite opposition from religious groups and a coalition of physicians, polls indicate that 75% of the public supports it. And while the legislation is being called historic in that it's the first of its kind to cover children of any age who can prove a "capacity for discernment," it's not exactly unprecedented. For more than a decade, the Netherlands has allowed terminally ill children older than 12 to request euthanasia in special circumstances.
Contrary to paranoid visions, children in Belgium won't be able to ask for life-ending medication by merely hitting a nurse's call button. They must be suffering from pain that doctors have deemed truly unmanageable. They must get approval from their parents and their medical team, and they must be evaluated by psychologists. They must make the request several times and demonstrate that they understand what they're asking for. And, of course, they must be close to death anyway.
The Netherlands has a similarly careful process, which might explain why in the 12 years since its children's euthanasia law was passed, only five children have received aid in dying. In all but the rarest cases, pain and suffering were managed through palliative care.
So while Belgium's new rule carries symbolic importance, it's unlikely to have much impact on when and how sick children die. And though the slippery-slope crowd will claim that the mere existence of such laws contributes to a laissez-faire attitude that could lead to death for the sake of convenience or financial reasons, the evidence has never borne out such concerns.
Data from Oregon — where medically assisted death for the terminally ill (but not for children) has been available since 1998 — have consistently shown that far more patients obtain lethal prescriptions than use them, though patients often report having greater peace of mind knowing the pills are there if they need them. Nor are Oregon pharmacies doing a brisk business in life-ending medications. Last year, 122 patients filled such prescriptions; only 71 took them.
Those numbers suggest that the "right to die" is less about its actual exercise than the abstract potential it represents. At the same time, there's a consensus in the U.S. that some patients should be allowed gentler exits than the brutal malingering that may constitute "dying naturally." A Gallup poll conducted in May found that 70% of respondents would allow physicians to end a terminally ill patient's life "by some painless means."
Still, only four states (Oregon, Washington, Vermont, Montana) have granted doctors some ability to aid patients in dying. Despite the fact that it's practically become a truism that Americans afford our pets more dignity in dying than we're able to give our loved ones, we remain a culture whose denial of death can have a devastating effect on the quality of the end of our lives. We might even be inching toward a place where we can talk about this subject with more honesty and less hyperbole.
In that sense, though Belgium's new law is apt to be implemented in only a small fraction of cases in that country, it may play an outsized role in starting important conversations here and elsewhere. And it's really time those talks got underway.