(10i) Giving people the choice between Euthanasia or not

Last month the Belgian Parliament approved that euthanasia should be allowed for children in some exceptional situations. I and many other people think this is a good decision although I understand why others are opposed. There was even a prayer session against it in Brussels, uniting many religions. Now the King needs to sign before it becomes law; let's see.

Children

Euthanasia on a child means ending a life before it really started. But even without the euthanasia the life would have ended and thus there would still have been no future, only a terrible end. People should not fear the law because euthanasia will not be allowed on healthy children, only on children who are terminally ill and ask to end their suffering (otherwise the law is wrong).

Health professionals should recognise they are sometimes powerless and that life can only be extended at the cost of major discomfort and/or pain for the very ill person who wants to die, but also for those who have to watch the suffering on their beloved one. This is a reason why in Belgium (and some other countries) adults can already decide how their own end should be, and now children will also be able to indicate enough is enough (with permission of their parents). But I think there are major differences between adults and children as I will try to explain below. In the end, doctors and patients have to decide on each individual case while I think families may be involved, but not decide, as they may block the wish of the dying and thus extend their suffering.

A grieving mother, something from all time and hurting all sections of society.

The law is needed

• to protect doctors, patients and relatives
• while it gives the right to everyone to die peacefully if they wish
• but the law is also needed so that what happens is as open as possible and thus patients' life can't be ended without their permission (thus it protects people who don't want euthanasia) while others can stop their own suffering.

As certain rules are to be followed, it is less likely errors are made. Thus, children (and adults) who don't want to die can't be euthanised while those who want can die with dignity. And euthanasia doesn't replace palliative care but adds to it when suffering becomes unbearable.

The law has a number of safeguards that protect children from being killed by evil doctors as some people fear some doctors may do:

• The child needs to be terminally ill and in great pain;
• The child should mention more than ones the wish to die, thus euthanasia will not be possible because the child has one bad day;
• More than one doctor and psychiatrists need to agree that the patient can't be helped;
• The parents are involved and need to agree.

Nevertheless, I think euthanasia for children doesn't mean telling children they can be killed when they are very ill. It doesn't mean teaching children at schools that they can choose death if they are very ill. Indeed, most children survive into adulthood and thus they should mainly be told about living, although that includes telling children at the proper moment that death is also part of life. Indeed, there are moments in everyone's life that we are confronted with illness and death, moments that can be used to reflect together with children.

For me, euthanasia for children means children who are very ill can indicate they prefer death above life and then others, parents and health workers can start talking about it, but not earlier. Because when a child starts talking about it, it is a signal that the child suffers unbearable (that may not always mean pain). Because children normally don't ask to die as they embrace life too much unless something is seriously wrong. In addition, they don't want to hurt their parents by dying.

Of course, many people are against because they are saddened when a child is dying. But some religious people are selfish in such that agreeing to euthanasia means they think God will punish them in the afterlife. They also often feel superior, thinking that non-religious people have no morals and thus no restrictions killing children. But only seriously mentally-ill people will kill healthy children. Therefore, normal people, including doctors and nurses and whether religious or not, will not consider euthanasia unless there is no way out the suffering. And when the child wants to continue living they will help the child by reducing its suffering. Indeed, euthanasia means a defeat as someone couldn't be cured while saving someones life means a victory for everyone and thus will be preferred. In addition, there are major checks (see above) to prevent that people are killed against their will while family members can go to court if they think things were done unlawfully. Still, I think that if doctors agree with the terminally-ill child that the suffering is too much, than the family should not be able to stop the wishes of the child although they can voice their concerns so doctors will recheck to be sure no errors are made (but I understand this will be even more controversial than the law that now exist).

Thus, for me, euthanasia for a child is something that is requested by a terminally-ill person, without the necessity that others start talking about it because when the child starts talking about death (sometimes even without knowing the word), it indicates the suffering really may have become too intense. Of course, others (health professionals, family) can talk about other possibilities such as more painkillers; certainly when pain is the result of a successful treatment, then this should be explained. But, if nothing helps and the child decides it is enough while doctors agree they can't safe the life, then euthanasia is a solution. It will be the last thing a child will ask as a very ill child will understand the consequences (otherwise the child would not understand that it would end the suffering) while often children will avoid the subject so they don't hurt their parents unless it becomes too much.

I think if parents notice the struggle of their child, they could mention they support every decision the child may suggest, or they may ask health professionals to tell the child if it is too difficult for them. Indeed, people involved in such a difficult decision should receive as much as help as they need, not only help for the child and family but also for health professionals who nurse the child. Afterwards, parents may feel relieved their child doesn't suffer anymore, even when they don't realise it at the moment.

Still, it is sad when suffering becomes so intolerable that even children prefer death and it is difficult to write it down as each case will be different. Therefore, I understand people who oppose euthanasia on children because no normal person ever wants to make such a decision. Nevertheless, we need to be able to talk about it, as this article explains very well.

Adults

But in a number of countries, euthanasia is already allowed for consenting adults while in a growing number of countries people are demanding the right to decide when, where and how to die. And when the end is near, people should be allowed to determine their moment. Of course, if people explicitly say that they don't want euthanasia, than this should be accepted, even when those persons suffer very much; unless they change their mind due to illness or old age. Still, if they refuse euthanasia, than even sedation can't be done as this is often used as euthanasia-in-slow-motion. But as I mentioned, we should be merciful enough to allow that dying people can change their mind. And we should also accept that many doctors have difficulties ending someone's life and thus euthanasia should be as easy as possible, for instance the patient can decide the moment by swallowing a pill so no-one is directly involved, unless the patient is unable (e.g. due to dementia or coma).

Fear of dying, not fear of death. Therefore, I want to decide not to suffer during my final moments as death can be a sadist.

Of course, euthanasia for an adult is different from that by children. Indeed, while most children have no notion yet of death unless someone in their family or friends died, adults understand what death is (i.e. the end), and certainly older people start thinking about it as it comes closer. And thus while children will only talk about dying when they are very ill, adults can think how they prefer to die while they are still healthy: either slowly or when they decide time has come to say goodbye to their beloved ones and to life itself. Often, the latter people will die more peacefully as they choose the moment of their own death and thus feel they are in control.

Complex cases

Thus people should be able to choose their own ending. I even believe that when mentally-ill people can't escape their demons, they should be allowed to determine their end; we should not be so cruel to force them to jump in front of a train or we should not be surprised when they kill others if we refuse them a way out their suffering. Of course, this is more difficult as they are not always terminally-ill while many mentally-ill people still enjoy life; but others don't and want peace. Should we prevent people, whose brain doesn't stop thinking and can drive them crazy, from dying in a peaceful manner? Nevertheless, first they need help before any other permanent solution may be considered because if they can be cured, then most will be more than happy to continue living. Indeed, euthanasia should always be the last resort and only when patients ask for it, not because society doesn't want to care any longer for someone.

Another difficulty are people in a coma, when doctors are convinced the person will never recover as there is too much brain damage (a recent example was former Israeli PM Sharon who was in a coma for many years until he died; we don't know how much he may or may not have suffered). These people can't make a conscious decision about euthanasia although in some countries doctors allow the person to die by starving them to death. Is it then any wonder that a loving mother decides to take matters in her own hand? Should health professionals in these cases not be able to end the person's life in an as humane way as possible, with agreement of the family? Better still, when euthanasia is legalised, a healthy person could have signed a declaration that in such circumstances euthanasia can be used if doctors believe a recovery is not possible, while families can respect the wish of their beloved one and decide together with the doctors when the final day will be.

Indeed, sometimes love means giving peace to someone who can't be cured. That doesn't mean we should not try to cure. And thus we should not give in immediately to someone who mentions the wish to die. But, maybe one day, people will be able to buy suicide tablets at specialist centres after a number of visits to doctors who determine the person is sure. Already such centres exist where people go for euthanasia, also people from countries where euthanasia is not allowed.

Euthanasia, such a difficult topic, still so urgently in need of regulation because many people want to be able to make the choice when they near their end. Some people who opposed euthanasia may use it while others who supported it may refuse it during their final moments. But at least, one should have the choice about something we simply can't avoid as death is everyone's destiny. And as healthcare improves, fewer young people will need to request euthanasia. Still, I don't think people will one day find eternal life (even stars die) although I believe people will get older in a more dignified way when more illnesses can be treated and thus people will be able to live much longer a good life, until they decide it is over.