Bioethicists have started preparing the way for the legalisation of child euthanasia in Canada, with one of the proposals advocating assisted suicide without parental approval.

Euthanasia in Canada is currently only available to capable patients aged 18 years or older, however the medical essay titled, Medically Assisted Dying in a Paediatric Hospital, published in the Oxford-based Journal of Medical Ethics, was written “with an eye to the near future when capable young people may gain access to Medical Assistance in Dying (MAID).”

In all other regards [than who initiates the euthanasia discussion], our working group has, at present, elected to conceptualise MAID as practically and ethically equivalent to other medical practices that result in the end of life. This theorisation of MAID is justified on the grounds that these practices share a common purpose of alleviating unendurable suffering and facilitate the patient dying on their own terms…and is reflective of our concern that the conceptualisation of MAID should not place additional burdens on the patient or function to limit the rights and freedoms to which patients are typically entitled.

The proposal goes on to state, if a child is mature enough to make decisions, doctors will not be required to inform parents or family members about the child’s decision to commit suicide.

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

Can you imagine a child discussing euthanasia with a trigger-happy doctor but deciding not to include her parents because she knows they’d oppose it? Can you imagine her parents turning up to the hospital to see their daughter, only to find an empty bed?

The essay goes on to suggest protections for medical staff willing to provide assisted suicide for children. “We will not make public the names of the healthcare providers at The Hospital for Sick Children who have volunteered to provide MAID, nor will we disclose a full list of persons who comprised our working group.”

We will, however, as an institution, publicly discuss the provision of MAID in an effort to normalise this procedure and reduce social stigma for everyone involved. It is right and appropriate for this duty to fall to a well-resourced institution rather than rest on the shoulders of individual patients and providers.

When it comes to euthanasia, the slope is slippery indeed. Assisted suicide is always sold with temporary restrictions.

Also see: Netherlands, euthanasia and the very slippery slope.

If euthanasia is no longer restricted to adults, we have good reason to think someday it will no longer be restricted to the terminally ill. Rather, it will be extended to people with varying quality of life circumstances. How do we know this? Because it’s already happening in the Netherlands.