The Dutch government announced plans to allow doctors to end the lives of terminally ill children who are under 13 years old, a decision that is bound to inflame the debate over physician-assisted death.
The Netherlands already allows doctors to facilitate the deaths of people who are over 12 or less than 1 year old as long as parents have given their consent.
In a letter to parliament, the Dutch health minister, Hugo de Jonge, proposed expanding the law to include children between the ages of 1 and 12 who are dying and suffering.
"In a small number of cases, palliative care isn't sufficient," de Jonge wrote. "Because of that, some children suffer unnecessarily without any hope of improvement."
He estimated that the measure would affect about five to 10 children every year.
Doctors in the Netherlands have expressed concern that they could be held criminally liable if they were to help end the lives of "incurably ill" children between 1 and 12, because the law had no provision for children that age who are expected to die imminently.
Under the current law, a doctor may end the life of a child younger than 1, with the consent of the child's parents, if the child is experiencing "intolerable and hopeless suffering," de Jonge wrote.
He said the new regulation would provide more transparency for doctors.
Three other European countries — Luxembourg, Belgium and Switzerland — allow physician-assisted death, though the laws differ in each country. Belgium allows children to die with the help of a doctor, but in Luxembourg, the law is restricted to adults with an incurable medical condition.
Canada, parts of Australia and Colombia have also legalised physician-assisted death for adults in certain cases.
In the Netherlands, parliament does not need to vote on the new regulation because it will be folded into the already existing law, de Jonge said in the letter.
Nevertheless, a parliamentary majority is expected to agree with the change, which will take a few months to finalise, a spokesman for de Jonge said.
"It's an intensely complicated and sad issue," de Jonge told Dutch broadcaster NOS on Tuesday.
According to Dr. Ira Byock, a palliative care physician and director of the Providence Institute for Human Caring, the development in the Netherlands is a worrying example of the growing reliance on medically assisted death to address wrenching health cases, rather than finding compassionate ways of helping people cope with pain and suffering.
"We can always manage someone's physical suffering," he said. "We can always provide medication that approaches general anaesthesia and allows someone to die gently — sleep through the end of their life."
Byock said he was concerned about growing calls in the United States to use euthanasia to help adults with degenerative conditions to end their lives.
"When patients who are suffering are seen as problems to be fixed, rather than whole persons to be cared for, we have set ourselves up for a situation that is damaging to the profession and to our society as a whole," he said.
Byock added: "We're all on this slippery slope."
Eight states and Washington, D.C., have laws that allow mentally competent adults with a terminal illness and six months or less to live to obtain prescription medication that will hasten their deaths, according to Death With Dignity, an Oregon-based nonprofit that supports such laws.
The new language in the Dutch law could create "pressure in the United States to try and expand our conservative policy to include people who are unable to consent but are terminally ill and adults," said Arthur Caplan, a professor of medical ethics at NYU Langone Medical Center.
But he expressed doubts that the United States would start following the example of the Netherlands, where people with mental illness have been allowed to end their lives with the help of doctors.
Americans have less faith in their medical system than the Dutch, who are more likely to believe doctors when they say a medical condition is hopeless, Caplan said.
The Netherlands is "a small country," he said. "The doctors and the patients know each other very well, and there is pretty good access to health care."
Caplan added: "In the United States, we have large segments of people who don't have access to good health care, and that means more mistrust."
Written by: Maria Cramer and Claire Moses
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