A Belgium minor has been euthanised following the country’s 2014 law modification that permits doctor to assist in the death of individuals of all ages, including minors, according to Wim Distelmans, head of the national committee for euthanasia.

Distelmans, in an emailed statement, added that this case was reported to the committee by a local doctor last week. Other than what was made public regarding his or her status as critically ill, and from a Flemish-speaking region, no other information was given.

In a statement to a national newspaper, Distelmans expressed relief that, “Fortunately there are very few children who are considered (for euthanasia) but that does not mean we should refuse them the right to a dignified death.”

Euthanasia, and assisted suicides, was legalised in Belgium in 2002, and the small European nation then modified its laws 12 years later – after fierce debate – to approve of euthanasia for minors “in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term”.

Several safeguards in place

For minors in Belgium, a request for euthanasia must be made personally by the minor. Thereafter this request would be studied by a team of doctors, in addition to an independent psychiatrist or psychologist. Lastly, parental consent is necessary for euthanasia to be carried out.

For adults, the safeguards vary from country to country.

The general rule is the applicant must be suffering from “consistent, unbearable pain”, with current medical science being unable to grant an improvement in the individual’s quality-of-life.

Some nations, such as the United States, require the individuals to be terminally ill. As a safeguard, the U.S. also requires two witnesses to provide confirmation of request, in addition to a second doctor providing confirmation that the patient is terminally ill.

While in the states of Oregon, Washington, and Vermont, the patient mental health must also be verified as not suffering from a psychological disorder such as depression that can cause impaired judgment. In the Netherlands and Belgium, a second doctor must confirm that a patient’s request is valid and their suffering unbearable.

Legal status of euthanasia and assisted suicides

Other countries that have legalised both euthanasia and assisted suicides include the Netherlands, and Luxembourg, while Colombia only permits euthanasia.

In Germany, Switzerland, Canada, and five select American states, doctors can assist in suicides, but euthanasia itself has remained illegal. However, none of the countries except Belgium permits euthanasia to be performed on minors of all ages.

One may then wonder, what is the difference between euthanasia and assisted suicides?

According to widely accepted definitions, euthanasia is the legal practice administered by a doctor with the deliberate intent of ending a life, with the purpose of relief of suffering. Methods commonly used include a lethal injection.

It stands in contrast to the practice of assisted suicide, which involves the action of intentionally helping another person kill themselves, by providing them with the means to do so, most commonly by prescribing a lethal medication.

The distinction lies in who administers the lethal dose; in euthanasia the doctor does it whie in assisted suicide, the doctor prescribes the method for the patient to do so themselves.

Fierce debate not likely to abate due to cultural values

In Singapore, in a speech given by Chief Justice Sundaresh Menon's speech at the Singapore Medical Association Annual Lecture 2013 raised the notion that Singapore recognises the right to die on the basis of the rejection of treatment due to “an impermissible invasion of his bodily integrity.”

However, having said that, he also stated that the “right to refuse medical assistance” is dissimilar to “the right to die”, and that killing oneself deliberately is seen as “a profound abdication of bodily integrity”

Of note is his statement that, in Singapore’s Penal Code, it is stated that “it is not an offence to commit an act which harms a person so long as it was not intended to cause death, was done with the consent of the person harmed, in good faith, and for the benefit of that person.”

This translates to the legality of administering a drug to relieve a patient from acute pain and discomfort might carry with it a risk that it might hasten his demise – otherwise known as “passive euthanasia” – but criminalises “active euthanasia”, which involves the administration of the same drug for the purpose of hastening the end of his life even if this brings incidental relief from suffering.

In Japan, mercy killings remain a murky area, where there is no formal legislation, and its legality stems from two local court rulings. However, as Japan faces an ageing population, a debate would be inevitable and may become relevant as Singapore and other Asian countries are beginning to face an increasingly ageing population as well.

“The view that it is not dignified as a human to simply be kept alive by medical treatment is becoming more common,” said Upper House member Teruhiko Mashiko, from the opposition Democratic Party of Japan and head of a lawmaker group set up a decade ago to discuss a law giving legal protection to doctors who withhold life-prolonging care with the patient’s consent.

Despite this, the traditional Japanese culture which dictates that families are obliged to care for elderly relatives has been a sore thumb in rejecting or withdrawing life-prolonging treatment; doing so would bring forth allegations of callous abandonment, and as such, families usually ignore the patient’s wishes.

Additionally, Japanese handicapped groups warn that the legalisation could open a can of worms by serving as a precursor for legalising euthanasia of those that society deems a burden, whether economically and socially.

Thus, proponents of mercy killings argue that a person suffering from terminal illness should be given the freedom to choose how and when they die, and should live a dignified life. They argue that we should be granted the liberty to die, just as we are granted the liberty to live.

In Germany, euthanasia was contentious prior to its legislation, due in part to its painful legacy from its World War past. However, the bill was ultimately passed with assisted suicide deemed legal on the basis of “altruistic motives,” and prohibited on a “business” basis.

The fiercest opposition came from Germany’s Jewish community, where the practice of taking one’s life is against their religious beliefs.

On the other hand, opponents argue that euthanasia is akin to murder, and given the advancement of healthcare technologies, palliative care can often give a terminally ill person a more comfortable, dignified death. Some even argue that the desire for mercy killings stems from depression. MIMS


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