Child euthanasia – the next stop on the slippery slope
Remarks delivered to Oxford University Students – May 16th, 2023
David Alton – Lord Alton of Liverpool
I want you to imagine Marie. It’s 2025 and Marie is a 15 year old Canadian girl. Three months ago her first relationship with her boyfriend ended and she remains heartbroken. Life doesn’t seem worth living anymore. Her self-esteem has plummeted. She feels less popular, less attractive and less talented than most of her friends at school. And in her state of distress, she reasons the rest of her life will be worthless and miserable. Not uncommon for girls her age, Marie has been ill with anorexia in recent years. Her recent circumstances have led her to relapse. So her parents take her to the local psychiatric hospital to see a doctor.
While in the waiting room, she picks up a leaflet and notices a reference to the country’s Medical Assistance In Dying, or MAID, programme, recently extended in scope to include those with mental illness. She secretly envies the opportunity to die, to be put out of her misery. When she gets home, she researches MAID on the internet and discovers it has now been made available to anyone over the age of 12 as long as death is ‘reasonably foreseeable’.
Marie’s research tells her that across the border in Oregon, there is a precedent for anorexia being considered a terminal illness qualifying for assisted suicide and so, without her parents’ knowledge, she books herself another appointment at the hospital and begins the process of applying for MAID. Her parents protest, pointing out she’d recovered from anorexia before and how her feelings of despair have been influenced by her recent break-up and the mood swings common for teenagers. But to their horror, they are told that the Canadian MAID laws for minors stipulatethat while “the parents… of a mature minor [may] be consulted in the course of the assessment process for MAID… the will of a minor who is found to have the requisite decision-making capacity ultimately take priority.” Marie’s request to die is approved and there is nothing her parents can do about it.
Does that sound far-fetched? It might, but earlier this year Canada’s Special Joint Committee on Medical Assistance in Dying issued a report recommendingthe extension of MAID to ‘mature minors’ and included exactly that clause I read out which would mean the will of a minor would overrule their parents’ wishes if they were deemed capable of making rational decisions. Indeed, pro-euthanasia campaigners in Canada favour MAID for minors being available for anyone over the age of 12.
Today I want to speak on child euthanasia being the next stop on the slippery slope, since the euthanasia of children appears to be the latest development in an incremental extension that seems increasingly inevitable in any country once euthanasia or assisted suicide is legalised.
Once upon a time, supporters of euthanasia and assisted suicide would try to dismiss warnings of a ‘slippery slope’ as scaremongering. Of course, those of us who had seen similar warnings come true concerning the introduction of abortion leading to abortion on a mammoth scale knew only too well how easily such laws can expand in scope and application.
At its most charitable it’s the law of “unintended consequences”; at its most cynical it’s a deception – a deliberate sleight of hand.
When it comes to euthanasia, the risk of a slippery slope is now undeniably evident from its rapid expansion in a number of countries where it has been permitted. And the latest development is the growth in allowing child euthanasia. The slippery slop ends in a quagmire.
In mentioning Canada’s plans for MAID laws to be extended soon to include children over the age of 12 – I should add that this is also alongside recommendations also to extend MAID to people with mental illness. However, not to be outdone by Canada, the Netherlands, where children aged 12 and over are already included in euthanasia provisions, plans were announced last month to permit euthanasia for children of any age, thereby catching up with what is already legal in neighbouring Belgium.
Child euthanasia of the youngest, or infanticide, was of course commonplace in the ancient world, in both Greece and Rome, particularly for babies with disabilitries and unwanted baby girls. It was also infamously practised in Nazi Germany, in particular for children with disabilities. In contrast, until recently it had been a mark of modern civilisation to reject such practices.
That all changed in the Netherlands in 2004 with the introduction of the ‘Groningen Protocolfor Euthanasia in Newborns’. The Groningen protocol formalised what had already been practised discreetly in the country for many years by permitting the euthanasia of infants up to one year old in cases thought to involve “hopeless prognosis and unbearable suffering” and where there is parental consent.
A 1997 study in the medical journal, ‘The Lancet’ discoveredthat “57% of all [Dutch infant] deaths had been preceded by a decision to forgo life-sustaining treatment”. Remarkably, parents were not involved in 21% of these decisions. Although such decisions ought to be distinguished from euthanasia, alarmingly the report went on to explain that “this decision was accompanied by the… administration of drugs with the explicit aim of hastening death in 8%” of cases. Of these, the study found a third of these babies would have likely lived for more than a month.
Even more alarmingly, the study found that in 1% of the deaths examined, a decision to give a drug explicitly to hasten death was made for infants not dependent on life-sustaining treatment.
If the deaths in the study were representative of a whole year, this would equate to 10–15 deaths per year in the Netherlands.
Despite the UN Human Rights Committee declaringin 2001 in response to such practices that it was “gravely concerned at reports that new-born handicapped infants [in the Netherlands] have had their lives ended by medical personnel”, the Groningen protocol was introduced to regulate the practice.
For those who would contend that infant euthanasia in the Netherlands is only permitted for rare and exceptional cases, a Dutch commission on euthanasia argued in 2013 that as many as 650 infants should be eligible for the practice in the country each year.
Now, all euthanasia is disturbing. But, one of the significant things to note about the Groningen protocol is that, by definition, unlike most forms of assisted suicide or euthanasia, infant euthanasia is ‘non-voluntary euthanasia’ since infants obviously cannot give consent. It is hard not to reach the conclusion that a form of eugenics is at play.
The authors of the Groningen protocols have even admittedits scope includes not only infants without hope of survival but also those who may survive beyond a period of intensive care. It also includes those for whom “a very poor quality of life, associated with sustained suffering, is predicted”, such as those with more serious forms of spina bifida – indeed, in the seven years leading up to the implementation of the Groningen protocol, its authors reported that 22 infants with spina bifida had been euthanised without any sanction. In reality, what was and is happening is essentially post-birth abortion, where infants with disabilities have their lives ended after birth rather than in the later stages of pregnancy as is of course tragically permitted in our own country.
This ought to alarm us. In its study of the Groningen protocol, the American College of Paediatricians observed that ”most of the medically stable children euthanised for presumed poor future quality of life were diagnosed with spina bifida. This condition may present a wide variety of clinical manifestations, most of which are treatable”. It continued: “the practice of newborn medicine has evolved dramatically. Many more neonates of increasing prematurity and complex conditions are treated successfully”.
In other words, babies with disabiloties are being killed who could otherwise live. So much for the Hippocratic oath’s age-old promise for doctors to ‘do no harm’! The answer is better palliative care and more support for the care of people with disabilities, not their elimination from society.
The Dutch experiment with euthanasia provides a textbook example of euthanasia’s slippery slope towards the full inclusion of children. In 2002, euthanasia was officially decriminalised in the country for those aged 16 and over – and for the purposes of our subject, many would of course consider 16 and 17 year-olds to be children. Euthanasia was also permitted for those aged 12-15, but unlike 16 and 17 year olds, parental consent was required. Two years later the Groningen protocol was established for infants up to the age of one. And now, just last month, the Netherlands has announced plans to allow euthanasia for children of any age, following Belgium’s lead in doing so in 2014.
Belgium’s story is an important one for those who think initial euthanasia safeguards can be maintained. When euthanasia was first decriminalised in the country in 2002, the inclusion of children was considered. However, the idea was eventually rejected because it was considered so controversial there were fears it might jeopardise the entire euthanasia bill. Fast forward twelve years to a country which had got sufficiently used to euthanasia for the Belgian Parliament to now feel able to extend it to include children as well.
As the Belgian lawstands, euthanasia is permitted for children of any age under certain strict circumstances including when a child is deemed close to death, in constant, unbearable, incurable pain and considered capable of understanding the consequences of their decision. Parental consent is also required though astonishingly this requirement was only added to the bill at the last minute to ensure a Parliamentary majority.
When Parliament did pass the law, it did so despite the objections of 162 Belgian paediatricians who, in an open letter, described the legislation as unnecessary and hasty, arguing that palliative care for children is effective and that “palliative care teams for children are perfectly adept at relieving pain, both in hospital and at home”. The doctors warned how the bill could lead to excessive pressure being placed on children and parents to choose premature death. In the years since, children in Belgium as young as 9 and 11 with conditions including cystic fibrosis have been euthanisedunder the legislation.
Currently the only countries in the world which permit child euthanasia in addition to Belgium and the Netherlands are Luxembourg, where it is permitted for 16 and 17 year olds, and Colombiawhere it is permitted for children from the age of 6 and where parental consent is not required once a child reaches 14.
However, as mentioned earlier, Canada has agreed in principle to join this ignominious club. If that were not to go far enough, the Quebec College of Physicians has even recommendedeuthanasia for babies with “severe deformations” and “very grave and severe medical syndromes”, thus expressing support for a Canadian version of the Groningen protocol. The extraordinary thing about Canada of course is that it has taken only seven years from the legalisation of assisted suicide to the recommendation of its extension to children – a slippery slope as steep as the country’s Rocky Mountains it seems.
Well what of the UK? Isn’t this all just a problem elsewhere and can’t we pride ourselves in being more civilised? Well, the reason this matters is because across the British Isles, in Westminster, Scotland, Jersey, the Isle of Man and Ireland, there are continuing attempts to bring forward legislation to permit assisted suicide. And Canada, Belgium and the Netherlands serve as a warning of where this could all lead, even when initial legislation is supposedly tightly drafted as including only the terminally ill as was the case in Canada of course. Indeed, how “terminally ill” is interpreted suggests even this supposed ‘tight’ language is open to broad interpretation.
But notwithstanding concerns about future changes in the law, there have already been calls from prominent voices for a form of child euthanasia in the UK. Back in 2005, the Royal College of Obstetricians and Gynaecologists recommended an open debateregarding the options of, I quote, “non-resuscitation, withdrawal of treatment decisions, the best interests test and active euthanasia as they are means of widening the management options available to the sickest of newborns”. Management options!
Both the consideration of “active euthanasia” and its description as a ‘management option’ are an indicator that the UK has not been as far away from its Dutch counterparts as we might like to think. The Royal College even argued there should be discussion regarding whether “deliberate interventions to kill infants”, specifically severely disabled newborn babies, be legalised, and chillingly suggested the provision of these options would save some families from years of emotional, social and financial costs, even going as far as to say that “a very disabled child can mean a disabled family”.
While Parliament has so far held firm in its efforts to resist euthanasia and assisted suicide, there is a concern the courts have sometimes made decisions in difficult cases on the basis of the same rationale used for euthanasia elsewhere. Now we need to be careful here. Questions concerning when it is right to withdraw treatment and allow nature to take its course are complex and ought to be distinguished from euthanasia. There is no moral obligation to extend life indefinitely.
We don’t have to go to heroic lengths to prolong a life – but that is decidedly different from deliberately ending a life.
But, be clear, treatment has been withdrawn in the UK even in the case of non-terminal illness and where a patient is conscious. In one case concerning a girl born with severe defects and deemed to be experiencing “horrific” pain, a British mother in 2014 chose to withdraw hydration from her 12-year-old daughter who was unable to feed herself because of her disabilities. The withdrawal of fluids left her, in her mother’s own words, to “suffer for days” and die “in pain”. It was the first time a child breathing on her own and not on life support or suffering a terminal illness had been allowed to die in this way.
The decision of the UK courts to permit the girl’s death was extensively criticised internationally with one prominent disability rights advocate declaringthat with the ruling, “the door for the dehumanisation of the disabled has now just been… totally swung wide open.” Such decisions are underpinned by the same arguments used for child euthanasia and fly in the face of the efforts made in recent decades to improve the rights and equal dignity of disabled people in this country.
My colleague, Baroness Jane Campbell of Surbiton, who has spinal muscular atrophy, is a Commissioner of the Equality and Human Rights Commission, and speaks in Parliament through an oxygen mask says this:
“Disabled peoples’ lives are invariably seen as less worthwhile than those of non-disabled people. Descriptions such as tragic, burdensome, and even desperate are routinely used without objection. Unless one is extraordinarily strong, this negativity impacts on the individual disabled person. If suicide were a legally and socially acceptable option, too many would succumb to this fate believing being ‘put out of misery’ to be expected of them… ………..[Euthanasia] is dangerous and threatening. I and many other severely disabled people will not perceive your support for it as an act of compassion, but one founded in fear and prejudice.”
So, having surveyed the expansion of the slippery slope to include disabled infants and older children, why should we be so concerned about child euthanasia in particular? Well for one thing, it’s hard to reconcile with the emphasis on safeguarding which has rightly become so prominent in the care of children. In recent years, society has made huge progress in the area of mental health, seeking to prevent suicide. Allowing assisted suicide or euthanasia for impressionable and vulnerable teenagers, even under what may seem to be strictly defined conditions, sends a message that suicide isn’t so bad after all and is a legitimate way out, if life feels hopeless.
As we have already seen, infant euthanasia also sends a message that the lives of people with disabilities are of lower value and a burden society would do better without. Some have been honest enough to admit this. The controversial philosopher and ethicist Peter Singerhas even written that“killing a defective infant is not morally equivalent to killing a person. Sometimes it is not wrong at all”. Elsewhere, in his book ‘Should the Baby Live?’, he claims “it does not seem wise to add to the burden on limited resources by increasing the number of severely disabled children”. Eugenics is alive and well!
In 1923 G.K.Chesterton published “Eugenics and Other Evils”. In it he said that
“Eugenics itself, in large quantities or small, coming quickly or coming slowly, urged from good motives or bad, applied to a thousand people or applied to three, Eugenics itself is a thing no more to be bargained about than poisoning.”
He went on to warn that “evil always takes advantage of ambiguity”
And this issue is laden with ambiguity. Consider, for instance, euthanasia for minors and the question of consent. While we have already noted that consent is impossible for infants, the gradual development of the brain is such that consent for those under the age of 18 ought to be treated with caution. As some of you have perhaps experienced rather more recently than me, extreme shifts in mood can sometimes accompany adolescence!
Issues that have nothing to do with physical health, relating to self-esteem, relationships, image and a range of other factors can easily influence how a young person might perceive an illness for example, leading them to make impulsive, irreversible choices about the future if offered to them.
The Report of Canada’s Special Joint Committee on Medical Assistance in Dying even concedes that it is “widely acknowledged that the frontal lobe of the brain, which plays a key role in risk assessment and decision-making, is not fully developed until well into adulthood” Yet, remarkably the report still recommends that minors should be allowed to consent to assisted suicide against their parents’ wishes.
Some Belgian legislators have similarly claimed young people have “as much right to choose” as adults when it comes to euthanasia, and yet such reasoning requires significant inconsistencies with how we restrict the choices of young people elsewhere – the ability to marry, vote or drive a car for example. It seems perverse to give young people who cannot do these things the ability to choose to die.
This was a point made by the 162 child paediatricianswho signed the letter I referred to earlier opposing child euthanasia in Belgium. In their letter, they explained how “under the proposed bill, the request for euthanasia is conditional on the minor’s capacity for judgement. In practice, however, there is no objective way of determining a child’s capacity for discernment and judgement. The matter is thus widely open to subjective appreciation and influence”.
The idea that young people can meaningfully consent to euthanasia is far-fetched. Determining whether consent is meaningful is as subjective as deciding whether suffering is “unbearable” or death “reasonably foreseeable”. The whole issue is fraught with uncertainty.
Worse than that, it contravenes human rights conventions, which I want briefly to touch on as we finish. One of my roles as a Peer is to sit on Parliament’s Joint Committee Human Rights. Human rights are intended to protect the most vulnerable and it is of course the most vulnerable whom euthanasia affects – the elderly, disabled, mentally ill, children and infants. These groups need protections under human rights laws.
And Article 2 of the European Convention on Human Rights, which I’d argue is the most fundamental of all the articles and underpins every other human right, is the ‘right to life’. The article begins by asserting “Everyone’s right to life shall be protected by law. No one shall be deprived of his life intentionally”. No euthanasia in other words.
Article 2 does consider exceptions and indeed makes allowance for a limited number – such as self-defence – but importantly does not include euthanasia in these exceptions. It therefore seems clear to me that euthanasia, being the intentional deprivation of life, cannot be compatible with human rights laws.
Indeed, Article 8, the ‘right to respect for private and family life, which campaigners try to use as a basis for euthanasia, explicitly limits the autonomy it bestows when that autonomy is in conflict with “the protection of healthor morals, or… the protection of the rights and freedoms of others”, and euthanasia quite clearly destroys rather than protects health. A right to self-determination is not a right to self-termination. There is no ‘right to die’ under human rights conventions. And I will be arguing as much later this month when the Joint Committee will be considering assisted suicide from a human rights perspective.
So where have we got to on the slippery slope? Well neither Canada, as part of the Anglosphere, nor Belgium and the Netherlands, as two of our closest European neighbours, are very different places from the UK. If the introduction of euthanasia or assisted suicide in those countries could lead to child euthanasia within a decade or less, the same could and will happen here. As Chesterton also remarked in “Eugenics and Other Evils”:
“sound historians know that most tyrannies have been possible because men moved too late. It is often essential to resist a tyranny before it exists.”
Once an avalanche begins its descent down a slope, it’s unstoppable and the only safe way to prevent what lies at the end of the slippery slope is therefore to ensure the descent never begins. It’s why we must resist all campaigns to change the law on euthanasia or assisted suicide before it’s too late.
