The Dutch government announced plans this week to enable doctors to end the lives of terminally ill children under the age of 13. This decision will spark the debate about doctor-assisted death.
In the Netherlands, doctors can already facilitate the death of people older than 12 years or younger than a year, provided that their parents have given their consent.
In a letter to parliament on Tuesday, Dutch Health Minister Hugo de Jonge proposed extending the law to children aged 1 to 12 who are dying and suffering.
"In a few cases, palliative care is insufficient," wrote de Jonge. "Because of this, some children suffer needlessly with no hope of recovery."
He estimated the measure would affect around five to ten children each year.
Doctors in the Netherlands have raised concerns that they could be held criminally responsible for helping to end the lives of “terminally ill” children between the ages of 1 and 12, as the law does not provide for any provision for children of that age who are expected to die immediately.
Under current law, with the consent of the child's parents, a doctor can end the life of a child under the age of 1 if the child has "unbearable and hopeless ailments," wrote de Jonge.
He said the new regulation would give doctors more transparency.
Three other European countries – Luxembourg, Belgium and Switzerland – allow doctor-assisted death, although the laws are different in each country. In Belgium, children can die with the help of a doctor. In Luxembourg, however, the law is limited to adults with an incurable disease.
Canada, parts of Australia, and Colombia have also legalized doctor-assisted adult death in certain cases.
In the Netherlands, parliament does not have to vote on the new regulation as it will be incorporated into the existing law, de Jonge said in the letter.
Nonetheless, a parliamentary majority is expected to approve the change, which will take a few months to complete, said a spokesman for Mr de Jonge.
"It's an extremely complicated and sad subject," said de Jonge on Tuesday to the Dutch broadcaster NOS.
According to Dr. Ira Byock, palliative care practitioner and director of the Providence Institute for Human Caring, the development in the Netherlands is a worrying example of the growing reliance on assisted death to address serious health issues, rather than finding compassionate ways to help people deal with pain and suffering.
"We can always deal with a person's physical suffering," he said. "We can always provide drugs that approach general anesthesia and allow someone to die gently – sleep until the end of their life."
Dr. Byock said he was concerned about growing demands in the United States for euthanasia to help adults with degenerative diseases end their lives.
"When patients who are suffering are viewed as problems to be corrected rather than whole people to be treated, we are prepared for a situation that is damaging to the profession and our society at large," he said.
Dr. Byock added, "We're all on this slippery slope."
Eight states and Washington, DC, have laws that allow mentally competent adults with a terminal illness and six months or less to receive prescription drugs that hasten their death, according to Death With Dignity, an Oregon-based nonprofit that promotes such laws supported.
The new language in Dutch law could "create pressure in the United States to extend our conservative policies to people who may not consent but are terminally ill and adults," said Arthur Caplan, professor of medical ethics at NYU Langone Medical Center.
However, he expressed doubts that the United States would follow the example of the Netherlands, where people with mental illnesses were allowed to end their lives with the help of doctors.
Americans have less confidence in their medical system than the Dutch, who are more likely to believe doctors when they say a disease is hopeless, Professor Caplan said.
The Netherlands is "a small country," he said. "Doctors and patients know each other very well and there is pretty good access to health care."
Professor Caplan added, "In the US we have large chunks of people who do not have access to good health care, and that means more distrust."