Vulnerable care. The Debate on Euthanasia for Decisionally-competent Minors in Flanders and the Netherlands

More than ten years after the introduction of euthanasia legislation in the Netherlands and Belgium, the debate has become current once more. The political and social discussion frequently centres on people unable to give informed consent, such as very young children and persons developing dementia. In this article, the focus lies on decisionally-competent minors. In Belgium, the parliament passed an act of law on 13 February 2014 that provides an opportunity to permit euthanasia for decisionally-competent minors, without stipulating an age limit. In the Netherlands, euthanasia is legally permitted for children aged twelve and over, although Dutch records show that euthanasia has very rarely been carried out among minors. Inspired by a care ethical approach, we were curious about the experiences of specialist doctors in their actual care practices with regard to seriously ill minors. A care ethical perspective draws attention to specific aspects: human interconnectedness, unicity, vulnerability and relational autonomy– rather than the ideal of individual autonomy – are considered to be at the core of humanity. A relational, care-ethical perspective offers scope for the question of whether adults, parents and practitioners, can handle the suffering in the specific context of young people, for young people’s future-oriented thinking, their relation with people around them, and for the acknowledgement of their developing autonomy. This article presents the results of an exploratory empirical investigation into the experiences of this problematic issue gained by nine Belgian and two Dutch doctors in actual care practices at university hospitals and specialist care centres. Their experience shows that decisionally competent minors who suffer unremittingly rarely request euthanasia. Essentially, young people with a serious illness do not want to end their life, but they want to end the unbearable nature of their symptoms. The interview respondents involved, express their experiences in language and images that are closely aligned with a care-ethical approach. They ask for more attention to be paid to terminology in the public debate, as well as the recognition that providing good end-of-life care to children and minors requires specific skills.status: publishe