No argument against death

By Wesley J. Smith

Once a society accepts the noxious notion that killing is an acceptable answer to human suffering, the definition of “suffering” never stops expanding.

The history of euthanasia in the Netherlands proves that maxim. The Dutch have allowed doctors to kill sick patients since the ’70s, taking an approach of quasi-decriminalization. Euthanasia was formally legalized in 2002. Over the decades, Dutch doctors “progressed” from euthanizing the terminally ill who ask for it, to the chronically ill who ask for it, to people with disabilities who ask for it, to the mentally ill who ask for it, and even to people with dementia who are unable to ask for it (as long as they left written instructions requesting it). The Dutch have also conjoined euthanasia with organ donation, creating a utilitarian impetus for lethal injection for both despairing patients and society. There have even been joint euthanasia killings of elderly couples who don’t want to experience the grief of widowhood.

Now the country is getting ready to allow little children to be euthanized. When euthanasia was first legalized, 16 was the age limit. Later, it was lowered to 12. Now, the government is proposing legislation that will allow pediatric euthanasia starting at age one. From the NL Times story

For the children referenced in the new policy, doctors are only allowed to give palliative care, like sedation, or withhold nutrition over an extended period of time until the patient dies. Doctors describe this as “a gray area” between normal palliative care and active life termination, he said, and they have been calling out for more regulation. . . . [Health Minister Hugo] De Jonge said his proposal will protect the interests of children, and will afford more transparency to the “gray area.”

Four points bear making here. First, the story notes that young children can already be killed via slow-motion euthanasia, known in bioethics parlance as “terminal sedation.” Unlike legitimate pain control, terminal sedation aims to cause death by keeping the patient in an artificial coma and withholding all sustenance until the patient dies of dehydration (thirst) in about two weeks. 

This is not the same procedure as “palliative sedation,” an ethical pain-controlling technique that puts the patient into lesser or deeper levels of sedation as the patient requires. The purpose of palliative sedation is to maximize the patient’s comfort. In such cases, death comes naturally from the underlying condition—not from the sedation or withheld food or water. 

Second, given the steady expansion of euthanasia eligibility in the Netherlands over the years, there is no reason to believe that the “terminal diagnosis” restriction will be followed—much less stick—for long. Some mentally ill people who are killed would otherwise live a normal lifespan, but that fact has been used as a justification for killing because it means the patient could experience many years of suffering. 

Third, doctors already euthanize terminally ill and seriously disabled babies—that is, they commit infanticide—thanks to a bureaucratic checklist known as the Groningen Protocol. If a three-week-old baby with, say, spina bifida can be killed in the Netherlands without legal repercussions, eventually it will be permissible to kill children who become seriously disabled (particularly if the disability is cognitive).

Finally, the Dutch frequently justify expanding euthanasia eligibility by claiming they are merely coloring in “gray areas” to permit greater certainty and transparency. Yet these redefinitions of the law only go in one direction—increasing the number of people eligible for lethal injection. Besides, transparency does not transform an act that is immoral into somehow being moral. It just makes the entire society complicit. 

The Netherlands won’t be the first country to permit child euthanasia. Belgium removed all age restrictions a few years ago. We know, based on government reports, that children as young as nine have been killed by doctors. One assumes their parents gave the go-ahead. But children are not so many pets to be put down when the owners think the time has come.

Pediatric euthanasia may soon come to this side of the Atlantic. Canada permits lethal injection euthanasia for adults—known as “medical assistance in dying” (MAID). As the country is preparing to expand its eligibility criteria, some hope that will include children—perhaps without parental consent. An article published last year in the Journal of Medical Ethics supported pediatric euthanasia. It was written by doctors who practice at a Toronto children’s hospital. Since Canadian children considered sufficiently mature may legally refuse life-extending care without parental consent, the doctors wrote, they should also be allowed to request a lethal injection. From “Medical Assistance in Dying at a Paediatric Hospital”: 

If . . . a capable [legally underage] patient explicitly indicates that they do not want their family members involved in their decision-making, although healthcare providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected. If we regard MAID as practically and ethically equivalent to other medical decisions that result in the end of life, then confidentiality regarding MAID should be managed in this same way.

Can you imagine visiting your sick child, only to learn that hospital doctors killed her without your knowledge or consent? The rage and agony would be unimaginable.

So what is the bottom line? Once a society embraces killing as an acceptable answer to human suffering and redefines assisted suicide as a “medical treatment,” the culture’s entire mindset shifts. Helping suffering people live ceases to be the overriding objective: These patients are rarely offered suicide prevention. Instead, death becomes the imperative, and not just for adults but eventually for sick and disabled children too—perhaps with organ donation thrown in as a plum to society.

It’s all so disheartening. As Canadian journalist Andrew Coyne once wrote about the growing popularity of euthanasia: “A society that believes in nothing can offer no argument even against death. A culture that has lost its faith in life cannot comprehend why it should be endured.” When the euthanasia death angel comes for children, who can say he is wrong?

Editor’s note. This appeared at First Things and is reposted with the author’s permission.