Dr. Louise Campbell:

In the Netherlands, the decision of a minor aged between 16 and 18 to avail of assisted dying may hold but parents have to be consulted. If the child is an emancipated minor and judged to have capacity, his or her decision may stand. However, it is very difficult with this cohort because they might not have the emotional maturity to appreciate the foreseeable consequences of the decision. That is the worry with children. They might have the intellectual capacity but not the emotional maturity. In the Netherlands, parental agreement has to be secured for minors aged between 12 and 16. The parents effectively make the decision, but with due attention to the child's wishes, as with other medical treatments. According to the regional committee report, one minor was assisted to die in 2016.

There are a tiny number of such cases which are very carefully scrutinised. In Belgium there is no lower age limit which is a cause for concern across jurisdictions. It is simple for a jurisdiction to state its age limit, for example, is 18 years, as they do in the United States and North American jurisdictions. There are ethical issues in providing for euthanasia in the case of minors, but it is carefully regulated and not about a child making a decision with which his or her parents are forced to comply. They are active decision makers in all cases involving minors. I mean no disrespect to anybody with a disability, but there are some children who will grow up enduring continuing pain, have an inability to interact with anybody in their environment and could require 24-hours-a-day care and it is justifiable to make a judgment on quality of life in such cases.

There is no such thing as a simple example; they are all multifactorial cases. The regional euthanasia committees publish annual reports which are worth looking at. They show that approximately 6,081 persons were assisted to die in the Netherlands in 2016, one of whom was a minor. They give samples of cases that meet the due care criteria. There is a one-page description of each case and practically all of the cases involve very debilitating physical illnesses. Between 75% and 77% of requests come from patients with cancer which in some cases has progressed to metastases and the patients have constant dyspnea, nausea, pain and difficulty in breathing. They might not be able to perform the activities of daily living and become preoccupied with the increasing pain they will face in the future. They do not only have physical concerns but also concerns about losing all control of bodily functions. People with ALS, Lou Gehrig's disease or motor neurone disease and neuromuscular diseases can be very concerned about losing all of their physical ability and being entirely dependent on others. It is for the individual to decide on the quality and value of his or her own life. Some people like Simon Fitzmaurice can tolerate this level of disability and do amazing things right up until the end of their lives, while others cannot bear the thought of a future of further debilitation and dependency.