More than a decade after legalising euthanasia for adults, Belgium is set this week to extend mercy-killing to terminally-ill children after lengthy public debate over the ethical issues at stake.
Despite strong opposition from religious institutions and even some paediatricians, a bill allowing euthanasia for minors facing "unbearable physical suffering" goes up for debate in parliament's lower house on Wednesday, before being put to a vote the following day.
If adopted as widely expected, the legislation will make Belgium only the second country after the Netherlands to allow incurably sick children to seek to end their lives.
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Lifting all age restrictions
While the Dutch law, the world's first euthanasia bill, enables mercy-killing in special cases for gravely ill patients 12 years or older, Belgium will be the first nation to lift all age restrictions.
The draft bill extending to minors, Belgium's 2002 "right to die" law, states that a child must be equipped "with a capacity of discernment and be conscious at the moment of the request".
The minor must also "be in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short-term".
Counselling by doctors and a psychiatrist or psychologist is required, as is approval by the parents.
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In the months of intense debate leading up to Thursday's vote, church leaders argued that extending euthanasia to the young undermines society's basic moral values and "risks trivialising" death.
But proponents see it as a "humanist's" response to pain.
"Suffering must be taken into account," Philippe Mahoux, the Socialist senator who sponsored the law, told AFP.
"It is illness and the death of children that is scandalous," not the euthanasia bill, he added.
In a first vote in the Senate in December, the proposal won a resounding 71 votes in favour, with 17 against and four abstentions.
Thursday's vote in the lower house is expected to see Socialists, Liberals and Greens members line up in favour, with centrist Christian-leaning parties opposed.
"We'd prefer to put the emphasis on assisting the end of a life, on palliative care," Social-Christian CDH party lawmaker Christian Brotcorn told AFP.
"But it's more expensive in terms of staff and medication than euthanasia."
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He also criticised the legislation for failing to address problems and potential loopholes such as possible discord between two parents over a child's request to be euthanised.
Based on witness statements from doctors, sponsors expect only a handful of requests each year and argue that legalising what is already being practised will save doctors from potential criminal prosecution.
"The existence of a law is the best means of guarding against possible malpractice," the daily Le Soir newspaper said.
In December, a group of paediatricians urged lawmakers to approve the legislation. "Why deprive minors of this last possibility," they said.
Picture: Child in hospital from Shutterstock
"Experience shows us that in cases of serious illness and imminent death, minors develop very quickly a great maturity, to the point where they are often better able to reflect and express themselves on life than healthy people."
Two percent of all deaths
Polls show a majority of Belgians backing the proposal but there was a surge of concern last year when a 44-year-old in distress after a failed sex change was euthanised on psychological grounds in a highly-publicised case.
While there were only six cases of euthanasia recorded on psychological grounds in 2004, there were 33 in 2011 and 52 in 2012.
Belgium logged a record 1 432 cases of euthanasia in 2012, up 25 percent. They represented two percent of all deaths.
After The Netherlands and Belgium, Luxembourg in 2009 also approved euthanasia, but for adults only. In Switzerland, doctors can assist a patient seeking to die but euthanasia itself is illegal.
In a nutshell:
The only four places that today openly and legally, authorise active assistance in dying of patients, are:
- Oregon (since 1997, physician-assisted suicide only)
- Switzerland (1941, physician and non-physician assisted suicide only)
- Belgium (2002, permits "euthanasia" but does not define the method)
- The Netherlands (voluntary euthanasia and physician-assisted suicide lawful since April 2002 but permitted by the courts since l984)
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Image: child in hospital from Shutterstock