Belgium is currently considering expanding a 2002 euthanasia law so that chronically ill children would be granted the right to choose to die. This proposed legislation has raised concerns from many groups about the implications of such legislation on the quality of care available to children and the potential exploitation of chronically ill children for their organs. Current legislation allows adults over age eighteen to exercise the right to choose to die. The practice has been on the rise in Belgium; between 2011 and 2012, there was a 25% increase in reported physician-assisted deaths, accounting for 2% of the total deaths in the country. Some doctors administering euthanasia procedures said they feel that part of caring for their patients is providing conditions in which a person can die with dignity. Before adults can access the right to die through euthanasia, they must show that they are suffering from a “hopeless medical situation,” though this standard includes non-terminal conditions. Potentially extending the right to die to children has led critics to express a renewed sense of concern about the implications of such legislation.

Religious and anti-euthanasia advocacy groups point to a number of informed-consent issues arising out of the practice of child euthanasia. One particular area of concerns is the use of organ donation in cases where children, whose organs are in high demand, did not consent. More generally, a 2010 report in the Canadian Medical Association Journal (CMAJ) revealed that nearly half of the interviewed Belgian nurses, who are not legally permitted to administer euthanasia drugs, admitted to participating in physician-assisted deaths. Another study published in CMAJ found that nurses perform 32% of assisted deaths without an explicit request or consent, and 1.8% of cases classified as assisted death occurred without the consent of the patient. It also found that nearly half of physician-assisted suicides in the Flanders region were unreported, which hinders oversight.

Consistent with the Universal Declaration of Human Rrights, states codified and extended the rights of life, liberty, and security of persons to children in Article 3 of the Convention on the Rights of the Child (CRC), to which Belgium is a party. This article mandates that the “best interest of the child” should be the guiding principle for all matters concerning children. Additionally, Belgium faces certain obligations surrounding a child’s right to express her desires in relation to medical treatment. Article 12 of the CRC states that children must be allowed to express their views freely in accordance with their age and maturity. The article’s meaning is explained in the Committee on the Rights of the Child’s General Comment No. 12, which states that children must be allowed to express their views on their individual health-care decisions. However, the Committee recognized that the child’s right to be heard must recognize the role a child’s maturity plays.

In the United Kingdom, a fourteen-year-old girl stated that she did not want to continue with her life-saving cancer treatments but later changed her mind and decided to undergo chemotherapy after receiving a text message from a friend. These apparently impulsive decisions are what critics of the law wish to avoid. Conversely, many people argue that children with serious and incurable diseases should have the same rights as adults to choose the appropriate form of treatment. Studies have shown that children often display greater lucidity than adults on the issue of death and often have skill, understanding, and maturity to make decisions about their personal medical situation. Parents of an eighteen-year-old who chose to exercise her right to die in the Netherlands said that their daughter’s decision allowed her to retain some dignity as her quality of life declined. Belgium faces the difficult task of balancing its obligations under the CRC to ensure that children’s voices are heard with its mandate to protect the child’s best interest.

Belgium is not the only country pursuing this type of legislation. A proposed law in the Netherlands would similarly expand euthanasia to children. As a child’s right to choose to die gains legislative ground, protection from potential abuses of euthanasia will become particularly relevant for suffering children, one of the continent’s most fragile groups. Because children are not always able to speak for themselves, the CRC requires that children’s rights be viewed through a different framework than that used for comparable rights afforded to adults. Consequently, simply expanding the current Belgian legislation to children may not take into account the complexities and vulnerabilities of youth. With the proper safeguards in place, Belgium may be able to successfully implement its proposed legislation and provide children with appropriate autonomy in decisions involving the right to choose to die.