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ADVANCE Perspective: Nurses

A Child’s Right to Choose?

Published February 24, 2014 7:24 AM by Catlin Nalley
After extensive debate and controversy, Belgium lawmakers made history with the recent decision to remove age restrictions on euthanasia.

"Under the amendments to the country's 2002 euthanasia law, a child of any age can be helped to die, but only under strict conditions," according to TIME. "He or she must be terminally ill, close to death, and deemed to be suffering beyond any medical help. The child must be able to request euthanasia themselves and demonstrate they fully understand their choice. The request will then be assessed by teams of doctors, psychologists and other care-givers before a final decision is made with approval of the parents."

Euthanasia and assisted-suicide is already a heated topic of discussion around the world, but Belgium's recent decision adds a new dimension to the debate.

When is a child old enough to understand death? And, how involved should they be in the medical decisions surrounding it?

A 2009 study, published in Pediatrics, found that "adolescent cancer survivors, like other adolescents, want to be involved in medical decision-making at the end of life."

However, not all adults agree. A Belgian nurse, who spoke to TIME, "argued that minors may not have the mental capacity or the vocabulary for requesting to die."

Before the issue of age can be resolved we have to come to a decision about euthanasia in general. For the U.S., assisted suicide is still, for the most part, illegal. Only four states - Oregon, Washington, Montana, and Vermont- allow it.

Where do you stand on assisted suicide? Do you support a terminally-ill child's right to decide when their life ends?

posted by Catlin Nalley

6 comments

To start - I do not believe in assisted euthanasia (meaning the use of a drug or drugs to cause death), but I do believe in assisting the death process by way of not doing treatment and only giving supportive care.  Each case has to be determined individually.  Some children as young as 6 are fully aware when treatment is no longer working for them and they just want to be home with their parents and do as much as they are capable of doing.  Their hospital/clinic can offer supportive care.  Hospice can provide supportive care at home.  Adolescents are certainly capable of deciding when to stop treatment if it is no longer stopping the progress of the disease.  

In my experience of providing home hospice care before there was hospice in my city, I came to believe that the best place for a child, his/her siblings, and parents to be when death occurs is at home.  I observed this experience several times and followed up with home visits afterward.  Those families seem to feel more comfortable that they did what the child wanted to do and the siblings felt that they helped in one way or another.  This may not be possible for every family due to their social situation or fear, but if it's what someone wants, staff should assist in every way possible to make it happen.  

I've had parents ask me when to stop blood transfusions, etc.  I told them to judge for themselves if it makes the child feel better or not.  If it doesn't seem to help and the child doesn't really want it, then they can ask to stop.  Physicians who care for these children are willing to go along with a parents decision and sometimes, a child's decision. especially when the end is near.  

This kind of assisting in the death process has been used for years and years.  No one talks about, it is just done.  It's certainly more ethical than keeping a child alive by extraordinary means when death is inevitable.  

Some parents want the use of extraordinary means regardless of the condition of the child. They haven't excepted that the death is inevitable and want to do everything possible to keep the child alive.  If this is what they want or if they want to stay in the hospital instead of going home, then this is what should be done.  It's their decision and no one else's.

Sandra, Hem/Onc - CPNP retired, Children's Hospital March 13, 2014 4:01 PM
Dayton OH

Who are we to lay a blanket judgement over the entire patient population that falls under the definition of "minor"? Murder?? Is it? Because in many instances, the chemotherapy itself is considered caustic and toxic. Additionally, as with many oncology cases, patients die from complication related to treatment (Sepsis secondary to neutropenia, for example). Isn't that murder? Knowingly introducing a toxic chemical into your child's body with the hope that it kills the cancer cells faster than the healthy cells is in essence, medical Russian Roulette, is it not? Because the reality of the situation is that there is no guarantee for a cure.

    We can also talk about the prevalance of cancer as a result of the overuse of cat scans on pediatric patients. The numbers are astounding.  Research has shown that the amount of radiation exposure from 2 to 3 head CT scans given to a child (sports related injuries/migraine diagnosis) can triple the risk of brain cancer, and if a patient receives more than 5 head scans the risk of leukemia triples (cancer.org, 2014). Is that attempted murder??

    So how is euthanasia for a minor murder? Under strict guidelines, when all extraordinary measures have been exhausted, how is alleviating a child's pain and suffering "murder"? How is it more ethical to allow a child to linger in a prolonged state of pain/suffering or altered mental status or under isolation in a hospital for a months at a time with no change than to allow them to die with dignity, just as we do with adults.

      This is the 21st century. We are not living in an age where "children should be seen and not heard". Every case is individual and the nurses that care for these patients are not murderers! Maybe it is time for some of those who work in healthcare to re-evaluate their role in patient care.

Beth, ED/Trauma - Asst. RN Mgr. February 28, 2014 12:01 PM
Central NJ

I worked in an Peds ICU for numerous years and have had teens with terminal illness plea with their parents to just stop everything and let them go; because they were hurting and everything had been done as many as 6-8times-from chemo, radiation, surgery, transplants, ecmo- and the teen plea with me please talk with my parents I know I'm going to die and I hurt so bad and just want this over!  I've even experienced my own child dying from an inoperable brain tumor and had to make the decision not to place my child on a vent; so I am not saying it is always right but maybe we should at least listen to the teen who understand what is going on-some of them can tell you more about their illness than nurses or some doctors.

Bob, Pediatrics - RN February 28, 2014 7:33 AM
Tampa FL

I worked in an Peds ICU for numerous years and have had teens with terminal illness plea with their parents to just stop everything and let them go; because they were hurting and everything had been done as many as 6-8times-from chemo, radiation, surgery, transplants, ecmo- and the teen plea with me please talk with my parents I know I'm going to die and I hurt so bad and just want this over!  I've even experienced my own child dying from an inoperable brain tumor and had to make the decision not to place my child on a vent; so I am not saying it is always right but maybe we should at least listen to the teen who understand what is going on-some of them can tell you more about their illness than nurses or some doctors.

Bob, Pediatrics - RN February 28, 2014 7:31 AM
Tampa FL

Stop the insanity!!! .  Children are too young to make life altering decisions about ending their young lives if chronically lll

This is murder

Margaret, Nurse - RN February 27, 2014 9:14 PM
Boston MA

None of us can really say what others feel. But if an adolescent has been very, very ill and has been told honestly that there is not a cure for whatever he or she has, I believe they should have the right to express their feelings and discuss what they would like done. No one can really feel another's pain, so to not let a knowledgeable adolescent have a part in the end of life is very unfair.

margaret, RN February 27, 2014 7:27 PM
shelton CT

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