Belgium's second house of parliament is set to decide on legalizing active medically assisted suicide for children. The planned expansion of the euthanasia law for adults has been hotly debated for months.
"Why wouldn't you give children, who are incurably sick and who are unbearably suffering the same possibilities adults have?" asked Dr. Jan Bernheim from the research team for terminal care at the Free University Brussels.
Bernheim wants to give terminally ill children in Belgium the option to voluntarily end their own life. According to the cancer researcher, children are surprisingly grown up and can think clearly when they are seriously ill.
"They're not as young as the calendar says. They are in fact psychologically much older and more mature than their calendar age would suggest," he told DW. "That's why the majority of Belgian pediatricians want to meet the children's desire to die in these cases."
Killing suffering children on demand?
Sixteen leading pediatricians wrote an open letter demanding an expansion of the practice of euthanasia to sick children, which was published in two Belgian newspapers.
However, an alliance of religious groups vehemently disagreed. Representatives of Catholic, Protestant, Christian Orthodox, and Muslim religious groups published a common declaration stating that euthanizing minors is morally and ethically reprehensible.
"A child cannot buy a house in Belgium. A child cannot buy alcohol in Belgium. And this law would allow a child to ask to be killed. And that is a real problem," Carine Brochier of the European Institute of Bioethics in Brussels told DW.
The upper house of Belgium parliament voted to extend the country's 11-year-old law permitting medically assisted suicide for adults to children and patients suffering from the initial stages of dementia in mid-December 2013. If the law passes, it will need to be signed by King Philippe to go into effect. The signature, however, is normally only a formality in Belgium.
Next to the Netherlands and Luxemburg, Belgium is the most liberal nation when it comes to euthanasia laws in the European Union. In other EU states, euthanasia is either forbidden, or severely limited. Almost 1,432 people in Belgium elected to be euthanized in 2012 alone.
Psychological suffering and euthanasia
The debate over euthanasia has heated up over the last few months after several spectacular cases emerged. In the October version of the Belgian magazine "Panorama," TV journalist Dirk Leestmans reported on a detainee who was granted the right to be euthanized.
The inmate said the detention and the conditions in jail had caused him extreme psychological suffering and he therefore wanted to die. The case is still being reviewed by the courts. The inmate hasn't been euthanized yet, but his request seems poised for approval.
Now, the TV reporter is asking the uncomfortable question of whether euthanizing detainees, who are not incurably ill, is essentially bringing back the death penalty in Belgium through the back door.
This is not the only case that created an international sensation. At the beginning of October, a 44-year-old, going by the name of Nathan, was euthanized after a failed sex change operation. He said his wish to die was legitimate because of unbearable psychological suffering.
Nathan was born a woman and suffered from the feeling of having the wrong gender identity all his life. He underwent so-called gender reassignment surgery in 2012, but his body rejected the new sexual organs. Nathan subsequently felt mutilated and told Belgian newspaper "Het Laatste Nieuws": "I didn't want to become a monster."
The doctor who gave him the lethal injection, Wim Distelmans, told the same newspaper that the difficult decision was made after six months of struggling with the issue.
'Euthanasia gives a sense of security'
According to Bernheim, euthanasia based on unbearable psychological suffering is not granted recklessly. "If death is still many months or even years away, then you have to consult a third doctor, who's often a psychiatrist. Then you need one month of respite, which means you have to wait one month until you can get it done."
Opponents of this new branch of euthanasia argue that the psychologically ill should be treated rather than killed by their own request. Brochier is concerned about softening the criteria and indicators for euthanasia.
"The supply of euthanasia is building the demand for euthanasia," she says. "The more you offer it the more people will ask for it."
She added that it would be better to further expand palliative medicine, to support the dying process by controlling pain and renouncing life-prolonging measures, such as artificial nutrition and respiration.
Cancer doctor Bernheim also wants an expansion of palliative medicine and says 30 percent of all people who demand to be killed because of their unbearable psychological suffering are denied their wish. From those whose wishes are granted, the majority decided to live and to only keep euthanasia as a last resort.
"The majority of these people continue to live. But they have the security that they could die if they really can't bear it anymore. But most of the time they continue to live."
'Society is changing'
Opponents of an expansion of euthanasia, such as Brochier, want a serious discussion within Belgian society after 11 years of legalized euthanasia. They say family members, hospital staff and doctors are extremely burdened by the euthanasia law. Despite its legal status, many doctors refuse to euthanize people.
"Euthanasia is not easy. It's not fun to kill someone. Euthanasia is really killing and that's not good for the person doing it, even if it is to kill pain and suffering. It's also killing society," Brochier said.
According to her, the number of unreported cases of euthanasia is high and has yet to be explored. Brochier reports of having spoken to elderly people who fear they will not receive proper medical treatment anymore because they think in the long run, euthanasia is more economical for hospitals than years of costly care.
According to opinion polls, three quarters of Belgians agree with the current liberal regulations for euthanasia.