UPDATE 10/14/18: Adam Rapoport, co-author of the report told CTV News that it is incorrect for news agencies to say they would be euthanizing children without parental knowledge.
“Those articles that have made it sound like we would do this without parental knowledge — that’s just not how we operate as an organization,” he said in a phone interview with CTVNews.ca. “To think that we would ever do that — I couldn’t even imagine the circumstance.”
However, there is a difference between parental “knowledge” and parental “consent”. Allowing a minor who is deemed “capable” to choose assisted suicide with parental knowledge is much different than a minor who does so with the consent of his or her parents. Knowing your child is choosing death is one thing, but approving it is completely different. Some may argue that no minor is actually capable of making such a decision based on the simple fact that he or she is a minor. Rapoport said the hospital will “err on the side of caution” when doctors are unsure about a child’s capabilities to make such a choice.
It is important to note that this policy is not in effect and was written out as a possible option for the future.
Doctors at Toronto’s Hospital for Sick Children, known as SickKids, have laid out a “road map” for killing their patients, including cases in which they would do so without parental permission.
In the proposed policy published in the British Medical Journal’s Med Ethics, backed by the University of Toronto’s Joint Centre for Bioethics, doctors, administrators, and ethicists look at the “ethical challenges of providing Medical Assistance in Dying in a paediatric setting” and outline how assisted suicide would play out for children at Sick Kids. Their flowchart does not include discussing assisted suicide with parents until a “reflection period” occurs after the child has already been killed.
Currently, assisted suicide is available to persons considered “capable patients” who are 18 years or older. This proposed policy is written with the future in mind — a future in which children under age 18 who are considered “capable” may choose to be euthanized. The authors of the paper are aware that this would come with “potentially serious consequences for practitioners and institutions”, but hope to “reduce social stigma” surrounding the euthanasia of children. If a child is considered “capable” and wants assisted suicide, he or she would also be able to say they want to die, and that they don’t want their parents to know until after the fact. Doctors would then be unable to tell the parents due to confidentiality laws. Legally, Ontario’s laws do not require that parents be involved in a minor’s decision to refuse treatment and therefore, this paper argues that they shouldn’t be involved in a minor’s decision to die by assisted suicide either.
“Usually, the family is intimately involved in this decision-making process,” the paper states. “If, however, a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although health care providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected.”
The authors also state that they do not see a difference between a patient refusing treatment versus a patient committing suicide.
“It’s a tough thing to know what to do next under the circumstances. This is now legal,” bioethicist Bridget Campion told the Catholic Register. “In my opinion, if we are committed to building a culture of life, forget the legislation. That ship has sailed. There are some things that we absolutely must make sure stay in place – that there can be Catholic health care, that there can be conscientious objection. But, to me, the biggest thing is, ‘OK, how do we build a culture of life? How do we build a culture of care?’ If we can do that and make it so that people don’t want medical assistance in dying, then we will have achieved something.”
Assisted suicide and euthanasia was legalized for adults in Canada in 2016. A 2017 study showed that 33 percent of doctors think assisted suicide should remain illegal for minors, while half think that “mature minors” should be able to choose assisted suicide. The timing of this new article is interesting as, according to the Catholic Register, it was published just three months before the Canadian Council of Academics is scheduled to report to Parliament about the medical community’s thoughts on allowing euthanasia for minors, psychiatric patients, and other patients for whom assisted suicide is currently illegal.