Toronto’s Hospital for Sick Children Writes Physician-Assisted Suicide Policy for Patients 18 & Up With ‘Eye’ on Future Allowance for ‘Capable Young People’

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TORONTO — Pro-life groups are expressing concern after employees with Toronto’s Hospital for Sick Children recently penned an essay outlining that they had been asked to develop a policy on how to respond to Medical Aid in Dying (MAID) requests at the hospital, and noting that the policy—although applying to those 18 and older—was also written “with an eye to the near future when capable young people may gain access to MAID.”

The paper, published in the British Medical Journal of Medical Ethics (BMJ), was written by Adam Rapoport of the pediatric advanced care team at the hospital and Emily’s House Children’s Hospice, along with Randi Zlotnik Saul of the bioethics department and the department of pediatrics, and Carey DeMichelis at the Joint Center for Bioethics at the University of Toronto.

They outline in the abstract for the report that their writings focus on the “ethical challenges” of providing physician assisted suicide in a pediatric facility, with a particular emphasis on “the theoretical questions that came to light when we were asked to develop a policy for responding to MAID requests at our tertiary paediatric institution.”

Canada’s MAID law, also known as C-14, has been in place for two years and allows for those at least 18 years old with an “irremediable medical condition” to request to end their life. As some have pondered further legal allowances, such as for the mentally ill or terminally ill “mature” children, the Hospital for Sick Children noted that their policy was written with forward thinking in regard to the possibility that MAID could one day be extended to minors.

“While MAID is currently available to capable patients in Canada who are 18 years or older—a small but important subsection of the population our hospital serves—we write our policy with an eye to the near future when capable young people may gain access to MAID,” the essays authors wrote. “We propose that an opportunity exists for MAID-providing institutions to reduce social stigma surrounding this practice, but not without potentially serious consequences for practitioners and institutions themselves.”

The concept that sick children could one day be put to death at a children’s hospital has alarmed some groups, but also the report’s exploration as to whether young people can elect not to have their family involved in the decision to end their life.

“How should health-care providers respond if a capable patient requests MAID but their parents clearly oppose this request? Are there situations in which MAID requests and administration would be kept secret from parents and other family members?” the paper asked, according to the National Catholic Register, which gained access to the full document.

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“In other circumstances in which capable young people make medical decisions that result in the end of life, the answer is ‘Yes,’ although, again, clinicians would strongly encourage the patient to discuss this decision with their family,” it outlined.

“It is not difficult to imagine how such a protocol could wreak havoc on society,” wrote Monica Burke of The Heritage Society. “When a culture differentiates between lives worth living and lives worth ending, the consequences to vulnerable populations—the young, the old, the sick, and disabled—are disastrous.”

“Suddenly, those who most require our compassion and protection become the most likely to be pressured to prematurely end their lives,” she opined. “No one should receive suicide assistance instead of suicide prevention—especially not children.”

As previously reported, Belgium euthanized its first child in 2016 after the law was changed to remove age restrictions for the terminally ill. While some applauded the move as providing care for those in pain, others said that there are ways to address pain other than killing the patient.

“Means of alleviating pain are widespread in Belgium within present medical scope, far more so than in most other countries. No patient, no child therefore, need suffer nowadays,” the blog states.

“As of today we are perfectly capable of controlling physical pain, smothering or anguish in the throes of death,” it explains. “Established palliative care teams for children are fully able to relieve pain, whether in hospital or at home.”

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