Considering medical assistance in dying for minors: the complexities of children’s voices

Abstract

Medical assistance in dying (MAID) legislation in Canada followed much deliberation after the Supreme Court of Canada’s ruling in Carter v. Canada. Included in this deliberation was the Special Joint Committee on Physician Assisted Dying’s recommendation to extend MAID legislation beyond the inclusion of adults to mature minors. Children's agency is a construct advanced within childhood studies literature which entails eliciting children’s voices in order to recognise children as active participants in constructing their own childhoods. Using this framework, we consider the possible extension of MAID legislation to most minors. We highlight important questions regarding how insights from children’s voices could be mobilised in the life or death context of MAID. We conclude that children’s voices have the potential to help determine their eligibility for MAID; however, incorporating children's voices in the context of MAID requires careful consideration due to the complexity of voice.

Assisted dying around the world: a status quaestionis

“…Many pediatricians in the Netherlands and Belgium disagree with strict age limits for euthanasia (40). The debate over expanding assisted dying to children has been ongoing since the passage of MAiD in Canada (41). Autonomy and the capacity to consent are central among concerns for opponents (41).…”

“…The debate over expanding assisted dying to children has been ongoing since the passage of MAiD in Canada (41). Autonomy and the capacity to consent are central among concerns for opponents (41). Although consideration is afforded to minors deemed mature enough to make informed decisions for themselves, children are often believed to lack the capacity to understand and reason and are therefore considered particularly vulnerable, though some argue that children should be seen as active agents with morally meaningful perspectives which should be considered with regard to end-of-life decision making (41).…”

Young people's perspectives on assisted dying and its potential inclusion of minors

“…While our study elicits the perspectives and preferences of young people, future work is needed to help operationalize how stakeholders such as healthcare practitioners and policymakers should mobilize these perspectives. More ethically focused work is needed given the amplified risks associated with uncertainty in the context of MAID (Singh et al, 2020). Moreover, future work should examine how the empirical results generated within this study should be mobilized to inform normative analyses and policymaking regarding MAID.…”

“…While slow, legal and policy conversations are starting to address MAID for mature minors in Canada following the CCA report mentioned above. Two recent Canadian publications have highlighted potential benefits of including young people in discussions and decisions regarding MAID for minors, yet neither had empirical data: Singh et al (2020) argued that engaging young people would help determine their eligibility for MAID by providing insight into their suffering and its intolerability, and Campbell et al (2022) argued that discussions with young people in the general population about MAID could challenge social hesitancy to discuss death and dying in paediatric health contexts.…”

The ethics of infant and early childhood mental health practice

“…To respect a child's agency means to acknowledge their perspective and give it value by eliciting, listening, and paying attention to these perspectives, sometimes referred to as hearing the child's voice (Hallett & Prout, 2003). Attending to the child's voice is increasingly recognized as an important aspect of ethical practice in healthcare settings (e.g., Carnevale, 2020; Kars et al., 2015; Singh et al., 2020).…”