Judging the Quality of Mercy: Drawing a Line Between Palliation and Euthanasia

Morrison, Wynne; Kang, Tammy I.

doi:10.1542/peds.2013-3608f

Cited by 22 publications

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“…Increasingly, death derives not only from the natural course of a deadly disease, but also from a number of medical decisions, such as the assignment of treatments that prolong the life of critical patients or the suspension of those treatments (life-saving technology can sometimes only delay the process of death) and the relief of severe symptoms by the use of drugs which can cause, as possible side effects, acceleration of death. This scenario can create difficult situations such as when patients feel hopeless, after realising that their suffering is unbearable, and ask the doctor to help them to end their lives [2][3][4][5] .…”

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“…Equally important, it is necessary to know how to discuss these issues with the patients and their families, while continuing to support them in what is probably one of the most difficult times of their lives 5 .…”

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“…Parents -who in general are unprepared to deal with the devastating possibility of death of their child and act as the child's advocates -are usually the main intermediaries in communication with health professionals 5,8 . When it comes to adults, there is often some prior information of the patient's wishes regarding decisions about end-of-life, decisions that family members might be aware of and use in order to make up their minds 13 .…”

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“…In fact, the involvement of minors in the decision making process is not linear and depends on age, level of competence, nature of decisions and experience with chronic diseases. In ethical terms, this interaction between the role of parents as legal representatives and the child's decision making capacity raises important questions about the rights of minors to self-determination, the limits of parental control and the balance between the best interests of the patient and his or her wishes 5,8 .…”

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“…Studies show that 5,6,14 most end-of-life care of children occurs in hospitals, especially in pediatric intensive care units (PICU). The decision to suspend the life support treatment is the most common -30% to 60% of deaths in the PICU are preceded by a process of active suspension, usually starting with The Belgian case of euthanasia for children, solution or problem?…”

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Caso belga de eutanásia em crianças: solução ou problema?

Silva

Nunes

2015

Rev. Bioét.

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By extending its euthanasia law to minors in 2014, Belgium has fuelled the international debate on this issue. In fact, Medicine does not always have something to offer when it comes to a child's serious disease. Nevertheless, should euthanasia be considered a viable solution? Keeping in mind the Belgian reality, this article analyses the relevance of the new law, considering, on one hand, children's growing self-determination capacity and, on the other hand, their lack of "life experience". Let's not forget, in addition, classical arguments against euthanasia, such as the disrespect for the value of human life and the eventual approaching of the slippery slope. An obvious solution for this problem is the implementation of a proper palliative care system. However, evidence about the quality of pediatric end-of-life care is scarce. Therefore, additional investigation is necessary in order to formulate and propose an appropriate public policy on the matter. Keywords: Euthanasia. Child. Belgium. Palliative care. Resumo Caso belga de eutanásia em crianças: solução ou problema?A aprovação da extensão da prática da eutanásia a menores de idade em 2014, pela Bélgica, reacendeu o debate internacional sobre as decisões médicas em fim de vida em crianças. De fato, a medicina nem sempre tem resposta para a doença grave de uma criança. No entanto, será a eutanásia uma solução equacionável? Partindo da realidade belga, este artigo analisa a premência da nova legislação, considerando, por um lado, a capacidade crescente de autodeterminação das crianças e, por outro, a sua falta de "experiência de vida", não esquecendo argumentos clássicos que contrariam a prática da eutanásia, como o desrespeito pelo valor da vida humana e a eventual concretização do argumento da ladeira escorregadia. Uma solução óbvia passa pela realização de cuidados paliativos apropriados. Todavia, sendo escassa a evidência sobre a qualidade dos cuidados pediátricos em fim de vida, é necessária investigação adicional para que se possam formular e propor políticas públicas adequadas a respeito da matéria. Palavras-chave: Eutanásia. Criança. Bélgica. Cuidados paliativos. Resumen Caso belga de la eutanasia en niños, ¿solución o problema?La aprobación de la práctica de la extensión de la eutanasia a menores en 2014 por Bélgica ha reavivado el debate internacional sobre las decisiones médicas en el fin de la vida de los niños. De hecho, la medicina no siempre ha de responder a la enfermedad grave de un hijo. Sin embargo, ¿debería considerarse la eutanasia como una solución viable? Partiendo de la realidad belga, este artículo analiza la emergencia de la nueva ley: considerando, por un lado, la creciente capacidad de autodeterminación de los niños y, en segundo lugar, su falta de "experiencia de vida", sin olvidar los clásicos argumentos que contradicen la práctica de la eutanasia, como el desprecio por el valor de la vida humana y la eventual realización de "rampa de deslizamiento". Una solución obvia es implementar los cuidados paliativos adecuados. Si...

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