Belgium has long been one of the most progressive countries when it comes to euthanasia. In 2002, Belgium formally legalized euthanasia by way of the Belgian Euthanasia Act, which allowed euthanasia for adults who experience “constant and unbearable physical or mental suffering that cannot be alleviated”.

Initially, euthanasia was applicable only to adults; however, with time, its application and scope has widened. The idea that a terminally ill child could wish to end his or her life and be able to do so has been met with strong opposition, with religious, moral, emotional, and cognitive factors underlying non-acceptance of this practice. Scientific data, moreover, confirms that a child’s brain is not fully developed and that this affects his or her decision-making capacity in various settings. Belgium, however, passed an amendment to its current euthanasia law in 2014, becoming the first country to legalize the practiced for children.

The 2014 amendment lifts the age restriction on euthanasia in Belgium, thereby allowing all people – regardless of age – to seek euthanasia. However, the law does impose some restrictions on minors who choose to exercise this right: the child must have a terminal or incurable disease, or be near death, or suffering from chronic pain, and must always have the consent of the parents and healthcare professionals. Moreover, the child must undergo an evaluation by a pediatric psychiatrist in order to certify that the he or she does in fact possess so-called “capacity of discernment” (regardless of the child’s biological age), and this must be noted in writing.

Since the amendment was passed, it has not been relied upon very often. Reports estimate that between 2016 and 2018, Belgian doctors resorted to euthanasia in three cases involving children under the age of 18. Although it has been relied upon in only a handful of cases, numerous studies conclude that the majority of physicians favor the 2014 amendment of the law.

There is no question that the issue of childhood euthanasia has sparked heated debates. In fact, researchers developed a methodology in order to categorize and better understand the arguments used in this context. It found that these arguments “can be broadly characterized using the four-principle approach of medical ethics: respect for autonomy, non-maleficence, beneficence, and justice.” While proponents of child euthanasia tend to ground their arguments in principles of beneficence and autonomy, opponents generally rely on the principle of non-maleficence.

Bioethical analyses of child euthanasia tend to focus on the issue of minors’ decision-making capacity. The Belgian law, similarly, hinges on the requirement that children possess the capacity to “discern” the concept of euthanasia and understand its implications. Despite concerns that the statute’s definition of  “discernment” is overly vague and hard to apply to concrete cases, the Belgian Constitutional Court has held that it was sufficiently clear as written and that the legislature was justified in not setting more specific criteria to evaluate capacity in this context. The Court found that possessing capacity “relates to the ability of the minor to understand the real implications of his euthanasia request and its consequences.

The debate about both the legality and morality of child euthanasia is far from over. It would benefit from not only additional research, but also further discussions among legal experts, health providers, ethicists, and other professionals.