House of Assembly Fifty-Third Parliament, First Session (53-1) 53 1 Parliament of South Australia House of Assembly published Motions Motions Euthanasia Euthanasia Mrs VLAHOS House of Assembly Taylor Mrs VLAHOS (Taylor) (11:54): I move: That this house— (a)	notes that— i.	the Belgium parliament has recently authorised the direct killing of children through euthanasia; ii.	euthanasia or assisted suicide is now routinely performed in Belgium and the Netherlands on persons with no terminal illness but with psychiatric disorders, such as anorexia, or depression or with disabilities, such as blindness; iii.	the Belgian Society of Intensive Care Specialists recently advised that they are prepared to conduct involuntary euthanasia—even upon children; and iv.	Dr Philip Nitschke during a recent visit to Perth offered instruction in methods of suicide, including how to illegally obtain pentobarbitone, a schedule 8 poison, and how to use nitrogen as an undetectable means of ending life; (b)	condemns the practice of child euthanasia; (c)	commends palliative care as an appropriate response to terminal and chronic illness; (d)	affirms the value of every human life, including those people living with mental illness or disability; and (e)	endorses suicide prevention as the appropriate response to all those who, for whatever reason, may think life is not worth living. I raise this motion this morning to talk about the issue of child euthanasia, which has recently been legislated in Belgium on 14 February. I am mindful of the fact that the United Nations Convention on the Rights of the Child states that 'the child, by reason of his physical and mental immaturity, needs special safeguards and care'. I think this chamber should be mindful of that when we talk about what the Belgian parliament recently passed on 14 February to enable children to access euthanasia in some circumstances without limitation of age. I would like to draw to the house's attention an article that I got from ABC Wire that gives a brief history of the legislation and how it passed: Belgium has become the first country to allow euthanasia for terminally ill children of any age, after its lower house of parliament passed...'right-to-die' legislation. The law passed with a…majority of 86-44, with 12 abstaining. Under the extension to the existing euthanasia law, all age restrictions will now be removed on the right to die. It goes beyond Dutch legislation that set a minimum age of 12 for children to be judged mature enough to end their [own] lives… Adult euthanasia became legal in the country in 2002. [Together] Christian, Muslim and Jewish leaders denounced the law ahead of the vote in a rare [declaration of joint affirmation]. 'This is not about lethal injections for children, this is about terminally ill children, whose death is imminent and who suffer greatly,' said Carina Van Cauter, from the Flemish Liberal Democrats who back the law… Children seeking to end their lives must be 'capable of discernment', the law says, and psychologists must test them to confirm they understand what they are doing. Parents must also approve of their child's decision. Those who oppose the law say it is a slippery slope, which could see terminally ill children pressured into deciding to end their [own] lives… Adolescents cannot make important decisions on economic and emotional issues in Belgium—and I will touch on that in a moment—but suddenly they have become able to decide whether someone should be allowed to die: themselves. The article continues: The new law specifies that children seeking euthanasia must be terminally ill rather than just in a state of unbearable suffering, which is the qualification for adults. Apart from Belgium and the Netherlands, euthanasia is also legal in neighbouring Luxembourg, and France is considering legalising it later this year. Switzerland allows assisted suicide if the person concerned takes an active role. In the United States, assisted suicide is legal in Montana, Oregon, Vermont and Washington states. I will go back to what you can and cannot do in Belgium if you are a child. I would say that this is an important fact, because it is well known that the neurophysiology of a child's brain does not in fact settle, or the wiring become hardened, until most people (particularly males) are in their mid-20s, around the age of 25 or 26. It is interesting to think that children are unlikely to be cognisant of the gravity of the irreversibility of the decision for euthanasia, especially those who are enduring a terminal illness. By virtue of their age, they are unable to decide to drive, to vote, to marry, or to consume alcohol legally, in recognition of the reality of the maturity of self-determination and that such actions are the result of neurophysiology. In Belgium, the legal age of drinking beer and wine is 16 and of spirits, 18; the legal age of consuming tobacco is 16; the legal age to go to a PG dance is 16; and to fly a plane is 16. The legal age to drive a car is 18; the legal age to have sex is 16; to prostitute oneself, which is legal in that country, is 18; and the legal age to marry is 18. It is also mandatory that you vote in Belgium, and that is at the age of 18. So, at a time when the Belgian parliament is saying that all those things must be conducted by an adult, it is allowing these children who are terminally ill the right to make a decision that is irreversible at a much, much earlier age. Children in such circumstances of poor health are particularly vulnerable to suggestion. It cannot be argued in any meaningful way that the discussion with a child in such circumstances could elicit free or informed consent. The very suggestion of euthanasia to a child by a parent or medical personnel is a loaded discussion in every circumstance. The very existence, therefore, of the possibility of euthanasia for children is, ipso facto, an abuse. I would now like to talk briefly about the role of the medical profession. Recently, the American College of Paediatricians issued a statement condemning the Belgian move, as follows: Physicians are healers not killers. An individual's future quality of life cannot be predicted by caregivers. The role of the physician is to promote health, cure when possible, and relieve pain and suffering as part of the care they provide. The intentional neglect for, or taking of, a human life is never acceptable, regardless of the health system mandates. The killing of infants and children can never be endorsed by the American College of Pediatricians and should never be endorsed by any other ethical, medical or social entity. I will also read briefly from the International Children's Palliative Care Network (ICPCN) which held a meeting in Mumbai in February and issued a statement about children's palliative care, calling on the Belgian government to reconsider its recent decision to allow for the euthanasia of children. At the conclusion of the first ICPCN conference in Mumbai, they declared that all children with life limiting conditions should have access to appropriate pain and symptom control and high-quality palliative care to meet their particular needs. The declaration fully reads as follows: We believe that all children (neonates, children and young people) have the right to the best quality of life. When they have life-limiting conditions they have the right to high quality palliative care to meet their needs. We believe that euthanasia is not part of children's palliative care and is not an alternative to palliative care. It is imperative that we work together to improve access to children's palliative care around the world, including ensuring access to appropriate pain and symptom control. We call on all governments to transform children's life through the development of children's palliative care, and in particular we urge the Belgian government to reconsider their recent decision to allow euthanasia of children. This includes: 1.	Access to children's palliative care within the children's health care system 2.	Access to appropriate pain and symptom management (including medications) for all children 3.	Supporting children and their families to be able to live their lives to the best of their ability for as long as possible. Joan Marston, their CEO, went on: Euthanasia is not and never has been part of palliative care and we believe the answer to a child's suffering is more and better palliative care services, not the ending of a child's life. I have discovered an interesting piece of work by Drs Arthur Caplan, Andrew Siegel and Dominic A. Sisti who are PhDs that was released recently in the Journal of the American Medical Association. All three men argue that children do not have adult capacity for informed consent. Again, I draw attention of the house to some of their reasonings: 'Children and adolescents lack the experiential knowledge and sense of self that adults often invoke—rightly or wrongly—at the end of their lives,' they argue…The Belgian law specifies that euthanasia would be permissible only for 'terminally ill children who are close to death, experience constant and unbearable suffering'. That suffering of such magnitude exists in modern pediatrics is an inexcusable tragedy. But the solution need not and should not be euthanasia. All patients, including children, must have access to adequate palliative care. Although access to adequate comprehensive palliative care is limited in many settings, it ought not be in developed countries such as Belgium…The goal of reducing suffering in children at the end of life is a laudable one. However, the ethical way to achieve this goal should be expanded education and clinical guidance around the provision of aggressive palliative care. I also draw the house's attention to the issue of how quickly the euthanasia debates have moved over the last decade or so and how they have progressed around the globe and how quickly the slippery slope to death is accelerating in some areas of the world. I ask my colleagues to think deeply on these issues that are nested together. Deaths by euthanasia in Belgium have rapidly increased from 235 in 2003 to 1,432 in 2012. Many of these deaths were not due to terminal illness. In 2012 Ann G. was euthanased for 'unbearable psychological suffering' relating to anorexia and sexual abuse. In December 2012 deaf identical twin boys were euthanased for distress having learned that they were going blind. In September 2013 Nathan Verhelst was euthanased for unhappiness following a sex change operation. It is the role of every medical profession to deliver care for ailing patients with compassion, always striving to preserve the patient's life, dignity and alleviate pain. Child euthanasia, as legal in Belgium, is not the way forward. This is not an acceptable approach to dealing with the issues related to end of life. Palliative care is the appropriate response to terminal chronic illness and I commend the Minister for Health for his work in this area. Former minister for health Martyn Evans, who is leading a task force in this area, continues to do great work, too, and I will continue to assist them in this area. It is important that the parliament recognises the value of every human life, including those people who are living with disability or mental illness. Suicide prevention is the appropriate response to all of those who may think life is not worth living and palliative care is the goal that we should be aiming for, for every child in our society. I ask that the chamber support this motion. Debate adjourned on motion of Mr Gardner.