Canadian Council of Academies
The State of Knowledge on Medical Assistance in Dying For Mature Minors (December 2018)
The principal ethically significant conclusion of this report is that an age-related cut-off for access to MAID is arbitrary. A person does not acquire the capacity to make a MAID decision magically at the moment of his or her 18th birthday, when the day before he or she did not. Rather, the issue is capacity to make a decision of this type, and capacity is a highly person-specific issue.
The Council notes that patients under the age of 18 are already permitted (if capable) of making decisions to limit or cease life-sustaining treatments, decisions which also have life or death consequences.
On the issue of capacity the Council notes a distinction between intellectual or cognitive capacity and emotional maturity. An over reliance on a simple cognitive test of capacity would not detect the potential nuances of a young person’s level of emotional maturity. Having said that, age itself does not preclude a person from having the emotional maturity to make a decision of this type. The emotional dependence or interconnectedness of young people with both their families and their care teams was noted – with the potential benefits – and drawbacks associated with that connectedness.
On suffering – it is clear that a young person can suffer in precisely the same way as an adult.
The Council stresses that good paediatric palliative care is a must before any extension of MAID to mature minors is contemplated.
MAID is permitted for mature minors in both Belgium and Holland, with some additional safeguards which include parental consent and or consultation through the process and additional medical and psychiatric consultations. It is noted, though not much discussed that euthanasia for young children and infants (without the capacity to consent) is permitted in Holland. This is not under discussion here.
Conclusion
There is no good reason for not extending MAID to mature minors. Excellent palliative care should always be the first and best response to these tragic situations. Additional safeguards may be required.
