Doctors from Toronto’s Hospital for Sick Children have published a plan in a prestigious medical journal in which they outline policies that would allow children to be euthanized –  in some cases, without parental consent.

Crux.com is reporting on the article which appeared in the British Medical Journal’s J Med Ethics issue. The article contained a flowchart that outlines how “medically induced death” would occur at the hospital. The authors, Carey DeMichelis, Randi Zlotnik Shaul and Adam Rapoport do not mention conversation with family or parents about how the child dies until a “reflection period” which would occur after the death occurs.

Currently, assisted suicide is available to “capable patients” who are 18 years or older. However, the Canadian Council of Academies is due to report to Parliament on the medical consensus about extending voluntary euthanasia in circumstances currently forbidden by law.

“The Canadian Council of Academies is specifically looking at extending so-called assisted dying to patients under 18, psychiatric patients and patients who have expressed a preference for euthanasia before they were rendered incapable by Alzheimer’s or some other disease,” Crux reports.

This well-timed article seems to be laying out the guidelines for the future of assisted suicide in Canada which will allow children under the age of 18 – who are deemed “capable” – to choose to be euthanized. And because of existing patient confidentiality laws, if a capable minor chooses not to include his or her parents in the decision, hospital staff must respect their wishes.

“Usually, the family is intimately involved in this (end-of-life) decision-making process,” the authors write. “If, however, a capable patient explicitly indicates that they do not want their family members involved in their decision-making, although health care providers may encourage the patient to reconsider and involve their family, ultimately the wishes of capable patients with respect to confidentiality must be respected.”

They go on to argue that there is no meaningful ethical distinction between a terminally ill patient choosing to refuse a burdensome treatment than one who chooses to die by a chemical injection before natural death occurs.

“Ontario does not require parents to be involved in a capable minor’s decision to refuse further treatment, therefore there is no legal reason to require parent involvement in an assisted death, according to the Sick Kids policy,” Crux reports.

Bioethicist Bridget Campion, a researcher, lecturer and writer with the Canadian Catholic Bioethics Institute, admitted that she is not surprised by the article.

“The fact is medical assistance in dying is now legal. And it’s legal in many places around the world,” Campion told the Catholic Register. “Now that it is legal, many practitioners are saying, ‘How do we do this?’ I’m not surprised at all.”

Although opponents of assisted suicide are now concentrating on fighting for conscience protections for clinicians and health care institutions, Campion says it’s tough to know exactly what to do next under the circumstances.

“This [assisted suicide] is now legal,” she said. “In my opinion, if we are committed to building a culture of life, forget the legislation. That ship has sailed. There are some things that we absolutely must make sure stay in place – that there can be Catholic health care, that there can be conscientious objection. But, to me, the biggest thing is, ‘OK, how do we build a culture of life? How do we build a culture of care?’ If we can do that and make it so that people don’t want medical assistance in dying, then we will have achieved something.”

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