Review of Medical Assistance in Dying Part 2: Assisted death for children as young as 12?

14 June 2022

A special committee of MPs and Senators are considering whether youth under 18 should have access to euthanasia and assisted suicide. The special committee focused on this topic for several hours last week, hearing from experts and stakeholders. There are strong differences in opinion, but many witnesses recommended opening eligibility to assisted death to youth under 18. 

A law professor told the committee last week that if they felt they needed to set a minimum age for medical assistance in dying (MAID), it should be the age of 12. Her actual recommendation, however, was that there be no minimum age of eligibility. Instead, she recommended assessing each youth as to whether they have the capacity to make the decision to have their life ended through MAID. 

Professor Constance Macintosh told the committee she believes setting the minimum age at 12 years would not leave out youth who may be capable of making this decision: 

“Where that number [of 12 years of age] is coming from is the psychological literature on youth and medical decision making, and it’s the youngest age that has been identified where it’s considered to be plausible that a youth would have decisional capacity.” 

Another witness in the same meeting, lawyer Bryan Salte who works for a provincial regulatory college for doctors, agreed that there should be no specific minimum age of eligibility for MAID. He suggested, though, that there should be an additional safeguard of consulting with the family when a minor requests assisted death. He would not recommend that the decision require family agreement or consent, but that the family should be at least aware of what was happening. 

A 19-year-old woman also appeared before the committee last week, to share her extreme concern and distress that youth with disabilities could become eligible for MAID. Ahona Mehdi, a member of the Disability Justice Network of Ontario youth action council member, told the committee: 

“I’m here today because I’m extremely concerned and distraught as a disabled youth about the potential expansion of MAID to mature minors in this country. Before I begin, I’d like each elected official and Senator to sit with this reality: had MAID been offered to me just over a year ago when I was accessing treatments as a minor, I would not be here to testify before you today.” 

Ms. Mehdi pointed out that disabled youth may feel like a burden to their families, which may influence their decision to die. She expressed concern about the potential of racism and ableism in medical settings creating pressure on disabled youth from marginalized communities. 

Another witness, clinical ethicist Franco Carnevale, told the committee there are strong disagreements among clinicians regards the justifiability of MAID for some minors. Some clinicians consider MAID a reasonable option for some minors, while others are categorically opposed. There was a consensus among the groups that Professor Carnevale consulted in his research that MAID should not be made available for youth for whom a mental disorder is their sole underlying medical condition. 

Alisha Montes, an associate professor of pediatrics at Memorial University, told the committee that MAID for mature minors carries the highest amount of risk as the consequence is death, and it is, of course, irreversible. She emphasized that the ability to balance risks and rewards is one of the last areas of the brain to mature, and that we have a duty to protect adolescents during this time of brain maturation.  

“What kind of a message does it send to suggest MAID when an adolescent is struggling through this difficult developmental time? Instead, we must believe in them. We must give them a reason to hope. We must delight in their individual talents, mentor them and teach them important skills necessary to overcome their challenges and be resilient.” 

In their questions to witnesses, some of the committee members asked whether they would support access to MAID for terminally ill 17-year-olds experiencing intolerable suffering. Senator Wallen asked Dr. Montes about youth much younger than 17: 

“Would you agree that there are children that are 9 or 12 or 14 or 17 but who have life experiences or who have lived with profound illnesses or pain or illness, that they might well be in a place, have the ability to make key decisions, perhaps in some cases as well as or even better than somebody who is 45 or 70 who doesn’t make wise decisions? Is that possible?” 

In her reply, Professor Montes pointed out that in her clinical experience it is very difficult to parse out what is really behind a request for MAID, that the request may actually be due to social stigma, poverty, or a very difficult home life. 

It is hard to imagine that this is even being discussed in Canada, or seriously considered as a way forward. Children and youth are particularly vulnerable because of their age and stage of development. They are a gift entrusted to the care of parents, supported by their extended famiy and community. Our collective responsibility is to care for them in any illness or distress, not to bring about their death.  

In its brief, the EFC urged the committee to reject MAID for minors. As the brief stated: 

Canadian laws set the minimum age at which Canadians may make significant decisions, such as voting. It is appropriate and reasonable to set a minimum age for the decision to end life.  

In general, the less weighty the outcome, the greater the role a minor plays in the decision. MAID cannot be undone or mitigated. It is intended to end life and is fundamentally different from any other type of medical treatment over which minors may have legal decision-making power.  

The committee will make recommendations to the government on whether or not to expand access to MAID in its final report, due this fall. The government is not required to do what the committee recommends, but it is often influential. 

Contact your MP today to let them know you oppose expanding assisted dying to youth under 18 years of age. Ask them to take steps to ensure that doesn’t happen. See EFC’s resources on how to engage with an MP and on the special committee studying MAID for more information. 

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