The Canadian Paediatric Society says its members are "increasingly" being asked by parents about the option of seeking medically assisted death for children, while a survey of doctors found nearly half of the respondents supported assisted death for kids with "progressive terminal illness or intractable pain."
Some 2,600 pediatricians were asked to participate in a survey about inquiries regarding assisted death for minors, both by parents and by children themselves. About 40 per cent responded,
Thirty-five pediatricians said they had "exploratory discussions" with a total of 60 patients under the age of 18 in the preceding year. Nine pediatricians received "explicit requests" for assisted death from a total of 17 minors.
Another 118 pediatricians said they had exploratory discussions about assisted death with the parents of sick children, involving 419 kids in all.
Forty-five respondents said they had received explicit requests for assisted death from parents, involving a total of 91 children. More than half of the requests involved a child under a year old.
A second survey was submitted to almost 2,000 members of the Canadian Pediatric Society and had a 29 per cent response rate.
In that survey, 46 per cent of respondents said they would support assisted death legislation being extended to include so-called "mature minors," a patient under 18 who can understand the nature and consequences of a particular decision.
Dr. Dawn Davies, a pediatric palliative care physician and chairwoman of the Canadian Pediatric Society's bioethics committee, said she was surprised by that response.
"I didn't think that there would be that much support for it," said Davies, adding that pediatricians who supported the idea did so with many caveats.
"There was a lot of 'Yes, but ..."' she said. "Yes, it could be supported, but there would have to be a lot of oversight."
Thirty-three per cent of the pediatricians who responded said assisted death should not be considered for minors under any circumstances.
Davies said it's "far too early" to make any decisions, but the medical community should start thinking about issues involving assisted death for minors and when it could be the more compassionate choice.
There needs to be "a recognition that parents are making this request not as a self-serving thing," she said, "that children have illnesses where there is really profound suffering."
Legislation enacted in June 2016 allowed eligible adults the right to seek out assisted death in cases of incurable illness or intolerable suffering. The bill also ordered an independent review regarding the idea of assisted death for mature minors. The review will be presented to Parliament in December 2018.
Davies, who was one of the co-authors of the two surveys, said only two countries - Belgium and the Netherlands - have laws allowing assisted death for children and such cases are extremely rare.
"I don't know how much we can learn from them because the numbers at this point are so small," she said. "Globally, there does not seem to be a lot of places to look for direction."
In the meantime, as a palliative care physician, Davies thinks there might be fewer requests for assisted death if end-of-life care were improved.
"Given that all of us will eventually die, it's going to be the common experience of our entire population," she said.
"Medical assistance in dying ... is accessible to every Canadian, but excellent palliative care has not been similarly enshrined."
