Minor patients, major differences: why children and adolescents should not have access to voluntary assisted dying

Currently, minors are able to access voluntary assisted dying (VAD) only in three countries – the Netherlands, Belgium and Colombia. Although the uptake by persons under 18 is extremely low, other jurisdictions – particularly Canada and the Australian Capital Territory – are actively exploring whether access to VAD should be extended to mature minors. A clear majority of public opinion in both Canada and the ACT supports allowing mature minors to access VAD. This paper considers the ethical issues involved in permitting minors to access VAD, including: minors’ emerging autonomy and developing cognitive and emotional maturity; their special sensitivity to influence from trusted adults; the role of parental responsibility and authority; and questions of discrimination and equality. It concludes that, given the differences between minors and adults, and the lack of clear, validated measures for assessing capacity and voluntariness, mature minors should not be eligible to access VAD.