Belgian lawmakers voted overwhelmingly on Thursday to extend the country's euthanasia law to children under 18.
The law empowers children with terminal ailments who are in great pain to ask to be put to death by their doctor if their parents agree and a psychiatrist or psychologist certifies they are conscious of what their choice signifies.
It has wide public support, but was opposed by some pediatricians and the country's Roman Catholic clergy. As House of Representative members cast their ballots and an electronic tally board lit up with enough green lights to indicate the measure would carry, a lone protester in the chamber shouted "assassins!"
Hans Bonte, a Socialist, said no member of the House hopes the law will ever be made use of. But he said all Belgians, including minors, deserved the right to "bid farewell to life in humane circumstances" without having to fear they were breaking the law.
The 86-44 vote in the House, with 12 abstentions, followed approval by the Senate in December.
Laurent Louis, an independent House member who opposed the legislation, said the majority of his colleagues were violating the natural order.
"A child is to be nutured and protected, all the way to the end, whatever happens," Louis said. "You don't kill it."
Another House member, Catherine Fonck, said the legislation was riddled with flaws and didn't address the possibility that one parent may favor euthanasia while the other is opposed.
All 13 proposed amendments seeking changes in the bill were defeated.
Daniel Bacquelaine, a physician and leader of the centrist Reform Movement, said it is wrong to think life and death questions should be reserved for adults. He stressed that the law imposed no obligations, and that no child, family or doctor would be forced to apply it.
The law will go into effect when signed by King Philippe. The Belgian monarch is not expected to oppose the measure, said Jean-Jacques De Gucht, a co-sponsor.
Belgium's euthanasia law, passed in 2002, previously applied only to legal adults. The neighboring Netherlands allows euthanasia for children as young as 12, providing their families agree.
How Belgium's child euthanasia law will work
The Belgian House of Representatives has approved extending the country's euthanasia law to very sick children under 18, with some added restrictions. Legal experts and physicians explained to The Associated Press how it would work, step by step:
STEP 1: EUTHANASIA LAW
Belgian law sets no specific timetable for euthanasia to be carried out from the time a patient first expresses the wish to be put to death. Dr. Gerlant van Berlaer, a pediatric critical care specialist at University Hospital Brussels, says in practice it takes weeks or months. A federal commission, half of whose 16 members must be medical doctors, was created by the 2002 law to examine all cases of euthanasia in Belgium and to ensure the procedures established by the law are respected.
STEP 2: INCURABLE ILLNESS
The child must have a terminal and incurable illness, with death expected to occur "within a brief period." The child must also be experiencing "constant and unbearable physical suffering." Like for adults desiring euthanasia, that diagnosis and prognosis must be agreed upon by the treating physician and an outsider brought in to give a second opinion.
STEP 3: UNDERSTANDS WHAT THEY ARE DOING
The child is to be interviewed by a pediatric psychiatrist or psychologist, who must determine that the child possesses "the capacity of discernment" and certify that in writing.
STEP 4: GETS THE AGREEMENT OF PARENTS
The child's physician must meet with the child's parents or legal representatives to inform them of the results of the consultation, and ensure they are in agreement with the child's request to be euthanized.
STEP 5: REQUEST IN WRITING
The child's request for euthanasia, as well as the agreement by parents or legal representatives, must be delivered in writing.
STEP 6: EMOTIONAL SUPPORT FOR ALL
The child and family must be given psychological care if they ask for it.
STEP 7: EUTHANASIA
There are two methods, according to Dr. Marc Van Hoey of Antwerp who says he performs between three and 10 euthanasia procedures a year. A terminally ill person can drink a barbiturate-laden syrup themselves or a doctor can administer the drug into an intravenous tube. Death comes within minutes either way.