Fernando Vergara/The Associated Press
Providing assisted death to children is a controversial subject even in the field of palliative care. Otherwise-outspoken advocates for the procedure here don’t talk about it. And families who may have availed themselves of it, entirely legally, have done so at home with private physicians and evaded the requirement to register such deaths with the Ministry of Health – to ensure no one finds out.
“Doing this for children is a whole new world,” said Ricardo Luque Nunez, a doctor and bioethicist who is an adviser to the Colombian Ministry of Health and oversees this issue. And it’s not, he added, a particularly comfortable world. “We looked at the literature on children and consciousness of death – and up to age six they don’t clearly understand death,” Dr. Luque said. “From age six onwards children can understand it, but it’s a magical idea – maybe you can come back to life. Only after 10 can you understand the inexorability of death, that it will happen to me and all others at some point. From 12, you have the cognitive and moral development at the level of making conscious moral decisions.
But Dr. Luque firmly rejects that idea: The key component of the Colombian regulation is that no one makes the decision for someone else. “You have to have limits that are very clear: that it’s a terminal illness and consent has not been given by others. The bioethical obligation is to protect the most vulnerable – in the debate over children this is very clear. And it’s terribly dangerous to open the door to debating who can decide for someone else.
“But the great majority of hospitals are religious institutions and they are actively opposed,” Ms. Ochoa said. “People ask their doctors, and doctors say, ‘We don’t do that here.’ ” The regulation gives a doctor the right to refuse to perform the procedure but requires them to find one who will within 24 hours. Ms. Ochoa said 75 families appealed to her organization for help last year because there was no committee at the hospital where their loved ones were dying.