Ms Tessa Holzman1
1Monash University, , Australia
Biography:
Tessa Holzman is a PhD Candidate with the Monash Bioethics Centre, researching the ethical implications of an autonomy-only approach to voluntary assisted dying. She has served as a member of the clinical ethics team at the Royal Children’s Hospital and the Monash Children’s Hospital.
Abstract:
The Netherlands is one of the very few countries that has legislation in place that allows voluntary assisted dying for people under 18. However, Dutch paediatricians have expressed discomfort about the lack of VAD options for children between 1 and 12 years old, as these patients still have the potential to be suffering unbearably. I will start this talk by considering the concept of paediatric suffering, and outline some of the recently pointed out philosophical issues with this concept. I then consider how children can be actively included in clinical decisions in a responsible and age-appropriate way. If this is not possible, for example because the child is not conscious or too tired from treatment to contribute, I consider the possibility of using Nelson et al.’s concept of paediatric authenticity. If this too is not possible, for example because the child is very young or is severely cognitively disabled, I will consider the best interests model, which is currently the prevalent approach in these situations. I will conclude that similarly to concepts of suffering and futility, the best interests model is ill-defined, unrealistically demanding, and has the potential to be value-laden and ableist. Instead, I propose centring paediatric end-of-life decision-making around the potential for severe harm. I will argue that this approach constitutes a more robust and practical way of addressing paediatricians’ concerns surrounding suffering. I will finish by clarifying how I interpret the meaning of harm as a term.