Netherlands Reveals Euthanasia of Two-Year-Old Child in Landmark Assisted-Dying Case

A Dutch review committee has examined a case involving the termination of life of a child who was almost two years old, after the toddler was born extremely prematurely and developed multiple severe medical conditions.

The case concerns a child born at 26 weeks who later experienced serious brain damage, cerebral palsy, visual impairment and drug-resistant epileptic seizures. The child also suffered from mucus accumulation in the lungs that made breathing difficult.

Dutch authorities confirmed that doctors and the child’s parents ultimately concluded that the suffering could not be sufficiently relieved through available treatment. The case was subsequently reviewed under the Netherlands’ special framework for children aged between one and 12.

Child had complex and severe medical conditions

According to the review report, the child was nearly 24 months old at the time of death.

The medical problems began with the child’s premature birth at just 26 weeks. Severe neurological impairment followed, alongside cerebral palsy and visual difficulties.

The toddler also experienced epileptic seizures that did not respond adequately to medication. Breathing was further complicated by mucus in the lungs.

The report said the child’s motor abilities, behaviour and personality were severely affected and were not expected to improve.

Doctors reached different conclusions during review

The decision was not made without further medical assessment.

The attending doctor consulted independent physicians for additional opinions. Those doctors initially concluded that the child was not experiencing unbearable suffering continuously and pointed to possible alternatives, including palliative treatment and other medication aimed at controlling the seizures.

A subsequent medical opinion reached a different conclusion, finding that the child’s unbearable suffering was clearly apparent and that the conditions for termination of life had been met.

The attending physician proceeded with the termination after considering the medical assessments.

Review committee found the doctor had acted with due care

The case was examined by the Dutch review system responsible for assessing whether doctors have complied with the applicable requirements.

The committee concluded that the physician had acted with due care.

Under the Netherlands’ rules for children aged one to 12, termination of life may be considered where a child is terminally ill, suffering unbearably with no prospect of improvement and there is no reasonable alternative for relieving the suffering. Parents must be involved in the decision, while the doctor must meet specific medical-care requirements.

The review process is separate from ordinary euthanasia involving patients who personally request termination of life. Dutch euthanasia legislation generally requires the patient to make the request themselves, while termination of life involving children under 12 falls outside the ordinary request-based framework.

Netherlands has separate rules for children under 12

The Dutch government says children between one and 12 who are terminally ill can, in specific circumstances, have their lives terminated following a joint decision involving their parents and doctor.

The doctor must establish that the child is suffering unbearably without prospects of improvement and that there is no reasonable alternative, including through palliative care. A special review committee subsequently examines whether the physician followed the required standards.

This differs from the standard euthanasia framework for patients aged 12 and over. Children aged 12 to 15 can request euthanasia with parental consent, while those aged 16 and 17 can make the request themselves, although their parents or guardians must be consulted.

Policy for one-to-12-year-olds was introduced separately

The Netherlands has permitted euthanasia under defined circumstances since 2002, but children below the age of 12 have historically been treated differently because they are generally regarded as unable to make a voluntary and well-considered euthanasia request.

The current framework specifically addresses terminally ill children between one and 12 whose suffering cannot reasonably be relieved. The Dutch government describes the procedure as an exceptional medical decision requiring parental involvement, medical assessment and subsequent review.

Case highlights difficult questions around assisted dying

The reported case is likely to draw attention because of the child’s age and the complexity of the medical and ethical questions involved.

The review committee’s finding does not mean that euthanasia is generally available to children under 12 on request. Rather, Dutch authorities distinguish between ordinary euthanasia, which requires a patient’s own request, and the separate procedure governing termination of life in certain cases involving very young, terminally ill children.

The case therefore provides an unusually detailed example of how the Netherlands’ safeguards operate when doctors and parents conclude that a very young child’s severe and irreversible suffering cannot be adequately relieved.