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The age limit for euthanasia requests in the Netherlands: a Delphi study among paediatric experts
  1. Sedona Celine de Keijzer1,
  2. Guy Widdershoven2,
  3. A A Eduard Verhagen3,4,
  4. H Roeline Pasman1
  1. 1 Public and Occupational Health, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
  2. 2 Department of Ethics, Law and Humanities, Amsterdam UMC location VUmc, Amsterdam, The Netherlands
  3. 3 Department of Pediatrics, University Medical Center Groningen, Groningen, The Netherlands
  4. 4 University of Groningen, Groningen, The Netherlands
  1. Correspondence to Sedona Celine de Keijzer, Public and Occupational Health, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands; s.c.dekeijzer{at}


Background The Dutch Euthanasia Act applies to patients 12 years and older, which makes euthanasia for minors younger than 12 legally impossible. The issue under discussion specifically regards the capacity of minors to request euthanasia.

Objective Gain insight in paediatric experts’ views about which criteria are important to assess capacity, from what age minors can meet those criteria, what an assessment procedure should look like and what role parents should have.

Methods A Delphi study with 16 experts (paediatricians, paediatric nurses and paediatric psychologists) who work in Children Comfort Teams in Dutch academic hospitals. The questionnaire contained statements concerning criteria for capacity and procedural criteria. Consensus was defined as ≥80% agreement.

Results The experts agreed that five criteria for capacity, found in a previous literature study, are all important. They agreed that some children between ages 9 and 11 could meet all the criteria. Consensus was reached for the statements that the entire medical team should be involved in the decision making and that a second independent expert must assess the case. Experts agreed that the parents’ opinion is relevant and should always be taken into account, but it need not be decisive.

Conclusion This study shows that the age limit of 12 years in the Dutch Euthanasia Act is too strong according to paediatric experts. Letting go of the age limit or lowering the age limit combined with adequate capacity assessment for minors younger than 12 are options that should be discussed further.

  • Euthanasia
  • Minors
  • Child
  • Ethics- Medical

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors SCdK, GW and HRP were responsible for the study concept and design. All authors interpreted the data. SCdK wrote the original draft while GW and HRP reviewed and edited the draft and the visualisations. Additional adjustments were made after further input from EV. All authors critically revised the manuscript for important intellectual content. HRP supervised the study. All authors gave final approval for the work to be published. SCdK is the guarantor of this publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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