Paediatric palliative care and paediatric euthanasia: clarifying a moral continuum

This Viewpoint explores the complex relationship between two approaches to end-of-life care for children-paediatric palliative care and paediatric euthanasia. Both approaches share the goal of alleviating suffering in children with life-limiting conditions. They differ about which interventions are permissible or forbidden in pursuit of that goal. Palliative care permits the withdrawal of life-sustaining treatments and even the administration of medications that might hasten death, as long as the goal of administering the medications is to relieve suffering and not to hasten death. With euthanasia, doctors and parents agree that palliative care interventions cannot relieve suffering, and so it is permissible to give medications with the goal of hastening death. Different countries take different approaches to these practices. In some countries, it is permissible to withdraw or withhold all life-sustaining treatments and to give sedating drugs that might suppress respiration, but it is impermissible to give lethal injections. The countries that permit withholding, withdrawing, and sedation typically rely on the doctrine of double effect: treatments intended to relieve suffering might be ethically permissible even if they foreseeably hasten death, provided that death is not the intended aim. In others, such lethal injections are permissible. In these countries, policies rely on considerations of the child's best interest and specifically on an abhorrence of pain and suffering. We argue that these frameworks express overlapping values of compassion, proportionality, and respect for the child's interests. Recognising this overlap allows paediatric palliative care and euthanasia to be understood not as moral opposites but as points along a continuum of ethically motivated responses to suffering at the end of life.