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Minors and euthanasia: a systematic review of argument-based ethics literature


Euthanasia was first legalised in the Netherlands in 2002, followed by similar legislation in Belgium the same year. Since the beginning, however, only the Netherlands included the possibility for minors older than 12 years to request euthanasia. In 2014, the Belgian Act legalising euthanasia was amended to include requests by minors who possess the capacity of discernment. This amendment sparked great debate, and raised difficult ethical questions about when and how a minor can be deemed competent. We conducted a systematic review of argument-based literature on euthanasia in minors. The search process followed PRISMA guidelines. Thirteen publications were included. The four-principle approach of medical ethics was used to organise the ethical arguments underlying this debate. The justification for allowing euthanasia in minors is buttressed mostly by the principles of beneficence and respect for autonomy. Somewhat paradoxically, both principles are also used in the literature to argue against the extension of legislation to minors. Opponents of euthanasia generally rely on the principle of non-maleficence.

Conclusion: The present analysis reveals that the debate surrounding euthanasia in minors is at an early stage. In order to allow a more in-depth ethical discussion, we suggest enriching the four-principle approach by including a care-ethics approach.

What is Known:
The Netherlands and Belgium are the only two countries in the world with euthanasia legislation making it possible for minors to receive euthanasia.
• This legislation provoked great debate globally, with ethical arguments for and against this legislation.
What is New:
A systematic description of the ethical concepts and arguments grounding the debate on euthanasia in minors, as reported in the argument-based ethics literature.
• A need has been identified to enrich the debate with a care-ethics approach to avoid oversimplifying the ethical decision-making process.

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Fig. 1


  1. 1.

    An English translation of this Act is available in the European Journal of Health Law, 8.2 (2001): 183–191.

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    An English translation of the original version of the Belgian Act is available in the European Journal of Health Law, 10.3 (2003): 239–255. It is also available in Ethical Perspectives 9 (2002): 182–188. The English version of the 2014 amendment is available at

  3. 3.

    An English translation of this Act is available on


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Author information




The author Giulia Cuman: Searched electronic databases for studies and selected included studies. Performed data extraction and drafted the initial manuscript.

The co-author Chris Gastmans: Collaborated in the search and selection of the included studies. Supervised the overall process, participated in revising the draft manuscript, and confirmed the final manuscript.

Corresponding author

Correspondence to Giulia Cuman.

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Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Communicated by Mario Bianchetti

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Cuman, G., Gastmans, C. Minors and euthanasia: a systematic review of argument-based ethics literature. Eur J Pediatr 176, 837–847 (2017).

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  • Euthanasia
  • Ethics
  • Minors
  • Paediatrics
  • End-of-life care