Thank you very much.
I might be able to add a bit of knowledge from a country that has some experience in medical aid in dying for mature minors. I'm a professor in pediatric palliative care, and I'm one of the authors of “The Groningen Protocol for newborn euthanasia”.
As important background, I'd like to share with you the situation in the Netherlands. We have a euthanasia law that starts at the age of 12, so those who are 12 years old or older can ask for euthanasia. Parental consent needs to be present until the child is 16 years of age, but if the parent and child disagree on the request, we follow the child. That is in the law.
We've had seven cases up to now of minors asking for euthanasia and whose requests were granted. Most of them—six out of the seven—were 17, and one was a 16-year-old. They all suffered from untreatable end-stage cancer, and they were suffering unbearably. That is one of the items that need to be fulfilled to get euthanasia.
This is infrequent. We have a population of 17 million people, and it has been done seven times, I think, in the last 15 years. All cases were reviewed and published and can be accessed by everyone.
An interesting development has been what we call neonatal euthanasia. We have a legal regulation in the Netherlands that allows parents of newborns up to the age of 12 months to request euthanasia if unbearable suffering is present. If both parents agree, there are some other requirements that need to be fulfilled. All cases must be reported and reviewed. Since the regulation came into place, we've had three cases of neonatal euthanasia in around 15 years. All cases that were reported were reviewed and considered carefully. It's very infrequent, but it is legal; it is a possibility.
The most recent development, which we just finished two years ago, is a four-year study of how children die in the age group of one to 12. This was qualitative research. We've come across some parents who have reported terrible deaths for their children. Some of them had brain tumours. Some of them had other diseases. These parents all asked for the possibility of euthanasia similar to neonatal euthanasia. This request was forwarded to the minister of health, who decided that a regulation should be made as an extension of the Groningen Protocol to include one- to 12-year-olds who are legally not capable of asking for formal euthanasia as written down in the law.
That regulation is now being designed. It's with the ministry of health at this stage, and at the end of this year we'll hear how the final formulation has come along. Personally, I expect that during the course of 2023, the Netherlands will allow euthanasia for minors between one and 12 years of age. Having said that, I'm also convinced that the number of cases we'll see will be as low as in newborns or even lower. However, the main strength of the regulation is that we're talking differently to parents. We can provide and discuss all the options that are available. They have a possibility, if their child's suffering gets awful, of asking for euthanasia.
Practice has shown, both in children above 12 years of age and in newborns, that this doesn't occur very frequently. Three cases in 15 years is not much. Yes, there is a development going on in legalizing deliberate life-ending for minors, but the biggest strength is that it allows a discussion about quality of life and quality of death that currently cannot be held as it should.