Exploring assisted dying policies for mature minors: A cross jurisdiction comparison of the Netherlands, Belgium & Canada

Medical Assistance in Dying (MAID) was decriminalized in Canada in 2016 for individuals 18 years or older who met eligibility criteria. Currently, individuals younger than 18 years are legally permitted to access an assisted death in the Netherlands and Belgium, but not in Canada. To-date, no work has compared factors shaping the policy processes and outcomes in these three countries. Therefore, our objective was to explore the legalities of assisted dying for minors in the Netherlands and Belgium, along with how each jurisdiction arrived at their respective policies and why the trajectory differed in Canada. After screening and compiling peer-reviewed and grey literature, we used Yanow's interpretive method for comparative work to review included materials. We framed findings using Hajer's discourse coalition theory. The Dutch and Belgian contexts relied upon a parliamentary approach in legalizing assisted dying for mature minors that emphasized suffering, whereas Canada's approach was initiated by a Supreme Court of Canada decision and emphasized human rights. While the Netherlands and Belgium viewed mature minors as capable to make decisions about assisted dying, the Canadian position on mature minors’ decisional capacity with respect to assisted dying remains unsettled. This work contributes to understanding how context and sociopolitical values shape assisted dying legislations and treatment of mature minors, while highlighting areas requiring further study amid ongoing debate in Canada.