Canada’s largest pediatric hospital is grappling with how to approach assisted dying in a new paper that has received criticism from some international groups that oppose euthanasia.

Published online in a Sept. 21 paper in the BMJ's Journal of Medical Ethics, a team at Toronto’s Hospital for Sick Children outlined a draft policy for responding to a request for medical assistance in dying (MAID) from an adult patient. The policy assessed their eligibility, looked at reflection period with the patient and family, and ultimately administering the procedure. The policy does not address children.

The new paper comes a few months ahead of an expected report by the Canadian Council of Academies, which was tasked by the federal government to produce a two-year research paper about circumstances prohibited by MAID law, including assisted dying for minors. Bill C-14 was passed in Jun 2016 and legalized medically assisted dying in Canada.

The Sickkids report has stirred some international attention from conservative publications like the National Review, which published a story earlier this month with the headline “Child Euthanasia without Parent Approval Pushed for (in) Canada.” Others have concluded that the new policy suggests parents might not be informed until after the child dies in some scenarios.

Co-author Adam Rapoport said that is simply not true.

“Those articles that have made it sound like we would do this without parental knowledge -- that’s just not how we operate as an organization,” he said in a phone interview with “To think that we would ever do that -- I couldn’t even imagine the circumstance.”

Rapoport, the medical director of the Paediatric Advanced Care Team, stressed that the policy is not for minors. MAID is currently only legal for adults. The policy is in draft form and has not been approved by the hospital.

But the statement that the policy was developed “with an eye to a future when MAID may well become accessible to capable minors” has been the primary focus for some readers. In Ontario, “capable young people can and do make the decision to refuse or discontinue life-sustaining treatment,” the Sickkids paper states. If medically assisted death is legalized for patients under 18, the hospital would face increased ethical dilemmas.

Tom Koch, a consultant in chronic and palliative care in Toronto, told that the paper is a “good faith effort by the hospital to find a way through the ethical, legal, and moral tangle that is facing hospitals, hospices, and other facilities.”

“There is pressure for the expansion of medical termination (MAID) into more and more situations where physicians are understandably cautious about it as the only or best alternative,” he said. But Koch has “severe reservations” about children’s hospitals administering MAID, which he believes should be more bluntly called “medical termination.” He is skeptical whether a “capacitated” minor can make a truly informed decision, referencing incidents where children have made medical calls that clearly reflect their parents’ point of view.

“I think that while legally competent, many adolescents, and especially pre-teens, can not legitimately make a call for their own termination,” he said in an email sent to

Rapoport thinks the skepticism is reasonable, but notes the hospital will “err on the side of caution” when a child’s capabilities are uncertain.

“These are things we engage in not infrequently. We’re regularly assessing the capability and capacity of young people to make serious medical decisions sometimes which involve end of life issues,” he said. “It is something that we think we do well.”