Twelve years after legalising euthanasia for adults, Belgium's parliament extended the right to die to terminally ill children of any age Thursday, despite opposition from the Church and some pediatricians.
After months of heated debate, the lower House of Representatives adopted the legislation by a large majority, making the largely Catholic country the second after the Netherlands to allow mercy-killing for children, and the first to lift all age restrictions.
The ground-breaking legislation was adopted by 86 votes in favour, 44 against and with 12 abstentions. Belgium is one of three countries in Europe to allow euthanasia for adults.
"It is not a question of imposing euthanasia on anyone ... but of allowing a child not to agonise in pain," said Socialist MP Karine Lalieux ahead of the vote.
Unlike the Dutch across the border, where euthanasia is allowed for children over 12, the law states that any incurably sick child may request to end their suffering if "conscious" and equipped with "a capacity of discernment".
"The right to life and death cannot be restricted to adults," said liberal MP Daniel Bacquelaine.
Addressing controversy over the decision not to set an age restriction for "discernment", he said a child's "legal age isn't the same as mental age."
Socialist senator Philippe Mahoux, author of Belgium's historic 2002 "right to die" legislation and himself a doctor, had called for the law to be widened to minors so as to offer a legal framework for medics for helping children in pain die as a question of mercy, but outside the law.
Euthanasia is "the ultimate gesture of humanity" and "not a scandal", he said. "The scandal is illness and the death of children from disease."
The law offers the possibility of euthanasia to children "in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short-term".
Counselling by doctors and a psychiatrist or psychologist is required, as is parental approval.
Before its adoption by a huge majority in the Senate in December, the upper house consulted dozens of medical specialists, lawyers and interest groups.
But during public debate, religious leaders of all faiths argued that extending euthanasia to the young risked "trivialising" death.
In recent days, the Catholic Church staged "a day of fasting and prayer" in protest and this week some 160 pediatricians petitioned lawmakers to postpone the vote on the grounds it was both ill-prepared and unnecessary.
- Euthanasia 'not a happy end' -
"Pain can be eased nowadays, there's been huge progress in palliative care," said cancer specialist and signatory Nadine Francotte.
In a stormy exchange in parliament on the eve of the vote, Christian Democrat member Sonja Becq argued that modern palliative medication could relieve pain in very sick youngsters, therefore allowing illness to run a natural course to death.
"Euthanasia is not the only way to die in dignity," she said. "Euthanasia is not 'a happy end'."
But Brussels palliative specialist Dominique Lossignol said it was mistaken to believe palliative care could remedy suffering.
"We do not have control over all types of pain, either physical or moral," he told AFP. "We doctors have been asking for an extension of the law for years."
Thursday's vote saw Socialists, Liberals and Greens members largely line up in favour, with centrist Christian-leaning parties opposed.
But party whips said it was up to individuals to decide how to vote on this life and death issue,
Critics said the legislation failed to address problems and potential loopholes such as possible discord between the two parents over a child's request to be euthanised.
And they asked how could adults be sure that a child had the "discernment" necessary to decide to give up life or even really understands the notion?
"Experience shows us that in cases of serious illness and imminent death, minors develop very quickly a great maturity, to the point where they are often better able to reflect and express themselves on life than healthy people," a group of pediatricians in favour of the legislation said in December.
Polls showed a majority of Belgians backing the proposal but there was a surge of concern last year when a 44-year-old in distress after a failed sex change was euthanised on psychological grounds in a highly publicised case.
Belgium registered 1,432 cases of euthanasia in 2012, up 25 percent. They represented two percent of all deaths.
Neighbouring Netherlands has seen only five euthanasia requests from youngsters in the last decade.