On May 16 2002, the Belgian parliament approved the original law permitting euthanasia. The law was voted in after three years of debate in parliament and within the Federal Advisory Committee on Bioethics. The focus of this chapter is an issue which has been of particular interest in recent public debates internationally: the extension of the law in 2014 to permit minors with ‘capacity of discernment’ to have access to euthanasia. Although the law now theoretically applies to Belgians of all ages, in reality, euthanasia for minors will be limited to older adolescents. This chapter considers how the issue of children’s access to euthanasia came to be considered and the process of reform including the positions and arguments of different entities. Also considered is parliament’s rationale for this change in the law. Of particular significance in the reform process was the view that the age barrier for euthanasia was perceived as arbitrary. The prime qualifier for a valid, well-considered and competent request should not be chronological age but mental age and maturity.

This chapter identifies international trends in end-of-life law reform from analysing ten case studies of reform from the United Kingdom, the United States, Canada, Australia, the Netherlands and Belgium. A key finding is that law reform is more likely to succeed when supported by ‘good process’. This includes effective consultation with key stakeholders and engaging with experts. Social science evidence is also increasingly influential in both legislative and judicial reform, particularly in relation to how assisted dying systems can operate safely in practice. Other factors contributing to reform are the support or advocacy of key individuals or groups, shifts in community sentiment, and changes in political composition of parliaments. The chapter also concludes that law reform is ultimately a political exercise. Compromise is often required for a law to pass. This has implications for designing effective end-of-life law, pointing to the need for critical evaluation of both proposed laws and how existing laws operate in practice. The chapter concludes with reflections about the future of end-of-life law.