Belgian lawmakers gave approval on Thursday to a measure allowing euthanasia for incurably ill children suffering from unendurable pain, and Belgium King Philippe is expected to sign it. The measure would make Belgium the first country to lift all age restrictions on legal, medically induced deaths.

Belgium is one of the few European countries that has legalized euthanasia, through a 2002 law allowing euthanasia for adults.  This measure extends that law to those under the age of eighteen.

Euthanasia may be requested by terminally ill children who are in great pain.  The measure requires the written consent of the parent.  The law states that the child would have to be terminally ill, face “unbearable physical suffering,” and make repeated requests to die before euthanasia is considered.

The legislation is supported by a strong majority of Belgians.  It is opposed by religious leaders, some medical professionals, and conservative politicians.  Opponents argue that modern medicine can alleviate suffering, the difficulty of judging how close to death a patient truly is, and whether a child has the mental capacity to make a request to die.  Opponents also express fears that sick people, particularly a child, may choose to die rather than burden others.

Just under 200 pediatricians signed an open letter Thursday urging more time for reflection before any decision is made.   The letter stated that medical advances mean that effective palliative care is available and that children do not have to suffer as they approach death.  It also said that extending the “right to die” to minors will only add to the stress and pain of families at a difficult time.

Supporters insist the measure is more a matter of principle than anything else, and that only a small number of children will ever be affected.

Under the strict guidelines of the measure no doctor would be forced to carry out euthanasia against his or her will, and no child would be refused the option of palliative treatment.