Belgium has become the first nation to remove all age restrictions to euthanasia, after King Phillipe approved controversial amendments to the country’s 2002 euthanasia law this month.

A child of any age may be helped to die under strict conditions: the child must be terminally ill, close to death and suffering a great amount of pain. Counseling by doctors and a psychiatrist or psychologist is required, as is approval by parents or guardians. The child must possess the “capacity of discernment and be conscious” of requesting death.

The amendments easily passed the Belgian House of Representatives 86 to 44 in February, following a vote by the country’s Senate in December in support of the measure.

Socialist Senator Philippe Mahoux, sponsor of the country’s 2002 “right to die” legislation, called for the law’s expansion because he said doctors have been illegally helping sick children die. Mahoux, a trained surgeon, called euthanasia “the ultimate gesture of humanity,” according to Agence France-Presse. “The scandal is illness and the death of children from disease.”

Opponents, including religious leaders and some medical professionals, argue that children are not capable of making such difficult decisions. “The law says adolescents cannot make important decisions on economic or emotional issues, but suddenly they’ve become able to decide that someone should make them die,” Brussels Archbishop Andre-Joseph Leonard said at a prayer vigil during the vote.

CitizenGo, a Spanish conservative lobby, delivered more than 200,000 signatures to the monarch demanding that he reject the bill, according to AFP. Alvaro Zulueta, one of the petition organizers, said more than 5,000 signatures came from concerned Belgians, although Italians made up the largest number of respondents.

In 2012, euthanasia accounted for 2 percent of all deaths in Belgium, up 25 percent to nearly 1,400 cases. A terminally ill person may drink a barbiturate-laden syrup, or a doctor can administer the drug through an intravenous tube to induce death.

Belgium is one of a handful of European countries where euthanasia is legal. The Netherlands legalized euthanasia in 2002, allowing it in some cases for seriously ill minors 12 and older. Luxembourg allows euthanasia for adults; Switzerland allows doctors to help patients die in some circumstances.

The bill is making waves across the U.S. Noted painter and Christian author Joni Eareckson Tada, a quadriplegic due to a teenage diving accident, called the law “devastating” and “the most liberal euthanasia law in the world.” Speaking during the National Religious Broadcasters Convention in Nashville, TN, Tada called for a “backlash” against it.

Euthanasia is banned in the U.S., but physician-assisted suicide, or “Death with Dignity,” is legal in four states: Oregon, Washington, Vermont and Montana.