Belgium has just voted to legalize euthanasia, or the right to suicide, for children of all ages. The law cleared the Belgian Senate in December and passed the lower house of Parliament today 86 to 44 with 12 abstentions. The law had 75 percent support in Belgium and was expected to pass, but it has provoked controversy with religious groups in Europe and around the world.

The law says a minor who requests euthanasia must "be in a hopeless medical situation of constant and unbearable suffering that cannot be eased and which will cause death in the short term." The suffering must be physical. The child must be able to express the wish to die themselves and demonstrate that they fully understand their choice, as evaluated by a doctor and a psychiatrist or psychologist. The child must also have the approval of his or her parents.

The law says a child must "be in a hopeless medical situation"

The law was proposed by pediatricians and politicians who say it will be a relief for children with terminal illness. Euthanasia is "the ultimate gesture of humanity," Philippe Mahoux, a doctor and the author of Belgium's 2002 euthanasia law, said before the vote today. "The scandal is illness and the death of children from disease."

Not everyone sees it that way. In Quebec, a four-year-old girl entreated the King of Belgium not to sign the new law. "Please do not sign the euthanasia law, for the sake of the children," the girl, who was born with a heart condition, says in a video posted on YouTube. The province is considering a law similar to Belgium’s original euthanasia law for adults, as is France.

The voices of children were notably absent from the debate in Belgium, although doctors assured the press that the issue was not just hypothetical. Jan Bernheim, a euthanasia advocate, doctor, and professor at Vrije Universiteit Brussel, says that’s because of the sensitivity of the question. "This is a very private matter," he tells The Verge. "Adolescents usually don’t go public. Some parents having lost a child were advocates."

"We notice a lot of prejudices from people abroad about this legislation," Inge Staelens, a spokesperson for the University of Brussels, where a doctor famous for euthanasia procedures is on staff, wrote in an email to The Verge. "People often forget that such a legislation cannot be voted in parliament, if there is no public support for it."

Opponents say children are too young to decide to die. "A child cannot buy a house in Belgium. A child cannot buy alcohol in Belgium. And this law would allow a child to ask to be killed," Carine Brochier of the European Institute of Bioethics in Brussels told Deutsche Welle. "The supply of euthanasia is building the demand for euthanasia. The more you offer it the more people will ask for it."

Euthanasia is also legal in Luxembourg, where patients must be 18, and the Netherlands, where they can be as young as 12. To Brochier’s point, the requests for euthanasia have risen steadily in the Netherlands since the law passed in 2002. However, only five patients under 18 have opted for euthanasia.

Requests for euthanasia have risen steadily in the Netherlands since legalization in 2002

Assisted suicide differs from euthanasia because the patient administers the lethal dose with a doctor present, rather than a doctor administering the entire procedure. In Switzerland and four states in the US, assisted suicide is legal.

Critics say the new Belgian law is too vague when it comes to assessing a child’s mental capacity to choose euthanasia, and that children are susceptible to pressure from their parents. There is broad disagreement in the medical and psychological communities about how much decision-making capability children have. Advocates counter that children with terminal illnesses often show the maturity of someone much older.

Stories of euthanasia are invariably heartbreaking

Forty-eight percent of requests for euthanasia in Belgium were carried out, according to 2011 survey of doctors published in the Journal of Pain and Symptom Management. Five percent were refused, 10 percent had been withdrawn, and in 23 percent, the patient died before he or she could be euthanized. "Patient characteristics associated with granting a request were age, having cancer, loss of dignity, having no depression, and suffering without prospect of improvement as a reason for requesting euthanasia," the survey’s authors concluded.

The stories of Belgian adults who opt for euthanasia are invariably heartbreaking: the pair of identical deaf twins who realized they were also going blind; the 95-year-old sprinter who invited friends over for an intimate party with champagne to celebrate his euthanasia due to cancer. No doubt the stories of children who choose death over life are even more tragic.