Euthanasia and caring for the dying in pediatric oncology

During the last 30 years pediatric oncology has developed therapeutic schemes for all kinds of tumors. Nevertheless, a third of the children suffering from malignancies have still to die. Therefore it is necessary to develop concepts, how to deal with the death of children and how to care for them and their families during the dying process, because the responsibility for these children does not end at the point of finishing therapy, but at the time of their death. Especially during this last part of life these children and their families need an extremely intensive care. Since most of the children want to die at home, we must also be able to care for them there, possibly in cooperation with a local colleague. This, of course, requires an adequate therapy against pain which is possible in most cases. The basement for an optimal care is to be very open to the children. If this openness is established right at the beginning of therapy it will later serve to cope with difficult situations. "Never to lie" is the most important principle. If the patients are not left alone during the dying process the claim for a final injection will be an exception. However, if euthanasia is required, it is rather an expression of despair and a cry for help. The application of very high doses of medicine, necessary in order to prevent pain, might lead to a shortening of life time. This is neither killing on demand nor euthanasia.