Euthanasia in Ireland

As predicted, the Joint Oireachtas Committee on Assisted Dying has recommended the legalisation of assisted suicide and euthanasia in Ireland. It claims they will be allowed under only strict conditions and with proper safeguards, but when you read the actual report, some of the conditions and safeguards seem neither strict nor proper. The main recommendation is that 'assisted dying' be made available only to patients who are within either six months or 12 months of death depending on their condition. This is objectionable enough, but even on its own terms, the report's recommendations would not create proper safeguards. For example, take Recommendation 28 of the report. It says: "The Committee recommends that two formal requests for assisted dying must be made, with a set specified interval between. At least one of these requests must be recorded in writing, and before two independent witnesses."

This is extremely loose wording. It does not tell us whether the two requests must be made to two separate individuals. Could the two requests be made to the same person? Nor does it say what the "set specified interval" between requests ought to be. Presumably, any legislation would tell us in due course, but it would be good to have some indication now. Do they have in mind two days or two weeks or something else? We are not told that the person or persons to whom the requests are made should be a doctor. Presumably, they ought to be, but we should be told. Then again, should doctors be involved in this at all except to confirm that the person is dying and is within a certain number of months of death?

Who would the "independent witnesses" be? Two friends? Two strangers? Two lawyers? Who knows? Also, no psychiatric assessment is needed except when there is a concern that the person seeking to die by euthanasia or assisted suicide is not mentally competent. There is no requirement in the report that the family of the patients be informed before the procedure. In some jurisdictions, health professionals cannot actively suggest assisted suicide or euthanasia to patients as an option. This can only come from the patient as protection against patients being led towards the procedure. In the Oireachtas report there is no recommendation that would stop doctors mentioning 'assisted dying' as an option, which is an appalling oversight, or was it deliberate?

The recommended protections for conscientious protection do not go far enough. Medical personnel will not be obliged to take part in 'assisted dying' but will have to refer a patient who requests to die in this way to another doctor. Institutions are offered no protection. This means a hospice, for example, could potentially be forced to allow its patients to die in this way if that is what a patient wants, regardless of the ethos of the hospice. In order to qualify for 'assisted dying', the person should be "diagnosed with a disease, illness or medical condition that is:

• both incurable and irreversible.
• advanced, progressive and will cause death.
• expected to cause death within six months (or, in the case of a person with a neurodegenerative disease, illness or condition, within 12 months).
• causing suffering to the person that cannot be relieved in a manner that the person finds tolerable.

The thirty-eight recommendations in the report, while extensive, demonstrate a problematic prioritisation of 'choice' over the intrinsic value of life and the potential for unintended consequences, especially for the most vulnerable in society. The report ignores the opposition of the main medical organisations in Ireland, particularly of those medical professionals who work in palliative care. But even on their own terms, some of the recommendations of the report are appallingly lax. The report has been barely analysed by a media distracted by the resignation of Leo Varadkar as Taoiseach, and which tend not to subject euthanasia advocates to proper critical scrutiny anyway. In the greater scheme of things this report, which represents a big step towards euthanasia and assisted suicide, is far more important than the resignation of any given Taoiseach. It beckons us to cross a moral Rubicon.

The Irish Medical Council 

The Irish Medical Council recently dropped from its ethical guidelines the prohibition on doctors deliberately killing their patients. It is hard to believe they are not paving the way for euthanasia. However, they made this change without properly consulting their members. However, most of the bodies representing the medical profession in Ireland remain adamantly opposed. This was confirmed after the recommendations of the Joint Oireachtas Committee on Assisted Dying in favour of the practice were published recently. They claim that legislating for assisted suicide is harmful and contravenes good medical practice.

The bodies that pushed back against the recommendations are the Irish Association of Palliative Care, the Irish Palliative Care Consultants' Association, the Royal College of Physicians, and the College of Psychiatrists of Ireland.

The Irish Association of Palliative Care stated: "We do not support any change in the law to legalize euthanasia or Physician-Assisted Suicide. Palliative care should exclude any action or treatment designed to cause a patient's death."

Instead of euthanasia and assisted suicide legislation, they advocate for "an emphasis on enabling dignified dying, delivered through the provision of palliative care, to help people live well until they die. The focus should be on ensuring that patients have access to resources and information about their end of life and dying."

The Irish Palliative Care Consultants Association also expressed deep disappointment with the majority report of the Committee, claiming that 'assisted dying' will inevitably and disproportionately place vulnerable people at risk. "In a progressive and inclusive society, we believe the fears and challenges of life-limiting illnesses, particularly if they lead to a wish to die, should be responded to with better care rather than facilitating an early death. In view of this, we do not feel that legislating for assisted dying is the appropriate answer to address these concerns".

The Royal College of Physicians of Ireland (RCPI) said they "oppose the introduction of any legislation supportive of assisted suicide because it is contrary to medical practice." The RCPI, which has more than 11,000 members, is the largest postgraduate medical training and professional body in Ireland.

Dr. Feargal Twomey, Chair of the RCPI expert group and a Consultant in Palliative Medicine, added: "The introduction of legislation on assisted suicide has the potential for immense harm and unintended consequences, and our view is that the potential harms outweigh the arguments in favour of legislation for assisted suicide." Dr. Twomey, who presented to the Oireachtas Committee on Assisted Dying last October, stated: "My concern about the inability for safeguards to be maintained leads me to say the only true safeguard is that the law does not change."

Another critical response came from the College of Psychiatrists of Ireland. They said that the recommendations of the Committee "undermine Irish society's strong focus on suicide prevention policy" and believe that Ireland "can do better in providing compassionate care to those who are dying than to introduce assisted suicide and euthanasia."

The consistent opposition from these medical professional bodies, who confront end-of-life situations daily, underscores a profound understanding of the complexities and the ill effects involved in legislating for euthanasia or assisted suicide.   Given their expertise and the concerns, they raise, it is essential for lawmakers and the public to reflect deeply on these perspectives before taking any decision on these matters.