The Irish Medical Council has updated its ethical guidelines for doctors. The standout change—and a disturbing change, especially given the supposedly ethical focus—is the removal of the very explicit direction: “You must not take part in the deliberate killing of a patient.”
The amendment to the 2024 Guide to Professional Conduct & Ethics for Registered Medical Practitioners comes in the section on “End of Life Care”. It was previously enshrined in the hitherto most recent edition (2016) of the guide as Article 46.9, providing the blunt, clear and unambiguous aforementioned command that proscribes doctors from being involved in euthanasia.
The Iona Institute, an Irish organisation that promotes the place of marriage and religion in society, calls the revision “a huge change to the code of ethics that governs doctors in Ireland”. It highlights that “the prohibition had been an age-old principal of medical ethics with roots going back to ancient Greece, so this represents a seismic shift”.
Admittedly nothing has changed under the law in Ireland. It remains the same: euthanasia, assisted-suicide/dying remains illegal. Though in 2023, a joint Senate-Parliament Committee was established to look at the ethical, societal and legal issues pertaining to “assisted dying”.
Again, nothing has “changed” there, and to date the Committee’s work is incomplete – further discussions are planned, no recommendations to the Parliament or the Minister for Justice have been made, and no legislation has been proposed or prepared.
But the question must be asked: Why has the Irish Medical Council removed such an explicit and clear instruction from its ethical guidance and while the parliamentary deliberations are still in progress?
A clue may be found when comparing the preambles to the 2016 and 2024 documents. In 2016, the guide stated: “References to the law are included where relevant, but this is not a definitive statement of the law, and may become out of date”. In 2024, there is a subtle change: “This guidance should be read in conjunction with all relevant policy and legal developments during its period of application.”
No longer is the guidance from the Medical Council reflective of the law as it stands—gone are those “references to the law”—rather it is an equivocation, taking into consideration all possible changes in the law that may arise in the coming years, while removing perceived obstacles to what is on the agenda of the current government.
Strikingly, another guideline that has been removed is as follows: “Medical care must not be used as a tool of the State. As a doctor, you must be free to make judgements about your patients’ clinical needs and to give appropriate treatment without political pressure.”
It should be a concern that the council’s previous support for the professional and ethical integrity of doctors that was articulated in the 2016 edition has been removed from the 2024 version. The Irish Medical Council can now indeed be perceived as a tool of the State through its new approach of providing an ethical guide that more easily aligns with potential legislative changes by the State even though they remain contested and have yet to go through parliamentary deliberation.
Whether this particular change has come in response to political pressure or otherwise, is unclear, yet it seems plausible that the Irish Medical Council is paving the way for the Irish Government to introduce euthanasia in Ireland—that manifestation as a tool of the State, which we were previously meant to be wary of and guard against.
There are other noticeable changes in this first updating of the Irish Medical Council’s conduct and ethics guide since 2016. Significantly, a detailed section on abortion has been removed in its entirety. The guidance no longer includes any mention of abortion as a specific area of care that is to be navigated by healthcare professionals. Previously the guide addressed the challenge, when dealing with abortion in an emergency situation, of navigating two lives, requiring doctors to “make every reasonable effort to protect the life and health of pregnant women and their unborn babies”. The 2024 version makes no reference to the unborn child at all.
A section on Telemedicine has been reduced to a brief instruction on ensuring the same standard of care is provided as for face-to-face consultations, whereas the 2016 guidance was more detailed, outlining the limitations of such remote medical support. Admittedly this change reflects, in part, the advancement in use of virtual consultations that took place during the coronavirus pandemic. But the change also comes amid the government’s insistence on retaining the right to telemedicine consultations to facilitate abortions, despite warnings that this endangers women.
Additionally, a detailed section on assisted human reproduction has been removed from the new guide, although the law on IVF and other related forms for assisted reproduction has not changed since 2016. Previously the guide stated that healthcare professionals “must not take part in the creation of new forms of human life solely for experimental purposes” nor “engage in human reproductive cloning”. The removal of this section aligns with what the Irish government has planned: it is seeking to introduce legislation allowing for international (foreign) surrogacy for couples in Ireland amid a wide range of “assisted reproduction” changes.
Have these changes come through a consultative process in the Irish Medical Council, or have they come about through a process of ideological institutional capture by individual members—or through pressure from the increasingly vocal euthanasia lobby that is just as active in the UK—who did not highlight changes to the wider Council, thereby letting them “slip through” unnoticed (as happens quite often).
According to the Iona Institute, Ireland’s Minister for Health “oversees appointments” to the Irish Medical Council, while “GPs were not consulted” ahead of the removal of Article 46.9 and the prohibition against the deliberate killing of a patient.
It would surely be a dereliction of duty to fail to pick up on the removal of a very blunt reference to not participate in deliberate killing—and yet the council appears not to have picked up on it or to have not been concerned by it. Furthermore, the removal of a long section on assisted reproduction would be hard not to notice. Yet the new edition of the council’s guide is now published, public and official, with these changes. Hence the question: What is going on?
The subtle and not so subtle changes to the guide—especially the deletion of the proscription on deliberate killing and of the principle to avoid being a tool of the State—suggest that something more calculated has been carried out. It is hard not to conclude that there has been a fundamental shift in how medical ethics are to be carried out in Ireland. Welcome to Brave New Ireland.
(Photo: Conceptual image showing a crucifix next to a vial containing pentobarbital: the debate between life and death, religious belief in the face of euthanasia. Photo credit: digicomphoto; iStockby Getty Images.)
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