Throughout last month the Irish parliament heard from interested parties on assisted suicide, covering a wide range of issues from the constitutional and legal implications, through the ethics of autonomy and the implications of changes on healthcare professionals.
The Joint Committee on Assisted Dying was formed in January initially to consider and make recommendations for legislative and policy change relating to a statutory right to assist a person to end his or her life and a statutory right to receive such assistance in Ireland, and is required to report to both houses of parliament on its findings nine months after its first public meeting which took place in June.
Officials from the Department of Justice and the Irish Human Rights Equality Commission (IHREC)] appeared at the first meeting. Representatives from the DoJ stated: “If the Oireachtas were to legislate, the courts would determine if the make-up of such a regime was constitutionally permissible and the practicability of any measure would be assessed in determining its constitutionality.”
The IRHEC noted that there would be particular requirements to safeguard vulnerable groups such as people with disabilities from any unintended consequences of such legislation, highlighting that there is no constitutional right to assisted suicide.
The second meeting considered the requirements of the Irish Constitution under Article 40.3.1 and 40.3.2 which place an express and solemn duty on the State and its organs – legislative, executive, judicial – to protect the sanctity of all human life, focusing in particular on the details and meaning of the decision in the Fleming v. Ireland case, where the Supreme Court held there is no constitutional right to determine the timing and manner of one’s death, whether through assisted suicide or voluntary euthanasia
The third public meeting considered what legal frameworks for assisted dying might look like and heard from, among others, the Anscombe Bioethics Centre which advises the Catholic Church in Ireland and the UK on moral questions arising from clinical practice and biomedical research
The second group of intensive sessions commenced on September 26 and representatives from Switzerland and the Netherlands presented on assisted suicide and euthanansia in those countries. Theo Boer, speaking about the situation the Netherlands, noted that after being involved in reviewing over 4.000 euthanasia cases “for myself, I switched from being moderately supportive of the Dutch euthanasia law to being increasingly critical”.
By early October, discussions centred on the ethics of end of life care and a later session on the situation in the United States. Later, Emma Walsh, the mother of inspirational teenager Donal Walsh, who died young from cancer in 2013, warned about the dangers of introducing assisted suicide and undermining palliative care.
“Can anyone here guarantee that elderly people will not be subtly or overtly pressured into taking end-of-life pills in a situation, for example, in which they are living in a family house and the child or grandchild is looking for a house or when the cost of their care is making them feel like a burden?” she asked.
She highlighted that positive impact of her son’s life that would have been lost had he been offered an assisted suicide pathway.
She said: “If Donal had taken the euthanasia drug either of the two times he was told he would not live long, the number of suicides in Ireland would not have dropped. This is a potential that could have been lost. All people with long-term illness have potential to change and improves the lives of family and friends as long as they live. That is a message of hope.”
The second half of last month saw two sessions – one discussing the healthcare professionals and the second looking more deeply at the Canadian Medical Assistance in Dying (MAID) model. In Canada, euthanasia was introduced for the terminally ill only, which is the main proposal currently being considered in Ireland but the grounds in Canada expanded extremely quickly, and continue to do so.
“Do not be Canada”, said Dr Heidi Janz of the Health Ethics Centre of the University of Alberta.
She warned the committee that MAID was initially legalised in 2016 for people with “irremediable medical conditions” but in 2021 the eligibility was expanded to people with disabilities, whose natural death is not reasonably foreseeable. From next year, those with mental illness as the sole underlying condition will qualify for MAID.
Dr Feargal Twomey spoke on behalf of the Royal College of Physicians of Ireland who has more than 11,000 healthcare member professionals, and he told the committee that assisted suicide and euthanasia are contrary to best medical practice.
He stated: “RPCI opposes the introduction of legislation for assisted suicide because, in our view, it is contrary to best medical practice. It is our view that the potential harms outweigh the arguments that can be made in favour of assisted suicide.”
The final public session looked at the issue of personal autonomy in dying. William Binchy, legal adviser to ProLife Campaign, a former member of the Irish Human Rights Commission for ten years and member of the Irish Law Reform Commission.
Professor Binchy said: “If we belief that life is futile, if we believe that it is better to be dead than alive, then in those circumstances there are very strong arguments for extending the scope of the entitlement to terminate life very widely to those who wish to die, not necessarily for medical reasons at all, and for those who cannot exercise that autonomous choice because they lack autonomy but are still in a situation where the judgment of the doctors or, indeed, of society is to ask ‘Is this life worth continuing?’”
While the substantive discussion emphasised the constitutional obstacles, the legislative challenges of protecting the most vulnerable and the very real slippery slope experienced in places such as the Netherlands and Canada, it should not be a surprise if Ireland were to introduce a legislative regime that would allow for assisted suicide, based on the hubris of some form of Irish exceptionalism that could avoid the reality of other jurisdictions.
The committee is half way through its deliberations. Ten hearings have been held and another eleven planned, by which time the committee will be ready to make recommendations to the Oireachtas – whether that will be legislative change or remaining the same, or something like a Citizen’s Assembly to explore the matter further.
(Getty)
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