End of Life Ireland

Frequently Asked Questions

It is an end-of-life option that allows eligible individuals to legally request and obtain medications/assistance from their own and one other doctor to end their life in a peaceful, humane, and dignified manner. This is a consultative process between the patient and their doctor within a structured framework, to ensure the patient is of sound mind and fully informed.

Voluntary Assisted Dying (VAD) is the preferred term because it emphasises that the decision to end one’s life is voluntary, that is, a considered, freely made decision on the part of an individual. Voluntary Assisted Dying also allows for medical assistance in the event an individual is unable to take the prescribed drug by themselves. 

Legislation for VAD and the conversations about end of life with two doctors will provide safety and security on choices available at the end of life.

We are all going to die. People are afraid of dying in awful circumstances, lonely, incapable, undignified and in unbearable pain. At present it is illegal to assist a person to end his or her own life, even though suicide is not in itself a crime. Currently under the Criminal Law (Suicide) Act 1993, it is an offence to aid, abet, counsel or procure the suicide or attempted suicide of another person. The maximum penalty is 14 years in prison.  This new legislation will allow a doctor to ‘assist’ an individual by prescribing a drug that the individual can take themselves. In cases where the person is physically unable to take the drug, a doctor may administer it. (This last provision removes an important source of possible discrimination against a person with medical or physical impairment.)

Everyone is going to die and the majority of people would like some control over how and where this happens. It should not be necessary for someone to travel abroad, or have to consider taking their own life, which can mean curtailing one’s life earlier than wanted. Instead they should have the choice to die at home on their own terms, surrounded by their loved ones.

There is a gap in the law which means that many people can have a ‘distressing death’, where there is physical and emotional pain to the individual and to his/her loved ones. There is also a loss of control (autonomy) over the circumstances of death and decisions about treatment. Because of this, many resort to seeking an assisted death abroad, which is very stressful, difficult and an option only available to those who can afford it. Others may decide  to take their own lives, which is likely to have serious emotional consequences for their loved ones. This also carries the risk that the attempt will not be successful, leaving the individual and their loved ones worse off both physically and emotionally.

Doctors say that they have always helped their patients to have a good death, long before Assisted Dying legislation. These doctors consider it their responsibility, only on  explicit request of the patient, to relieve terrible suffering at the end of life. Research in the UK suggests that already 1000 people each year receive help to die, illegally from a doctor at their request. Without legislation, this act of compassion puts the doctor at risk of prosecution.

The Bill seeks to give individuals control over their death in that same way that they have control over other aspects of their lives.  International experience shows that those who qualify for a voluntary death experience a great reduction in mental stress and are able to enjoy the time remaining to them, without the fear of pain and distress and for their loved ones who watch them suffer.  In Oregon, where Voluntary Assisted Dying has been available for over 20 years, research shows that a third of those who qualify for end of life assistance, do not go on to avail of the service.

No. On the contrary, it will enrich life by creating choice, a sense of control, and an opportunity to plan the time and place of one’s death. There is evidence that the quality of life actually increases, once a person has decided to end their life with assistance. Having no option,facing intolerable suffering and lack of dignity towards the end of life, creates distress and depression.

Someone who:

  • Is terminally ill
  • Is over the age of 18
  • Is resident on the island of Ireland for a minimum one year
  • Has a ‘clear and settled intention’ to end his or her own life
  • Has made a declaration to that effect which has been witnessed by two doctors (one independent).
  • Has the capacity to make the decision.

Doctors must be satisfied that the individual has made a voluntary decision ‘without coercion or duress’ and that the individual has the capacity to make that decision.

No. In countries where VAD is legalised, it is still punishable by law, unless it is carried out by a physician under very strict conditions and with due care. In these countries, people do not have a right to VAD, they can request it but many requests are denied. For example, in Holland about two thirds of requests are denied. Doctors are not obliged to perform VAD. They have a right to refuse, but they do have a duty to refer to another, consenting physician.

The Act defines capacity as the ability ‘to understand the nature and consequences of a decision to be made by a person in the context of the available choices at the time that the decision is made.’  The person who requests access to VAD will be assessed for mental capacity. The criteria for ‘competency’ are: to understand the illness and treatment related information, to appreciate the significance of this information, to be able to weigh up options using reasoning and logic and to be able to communicate a choice. 
The Assisted Decision-Making (Capacity) Act 2015, although not fully enacted, seeks to enable individuals with communication or other difficulties, to reach and express a decision. This Act further places the choices of the individual above the judgment of others about the individual’s ‘best interests’.

A terminal illness is an incurable and progressive illness which is unlikely to be reversed by treatment, from which the person is likely to die as a result of that illness or from complications relating to it.

It is not about a right to die, as we are all going to die anyway. It is about choice, a right to have an option of where, when and how and a right to die with dignity.

The Act does not contain a ’less-than-six-months-left-to-live’ clause, which means that it could apply, not only to individuals with terminal cancers but also those with neuro-degenerative diseases such as Multiple Sclerosis (MS) or Motor Neurone Disease (MND), where it is more difficult to determine the likely length of life remaining. Prognosis is not an exact science. Research shows that doctors tend to overestimate rather than to underestimate. A specialist may be consulted to assist with diagnosis and prognosis. Doctors say that this is a complex issue in view of sudden changes in the course of the illness, subjective medical assessments, availability of new treatments, etc. Although it may afford some legal boundaries, doctors in their medical practice find it easier to work with the definition ‘a reasonable expectation of death’ within a certain time.

During the debates about the 2015 proposal of this Bill, a medical ethicist defined autonomy as follows:- ‘Autonomy refers to a person’s interest in making and acting on choices of momentous significance in that person’s life according to that person’s most cherished values and beliefs. It is not just about having a range of choices and choosing between them.’ Supporters of legislation for Voluntary Assisted Dying take the view that: ‘Having considered themselves autonomous and self-determining adults throughout their life, supporters [of VAD] believe that they should continue to be autonomous, self-determining adults at the end.’

However, autonomy is never ’unfettered’. That is to say, individuals live within societies and have obligations, not least the obligation not to cause harm to others. Autonomy is the sign that respect is given to the individual, and with respect comes dignity.

Unbearable suffering is seen as a person is in great pain, physically and psychologically, which can no longer be alleviated. The tolerance level of suffering is defined by the patient. Patients say that the lack of dignity, the total lack of control over bodily functions and the resulting psychological pain and suffering, is the hardest to bear. Many patients then beg to be relieved of their suffering.

VAD is not provided to someone who is vulnerable or incapable of making a considered decision. 

It is chosen in collaboration with the patient’s doctor and family; with the full consent from the patient who has made a well considered request. The autonomy of the person to make such a decision must be respected. In short, it is not the intent of a doctor to ‘kill’ a patient but to compassionately assist them, in full respect of the patient’s wishes to die with dignity.

No, because they do not fall within the criterion of a terminal, progressive illness. All people have the right to be treated equally under VAD legislation.

Yes, the average progression of dementia until death is about seven years and can be considered a terminal illness with a patient experiencing mild symptoms of forgetfulness at onset. At around the four-year point of the illness,  this moves to a  loss of capacity and the person is then deemed under law as not ‘competent’, no longer ‘capable’ of making the decision that they want to die.

This law protects vulnerable citizens: persons with dementia, physical and mental impairments. These conditions do not fulfil the eligibility criterion  for VAD. These groups will be treated equally to the rest of the population. There is no evidence from other countries where VAD is allowed, that any such abuse is happening.

The ‘slippery slope’ argument is not backed up by evidence. In Oregon, the law has remained the same for over 20 years and no doctor has ever been prosecuted.

Assisting a person to end their life cannot be equated with suicide. 

In most cases of suicide, there remain alternatives and treatment available. Clinical depression is not seen as a terminal illness and thus does not qualify for VAD. 

Suicide is a lonely, painful and undignified way of dying without support of a doctor or loved ones. It also leaves the family traumatised and feeling guilty. Assisted Dying on the other hand, involves and supports family and loved ones. 

Suicide is not always successful. Attempted suicide can leave the person more traumatised and disabled when unsuccessful. VAD results in a certain, controlled and compassionate death.

No. On the contrary, the evidence demonstrates it leads to less suicide as people feel more in control, less fearful about dying. They know that they know a planned,  more peaceful and more dignified death is possible.

Yes it can. Palliative Care and Voluntary Assisted Dying are not mutually exclusive. They can work together and complement each other very well. In Oregon and Victoria and in the Benelux countries, the Hospice Associations acknowledge that assisted dying and palliative care can work together and they are viewed on a continuum of options, from palliative pain relief, or refusal of further interventions, or Palliative Sedation or Assisted Dying. When someone requests assisted dying, doctors are required to inform their patients of all their treatment options, including palliative care.

Yes it does. Many patients choose or their doctors decide, palliative sedation and die a peaceful death. However, the process of dying can be a prolonged period of suffering, which is what many who seek VAD do not want.  However,  research shows pain relief for ‘refractory symptoms’ is unsuccessful in 5% of cases. Palliative sedation, leading to an unconscious state, can last for days and does not allow for communication and conscious presence until the last moment, whereas with Voluntary Assisted Dying, the  person remains engaged and aware until the last minute. The time of their dying is in their control and death occurs mostly within 10 minutes of being assisted.

Yes. Patients can and should discuss their wishes,  their options for treatment and end of life care with their doctor. Arising from this, the patient can choose what they want. No Resuscitation. No CPR or No Further Treatment. 

When asked about the option of Assisted Dying, the doctor must inform the patient of these options. All end of life wishes must be expressed by the patient and recorded in an Advance Health Care Directive or a Living Will. The doctor has a right to refuse to facilitate but has the duty to refer the patient to a consenting colleague if they do not want to take part in this procedure.

Family doctors and consultants report that most of the time it is very gratifying to help a person to die well. They say it is an emotional and personal experience that connects the doctor with their patient at a basic human level. A relationship of trust has developed where mutual respect and compassion are the key ingredients. Patients and family are always most grateful for this help.

The family can be involved in discussions with the doctor and the patient, if it is agreed by the person. The doctor will be mindful of the possibility of undue influence by family in their assessment of the VAD request. The family is engaged in a supportive capacity, taking part in conversations about dying and is involved in planning. This enables the family to adjust and come to terms with losing someone they love and begin to accept the impending death. Families often say that it is more difficult for them to let their loved one go than for the dying person to leave. It has been shown that collaboration with and involvement of the family increases the quality of the end of life experience for all. Families also find they come to a place of acceptance after losing a loved one with a less heavy heart, the intensity of their grief lessened knowing their loved one had a ‘good’ death at a time and place of their own choosing.

All views on assisted dying are to be respected, including those of people who object on religious grounds. Assisted Dying is only one of a number of end-of-life treatment options.  

The majority of people do not avail of VAD, or do not resort to choosing it in the end. It is all about having the option or choice. As with many choices in life, an individual’s right to choose is to be respected, even if it is something one would not choose for oneself. 

However there are many religious people who do support VAD legislation. Polling in the UK shows that 79% of religious people support a change in the legislation.

Archbishop Tutu, a most respected religious man, supports assisted dying. Many Christians in Victoria, Australia support assisted dying in Victoria, arguing we should support it on the basis of compassion, which is a basic value in all religions. They note: Was not Jesus the living example of compassion and did he not suffer terribly at the cross, begging to be relieved of his unbearable suffering? Didn’t he request to be assisted? www.christiansforvad.org.au

As things stand, Ireland’s proposed VAD law is amongst the strictest in Europe and will have extensive safeguards in place, drawing on the experience of countries where VAD has been available for many years.  In the Netherlands, Belgium, and Luxembourg, VAD is legal, including minors (under very strict conditions) in the Netherlands and Belgium.

Switzerland is one of the rare countries that allows assisted suicide by patients administering a lethal dose of medication themselves. It does not, however allow active, direct euthanasia by a third party. 

In France, the law acknowledges a right to die and doctors can prescribe pain killers even if their use under certain conditions can result in death, once the patient is in an advanced stage of an incurable disease.

The Justice Committee will determine whether submissions made will be made available to the general public once they have made their initial review.  Organisations/associations may choose to make their own submissions publicly available.  Submissions made by End of Life Ireland, EOLI and Irish Doctors Supporting MAiD are accessible (with their permission) on our home page.