The Oireachtas has set up a Committee of TDs and senators under the Chairmanship of Michael Healy-Rae to consider the issue of ‘assisted
dying’ and report by June 2024. The Joint Committee on Assisted Dying has been asked to examine four aspects. First, how assisted dying might work in Ireland, second, the safeguards, and third the ‘constitutional, legal and ethical’ issues, fourth, ‘possible unintended consequences’. I look at each of these over the next few articles.
The Role of Doctors
Ireland is not so different from most of the other countries which have provisions for assisted dying. Individuals applying for assisted dying are
examined by two doctors to see that the specific criteria are met. Those criteria include terminal illness and in some cases a prognosis of limited life expectancy. Those examinations will also include the doctors’ opinion that the applicant is competent to make a legal decision (’of sound mind’) and that the decision to apply is free and not coerced and that the implications are understood.
This is broadly the situation in most countries. However, there is a view that a normal life events like dying should not be ‘medicalised’, individuals should be free to determine that their life or suffering is intolerable and with no reasonable prospect of relief and so be able to end their lives within the provisions of the law. The argument is that only the individual can determine whether their life is intolerable and no-one else has the right to do so. This is not the actual practice anywhere except possibly in The Netherlands and Belgium and then there are other strict conditions that must be met.
Given the high regard in which doctors are held and their generally close relationship with patients and their families, it would be a sensible for
Ireland to adopt the ‘medical’ model which is used in most jurisdictions.
This issue raises the matter of things to be avoided in any legislation, so I’ll mention three difficulties that have arisen elsewhere. In some jurisdictions, healthcare personnel are not allowed to raise the topic of assisted dying with a patient: the patient must raise it first. This is a seriously inhibiting clause. As one doctor put it, ‘I would feel negligent if, as part of a discussion about the course and treatment for a cancer, I was not able to inform the patient about all the options for treatment, including palliative care and assisted dying.’
An insistence on self-administration of the dose should be avoided. This may give rise to disastrous consequences if the individual can’t swallow properly or is suffering from vomiting or has poor control of movement. In Canada and New Zealand over 80% of individuals opt for medical administration of the dose, usually by intravenous injection which results in a calm death in a few minutes.
Finally, the individual should not be required at the time of death to give a further consent to the procedure. Some patients may not be able to give consent at this point (for example in late-stage dementia).Their earlier valid decision to seek VAD should be respected.
Alan Tuffery is a member of End of Life Ireland. We are a voluntary group advocating for legislation to allow Voluntary Assisted Dying in Ireland. This is the fifth in a series of fourteen short articles on issues about voluntary assisted dying (VAD). The first article can be found here