(10/14) ‘Vulnerable Groups’

Over the next few articles in this series I am going to consider some of the arguments against Voluntary Assisted Dying (VAD). In this one I consider the risk to groups of people who are regarded as ‘vulnerable’.

My understanding of ‘vulnerable’ groups in the context of ‘assisted dying’ is that they have less power over their lives and somehow might be pressured into seeking to end their lives. Groups often mentioned are those with disabilities and older people.

Groups may be discriminatory

The main reason I prefer the term ‘voluntary assisted dying’ to ‘assisted dying’ is that it emphasises the voluntary aspect. It is a matter for the individual to make a decision about their circumstances and whether they want to seek to end their life. That decision must be free, not coerced and made in the full understanding of the implications. The decision to seek ‘assisted dying’ is an individual decision. Treating people as part of a group without regard to their individual circumstances and wishes is dehumanising and undermines an individual’s dignity.

There is no reason to think that people with disabilities — as a group — are not capable of making a voluntary decision. If they are not capable, even with assistance, to make such a valid decision, they cannot succeed in an application for ‘assisted dying’. They are specifically excluded under the law, not because of their disability but because of their inability to make a decision under the law — they are not legally ‘competent’. Again, this is a decision about an individual, not a group.

This makes sense. Why should a person who has a mobility problem or who is visually impaired be automatically excluded from any provision of the law? Indeed, such an exclusion is illegal under various equality acts. The same principle applies to older people‚ they must be treated as individuals.

In the original law on ‘Medical Assistance in Dying (MAiD) in Canada, people with disabilities were excluded. The Supreme Court in Canada decided that was discriminatory and the law was changed so now they are treated in the same way as everyone else.

Advance Healthcare Directive

An Advance Healthcare Directive (AHD), sometimes known as a ‘living will’, allows an individual to specify their wishes for medical treatment in the event they are not able to make decisions for themselves. At present we cannot apply for medical assistance in dying. As soon as our legislators pass a law that gives us that right, we will have the power to choose that option if we wish. I recommend completing an AHD and discussing it with your doctor and close family. As a friend said: ‘Preparing for end of life is an act of love.’ It is helpful to your nearest and dearest to tell them what your wishes are. Don’t leave them to guess.

The Assisted Decision-Making (Capacity) Act gives force to AHD as an expression of a patient’s wishes and they must be respected. (The same idea is in the doctors’ Code of Practice.)

Advance Healthcare Directive forms are available here and I wrote a series of posts that includes issues such as completing an AHD, making a will and power of attorney.

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 tenth in a series of fourteen short articles on issues about voluntary assisted dying (VAD). The first article can be found here.