(6/14) What About the Safeguards?

The Oireachtas Joint Committee on Assisted Dying has been asked to examine the safeguards around ‘assisted dying’. In this article I look at the experience of legal safeguards in other countries.

Assessing medical criteria

In all jurisdictions, in order to be accepted for ‘assisted dying’, at least two doctors have to certify that the applicant meets the medical criteria of the law. In some places they must be satisfied that the applicant has a terminal illness and they there is a reasonable expectation that the applicant will live for less than six months. (‘Reasonable expectation’ is a legal concept: doctors are not able to determine these things precisely.) In other places the law may be less restrictive and the doctors will certify that the applicant has intolerable suffering and there is no reasonable prospect of relief.

In most places there is more than one stage in the application process, so that there is a first screen followed by a referral to a further consideration before a final application is allowed. In most jurisdictions all completed applications are scrutinised by a technical committee to see that that they all comply with the law and there are detailed reporting procedures. For example, in Queensland a very detailed procedure is set out along with penalties for failure to complete them properly and in a timely manner.

Doctors are well used to assessing the competence of their patients to understand what is being said to them and the implications of any decisions they have to make. In Ireland we now have the Assisted Decision-Making (Capacity) Act which provides for assistance for those who have difficulties such as communication problems or learning difficulties.

Balancing safety with efficiency and cost

It is vital to balance the thoroughness of the safeguards with timeliness, efficiency and cost to the applicant. The law is dealing with people at the end of life who may be in pain or suffering other forms of distress associated with their illness and its consequences. Time is important — and so is cost. If there are too many steps with significant costs at each step, VAD will be put out of reach of many people. It is arguable that the costs should be borne by the state.

Likely demand for ‘assisted dying’

This raises the question of the likely number of people who will seek to use VAD. In most jurisdictions where VAD has been available for a few years, the number of cases settles down to around 4% of all deaths. In Ireland there are about 33,000 deaths per year, so that would mean about 1,000 deaths by VAD each year (plus, say, 200 whose applications are unsuccessful, or who do not complete the process). That would not impose an insupportable burden on the state’s finances and would alleviate much suffering. This does not seem likely to create an intolerable financial burden for the state. In any case it would be a small price to pay for a more compassionate society.

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