4. What is a Valid Choice?
An important element of Voluntary Assisted Dying (VAD, my preferred term) is the ‘voluntary’ element. It is crucial that an individual’s decision to seek to end their life is a free, considered decision with all the implications understood. This is related to ‘legal competence’. That is, the idea that an individual is capable of making a decision which is acceptable in law — the individual is in control of their decision-making. The law recognises that competence may change with time. In other words, an individual might be competent at some times and not at others. Competence can also vary over different aspects of life. The individual must be competent at the time of making the decision and must understand the implications of their decisions in that area.
Many of those who are not persuaded of the desirability of VAD fear that individuals may be somehow coerced into seeking to end their life by others who stand to gain by their death. We should therefore look at the safeguards against coercion. (This will form the bulk of a later article.)
Key Role of GPs
One of the great strengths of Irish society is the usually close relationship between general practitioners and their patients and their families — often stretching over many years. This means that GPs are in a good position to assess the capacity to make a decision. As an Australian doctor who was a supporter of VAD put it: ’Doctors assess competence every time they have a conversation with a patient.’ The GP is also likely to know the family circumstances and therefore to know whether there is pressure on the individual to seek VAD. In most jurisdictions the validity of an individual’s decision to seek VAD is independently assessed by two trained doctors. Doctors are a highly trusted group in Ireland.
Assisted Decision-Making (Capacity) Act
An important development in Irish law has been the recent implementation of the Assisted Decision-Making (Capacity) Act which is intended to assist individuals to make decisions about their lives. For example, someone who has difficulty communicating will be able to make their wishes known in whatever way suits them best. (See Decision Support Service website). Those who assist them will also ensure that it is a free decision and not the result of coercion.
This is a most welcome development and shows a proper respect for individual citizens in line with the FREDA principles of fairness, respect, equality, dignity and autonomy. These principles have been adopted by the Health Information Quality Authority (HIQA) in relation to the provision of healthcare.
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 fourth in a series of fourteen short articles on issues about voluntary assisted dying (VAD). The first article can be found here.