Nuala O’Loan
The View
Have you ever felt really vulnerable, totally unable to control the circumstances of your life, knowing that you are reliant on others for your ongoing safety and existence, fearful of the future and of being a burden to others, afraid that you are perceived as having no real value in this complex world?
Hopefully you have never known these feelings, never experienced such fears and emotions. Yet many people have, including some people who suffer from terminal and serious illnesses, people with life limiting disabilities, people who are moving into the nightmare of dementia in its various forms, and those who are simply growing too old to be able to care for themselves as they would wish to do.
As a caring society, surely compassion, empathy and humanity demand that we do all we can to support such people: to provide adequate, focused medical and therapeutic support; to ensure appropriate forms of living respecting the dignity of each individual; to make available hospice, residential or nursing care to those who need it. Yet we know that appropriate care is not available to all who need it. It costs money, sometimes a lot of money – a problem in a world of competing needs.
Lethal drugs
At the moment the Dying with Dignity Bill is going through the Dáil. It provides that doctors will be licensed to supply or administer lethal drugs to terminally ill people who ask for them and who meet certain conditions. Both euthanasia and assisted suicide are provided for in this very short bill; they are described as “assisted dying”.
The people of Ireland need to know what is contained in this bill so that they can speak up against it.
Terminal illness is defined as “an incurable and progressive illness which cannot be permanently reversed by treatment, and the person is likely to die as a result of that illness or complications arising” from it. It is not limited to terminal cancers, but would also include conditions such as some types of muscular dystrophy, Parkinson’s disease, MS, some forms of diabetes and some heart disease (which can often be so managed and treated that people can live for years, even decades), and some forms of dementia. This is a huge range of conditions, many of which are not normally understood to be “terminal”.
All that would be required to enable someone to ask for assisted suicide or euthanasia is that the person is terminally ill as described in the previous paragraph, is over 18, has been resident in Ireland for one year and has made a declaration of a clear and settled intention to end their own life.
To sign a declaration a person must have capacity, which is to be assessed on the basis of his or her ability to understand the nature and consequences of such a decision in the context of the available choices at the time the decision is made. If necessary, the bill says an explanation can be given “in a way that is appropriate to his or her circumstances (whether using simple language, visual aids or any other means)”.
This debate is about public safety, not about personal morality…”
The reality of course is that prolonged illness, pain and loss of dignity can weaken people, sap their strength and their zest for life for a while, but not necessarily permanently.
It may well diminish their ability to make an informed decision, as may learning difficulties. It will be very difficult under this proposed law to protect people from making such decisions in moments of depression, for example. Whilst such decisions can be changed, that does not always happen.
In one recent case in the Netherlands, a woman had made such a declaration and subsequently when the time came for her to be euthanised, appeared to understand what was happening to her and struggled against it. She was held down and killed. The doctor was prosecuted but acquitted.
Baroness Ilora Finlay, an international expert in palliative medicine, opposes legal change such as Ireland’s new bill: “This is not, as some allege, about religion. While many people with religious beliefs oppose legalisation of assisted suicide, so do many with no such beliefs. This debate is about public safety, not about personal morality.”
I, too, oppose assisted suicide and euthanasia on grounds of public safety. I also oppose it because I believe that God made each of us and loves each of us, and that each person makes a unique and often changing contribution to the lives of others, sometimes unknowingly. I oppose it because it is not inevitable that people should die in great pain: proper palliative care, which seeks, “neither to hasten nor to postpone death” and is about care at the end of life, not about ending life, can, in most cases manage pain now.
People have many reasons for seeking assisted suicide: on average more than half of those seeking assisted suicide do so because they fear becoming a burden; they may be pressurised by relatives who do not want money spent on care and their fears may be heightened by the suggestion of pain and lack of dignity; they may be suffering from serious depression; they may have an illness which is treatable, but fear that the treatment will not work. They may not know how much they are loved and cherished and how important they really are.
The doctor does not need to know the patient”
People have expectations that assisted death will be immediate and peaceful, but the reality is that this is not always the case. It was reported in the journal, Anaesthesia, in 2019 that for all forms of assisted dying, “there appears to be a relatively high incidence of vomiting (up to 10%) prolongation of death (up to seven days) and reawakening from coma (up to 4%), constituting failure of unconsciousness”. Such a death will not, therefore always be simple and pain free.
Ireland’s bill contains little protection for the vulnerable. The doctor does not need to know the patient; the patient could come from Northern Ireland where these processes are illegal; there is no requirement for psychiatric or other assessment to determine capacity to make the decision; the fact that the person can retain information only for a short period is not a bar to making such a decision. It is not clear how doctors will ensure that there has been no undue pressure put on the person.
There is no requirement that the two doctors who must sign the declaration are present when it is signed by the person. There is no proper protection for doctors who have a conscientious objection to ending a life – they must refer the person to a doctor who will help them to end their lives.
The doctor only has to stay until the drug has been administered, only has to be “in close proximity but not necessarily in the same room” as a person who is ending their own life, and does not even have to stay until death occurs, whenever that may be.
Those who believe in life and the need to protect the vulnerable must surely speak with compassion and urgency to prevent the passing of this bill, and to keep Ireland a safe place for all her people.