A clash of worldview at the ‘assisted dying’ hearings

The Oireachtas committee on ‘assisted dying’ has met three times in the last two weeks. As usual, the hearings offered useful insights into the thinking of both sides of the divide. What follows are some highlights from the meetings.

Session One

The first session held on Tuesday 3rd October was dedicated to ethics.

Dr Thomas Finegan, assistant professor at Mary Immaculate College Limerick and member of the board of the Iona Institute, told committee members that euthanasia is a violation of the value of life. When introduced in the healthcare system, euthanasia goes against the primary healthcare norm which prohibits the intentional killing of a patient.

“Even if all such future choices were safeguarded from coercion, it would still be the case that the central purpose of healthcare is being overturned or at least severely qualified”, he said.

Euthanasia is often presented as a choice and defended in the name of personal autonomy but if we accept this principle, all attempts to draw a limit in terms of when or by whom it can be accessed will appear as unfair discrimination to someone who is excluded, he claimed.

“Consistency demands that if euthanasia were to be legalised, it would be available on virtually all medical grounds, including, for example, chronic illness, conditions closely associated with disability, experience of suffering – which is inherently subjective and not limited to physical suffering – and mental disorders, once capacity remains,” he said.

Dr. Annie McKeown O’Donovan, from University of Galway, believes that assisted suicide should be permitted but only when death is “imminent”, and the intent is to reduce harm. She also believes that no one apart from the patient should administer the lethal substance, and so she opposes direct euthanasia, that is, when the substance is administered by a third party such as a doctor.

Dr Finegan replied that the logic of seeking to minimise harm means that assisted suicide should be offered even more to those who suffer chronic illness and therefore have more suffering ahead of them than those near death.

Dr Kevin Yuill, representing ‘Humanists Against Assisted Suicide and Euthanasia’, reminded the committee that “the inherent problem with any assisted dying legislation is that it is based on a subjective idea of suffering, what it means and who is suffering.” He mentioned the case of a Canadian man who sought ‘medically assisted dying’ because he was homeless.

This prompted a harsh reaction from Deputy Gino Kelly, who accused Dr Yuill and Dr Finegan of using “deeply distasteful and very selective language, to say the least.”

He also demanded evidence on the spot from Dr Yuill to back up his claim about the homeless person, and when he said he could not do immediately, saying he would do so later, Deputy Kenny angrily accused him of not being credible.

But the case Dr Yuill was referring is well known. Mr Amir Farsoud, a disabled 54-year old, applied for ‘medically assisted death’ because was about to be made homeless and had no money. His request was approved by his GP although it needed a second doctor to approve it. It did not go ahead, but from next year in Canada, people suffering from mental suffering will be able to apply for ‘assisted dying’.

Similar cases are emerging, here is another example.

A recent survey showed that 28pc of Canadians believe that homelessness should be a ground for access to assisted dying.

Also, a recent article in the New Atlantis revealed conversations between Canadian practitioners of euthanasia who believe the procedure should be made available for non-physical suffering.

Session Two

The second session of the hearings last week was devoted to the experience of the United States.

Dr Mark Komrad, a clinical psychiatrist at Johns Hopkins Hospital and a clinical assistant professor of psychiatry at the University of Maryland, told the committee that assisted suicide is not widespread in the US, and there have been 270 failed attempts to introduce such legislation in many states. Nine states have passed laws inoculating themselves against such legislation ever being introduced there in the future, he said.

Where legal, those practices can go terribly wrong. In Colorado, patients with anorexia were prescribed lethal drugs. In Oregon, at least nine patients survived after having taken such drugs.

The other two experts,  Dr Tom Jeanne and Prof. Margaret Battin who both support assisted suicide, were a representative of the Oregon Health Authority and a professor of philosophy respectively.

Oregon has been presented as a good model by some who spoke to the committee in the past. Rates seems to be lower than countries such as Canada or the Netherlands, even if the numbers of those who died by assisted suicide have increased more than fourfold in the last five years.

The law allows only terminally ill patients to kill themselves through the self-administration of a lethal drug prescribed by a doctor. Most of them die at home. This seems to make a big difference to numbers because people seem much more reluctant to self-administer a poison than to have a doctor do it for them.

Dr Komrad noted that the drugs are not monitored after they are provided to those who have requested them. In one case they were stored in a house for more than four years, with the risk that others might have taken them.

He commented: “The experience with assisted suicide in the US has demonstrated inadequate and mutating guidelines that eventually push beyond the limited scope of the original laws; flimsy safeguards; zealous physicians who do not follow the law … Leading medical organisations have declared this bad medical ethics, and the majority of American legislators have concluded that it is poor public policy. I hope Ireland can learn from our bad example”.

Senator Ronan Mullen mentioned a very recent study from the British Medical Journal which found that 46pc of those who opted for ‘assisted death’ were less concerned about their own suffering and more concerned about being a burden to others.

It also found that in Oregon, whereas in the past most of those accessing assisted suicide were using private insurance to cover their expenses, now public insurance is mainly covering costs. Assisted suicide in Oregon is covered by Medicaid, the government program that provides health insurance for those with limited income. This change from predominantly private to mostly public funding could explain the growth in number of cases of assisted suicide in Oregon, particularly among the less wealthy.

Session Three

This week, the Oireachtas heard from four witnesses from Ireland.

Elma Walsh (pictured), whose son teenage Donal became known in 2013 for his battle with cancer, told the Oireachtas Committee of his good experience with palliative care, which allowed him to live the last months of his life as an inspiration for his peers. He visited schools and spoke against suicide, encouraging young people to value life.

Donal died with dignity, the mother said. She cautioned that by removing the present legal ban on euthanasia/assisted suicide the value of life will be significantly reduced.

The other three witnesses support assisted suicide and/or euthanasia to varying degrees.

John Wall, who was diagnosed with a terminal illness, believes that assisted suicide should be available when “it is blindingly obvious that the end is very nigh”.

Tom Curran, whose late partner Marie Fleming lost a Supreme Court case to access assisted suicide in 2013, favours the Swiss model, where a legal drug can be administered by non-medical professionals. He believes that anyone of a sound mind should have that choice, for any reason.

“It is not about aid or about end of life. It is about a choice as to when you feel that your life had ended”, he said.  In the past, he admitted that he had helped Irish people in Switzerland to access assisted suicide.

Garret Ahern, another witness, told the Committee about his late wife Vicky Jannsens who legally took her life in native Belgium, this April after having suffered from breast cancer for ten years. He lamented that it could not have happened here.

Mrs Walsh expressed fear that even a law for limited cases will be extended in the future. “Society must promote hope” she said, “assisted suicide is a statement of no hope. Palliative care allowed Donal to spread a message of hope and reduce the number of suicides. Telling young people that their life is valuable, no matter how uphill it may seem at the time, is important. As Donal said, “Everybody has their own mountain to climb.” Legalising assisted dying is to bring about a clash in society. Life is valuable no matter our age or circumstances. We can all help to fight against suicide by turning our back on assisted suicide.”

Committee hearings continue.