‘Assisted dying’ recommendations slapdash and dangerous even on their own terms

As predicted, the Joint Oireachtas Committee on Assisted Dying has recommended the legalisation of assisted suicide and euthanasia in Ireland. It claims they will be allowed under only strict conditions and with proper safeguards, but when you read the actual report, some of the conditions and safeguards seem neither strict nor proper.

The main recommendation is that ‘assisted dying’ be made available only to patients who are within either six months or 12 months of death depending on their condition. (For more details below).

This is objectionable enough, but even on its own terms, the report’s recommendations would not create proper safeguards.

For example, take Recommendation 28 of the report. It says: “The Committee recommends that two formal requests for assisted dying must be made, with a set specified interval between. At least one of these requests must be recorded in writing, and before two independent witnesses.”

This is extremely loose wording. It does not tell us whether the two requests must be made to two separate individuals. Could the two requests be made to the same person? Nor does it say what the “set specified interval” between requests ought to be. Presumably any legislation would tell us in due course, but it would be good to have some indication now. Do they have in mind two days or two weeks or something else?

We are not told that the person or persons to whom the requests are made should be a doctor. Presumably they ought to be, but we should be told. Then again, should doctors be involved in this at all except to confirm that the person is dying and is within a certain number of months of death?

Who would the “independent witnesses” be? Two friends? Two strangers? Two lawyers? Who knows?

Also, no psychiatric assessment is needed except when there is a concern that the person seeking to die by euthanasia or assisted suicide is not mentally competent.

There is no requirement in the report that the family of the patients be informed before the procedure.

In some jurisdictions, health professionals cannot actively suggest assisted suicide or euthanasia* to patients as an option. This can only come from the patient as a protection against patients being led towards the procedure. In the Oireachtas report there is no recommendation that would stop doctors mentioning ‘assisted dying’ as an option, which is an appalling oversight, or was it deliberate?

The recommended protections for conscientious protection do not go far enough. Medical personnel will not be obliged to take part in ‘assisted dying’ but will have to refer a patient who requests to die in this way to another doctor. Institutions are offered no protection. This means a hospice, for example, could potentially be forced to allow its patients to die in this way if that is what a patient wants, regardless of the ethos of the hospice.

In order to qualify for ‘assisted dying’, the person should be “diagnosed with a disease, illness or medical condition that is: a) both incurable and irreversible; b) advanced, progressive and will cause death; c) expected to cause death within six months (or, in the case of a person with a neurodegenerative disease, illness or condition, within 12 months); and d) causing suffering to the person that cannot be relieved in a manner that the person finds tolerable.”

The 38 recommendations in the report, while extensive, demonstrate a problematic prioritisation of ‘choice’ over the intrinsic value of life and the potential for unintended consequences, especially for the most vulnerable in society.

The report ignores the opposition of the main medical organisations in Ireland, particularly of those medical professionals who work in palliative care.

But even on their own terms, some of the recommendations of the report are appallingly lax. The report has been barely analysed by a media distracted by the resignation of Leo Varadkar as Taoiseach, and which tend not to subject euthanasia advocates to proper critical scrutiny anyway.

In the greater scheme of things this report, which represents a big step towards euthanasia and assisted suicide, is far more important than the resignation of any given Taoiseach. It beckons us to cross a moral rubicon.

* Assisted suicide is where a patient gives themselves a lethal substance provided by someone else. Euthanasia is where the lethal substance is administered by a third party such as a doctor.