Committee hears ‘assisted dying’ should be available to the mentally ill

The hearing of the Oireachtas committee on the legalisation of euthanasia and assisted suicide (EAS) in Ireland has probably revealed a lot more of the agenda of some of its proponents than they intended.

For example, at one of the sessions, Senator Lynn Ruane suggested that so called “assisted dying” should be offered to those who have a severe mental illness as well as those who have a terminal physical illness. Canada is currently in the process of making precisely this extension to its already expansive law.

Senator Ruane said: “I feel we also need to weigh mental suffering in the same way as we weigh physical suffering. The thinking is based on terminal rights.”

“Terminal”, she explained “means that a person is likely to die or that is the trajectory of the illness over whatever period of time, or that the illness is likely to cause death. The argument could potentially be made that when it comes to decades of suffering with a chronic mental health illness that has not responded to treatment, and in spite of various types of treatment interventions, life has not improved. A person could say that he or she intends to end his or her life in the next six months. When do we say that terminal illness is only related to physical illness?”, she said.

In reply to this suggestion, Dr Louise Campbell, a lecturer in medical ethics responded that this is something to be seriously considered and it would be a form of discrimination not to include such patients.

She told the committee: “If we have a duty to one category of person in that situation, do we not have an equivalent duty to another category of person, provided that he or she meets the capacity and voluntariness requirements and provided that there are additional safeguards in place to ensure that those capacity and voluntariness requirements are met in the case of mental illness? I agree that it could be seen as discriminatory not to allow it. I could see that it would pose problems from a disability rights point of view, but it has been argued that it could be discriminatory to distinguish between suffering based entirely on physical illness and an equivalent degree of suffering based entirely on mental illness. It is something to seriously consider”, she said.

Currently, in Belgium and the Netherlands euthanasia and assisted suicide (EAS) is offered to people whose only condition is psychological suffering. They do not need to be physically ill. In Canada, this will be possible from March 2024.

In the Netherlands, EAS can be requested for any “unbearable suffering without prospect of improvement” and this includes psychological suffering of people with intellectual disabilities or autism spectrum disorders.

A recent study found that 77pc of Dutch patients with intellectual disabilities or autism who requested EAS “described being lonely or socially isolated as a major cause of suffering. This often stemmed from feeling rejected and different from others. For patients with autism spectrum disorders in particular, their difficulty in making or coping with social contacts was a major factor.”

More than half (56pc) of survey respondents mentioned lack of resilience or coping strategies as the reason for their request for EAS. In one-third of cases, physicians noted there was ‘no prospect of improvement’ as autism spectrum disorders and intellectual disability are not treatable.

Following the logic of Senator Ruane, if these patients believe they are suffering unbearably and there is no prospect of improvement, maybe they should eventually be offered “assisted death” in Ireland as well?

It was notable that other proponents of legalising assisted suicide for the terminally ill in Ireland, and who are also members of the committee, did not criticise either Senator Ruane or Dr Campbell for going too far.

We can already see the direction of travel on this issue. It will be introduced for the terminally ill, and then other groups will be allowed to avail of it.

As Professor David Jones of the Anscombe Centre told the same committee: “If one crosses the Rubicon, as it were, it is very difficult to have lesser barriers which will be as effective. If we have abandoned this historically very well-established and very deeply rooted rule against euthanasia and assisted suicide, how long could we maintain a much more arbitrary rule such as it being available for people with six months to live but not for those with seven months to live? That is obviously not as fundamental a principle. How long could we maintain a rule that it should be permitted for those with this diagnosis but not for that diagnosis? If we look at what happens in these different jurisdictions, and this is something common to the different jurisdictions, numbers go up in every one, categories tend to expand and restrictions tend to drop away.”

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