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Dublin: 7 °C Wednesday 22 May, 2013

Column: Assisted suicide ruling will be a landmark for Ireland

A terminally ill MS patient is due to learn whether she be allowed to die with the assistance of her partner, writes Sharon O’Connor.

Sharon O'Connor

A FORMER UCD lecturer, Marie Fleming (58), and her partner, Tom Curran, have mounted a legal challenge against the State claiming that the law surrounding assisted suicide in Ireland is unconstitutional. Ms Fleming was diagnosed as suffering from multiple sclerosis in 1986 and is currently in the terminal stages of the illness. She is in constant pain, no longer has the use of her limbs and requires full time care.

Ms Fleming’s wish is to die at the time of her choosing with the assistance of her partner since she is physically unable to take any action herself. Mr Curran, a recipient of the Wicklow Carer of the Year award, has expressed his willingness to carry out his partner’s wishes however, he cannot do so without the fear of prosecution and imprisonment. Although Mr Curran has stated that he will go to prison if needs be, Ms Fleming does not want to risk such repercussions.

Mr Curran told the Irish Independent:

It would give Marie such comfort, such peace of mind, to know that I will be there for her and that she will not have to suffer needlessly. It would give her comfort to know I could help without the threat of prison. Peace of mind, that is what this case is about.

The relevant legislation is Section 2.2 of the Criminal Law (Suicide) Act 1993, which “renders it an offence to aide, abet, counsel or procure the suicide of another”. Those prosecuted under this section face a maximum 14 year jail term. Ms Fleming’s children who are supporting her constitutional challenge would also face possible imprisonment if they were to be present in the room where someone was helping their mother to die.

The only legal option available to Ms Fleming would be to travel to the Dignitas clinic in Zurich, Switzerland and although she joined Dignitas five years ago Ms Fleming has said that she does not want to die “in an industrial estate far from home.” Ms Fleming’s legal case is that this legislation discriminates against disabled people breaching her rights under both the Constitution and the European Convention on Human Rights. She is also calling for the Director of Public Prosecutions to outline the factors to be considered in deciding whether to prosecute cases of assisted suicide.

Vegetative state

Evidence and legal submissions concluded in the six-day case on 14 December 2012 and judgment will be delivered by a three-judge High Court tomorrow, January 10 2013. This being the case it should be considered whether the change in the law that Ms Fleming is seeking is foreseeable.

Previously, the Supreme Court decided in 1995 that the right to die included the right to die a natural death. That case involved a woman who had been in a near-persistent vegetative state for over twenty years. The Court allowed the woman’s feeding tube to be withdrawn so that she could die a natural death however, it was made clear that it would not condone any bid to bring about a person’s death through positive action.

Assisted suicide is also illegal in the UK however, there does appear to have been a shift in attitude in recent years with the Director of Public Prosecutions, Keir Starmer QC, issuing guidelines in February 2010 recommending that those assisting another in committing suicide should not be prosecuted in certain circumstances.

These guidelines were issued in response to a legal challenge by Debbie Purdy, another sufferer of progressive Multiple Sclerosis, who wanted to ensure that her husband would not be prosecuted should he play a part in her death. In addressing the need for a new legal framework, twelve advocates for change formed the Commission on Assisted Dying in November 2010. It was commissioned by the campaign group Dignity in Dying and funded by the author, Terry Pratchett, who is himself a sufferer of Alzheimer’s disease, and Bernard Lewis, a businessman.

Safeguards

Following a year’s investigation the Commission published a lengthy report on January 5 2012. This concluded that the current legal status of assisted suicide is both inadequate and incoherent and opined that assisted dying should be offered as a choice to terminally ill patients provided that stringent safeguards are observed. The Commission not only suggest a new legal framework but also recommend that substantial improvements are made to health and social care services so that high quality end of life care is universally available.

The Commission has implemented strict eligibility criteria which a person must comply with before they can proceed with requesting an assisted death:

  • The person concerned is aged 18 years or over and has a diagnosis of terminal illness;
  • The person is making a voluntary choice that is an expression of his or her own wishes and is not unduly influenced by others;
  • The person has the mental capacity to make a voluntary and informed choice; and
  • The person’s decision-making is not significantly impaired as a result of mental health problems such as depression.

In addition to this, certain safeguards would be put in place such as:

  • The person who requests an assisted death is fully informed of all the options available to them for treatment, care and support and still wishes to proceed;
  • An assessment to determine if the person meets the eligibility criteria is provided by at least two doctors who are wholly independent of each other; and
  • The patient must take the final action to end their own life.

The report has angered pro-life campaigners such as the Care Not Killing alliance who fear that a change in the law will increase the pressure on vulnerable people to end their lives so as not to burden their loved ones. It is expected that a bill on assisted dying will be tabled in the House of Lords this year.

Similar arguments were made by the State in Ms Fleming’s case. Dr Tony O’ Brien, a physician in palliative medicine at Cork University Hospital and Chair of the Council of Europe Expert Committee on palliative care, said that “[T]he beauty of the current legal situation is that it is clear. I am fearful that if we start modifying that and making exceptions, it will significantly muddy the waters”.

His recommendation was that Ms Fleming’s life could be “greatly enhanced and significantly improved” by active engagement with palliative care professionals and consultant led pain services. Professor Rob George, a British specialist in palliative care, was also called to the stand where he laid out his concerns in relation to a “slippery slope”.

This is no doubt that Ms Fleming is in an untenable situation. However, if assisted suicide is permitted, even in the most exceptional circumstances, it would have to be considered if the floodgates could be kept closed. For now, we await receipt of what will be a landmark judgment.

Sharon O’Connor is a solicitor with Beauchamps Solicitors.

More: Court to rule on assisted suicide case on 10 January>

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Comments (67 Comments)

  • A friend of mine in the States took an overdose in March. She was suffering from a terminal illness and was quickly losing control of her limbs so although she was not ready to leave the world yet and hadn’t said goodbye to her children she took the opportunity while her husband was away and could still use her hands to take the tablets. When her carer came in hours later she called emergency services and the husband. The husband arrived in the hospital and told them he had power of attourney and that she had instructed a ‘do not recuscitate’. They insisted on recuscitating her and arrested her husband for trying to interfere. She regained consciousness the following day and he was left out of jail but because of her actions she now had to use a catheter for the rest of her life. In August she starved herself. It took 12 days and was painful for her family to watch, mercifully she was given lots of pain relief. I think it’s such a disgusting way to treat people; to insist that they live despite their pain just so what???? Were assisted suicide available she would have been happier during her illness knowing that when it became too bad she could die with dignity. She took the overdose before she actually wanted to go. People go to Switzerland before they actually want to die. Just because their loved ones would be charged if the person had to be assisted. So people are starving themselves to death as it’s the only way they can legally go. It’s despicable, even prisoners on death row are entitled to a final meal.
    I wrote the above as a comment on the journal’s poll ‘do you support assisted suicide’ a few weeks ago. I’m posting it again just to remind people that these people are human beings and so are their families. This woman was my friend and it haunts me to think she had to starve herself but I’m telling her story so that people might grow up and realise that it is the obsession with ensuring someone else’s life and suffering goes on despite their desires is abhorrent, not the people who want help the afflicted.

    Reply
  • Regardless of religious nonsense this should be welcomed. Theres worse things then death that befall people and I for one would welcome any legislation that put my life and its outcome under my control.

    Reply
    • Who’s maker? Society has the right to chose to keep someone alive in a vegetative state through medicine, but a woman cannot decide to die with dignity? This should have nothing to do with religion, religious beliefs should not inform statute.

      Reply
  • reds 09/01/13 #

    A dog would have a dignified death if they had a terminal illness. Why do we deserve anything less??

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  • Yeah, just let them die in intense pain, sure if they want to go to heaven they’ll deal with it.. are you for real? I’d presume not, but you can’t be sure people aren’t genuinely that stupid.

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  • I hope they win. People with terminal diseases and in constant pain should have the right to end their lives. Anything less is barbaric, and it seems to me the only reason they don’t currently have the right is because generally they don’t have the ability to lobby for change.

    Reply
  • This country has an obsession with the notion floodgates being open where personal choice exists.

    This is a deeply personal decision made under the most difficult of circumstances. I hope this womans rights are vindicated tomorrow.

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  • @Brian Those girls had names, Shannon and Erin Gallagher. I can’t imagine how their families must feel, and don’t ever want to, reading comments like yours must add to their heartache. Yes, suicide is terrible. The rest of your comment is nonsense and you seem to miss that the topic here is “Assisted Suicide”.
    Anyone that finds themselves in a position to be considering assisted suicide will usually not want to die, they’ll prefer to live. It’s not a case that they’re choosing death over life but rather their illness is so severe that they’re forced to consider a peaceful death, on their terms, over an agonizing slow death due to their illness. They will often take into account their loved ones and those they leave behind, not wanting to put them in difficult positions, knowing they may have to nurse them for long periods and watch someone they love suffer and eventually die. A traumatic event in itself. Just choosing assisted suicide can be a compassionate act in itself, an act of love. Is that so sinful?

    Reply
  • Mjhint 09/01/13 #

    I hope that a good well thought out decision is made & that this lady gets to choose her own path. I for one will not ask her to suffer because of any so called moral teachings.

    Reply
  • I hope she gets what she wants.

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  • Jenni 09/01/13 #

    Really, if this woman and her family feels this is right choice for them, who are we or the government to dictate whatt they do. I know if I was ever diagnosed with something terminal I would like to have this option available to me. Pro-life people drive me nuts. Ok everyone is due an opinion but honestly, give it over!!!

    Reply
  • I hope it’s introduced, no-one has the right to deny me a dignified death. If I am diagnosed with a fatal disease or dis-ability and the usual people that like to control others lives. Are Religious biddy’s, afraid of dying and inteferring! If you can put an animal out of its misery, then what makes anymore superior!

    Reply
    • mart_n 09/01/13 #

      It’s a bit more complex that you make out though. Technically nobody denies you the right to end your life (there’s not much anyone can do about it if you do). What’s being talked about in relation to this issue is more than the rights of individuals, it’s about the rights of doctors and health care professionals to determine whether they want to be party to it.

      If changes are introduced they’re not going to be universally applicable.. I hope there are changes made though.

      Reply
    • It’s as simple as this, only the objectors complicate matters and for their own agenda! If I have a fatal illness tomorrow, they tell me it’ll be a painful death and drawn out. Then I am leaving, with dignity and good memories of what remains. Fact is, we live, we die and get over it!

      Reply
    • Tell me more Obi Wan Kenobi

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    • Vincent,if you disagree with the comment make a valid counter comment but attacking the person makes you seem idiotic and ridiculus.Be nice play the ball.

      Reply
    • I looked after a family member, who died after a year of pain. Then his wife, came down with a serious brain disease a month later and eight years on. She is still alive and suffering, being allowed a dignified death would be a humane thing to do!

      Reply
  • mart_n 09/01/13 #

    Is interfering in other people’s lives to the point where they are powerless to choose to end their own suffering not considered a sin?

    Reply
  • You’re a Poe, aren’t you? You just HAVE to be!

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  • In a hopeless situation with the future being the inevitable withdrawal of abilities, with pain, loss of dignity and independence, with only pain and suffering to look forwards to. Combined with people’s pride and not wanting to be a burden and the emotional pain involved.

    It should be available for rational reasonable people to make the choice best for them in their circumstance.

    This is less about expanding people’s rights to their own lives as it is about restricting the state and religious interference…..which the only result is to force people to suffer unimaginable pain and suffering….WHY???

    I really hope this poor woman is vindicated and supported, and given the respect and dignity to make the decision for herself without fear!!!

    Reply
  • This is about choice and having the ability to make this choice nothing else. Most people will have opinions on this based upon their ethical or religious values, but they are only opinions and gives nobody the right to prolong suffering.
    Our government should do some serious research into this subject and consider legislation that would address this and prevent any kind of abuses that could happen. Realistically I cannot see this happen because our Government (both houses) are still being dictated to by the bullshit peddlers in the Vatican.

    Reply
  • Government should have NO say in this.

    If this was me, I would not be running it by them, but fair play to her for looking after her husband’s future, and *hopefully* helping evolve Irish society another step beyond veiled feudalism.

    Reply
  • Hopefully the lady involved in this case will be granted her wish to die a dignified death at a time of her choosing with the help of her partner who will not be threatened with any criminal proceedings. If any religious deity has an objection I’m sure they will deal with it after the event. Not for us to stand in judgement on someone else’s choice.

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  • What floodgates?? It’s not as if the country is over-run with terminally ill people who wish to commit suicide and are just waiting for the law to change. Those opposed to this make it sound like we will all suddenly want to kill ourselves, when this is clearly rubbish. Not even everyone with a terminal illness would choose to end their own lives. It is also completely wrong to compare assisted suicide by people with a terminal illness to the tragedy of when young people commit suicide.

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  • Brian generally doesnt respond to comments made in response to his. The sign of a closed off mind, perfect for manipulation by an organised religion.

    Brian do tell me though who says it is a sin?

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  • That’s me in the picture, my opinion is what you read and that’s the truth!

    Reply
  • Tricia- I’d ignore anyone’s comment, without a proper i.d. attached too it! These people are cowards, No I.d. and No credibility!

    Reply
  • mcgoo 09/01/13 #

    @Brian, disgraceful comment, editors/site mods should give serious consideration to removing it.

    Reply
  • @ Stephen. If that is your real name..

    I could Just as easily put up a pic of a friend and call myself Mick O’Brien.

    Don’t mind the avatars or pseudonyms.

    Read the words, concentrate on the point. Simple.

    Reply
  • Shem 09/01/13 #

    @Padraig, he doesnt have an opinion, just a bad attitude and too much time on his hands.

    Reply
  • Sin is just a made up story for children and the mentally poor.

    Reply
  • Please god they listen to her and allow her to die with dignity and compassion

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  • Well, their Lordships came to a decision, the wrong one, as usual, (so what’s new?) a decision based on the fact that they are most probably Christians; it was after all the Christian St. Augustine that first condemned suicide – the early Christians and so-called ‘pagans’ and ‘heathen’ had no problem with it; check out the history of suicide to see how the Church influenced the views of those that run things in the ‘civilised’ West; and especially a nation-state like Ireland; it would be interesting now to have a different set of Judges re-examine the case, this time non-religious Judges, that is, objective men and women who are able to see things outside anachronistic boxes.

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  • Responding to MjHint’s comment. It would be interesting to see in the last Census of Ireland how many people put down Catholicism as their religion and how that matches up to the responses to this article.

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  • So it is a Catholic country after all. Legal contortions couldn’t even get it through.

    Reply
  • Brian Horgan I’d guess you have never heard of compassion?

    Reply
  • not all of us follow your beliefs, so they shouldn’t impact laws that have nothing to do with them

    Reply
  • he’s entitled to his opinion without being judged. seem to be very judgemental comments followingvthe original one. this website is littered with them. makes me sick.

    Reply
  • folks that’s bullying. he’s entitled to his opinion. less of the degenerate comments would suit yee better. yeer all on here to have a go at people, no lives outside the internet I guess. it’s a shame. cyberbullys.

    Reply
  • you’re comparing two healthy young girls to people dying slowly and painfully with no quality of life who can’t cope anymore?

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  • The reality is in hospitals and nursing homes up and down the country the terminally ill are routinely helped on their way. Though sympathetic, I do wonder sometimes why people in this situation go through the trauma of the courts. Seems like an awful waste of your final months and years.

    Reply
    • mart_n 09/01/13 #

      Can you provide any source at all for that claim about people being ‘helped on their way’?

      Anyway, assuming what you say is true, it doesn’t address the issue of people being allowed to choose when they are in indescribable pain yet not close to passing away.

      Reply
    • @mart_n…God forbid someone you know gets that ill, you’ll see for yourself.

      Reply
    • mart_n 09/01/13 #

      People I know and love have got sick, Vincent. I’ve seen the suffering that people go through and sometimes it’s for no other reason than to appease family members. It’s not a nice thing, and it shouldn’t be up to the public at large to decide what options are available to individuals in those circumstances.

      The choice should be made between patients and doctors acting in a morally just way on good will, not what is written in a dusty old book that most people will ever need to read.

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    • What nursing homes up and down the country routinely help people on their way, Vincent? This is a sweeping statement with no facts to support it!

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    • @siobhan- I’m not talking about pillows over the head, here!!!

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    • Vincent, what I think you’re referring to is a specialty in medicine called palliative care.
      Patients are referred to palliative services in their dying days (usually literally days) for non-invasive care. That is, care that gives the patient dignity, allows them to pass on peacefully, and allows relatives and friends to see that their loved one is comfortable, not in pain or suffering, but just slipping away.
      Doctors and nurses face decisions every day that effect patients in ways that you might not even think possible. Do we feed the patient knowing that it causes her more pain to swallow or digest the food than it might be worth? Do we continue to carry out resus on him knowing that with time passing so does the possibility for a full recovery. Do we continue aggressive treatment knowing that its overall effect is harming quality of life for the patient. We make these decisions with the patient, their family and loved ones, and we make them in the best interest of the patient, and the patient alone.
      Your insinuation that nurses and doctors “help” patients off this mortal coil is incorrect, and if you know of any incidences where it has happened I strongly advise you to contact the IMC and ABA, as such a practice is not permitted under Irish medical/general law. Hence why a court case is required for this woman. You should really try putting a bit more effort into your comments.

      Reply
    • Vincent how dare you make such an openly libellous comment about this nations healthcare staff.

      I work in several nursing homes and this is most certainly NOT the case in any of them. If it were I would not have the opinion I have on this issue.

      I have had residents ask me why god doesn’t answer their prayers and let them die, I have watched people’s minds unravel, their bodies literally freeze up and contort, or they completely withdraw..
      I see residents doing everything they can to hasten their death and being circumvented – if they refuse to eat they have peg feeders fitted, they aren’t allowed to smoke or drink very much, they aren’t allowed sharp knives and access to drugs is strictly monitored.

      Not every one of these residents would choose euthanasia – but if they had then their choices should be respected.
      If you had seen half of what the people working in these places have you would have a very different opinion.

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    • Vincent think you need to back up that claim if you can.

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  • @stephen- but you have a picture and no credibility?!? I’m confused.

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  • Life and death is in the hands of the maker. We do not need demi-gods on earth having the right and power to legalise suicide. However misguided and well intentioned they may be.

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    • Rehan- I decide what happens to me, you or others have no right to force your Religion into my life. If you want to believe in fairies and sky gods, off with you and keep it to yourself!

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    • @rehan; well, as soon as this “maker” decides to prove his/her/its own existence and give evidence in the supreme court attesting to the misguided act of legislating for assisted suicide then we’ll all take note. until then your “maker” doesn’t get to impose any beliefs on the rest of us.

      Reply
    • reds 09/01/13 #

      The maker? So your parents I assume?
      I just hope for your own sake that you’re a troll, otherwise I question your sanity!

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    • Your ‘maker’ is your ma and da.

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    • Rehan We, as human beings decide every day what will happen to us, to a degree we are masters of our own fate. Sure, we can’t decide not to get cancer, or not to have a heart attack and a religious person may say things like that are “in the hands of the maker”. Others would say by eating a balanced diet, not smoking and exercising etc. we CAN influence these things.
      Have you ever heard the story of the man who’s house was flooded, he was a religious man. He prayed. As the firemen came to his door he said no, God will save me and prayed again. The water rose to the first floor and again the firemen came, in boats this time. Again he said no, God will save me. The water rose again to the level of his roof. As he huddled on his roof a helicopter came. Again he said no, God will save me. He drowned. When he came before God he said, “God what went wrong, you didn’t save me?” God replied, “What, are you deaf? I tried three times”.
      Religious or non religious, it makes no difference, we still have to fend for ourselves in this life, if you sit and wait for God, you starve. If fate, God, the maker, call it what you want, deals someone a terminal illness and it reaches a stage they find they can no longer cope with then surely they are entitled to end their life on their terms? With dignity. With compassion. This isn’t a question of people wanting to end their lives on a whim but instead wanting to end their lives while they can say goodbye to those they love, to hug a loved one a last time, to say that last goodbye, to end their agony. On their terms. Is that too much to ask? I don’t think so.

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    • Jed… great comment well put.

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    • First off, Jedi – bravo, so well put..

      Rehan – have you seen what some of these conditions can do to a person? What loving god does this to their creation? Someone asking for assisted suicide does so because they literally cannot do it for themselves – this lady cannot move, Terry Pratchett has Alzheimer’s and at some point of his progression he may well end up with no idea where or who he is, wetting himself because he’s forgotten what toilets are. Other become completely locked within themselves – unable to communicate, yet their eyes convey immeasurable pain and fear.

      I have watched the elderly lose their faith because their prayers to end their suffering and pain seem to go unanswered..

      To my mind, this is cruelty. We treat our pets and farmyard animals better (and we treat them quite poorly as it is). Where is our compassion? Our empathy? Surely a loving god would expect us to have these traits in abundance?

      Reply
    • I knew it would be only a matter of time before somebody brought the Goblin leprechaun or fairy based argument into the discussion…..thanks for that Rehan.

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    • “Life and death is in the hands of the maker” when are you people going to leave all this middles ages hocus pocus nonsense behind you? This is about having the right to chose, if you are terminally ill and or suffering or are going to suffer surely the most humane way to deal with it is to allow a person to make the choice which best suits them and their loved ones. Why should the state or any religious cult have any say in the personal choices we make as human beings. If you follow a particular brand of religion and wish to adhere to the diktats of that sect or cult then that’s up to you but how dare you even think about forcing your beliefs on others who do not share them. What you at the end of your life is up to you but in the case Ms Fleming it should be entirely down to her and her partner and children to decide what is best for them. Keep your airy fairy nonsense to yourself and let those of us live in the real world make our own decisions thank you very much!

      Reply
  • Cat amongst the pigeons. Purpose served. But I am a bit surprised by the vitriol of some replies. And this from nationals of a Catholic Ireland !!!

    Reply

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