THE OIREACHTAS COMMITTEE report on assisted dying has recommended that the government introduce legislation allowing the practice, but not without a long list of conditions. 

The recommendations come after a reportedly fraught end to nine months of debate and expert testimony, which included division among committee members. A minority report from three dissenting members on the 14-person committee is expected to be published at 4 pm today. 

Those dissenting members are Cathaoirleach and independent TD Michael Healy Rae and independent Senator Rónán Mullen. 

In the report published this afternoon, the committee made 38 recommendations, most of which focused on ensuring safeguards are in place to prevent people from being coerced into ending their lives, or from making a decision to end their life without being fully capable of doing so. 

The committee recommended that such coercion be treated as a criminal offence. 

A national, independent oversight body with the sole responsibility for assisted dying should be established, according to the report, and that body should have a joint protocol established between it and the HSE. 

“For the purpose of this report, assisted dying is used as a blanket term for all  cases where medication is voluntarily administered to hasten a patient’s death.

“Assisted suicide is used to denote that the medication is administered by the patient themselves.

“Euthanasia is used where a doctor or health worker administers the medication,” the document said. 

Decision-making and eligibility 

The Committee recommended that assisted dying be available only to a person diagnosed with a disease, illness or medical condition that meets all four of the criteria listed below.

The condition must be:

• both incurable and irreversible;
• advanced, progressive and will cause death;
• 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
• causing suffering to the person that cannot be relieved in a manner that the person finds tolerable.

A person should have to make two formal requests for assisted dying, according to the report, that must be separated by a specified interval. At least one request should be written and witnessed by two people, it added. 

Another recommendation is that healthcare workers involved in assisted dying be trained to “the highest possible level” when it comes to identifying coercion and that suspicions of coercion be reported to gardaí. 

Eligibility for assisted dying is also addressed in the report, with the committee recommending that doctors be trained to assess people’s decision making capacity and voluntary willingness to follow through with their decision.

Should a person who has already been assessed in this regard lose their decision-making capacity temporarily, their eligibility should be suspended during that time, the committee recommended. 

For those deemed eligible despite concerns over their mental competency, a psychiatric assessment should be carried out, it said. 

The committee also said that there should be an age limit of 18 years or older and a guardian, carer, or holder of power of attorney should not be allowed to make the decision for the person in their care.  

Palliative care vs assisted dying

Notably, the committee has not recommended that people be permitted to include assisted dying in their advanced healthcare directives, which detail a patient’s wishes regarding treatment in the event they cannot take the decision themselves.

An updated palliative care strategy from the Department of Health was also recommended and the committee said that palliative care and assisted dying should operate “completely separately and independently of each other”.

The committee also advised that funding for public awareness about palliative care be increased. 

People inquiring about assisted dying after a terminal diagnosis should be presented with the alternative of end-of-life care, the report said. 

Conscientious objection and disability rights 

The committee recommended that doctors who refuse to provide assisted dying services should have the right not to do so but that this should not lead to “closing off access” to the service, and that legislation should reflect this.

Before legislation is put in place, the committee said that the UN convention on the rights of people with disabilities should be ratified. It also said that research should be conducted into economic disadvantage and health outcomes and into the mental health issues experienced particularly by older people. 

Finally, the report recommended that legislation on assisted dying should use clear and unambiguous language and include definitions of terms including medical descriptions of methods permitted under any Act.