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Dying with dignity

Assisted dying legislation 'contrary to best medical practice', Committee hears

The Oireachtas Committee also heard arguments in favour, with doctors saying autonomy should be encouraged.

LEGISLATION ON ASSISTED dying in some circumstances would contradict medical best practice, an Oireachtas Committee has heard.

However, some medical practitioners see it as an essential vessel for autonomy for patients with serious illnesses. 

The committee is currently examining whether to introduce voluntary assisted dying laws in Ireland, following the passage of a bill tabled by People Before Profit TD Gino Kenny in 2020.

The committee was established in January and this morning it heard from three medical representative groups, who clashed on the issue.

In his opening statements, Dr Feargal Twomey, a consultant in palliative medicine at the Royal College of Physicians, said the “potential harms outweigh the arguments in favour”.

“The concept of autonomy of the person is emphasised often in discussions. However, a
person’s autonomy cannot be absolute and must be balanced against the risk of harms to
others,” he said.

One of our concerns is that any legislation cannot adequately safeguard vulnerable members of society.

According to data from Oregon in the United States, the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable, loss of autonomy, and loss of dignity. 

There was also an increase in the number of people citing financial concerns among the reasons.

“When someone expresses a desire to die, we need to be sure we are exploring the nuance
in the expressed desire to die and having a deep conversation that includes all of the
options available,” Twomey continued.

“Many individuals requesting assisted suicide/euthanasia don’t want to die but to escape their suffering.”

Choice

Dr Andrew Lyne, chairperson of a group of over 100 doctors who support the legalisation of assisted dying, said “medical paternalism” is no longer acceptable.

“Patients’ choices should be respected and supported where reasonable, with decision-making shared between doctor and patient,” he said.

“As a society we have empowered individuals through referenda to take control and reasonability of their personal lives. Ireland is now a progressive, caring and compassionate society which respects individual’s rights.”

Lyne argued that vulnerable groups are not overrepresented in places where assisted dying is available.

“In fact, people who choose Assisted Dying tend to have higher incomes, are younger, are more likely to be married and to be living at home.

“It is understandable that an individual may choose to end their suffering, when they lose their ability to function, there is no prospect of improvement and death is foreseeable.”

How would it work?

Dr Brendan O’Shea, from the same group, suggested a list of safeguards, inspired by the systems of Australia and New Zealand.

Patients would be required to be over 18 years old, have the capacity to consent to dying and have a progressive, incurable, terminal illness. This would not include mental illnesses.

They would also be given a two-week ‘reflection period’ reduced to five days for people with a short prognosis.

There needs to be two independent medical assessments by two doctors, both of whom have completed appropriate training would also be required.

The Irish Hospital’s Consultants Association (IHCA) hasn’t taken a definitive stance on the issue, but expressed concern about the logistics of providing the option to patients, given that resources may be limited.

“We know internationally that one of the main reasons why patients choose assisted dying is a fear of being a burden on others,” it said in opening statements.

“Assisted dying cannot be an alternative to timely, accessible, comprehensive high-quality health and social care supports for the people of Ireland especially for those with complex serious illnesses.

“Members have also informed us that patients and families can be concerned or reluctant to get involved with palliative care because of fear that palliative care hastens death.”

The Committee will meet again later today, where it will hear from Canadian experts on how assisted dying has developed there.