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Dying with dignity
Explainer: Everything you need to know about the assisted dying bill set to come before the Dáil
New legislation could soon see assisted dying legalised in Ireland.
THIS WEEK, THE Dáil will debate a new bill which could legislate for assisted dying in Ireland if it is passed into law.
The bill, which has been tabled by People Before Profit TD Gino Kenny, aims to enable citizens to die with medical assistance if they are suffering from a terminal illness.
The practice is legal in several other countries and already has a number of high-profile proponents in Ireland, but is highly contentious and fraught with ethical dilemmas.
Here’s our crash course in what assisted dying means, the arguments for and against it, and what the proposed legislation entails.
What is assisted dying?
As the term suggests, assisted dying is the act of deliberately providing medical assistance to another person who wishes to end their own life.
For example, if a friend or relative of someone helps them to procure drugs in the knowledge that they intend to use those drugs to kill themselves, they would be engaging in the act of assisted dying.
The practice differs from euthanasia, which is what happens when a second party intentionally ends someone’s life to relieve their suffering – like a doctor administering a lethal injection to someone who is terminally ill.
Helping someone take their own life is currently illegal under Irish law, while taking one’s life is not.
Under Section 2 of the Criminal Law (Suicide) Act 1993, anyone who “aids, abets, counsels or procures the suicide of another [person]” can be convicted and imprisoned for up to 14 years.
Last year, an Amárach/Claire Byrne Live poll for TheJournal.ie found that 55% of people think that assisted suicide should be legal in Ireland, with 22% of people opposed.
Why is it in the news?
A new bill which would legalise assisted dying, the Dying with Dignity Bill 2020, is set to come before the Dáil after being launched earlier this month.
The issue has made headlines already in recent years through the cases of Marie Fleming (who lost a Supreme Court appeal to establish a constitutional right to die) and Gail O’Rorke (who stood trial on charges that she tried to assist the suicide of her friend).
Although it was initially expected that the bill would be defeated by the Government, there is now a real possibility that it could progress after the coalition parties last week signalled that a conscience vote could take place.
This is where TDs are allowed to vote on an issue according to their own personal conscience, rather than having to vote on an official line set down by their party.
Speeches in favour of a conscience vote were made by Fine Gael TDs and senators at a party meeting last Wednesday, before Green Party leader Eamon Ryan suggested he would allow a conscience vote on the proposed legislation on Thursday.
By Friday, Taoiseach Micheál Martin also indicated the possibility of a conscience vote among Fianna Fáil TDs, saying it was the party’s recent policy for votes on life or death issues.
What’s in the Dying with Dignity Bill?
According to its explanatory memorandum, the purpose of the bill is to “make provision for the assistance in achieving a dignified and peaceful end of life” in those who wish to die, particularly those who are suffering from a terminal illness.
It comprises 15 sections, which lay out who could seek assistance to die, the criteria under which they could do so, and rules around the role of those who would provide medical help for them.
Under the terms of the bill, a person could only seek assistance to die if they had a terminal illness, defined as one which is “incurable, progressive, and… which cannot be reversed by treatment”. This illness must be verified by two medical practitioners.
The person must also be aged 18 or over and resident in Ireland for at least a year.
Crucially, a person who says that they want assistance to end their own life must have the capacity to do so, something which would also be assessed by medical practitioners.
If a person meets these criteria and then wished to end their own life, they must state their clear intention to do so and sign a declaration in the presence of a witness, which would also have to be signed by two medical practitioners.
Neither of these practitioners could act as the person’s witness. In other words, the declaration will have to be signed by four people.
Two weeks after the declaration becomes effective, a doctor would then prescribe substances to enable the person to end their own life.
A medical practitioner or their assistant (i.e. a nurse) could provide the person with these substances and help them to administer them and would have to remain with them until they took them or chose not to do so.
At all times, medical practitioners would have to take records, including a final declaration that the assisted dying has been carried out, no more than a week after the substance would be administered.
Safeguards
Given the moral considerations involved in the entire process, the bill also contains safeguards to ensure a person would be qualified to make a decision to end their own life.
The bill does not just contain criteria for the person who will die: there are provisions for conscientious objection for medical practitioners who are morally against assisting in a patient’s death.
If the bill became law, the roles of two medical practitioners, one of whom would have to be independent, would be central to the entire process.
The independent practitioner would not be able to be a relative, partner or colleague of the first practitioner (who would likely be the person’s own doctor).
At various stages, these practitioners would be relied upon to ensure everything – from the person’s medical condition to the transparency of their decision to end their own life – is above board.
At the first stage, the two medical practitioners would also have to verify the person’s terminal illness and assess their capacity to make the decision to end their own life.
Those who cannot understand or retain information about ending their life or those who cannot communicate their decision to do so would not be allowed to request assistance.
So someone who is in a coma, for example, could not be deemed able to seek medical help to end their own life if the bill becomes law.
Meanwhile, there would also be certain criteria around the person’s declaration.
As well as the two medical practitioners, the declaration would have to be signed by a witness, whom the bill specifically states must sign it in the presence of the person who wished to die.
This witness would also have to be someone who would not benefit from the person’s estate after their death.
Any of the four people who would sign the declaration could later revoke their signature, and they would not have to do so in writing.
Both medical practitioners would also have to be satisfied that the person seeking to die was fully informed of the palliative, hospice and other care available to them.
The person would then have to wait 14 days after the declaration became active – the date on which it is signed by the independent practitioner – before they could end their own life.
However, this would be reduced to six days if both medical practitioners believed that a person’s death from terminal illness could occur within one month of the day the declaration takes effect.
Finally, any substance that would be provided to the person who wished to die could only be delivered after an attending doctor confirmed the person had not revoked and did not wish to revoke their declaration.
If the person did decide not to take the substance, the medical practitioner would have to immediately take it away from them.
What do proponents of assisted dying say?
Most arguments in favour of assisted dying are either ethical or practical considerations focusing on compassion and personal liberty.
From an ethical standpoint, some proponents say that people should be allowed to choose how and when to end their own lives under the principle of free choice.
They say this is particularly true when a person wants to reduce their suffering due to a terminal illness, but can’t do so in a palliative setting or without facing additional suffering.
Some argue that those who are going to die anyway should be allowed to avoid the pain and anxiety that sometimes comes in the final months of terminal illnesses.
Where assisted dying is available, it’s argued that a person can have a more peaceful and dignified death than if they chose to end their own life outside a medical environment.
Others also suggest that many practices used in end-of-life care, such as palliative sedation (where a person is sedated with non-lethal drugs to ease their suffering) is a form of assisted dying, particularly as some sedatives can risk shortening a person’s lifespan.
What are the arguments against assisted dying?
As the safeguarding criteria in the proposed legislation shows, assisted dying is an extremely complicated process and there are worries that it could be open to abuse.
There are concerns that introducing the procedure could be a slippery slope and that it could progress from those who are terminally ill to other parts of the population – such as people with disabilities.
There are fears that vulnerable people could be coerced into agreeing to end their own lives, or that assessments of a person’s capacity to decide could fail.
Meanwhile, some have questions about whether assisted dying is a solution to suffering in a society that offers palliative care, where people can die in a dignified and painless manner.
There is another argument which asks whether more investment in this kind of treatment is required, rather than legislating for a process that is far more complicated.
Ethical considerations also play a part, as they do among proponents of assisted dying.
Many wonder whether helping a person to end their own life is any more moral than murder, while others have questioned if the practice is compatible with medical ethics and the role of doctors to heal, rather than harm, those they treat.
What happens next?
The Dying with Dignity Bill will be debated in the Dáil on Thursday, before TDs vote on whether it should proceed to committee stage for further oversight next week.
Sinn Féin, Labour, the Social Democrats and People Before Profit have all said they will vote in favour of the bill next week, but there are some Independent TDs who will not.
The three Government parties will likely confirm whether they will allow a free vote on the proposed legislation before Thursday’s debate – which could indicate how likely the possibility of assisted dying becomes in the next few years.
In the meantime, you can read the full bill for yourself here.
If you need to talk, support is available:
- Samaritans 116 123 or email jo@samaritans.ie
- Aware 1800 80 48 48 (depression, anxiety)
- Pieta House 1800 247 247 or email mary@pieta.ie (suicide, self-harm)
- Teen-Line Ireland 1800 833 634 (for ages 13 to 19)
- Childline 1800 66 66 66 (for under 18s)
