Recommendations for 'assisted dying' are wrong and dangerous, even by their own standards

As predicted, the Joint Oireachtas Committee on Assisted Dying has recommended the legalisation of assisted suicide and euthanasia in Ireland. It claims they will be allowed under only strict conditions and with proper safeguards, but when you read the actual report, some of the conditions and safeguards seem neither strict nor proper.

The final report from the Committee, presented last month, includes some criteria to qualify for assisted suicide and euthanasia, but it also recommends a formal review of the legislation after three years of operation, when these criteria could be changed. We all know that they will be changed, as it has happened in other countries.

Specifically, the report recommends that so-called “assisted dying” should be offered to adults who are Irish citizens or have been residents here for at least one year.

In order to qualify, the person should be “diagnosed with a disease, illness or medical condition that is: a) both incurable and irreversible; b) advanced, progressive and will cause death; c) 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 d) causing suffering to the person that cannot be relieved in a manner that the person finds tolerable.”

This is objectionable enough, but even on its own terms, the report’s recommendations would not create proper safeguards.

For example, take Recommendation 28 of the report. It says: “The Committee recommends that two formal requests for assisted dying must be made, with a set specified interval between. At least one of these requests must be recorded in writing, and before two independent witnesses.”

So, two requests have to be made, only one of which in writing and before two witnesses.

This is extremely loose wording. It does not tell us whether the two requests must be made to two separate individuals. Could the two requests be made to the same person?

We are not told that the person or persons to whom the requests are made should be a doctor. Presumably they ought to be, but we should be told. Then again, should doctors be involved in this at all except to confirm that the person is dying and is within a certain number of months of death?

Who would the “independent witnesses” be? Two friends? Two strangers? Two lawyers? Who knows?

The report does not clarify who will assess the requests and, specifically, no mental health assessment is recommended. It only says that “the doctors have an obligation to acknowledge receipt of the request and should deliver a response within a specified timeframe.” According to the recommendations, a qualified psychiatrist is required only when there are concerns that the person might not be competent to make an informed decision.

The report recommends an interval between the two requests, but it does not specify its length. It could be two weeks or a day. Such intervals are required, in some jurisdictions that permit assisted suicide or euthanasia, as “cooling off” periods that allow the patients to reflect about their decision.

There is no requirement in the report that the family of the patients be informed before the procedure.

In some jurisdictions, health professionals cannot actively suggest assisted suicide or euthanasia to their patients as an option, but they can only accept requests coming spontaneously from patients. This is a protection against patients being coerced or led towards the procedure.

In the Oireachtas report there is no recommendation that would stop doctors mentioning ‘assisted dying’ as an option, which is an appalling oversight, or was it deliberate?

The recommended protections for conscientious protection do not go far enough. Medical personnel will not be obliged to take part in ‘assisted dying’ but will have to refer a patient who requests to die in this way to another doctor. This is seen by many doctors as a form of coerced participation. Institutions are offered no protection. This means a hospice, for example, could potentially be forced to allow its patients to die in this way if that is what a patient wants, regardless of its ethos.

The final report received approval by nine of the Committee’s fourteen members. Three members voted against it. Notably, the Chair of the Committee, independent Michael Healy Rae, voted against, together with Fianna Fail TD Robert Troy and independent Senator Ronan Mullen. One member of the Committee was absent from the final vote and one, namely Pa Daly from Sinn Fein, abstained.

The three members who voted against also presented a minority report, which I will analyse in the future.

The 38 recommendations in the report, while extensive, demonstrate a problematic prioritisation of ‘choice’ over the intrinsic value of life and the potential for unintended consequences, especially for the most vulnerable in society.

The report ignores the opposition of the main medical organisations in Ireland, particularly of those medical professionals who work in palliative care.

The report glosses over the evidence presented by many experts regarding the deeply divisive and contentious outcomes observed in jurisdictions like the Netherlands, and Canada, where the slippery slope of criteria expansion and the blurring lines between voluntary and non-voluntary euthanasia have been well-documented.

Even on their own terms, some of the recommendations of the report are appallingly lax. The final document has been barely analysed by a media distracted by the resignation of Leo Varadkar as Taoiseach, and which tend not to subject euthanasia advocates to proper critical scrutiny anyway.

In the greater scheme of things this report, which represents a big step towards euthanasia and assisted suicide, is far more important than the resignation of any given Taoiseach. It beckons us to cross a moral rubicon.