Ottorino Respighi: A Dream of Italy

The minority report of the Oireachtas euthanasia Committee

 

The introduction of euthanasia in Ireland could lead to the closure of care homes and have an ill effect on the healthcare system, according to the minority report from the members of the Oireachtas Committee on Assisted Dying. A government seeking savings in the healthcare system could favour assisted suicide over comprehensive end-of-life medical treatments, they said.

Last month, the Joint Oireachtas Committee on Assisted Dying presented its final report, which received approval by nine of the Committee’s fourteen members. A minority report was also produced on that occasion, but its release coincided with the resignation of Leo Varadkar, which overshadowed its public reception. Given the circumstances, it is worth now considering the contents of this minority report and the significant issues it raises.

According to the minority report, several critical issues have been overlooked or insufficiently addressed by the Committee.

Firstly, there are worries that the introduction of euthanasia or assisted suicide could detract from the quality and availability of palliative care services. The minority members are concerned about the economic implications of introducing assisted dying, including the potential for healthcare cost-cutting measures that could favour assisted dying over more extensive and expensive care options.

“Why should the service be provided by the State? How can one ensure that a Government seeking savings in the health-care system will not prefer assisted dying over end-of-life medical treatments? How can one ensure that health insurers do not promote assisted dying as a cheaper option for elderly or chronically ill patients? Given the potential, and possibly hidden, impact of potential budgetary savings on policy, the Committee should have undertaken to investigate these matters in depth.” (p. 33)

A second major critical issue regards the ethical implications for healthcare providers involved in “assisted dying”. Requiring professionals to participate in or refer for euthanasia and assisted suicide can compromise their ethical standards and the trust placed in them by patients, says the minority document.

More specifically, because the Committee recommends that only individuals should be allowed to avail of conscientious objection to euthanasia or assisted suicide, institutions with a pro-life ethos such as Catholic hospitals or nursing and care homes may be forced to close, as it has happened in other countries.

“The [Committee] majority believes that, once the State legislates for assisted dying, it must somehow become an obligation for a State-funded institution, or indeed any caring institution, to provide it. Yet any legislation reflecting such thinking may lead to the closure of many care homes and the withdrawal of staff from an already understaffed Irish healthcare sector.” (p. 32)

Another criticism from the minority is that the safeguards proposed by the Committee’s final report are inadequate for protecting vulnerable groups, including the elderly, disabled, and those suffering from mental illnesses. These safeguards would fail to prevent coercion and abuse effectively.

“The Committee majority voted down a recommendation to make it a criminal offence for any health professional to advertise assisted dying or to initiate the question of assisted dying with any patient.” (p. 19)

The minority report highlights potential societal impacts, such as the normalisation of euthanasia and suicide, and their effect on societal attitudes towards the elderly and disabled. The Committee minority members are concerned about the message the report sends regarding the value of life, especially for those considered vulnerable. The official final report fails to adequately address the complex psychological impacts of assisted dying on patients and their families. This includes the risk of increased suicide rates and the need for comprehensive mental health supports.

The minority report also expresses concerns about the legal implications of assisted dying, including potential challenges to the constitutionality of such legislation. They worry about the legal precedents it might set and the implications for the right to life enshrined in the Constitution.

The minority report was endorsed by the three members of the Joint Oireachtas Committee. Notably, the Chair of the Committee, independent Michael Healy Rae, together with Fianna Fail TD Robert Troy and independent Senator Ronan Mullen. One member of the Committee was absent from the final vote, one member, namely Pa Daly from Sinn Fein, abstained, and the rest voted in favour.

RTE’s hopelessly unbalanced review of Ireland’s abortion law

At a time when the government is considering a further liberalisation of our already permissive abortion legislation, RTE Investigates this week aired a documentary on “the realities of Ireland’s current abortion services” which was far from being fair and impartial. In fact, we didn’t get to hear from a single pro-life advocate, and it did not tell us that some of the experts we did get to hear from are, in fact, long-time pro-choice advocates. All in all, a very bad day’s work.

The documentary, which was aired on Monday night, included several ‘sting operations’, in an attempt to “expose” pro-life agencies that offer support to pregnant women. Three health professionals were introduced in neutral terms and were asked to comment on the advice those agencies were giving.

One of them, Mark Murphy, portrayed in the documentary as merely a GP, actually served as the national spokesperson for Together for Yes, the organisation leading the campaign to repeal the 8th amendment during the 2018 referendum. We were not told this.

Similarly, psychiatrist Veronica O’Keane featured in the documentary. She responded in shock to some of the advice being offered to pregnant women by the pro-life agencies, but she was a long-time critic of the 8^th Amendment. Again, the innocent viewers at home were not informed of this, potentially leading them to perceive those doctors as impartial experts.

Yet, the most egregious example involved Dr. Jonathan Lord, who was portrayed in the documentary solely as a “consultant gynaecologist.”

In fact, Dr Lord is the Medical Director of MSI Reproductive Choices UK, one of the leading providers of abortion in the UK.

This chain of abortion clinics has a history of failings that put women at risk, but we are not told about this either, which is interesting given that the programme was supposed to be partly an exposé of manipulatively emotional practices.

In 2016, inspectors from the UK Care Quality Commission found numerous failings at MSI clinics, including staff “bulk signing” consent forms, limited clinical oversight, poorly trained staff, and at least one case in which a vulnerable woman was given a termination despite not understanding what was going on.

A further inspection in 2017 found more failings.  (You can read the official reports here: https://www.cqc.org.uk/provider/1-102643434/reports )

MSI were also accused of paying their staff performances bonuses for persuading women to have abortions.

MSI Reproductive Choices UK used to be called "Marie Stopes UK" but in 2020 they removed the reference to Marie Stopes as she was a racist eugenicist who wanted the "hopelessly rotten and racial diseased" to be sterilised.

Inviting a representative from the most fervently pro-abortion sector to offer insight on purported "rogue pro-life agencies" is akin to soliciting commentary on animal cruelty from the CEO of a slaughterhouse corporation.

The programme also presented the stories of three women who went to England to have a termination. Their unborn children were diagnosed with some anomaly that would not qualify for abortion here in Ireland as they were expected to live more than 28 days after birth.

We were not told what the anomalies were. What life expectancy did the children have? Was it weeks, months or years?

Is RTE now effectively campaigning for abortion to take place in Ireland when a foetus is found to have an anomaly that might not result in death for years? Would that include Down Syndrome? We know from British figures that many of the Irish women who still travel to England for abortions (206 according to the last report), do so because their babies have conditions like Down Syndrome.

Even though the documentary was about the operation of our abortion law, it signally failed to tell us how the number opting for abortion keeps on increasing, probably far past the point that the average person who voted Yes in 2018 expected. It looks like 10,000 abortions took place here last year.

The undercover investigation of the counselling agencies didn’t even reveal very much. For example, one of the Gianna Care counsellors advised the RTE undercover reporter to read online about the possible bad emotional effects of abortion. But shouldn’t pro-choice agencies also do this?

Two RTE journalists attended, on false pretenses, a spiritual retreat for women who regret their abortion. It would have been insightful to hear from those women. RTE failed to interview them, or to interview Bernadette Goulding, the organiser of those retreats, who herself regrets her past abortion and dedicates her life to supporting women who have undergone similar experiences.

Furthermore, why would a documentary purportedly focused on “the realities of Ireland’s current abortion services” fail to even acknowledge, let alone interview, women who have undergone abortions after being incorrectly told that their baby had a fatal anomaly?

The programme set out to review Ireland’s abortion law and services, but the lack of balance in it was so bad, it deserves a review of its own.

Major surrogacy conference seeks international action to ban the practice

 

The Vatican has just released a new document on the topic of human dignity. Among other issues, it addresses the ethical problems of surrogacy—including the commodification of babies and the financial exploitation of low-income women who are contracted to be surrogates.

Ireland is in the process of adopting one of the most permissive laws in Europe on the issue, but elsewhere, opposition to the practice is mounting.

A major conference advocating for a worldwide ban on surrogacy was held in Rome last weekend. Experts at the conference argued that an international treaty is necessary to halt the practice. Although national bans have some impact, couples and single men may still travel to countries where surrogacy is legal or unregulated. This is why it is crucial for states to unite and establish a system to penalise corporations that serve as intermediaries between surrogate mothers and commissioning parents.

Some countries, such as Italy, are in the process of criminalising international surrogacy, punishing Italian citizens who engage in this practice abroad. Such an approach should be adopted by every country, the conference heard.

Banks and financial institutions play a pivotal role in the international surrogacy market, positioning them as critical targets in efforts to achieve worldwide abolition of this practice. At the conference, it was proposed that the responsibilities banks currently have in combating terrorism and money laundering should be expanded to include scrutiny of transactions related to surrogacy.

The meeting in Rome saw the participation of international experts and activists, including the Italian Minister for Family, a representative from the Holy See, various politicians, and notably, two United Nations officials. The UN Special Rapporteur on violence against women and girls, Reem Alsalem, and a member of the UN Committee on the Rights of the Child, Velina Todorova, attended as observers.

The politicians represented a broad spectrum of political affiliations, spanning right, centre, and left-wing parties. Similarly, the experts and activists brought a diverse range of ideological viewpoints to the discussion, including feminism, conservatism, and Christian Democracy, among others. This diversity underscored a rare consensus across political and ideological divides on the perils of surrogacy, a consensus that appears to be absent in Ireland.

This conference followed the launch of a declaration in Casablanca (Morocco) in March 2023, signed by 100 experts from 75 countries, calling for the universal abolition of surrogacy. The Casablanca Declaration initiative is led by Olivia Maurel, a French/US feminist activist conceived through surrogacy. The 32-year-old mother of three has faced mental health challenges from a young age, only later discovering the truth about her origins. She has since become one of the most vocal opponents of the “womb market.” At the conference, she gave a moving and powerful testimony about how surrogacy has affected her life, describing the commodification of children and women as a new form of slavery.

Before the conference, Olivia Maurel had a private audience with Pope Francis, who endorsed the conference’s goals. In January, the Pope had already called for “an effort by the international community to universally prohibit this practice,” a call reiterated in the new document on human dignity. Maurel is keen to stress that that she does not come at the issue from a religious perspective because she is an atheist.

The Rome conference continues the commitment of the Casablanca Declaration and aims to promote national and international initiatives, leading to the adoption of an international treaty among states.

At present, Ireland is far behind the curve on the matter, lost in the pretence that any ethical problems arising from the practice can easily be dealt with.

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.