Consultant geriatrician slams Oireachtas Committee support for assisted suicide

A consultant geriatrician has slammed the Oireachtas Committee on Assisted Dying’s reported decision to recommend legalising assisted suicide and euthanasia, saying that the “majority” of Irish medics are do not want it legalised.

Professor Desmond (Des) O’Neill, a lecturer and Consultant Geriatrician at Tallaght Hospital in Dublin, told RTE’s DriveTime programme that “most of the doctors” who “deal with death” on a daily basis see assisted suicide as something “that undermines care.”

Prof O’Neill argued that the practise “cannot be limited, cannot be regulated” – while describing the Oireachtas Committees reported move in favour of assisted suicide as “very disappointing” and “quite disturbing”.

And the top expert said the Committee’s decision didn’t make it “more acceptable that … we should kill people as part of our repertoire as doctors” instead of striving for better care.

He was speaking as reports broke on Thursday that the Committee, which ended its public sessions last month, was to recommend the introduction of both assisted suicide and euthanasia after months of deliberation. The proposal would be that Irish law be changed to allow someone to legally end their life if they have between 6 and 12 months to live.

Those who have been diagnosed with an illness or a medical condition that is “incurable, irreversible, and progressive” and at an advanced stage that will cause death within six months would be allowed to end their lives under an assisted suicide regime. However, it is understood that those with neurodegenerative conditions would have the time limit extended to six months.

Asked about the direction taken by the committee, Professor O’Neill said: “I think this is very disappointing. The Royal College of Physicians in Ireland, which represents over 15,000 doctors – including most of the doctors who actually deal with death every day, the palliative care physicians, would see this as something that undermines the whole impulse of care. 

“And in the words of the Danish National Council of Ethics – and again, we often look to Nordic countries for guidance on how to do things smartly – it can neither be regulated nor limited, and it utterly and radically alters how we view caring for each other; how we view disability, ageing, and dying.”

“And it’s very hard, often, what we are trying to look at here is how do we provide care in such a way that it doesn’t compromise care of those with these conditions, or make it more acceptable that – instead of striving for ever-better care –  that actually we should kill people as part of our repertoire as doctors. This is something that is quite disturbing, and again, is being landed back onto a medical profession that has said, apart from a vocal minority, that this is something that we think goes against the grain of providing good care,” he added.

Professor O’Neill said that the majority of medical profession would “almost certainly” be opposed to the introduction of assisted suicide or euthanasia.

“What we know is that the College of Physicians – representing 15,000 doctors and trainees – [is in opposition] and again I think trainees and junior doctors need to be listening very carefully because this is what’s heading their direction,” he said.

He went on to point to the experience of the Canadian province of Quebec, adding:

“What is interesting is that what we found in Quebec is that before [assisted suicide] was implemented, two thirds of Quebec doctors thought it could be a good idea. But when it was actually there, two thirds said ‘No, this is not a good idea,’ and we’re hearing articulate voices that actually spoke to the Joint [Committee] from both the Netherlands and Canada that what is now emerging is really troubling.”

He also referred to the testimony given before the Oireachtas by Dr Harvey Max Chochinov, a Professor of Psychiatry at the University of Manitoba. Dr Chocinov, who spoke before the Joint Committee in November

“People should listen to Harvey Chochinov’s presentation and also the Dutch presentation. So it cannot be limited, it cannot be regulated, and it utterly alters the framework within which we view each other; within which we provide care for eachother.”

Dr Chocinov urged against changing the law, detailing how programmes like Medical Assistance in Dying (MAID) had been “harmful” for Canadians.

“A wish to die is an expression of human suffering,” he told politicians. “Clinicians must learn to sit down and lean into discussions exploring the nature of patients’ anguish, discerning their sources of distress, identifying potential solutions or mitigation strategies, recognizing that even the very acknowledgement of suffering—like feeling a burden to others, or no longer feeling like the person they once were—is a form of affirmation that can sustain patients’ sense of worth and safeguard integrity of personhood.”

He also called on healthcare providers to address suffering, “which includes not abandoning patients, investing in who they are as people, offering kindness, respect, and hope, affirming the ongoing worth of patients as human beings, while maintaining professional therapeutic humility.”

Dr O’Neill also pointed to a case in the Netherlands, which he said was “troubling”.

Doctors in the Netherlands are permitted to carry out euthanasia on patients with severe dementia without fear of prosecution even if the patient no longer expresses an explicit wish to die, the country’s highest court ruled in 2020.

“And we’ve seen really, really troubling examples. For example, in the Netherlands, where a woman with Alzheimer’s disease was euthanized against her clear wishes at the time, and the erosion of the positive gates towards care was that the medical profession, the courts, and the media, supported the doctor rather than the vulnerable patient,” he said.

He also said that in the context of palliative care, euthanasia or assisted suicide was “inappropriate” and “not a good thing.”

“What we’ve seen in Canada are hospices being defunded because they don’t provide euthanasia,” he said. Dr O’Neill also said it was the case that Canadians were not supposed to be offered assisted suicide or euthanasia as an option, “and it clearly now is being put on the table as an option,” describing this as “very problematic.”

Asked about the issue of “difficult cases” and “personal choice,” Prof O’Neill pointed out that the Committee, along with advocates of assisted suicide, had heard from those with disabilities who harboured “a real fear” about what assisted suicide could mean for their future.

“The real problem here,” he said, “To a certain extent, is a neoliberal concept of giving autonomy value over anything else. But as one of the great foundation ethicists said, all autonomy is exercised in the embrace of others. So we’ve got to position autonomy and choice in terms of what it does to the rest of the system. Could you have autonomy not to wear your seatbelt, or not to wear a crash helmet? We know that impacts on the broader canvas – so our autonomy is limited in many ways.

“It’s a reasoned debate to say that autonomy has to be seen in context with justice, with care, and with support for the vulnerable. The real worry is that there is a neoliberal concept of my autonomy over everything else. We want to support everybody who is suffering. We want to continue to develop as development has occurred, and as I said, it’s about taking autonomy in context.”

Jane Lazar, End of Life Ireland spokesperson, welcomed the expected recommendations from the Joint Oireachtas Committee, saying the organisation was “very pleased.” Ms Lazar said she would “respectfully disagree” that assisted suicide would undermine palliative care.

“We have trust and faith in what the Committee has recommended,” she said.

The Joint Committee’s report is set to be published on March 20th.

You can listen back to the debate here.