Rival assisted suicide reports a matter of life versus death

The Oireachtas Committee on Assisted Dying released its report yesterday which recommended primarily that Ireland legislate for assisted suicide. At the same time, three dissenting committee members presented a minority report recommending a rejection of the practice and greater investment in end-of-life and mental health supports.

The final report of the Joint Committee on Assisted Dying was released yesterday following nine months of examination of the question of whether or not Ireland should legislate for assisted suicide. It came to a majority conclusion that Ireland should, in fact, legislate for assisted suicide and so the bulk of its 38 recommendations are related to the practicalities of introducing it in medical and legal domains.

“The Committee recommends that the Government introduces legislation allowing for assisted dying, in certain restricted circumstances as set out in the recommendations in this report,” the report’s opening recommendation reads.

In contrast, the minority report presented by committee chair Michael Healy-Rae TD, Independent Senator Rónán Mullen and Fianna Fáil’s Robert Troy TD focused on recommending that Government not introduce legislation for assisted suicide, arguing that the “case has not been established, whereas the case against any change is overwhelming”.

“There are no lives not worth living. We recommend that the existing ban on assisted dying be maintained without exceptions. We recommend that no change be made to the Criminal Law Suicide Act 1993,” the minority report says.

The final report of the Joint Committee on Assisted Dying

The recommendations made by the report produced by committee are largely concerned with the practicalities surrounding legislating for assisted suicide in Ireland. As such, eligibility for assisted suicide is focused on by three of the recommendations. It recommends that:

–        Eligibility should be limited to Irish citizens or those resident in the State for at least one year.

–        Assisted suicide should be limited to people aged 18 and over.

–        Only a person 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, is eligible to be assessed for assisted dying.

When it comes to what would be required to facilitate the legality of the practice, the committee recommends a variety of measures including:

–        That any legislation for assisted dying may entail amendments to the Criminal Law Suicide Act 1993.

–        Where any person has failed to adhere to relevant statutory requirements governing assisted dying, he or she will have committed a criminal offence.

–        That any potential legislation on assisted dying provides that where a person has been proven guilty of coercion, they will have committed an offence under the Act.

Many of the recommendations are focused on ensuring that the relevant professionals – medical professionals, primarily – are up-trained to be able to spot coercion when dealing with patients who apply for assisted suicide. On the topic of coercion, a notable absence in any of the recommendations is the topic of “societal coercion”, on which the committee was briefed by Drs Sinead Donnelly and Louise Campbell, as well as Sinéad Gibney of the Irish Human Rights and Equality Commission (IHREC).

This absence was commented on by the dissenting committee members, who said that the report didn’t adequately address “the difficulties posed by the risk of societal coercion”.

The committee report does attempt to recommend a number of safeguards, such as eligibility assessments and the establishment of a national body with sole responsibility for all aspects of an assisted suicide regime. It also makes recommendations that overlap with the minority report, including the ratification of the Optional Protocol of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and a need for “much increased mental health supports”.

A recommendation is also included, again overlapping with a minority recommendation, that research be conducted that looks at the relationship between “economic disadvantage and health inequalities, and the question of people feeling a burden”.

The Minority Recommendations

While the committee report contains recommendations that the dissenting minority can get behind, as mentioned above, the minority report is of an entirely different focus which flows from its primary rejection of legislating for assisted suicide or euthanasia in Ireland.

The focus for the dissenting trio is on “active efforts” to create a society where “people are able to live life on equal terms, free from discrimination”. To that end, they recommend the aforementioned ratification of the Optional Protocol of the UNCRPD, as well as:

–        Ongoing studies on ableism in Irish society to help establish ways in which it can be mitigated

–        That ‘informal carers’, of not just people with disabilities but older people too, be supported through funding, counselling, respite provision and more

–        That healthcare workers become fully familiar with ‘intensive caring’ to enable them to tend to patients who feel their lives aren’t worth living

–        That suicide prevention funding and high-quality palliative care funding is secured

–        Much increased mental health supports to help identify depression and for those receiving a terminal diagnosis

Studies on the effect of economic disadvantage and health inequalities in causing people to feel a “burden” in society, pain management in light of scientific advances and national research on coercion, coupled with training for healthcare staff to recognise and assessing such abuse are also encouraged by the minority.

“Discussion of assisted dying is, in itself, undermining of the welfare of vulnerable persons. It engenders fear and worry. The State must at all times properly protect the right to life of all vulnerable citizens and vindicate the life and person of each and every citizen,” it reads.

An additional caution is advised by the report as a result of the “disasters” visited upon other countries’ healthcare systems by assisted suicide/euthanasia legislation.

The difference between the reports and their recommendations is summed up by a line from the minority, in whose view “helping all citizens to live and die in an environment that respects their dignity” should not be tied to legislation on assisted dying. Based on the committee’s final report, the majority seem to disagree.