The Joint Oireachtas Committee tasked with making a recommendation on whether or not to amend Irish law to permit assisted suicide, has heard concerns about the ability to protect vulnerable people from coercion if the practise is legalised here.
A representative from the College of Psychiatrists in Ireland told the Committee that “there is another way” and urged that “we can do better” than legalising assisted suicide – in turn bringing “great leadership for others to follow” when it comes to end of life care.
The meeting between experts and politicians heard from presentatives from the College of Psychiatrists of Ireland, from the National Suicide Research Foundation, and from Dr Léopold Vanbellingen of the European Institute of Bioethics.
The committee was also set to hear a video submission from Mr Brendan Clarke, an advocate of assisted suicide, who passed away in August.
Both the National Suicide Research Foundation and the College of Psychiatrists in Ireland cautioned that assisted suicide posed a threat to the vulnerable.
Chief Executive of the College of Psychiatrists in Ireland, consultant liaison psychiatrist Dr Siobhán McHale, said that there were “many challenges to consider” regarding the provision of assisted suicide.
She said that there was an “important minority” of patients in Ireland who are not at present receiving the optimal level of specialist palliative care and psychosocial support to allow them to die with dignity – something which they said “cannot continue.”
However, she said the answer to the problem “is not to end our patients’ lives.” Dr McHale said that the solution would be found in interrogating “each and every incident of concern,” in clarifying relevant contributory factors, and to provide appropriate evidence-based interventions – ranging from improved pain control to family support.
“In Ireland, as internationally, we know that there is an unequal distribution of palliative care services, a dearth of psychological and psychiatric supports available to people with challenging health journeys, and insufficient research in end-of-life care, with most ethics proposals explicitly excluding patients at end of life from research,” she said.
“Addressing these deficiencies is the necessary next step, not to enable ending the lives of terminally ill people as a way to avoid these challenges. We can do better.”
The head of the College of Psychiatrists in Ireland further pointed out that as psychiatrists, it was their belief it was “not possible to clearly differentiate between suicidal patients and patients who request assisted dying.”
“Suicidal people are human beings who cannot see any alternatives to ending their present or predicted future suffering other than by ending their lives,” Dr McHale said.
Representation for the professional body further stressed that suicide is preventable, and that interventions that are proven effective in suicide prevention should “take precedence” across our health system.
Dr McHale spoke about the work of CPI, which sees the body engaging with and supporting over 12,000 people in Irish emergency departments each year, who have suicidal thoughts. Patients supported include those who “cannot see any alternative to ending their lives.”
She said, however, that effective support can only be facilitated if patients and their families have access to good quality palliative care, mental health, social work and disability services.
‘CREATING ONE CLASS OF PEOPLE FOR WHOM LIFE IS EXPENDABLE’
“Far too often they don’t. The view of our college is that we need to find a better way to substitute for these deficiencies than by offering assisted dying,” she said.
The committee also heard that attempting to establish an “absolute right” to bodily autonomy by legalising assisted dying “may undermine” other individual and group rights by “creating one class of people for whom life is expendable.”
“That particular view may be extended by society to all groups possessing such attributes such as permanently disabled people,” the consultant psychiatrist said.
“Finally, with regard to the question of whether one person’s choice of assisted dying will have an impact on another who does not so choose. We would say the introduction of assisted dying legislation means that every person has to then choose it as a potential option or not for their end of life care.”
“No person is an island,” they said in conclusion, adding that what was being considered was “a radical change to our legal system and the direction of our society.”
“It will take great wisdom and courage to find the balance for not just those who have clearly heard voices, but the unheard voices whispering from the future,” she added.
“Our college believes there is another way and that Ireland can bring great leadership for others to follow.”
Psychiatrist Eric Kelleher, meanwhile, told politicians that people who get a diagnosis of serious illness, including cancer, experience heightened suicidality for six months, after which time this decreases.
Dr Kelleher cautioned against “normalising” deliberately ending life for the reason that it could “expose more people to vulnerability”.
Chief Executive of the National Office for Suicide Prevention (NOSP) Dr Eve Griffin also addressed the committee. She said that those who die by assisted dying “are generally older in age and are more likely to be female”.
Dr Griffin went on to note that more than three quarters of those ending their lives by suicide are male, but stressed that both men and women share some “potential risk factors.” These, she said, include, “living alone” – which can lead to “social isolation and loneliness,” “not identifying as being religious,” and “having no children.”
She also said it was likely that the prevalence of mental health conditions such as depression are under-reported as an undiagnosed in people who request assisted dying.
Léopold Vanbellingen, a research fellow at the European Institute of Bioethics in Brussels, also spoke to the Committee. He said there has been a “constant increase” in Belgium of the euthanasia of patients suffering from depression or other psychiatric conditions such as autism.
He said that twenty years worth of research into legalised assisted dying had prompted the institute to conclude that “despite their alleged safeguards, each of these national laws rapidly tend to pose a threat to the lives of vulnerable people”.
Dr Vanbellingen said that those most at risk of the “inescapable threat” of assisted suicide were elderly people who are dependant, along with those suffering from mental illness.
The doctor in law at the University of Liverpool told the committee that people in Belgium were choosing assisted suicide for reasons other than serious disease. Reasons included “impaired eyesight, hearing problems, walking disorders or incontinence,” he told the committee.
“In Belgium in particular, there has been a constant increase in euthanasia of patients suffering from depression or other psychiatric conditions such as autism,” he said before going on to mention a 23-year-old woman who ended her life under the law.
“Shanthi was a young Belgian woman suffering from depression. She was also one of the victims of the March 2016 terrorist attacks at Brussels Airport. She was already suffering from depression before before that, but obviously things did not improve afterwards,” he explained.
Dr Vanbellingen explained how the young woman had received approval to end her life from two doctors, and did so, dying by euthanasia in March 2022.
He also said legalising the practise would pose a threat to healthcare practitioners, saying that in practise, it’s legalisation imposes pressure on staff, making them “increasingly vulnerable.”
“In theory, each of these laws protects a health care professionals who consciously object to participating in euthanasia. But what we do see in practice is that the individuals take the subjective nature of assisted dying leads to implicit or explicit forms of pressure on doctors and nurses to agree to be involved in the practice of euthanasia.
“One example here is the latest amendment to the Belgian euthanasia law, which aims to force every hospital or nursing home to accept the practice of euthanasia within the walls.”
Dr Vanbellingen said in conclusion that assisted suicide could impact “the elderly who are tired of living, young person who suffers from mental illness, and ultimately any person in a vulnerable situation who at some point considered as that that his or her life may not be worth living.”
The committee was also due to hear a video testimony from the late Brendan Clarke, an advocate of assisted suicide, however the showing of the video submissions were delayed due to technical issues. Mr Clarke was due to address the Committee but he died in August, before he had a chance to attend the session in person – with a submission from Mr Clarke having been filmed by the Committee before he died.
Prior to Tuesday’s meeting, People Before Profit’s Gino Kenny, said Mr Clarke’s message was one which called for “people living with a terminal diagnosis to be granted much greater choice to continue or to not continue with their life.”
The 72-year-old, who had Motor Neurone Disease, had contracted the condition last year, and had called for the legalisation of assisted suicide. In an interview given to The Sunday Times two months before he passed away, he said that despite being grateful to doctors for their care, they were “only prolonging a life that I don’t want to live.”
Cathaoirleach and Committee Chair, Independent TD Michael Healy Rae, sent the committee’s condolences to Mr Clarke’s family, while thanking them for facilitating his testimony.