Ciara Kelly: 'Euthanasia - when does the right to die becomes the duty to die?'
Last week former Belgian Paralympian Marieke Vervoort ended her life through assisted suicide. She had a progressive neurodegenerative disease which caused her to experience seizures, paralysis, constant pain and an inability to sleep.
Euthanasia is legal in Belgium and in 2008 she signed the papers which allowed her to choose to end her life last Tuesday.
Marieke had won gold and silver at the 2012 London Paralympics and a further two medals in Rio in 2016 but the battle with her illness was one in which there could be no winners. A book of condolence has been opened for her in her home city of Diest.
And I think most people feel huge sympathy for her. She was 40 and clearly a very gutsy woman, competing in the extraordinarily competitive paralympics while struggling with a particularly cruel disease. In the run-up to Rio she said she was considering using her euthanasia papers and described those Games as "her last wish".
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The latest polls on whether or not we would favour bringing in euthanasia here show a majority of people believe we should.
Claire Byrne Live, in association with The Journal last month, found 55pc of us favour people being allowed to choose assisted suicide if they so wish - and many people believe that in a progressively liberal Ireland this ethical issue is the next one we have to address. I agree the conversation should be had, but there are many aspects which need to be discussed around assisted dying, both for and against.
The compassion argument in favour of assisted dying is very clear. Leaving someone in uncontrollable and progressive pain and distress with no hope of relief or cure is hard to comprehend. "We wouldn't do it to dogs," people often say. And that's true. But that's because we put less value on the life of a dog, not more.
My liberal head supports this idea - compassion is a good thing and wanting to help end someone's suffering is an understandable and valid choice. There are conditions that medicine struggles to manage or contain the symptoms of, and I think actively leaving someone in constant pain and anguish is cruel.
But it is more complicated than that, and if we are to take this decision for our country we must also consider the arguments which my doctor head keeps putting forward.
What about when the right to die becomes the duty to die? Many severely ill people need round-the-clock care. And in Ireland that usually means family carers. The sick person recognises and often worries about the burden this places on their loved ones. What if it isn't that the person wishes to die for themselves at all - what if they want to spare their family having to care for them 24/7, feeding them, changing them, washing them and seeing them in pain?
Opening up this conversation means people in that position may feel they should consider expediting their own death to protect their loved ones from struggling to care for them.
Many of those we hear about who wish to go the assisted suicide route suffer from neurodegenerative disorders such as MS, those crippling conditions that leave you with seizures, pain, paralysis or even 'locked in'. You can imagine how awful that is for them. But what about other medical conditions? Do we open this up to myriad situations? Those with terminal illnesses? Shortening a life of suffering for those who are dying anyway may be palatable to many people but what about other things?
Paralysis? Should there be time restrictions on that? So that in the immediate aftermath of an acute paralysis you cannot choose it? Someone who has become paralysed in their teens may feel for a period of years after an accident their life isn't worth living but, if given time and support, might they feel quite differently should they make it to 27 or 35?
A 23-year-old British rugby player died by suicide in Switzerland in 2008 after being paralysed from the chest down. Is that an acceptable outcome? Would he have felt differently had he reached a more mature stage of life?
Old age? An 85-year-old woman in Belgium opted for euthanasia immediately after her 58-year-old daughter died unexpectedly in routine surgery, citing grief and subsequent poor quality of life. Some people believe that's acceptable, to others the idea of elderly people choosing to die in such a manner is anathema.
And lastly, if we allow assisted suicide for those suffering from old age, grief or physical illnesses, does that beg the question of how we view suicide for those suffering from mental illness?
Should suicide become considered a valid choice for those with severe depression? Schizophrenia? Bipolar disorder?
My doctor head is deeply concerned about all of this. As someone who might have been tasked with ending the life of a patient who chose legally assisted suicide, I would want all these things discussed at length.
And lastly, I have read studies where, in some jurisdictions, hospital bed managers have encouraged patients to be asked about end of life choices when there is pressure on beds. I think we need to be very careful about glibly deciding we all have a right to die without first discussing in detail the possible pitfalls surrounding this.
I'm no longer firmly against euthanasia in the way I once was and I feel as a mature society the conversation should take place for the sake of patients who are currently suffering dreadfully and would like to access it. But if it is to be brought in, safeguards and protections must be put in place to protect patients from the laws of unintended consequences.
I also believe - much like free contraception going hand in glove with our legalising abortion in this country - that enhanced carer supports for those who might consider euthanasia, should it be legalised, must be extended as a priority. That in the end may prove to be the biggest stumbling block to this.