Death is a momentous event, so it’s surprising how much we Irish leave it up to chance
Watching someone die makes you think about death. Both my parents died in relatively dignified ways.
They both reached a point where they accepted death was close and were ready for it. In my mother’s case, she stopped receiving a treatment because she decided what was presented to her as the best-case scenario didn’t seem all that good. She took a decision to die. She received palliative care, which reduced her pain, but through the use of drugs physicians also effectively sped up the process. She was assisted in her dying. We regard that type of care and assistance as humane — and it was — yet assisted dying remains illegal in Ireland.
The State has two guides to how we regulate death. The first is the Bible, specifically the commandment “Thou shalt not kill”. The other is the Hippocratic Oath, which commands doctors to “Do no harm”. These are good guides. Much of Christian teaching is generally conducive to a well-functioning society. And who would want our medics to do harm?
But difficulties arise when facilitating the continuing of a life is doing harm. Most of us who have witnessed death know it can be unpleasant, but so are the weeks and months that precede it. For people with chronic illnesses, those weeks and months of pain and a loss of dignity might have to be endured for years. And that leads to people making horrific decisions to end their own lives.
Last month, an 83-year-old woman in Zaragoza, Spain, died by throwing herself from her balcony to end possibly years of being bed-bound in a flat, in constant pain, and with no hope of recovery. Spain had introduced a law on assisted dying during the summer, and Emilia, as she is known, had pleaded desperately with her doctors for an assisted death, but they did not even process her application despite her fulfilling the requirements of the new law.
Spain is just the latest in a list of countries that have legalised assisted dying. Switzerland is probably the best-known, but it is used more widely in Belgium and the Netherlands. In the Netherlands, one in 25 deaths now occurs through the assisted dying laws.
This suggests that one of the arguments against assisted dying has some validity. Opponents fear there will be a slippery slope. Once we allow physicians to assist people to die, we will lose control of the process and it will be used more freely than we had anticipated.
The Netherlands started by only allowing assisted dying for the terminally ill. Then for the chronically ill, and for those whose suffering was psychological; also for incompetent patients, including children.
Slippery slope arguments aren’t all that good. If the State loses control, or it’s used too freely or against people’s will, there is nothing to stop us changing the regulations, to introduce further safeguards and protections.
In fact, it may be the case that the practice in the Netherlands reveals the extent of the problem; simply, there are more people who would like the choice of how to die than we know or are willing to acknowledge. A few weeks ago, the Sunday Independent told the story of Elizabeth and Patrick Larkin, who took their own lives in a planned way because they could not tolerate the idea of living without each other. More recently, a couple in Kenmare, Co Kerry, are suspected of having made the same decision.
While undoubtedly sad, it also shows these people having some agency in their lives. We speak frequently of the right to life, but that should include the right to die, especially how and when we choose to die. For such a momentous event, it is surprising how we leave it up to chance.
The other argument against assisted dying is that a “right to die” might be seen by some as a “duty to die”. So people dependent on constant care might feel they are a burden, and perhaps be pressurised or just feel pressurised to choose to die, which would be no choice at all. These are concerns we should take seriously. But the possibility of abuse should be dealt with through safeguards, not by denying everyone the right to die.
There is broad public support in Ireland for the right to die. A recent poll shows that seven in 10 people are opposed to prosecution of someone who assists a suicide for a terminally ill person. About the same number would support legislation to bring in assisted dying. There is legislation before the Oireachtas, but it is widely seen as being poorly drafted.
Irish medics, the people we expect to carry this out, are opposed to assisted dying. A survey of Irish consultant physicians, conducted by researchers in UCC, shows that about seven in 10 are opposed to legalising assisted dying. These opinions may change, and we see in the UK that the British Medical Association has dropped its opposition, adopting a neutral position on this debate.
But few politicians see there is anything to be gained politically from raising assisted dying as an issue. A prominent liberal politician once said to me he never wanted to see his name and the word “abortion” in the same newspaper article. In the 1990s and early 2000s, it was an issue that was forced on to politics by the courts. It took the death of Savita Halappanavar to give it the broad public attention it deserved.
Part of the reluctance of middle-ground politicians to deal with the issue was that people on either side of the debate refused to acknowledge the genuine position of their opponents.
We should start by accepting there are good people on either side of the assisted dying argument. It would be a failure of the political system and Irish society if we were to wait for a prominent tragedy to force us to confront the difficult question of how we die.
Dr Eoin O’Malley teaches public policy at Dublin City University