Ireland needs to have a dignified debate about end of life

This week the Oireachtas Committee on Assisted Dying is set to publish its report, in which by majority vote it will recommend that both assisted suicide and euthanasia be made legal in Ireland. These are big questions that have been talked about a lot in recent years, and it was considered time to do something about it.

This special committee, made up of both TDs and Senators, was therefore established last year. Its remit was to consider and make recommendations for legislative and policy change about a lawful right to assist a person in ending their life. It has been discussing these matters in great detail, spending a lot of time debating the issues with expert witnesses.

It is a complex matter in every possible way, bringing a level of sensitivity outside the usual realm of politics. It is – to put it mildly – a serious business. The terminology is obviously important. Assisted suicide means that a person would take the action that ends their life themselves, whereas euthanasia is where someone else brings that life to an end.

These are matters of the gravest importance, and this report should therefore stimulate a major debate. It must produce a much better debate than we have had on our recent referendums. That wouldn’t be hard, you might say.

The details of the committee’s views will be published this week. It is already reported that they will say that a law should be passed which would allow someone with an illness or medical condition that is incurable, irreversible, progressive, and advanced, and will cause death within six months, to have the right to end their life.

The committee will argue that such a law should apply only where a terminal illness cannot be relieved in a way that the ill person finds tolerable. In other words, you must have an illness of the type described to be eligible for assisted suicide and euthanasia. The details of the types of conditions that will make someone eligible will be outlined, and they will not make for easy reading. Any other circumstance leading to providing assistance to someone dying would remain illegal.

The committee will recommend a system to regulate all this. There will be lots of proposed safeguards, which will detail all the penalties for any abuse of the system. You can expect recommendations about protecting medical doctors, nurses and practitioners who do not want to participate on the grounds of conscientious objection. That itself will raise questions. What kind of objection will be allowed by such a law? One that simply says you don’t have to do it, or one that requires a doctor who objects to recommend another doctor who does not? That will be a major subject of the debate.

There will be much detail about how a person would establish their eligibility for the legal protections that the law would give. There will be much about the processes under which life would be brought to an end – and the methods that could be used. The report will have to consider and confront the question of what constitutes ‘consent’. That is a hard thing to define. They will have to be clear about how consent is given and how it can be considered to be free in the context of terrible pain; of medication impacting judgement; and in respect of any perception by the ill person as to what the wishes of their next of kin might be – and how that might affect their decision.

This question of subtle coercion, the possibility that an ill person could be persuaded that it would all be easier if they just made the decision to end their life, will form a significant part of the debate. The report will address this by talking about all the safeguards and penalties that will be put in place to prevent it. Whether that can be prevented, let alone policed, will require rigorous analysis.

The view is that this change does not require a constitutional amendment and can therefore be made legal through legislation. That itself will become the subject of vigorous debate. If ‘durable relationships’ deserved a referendum, why not assisted dying and euthanasia?

The recent referendums and the upcoming general election will form the political backdrop to all this. Many will feel – especially in Fianna Fáil and Fine Gael – that the political lesson of the referendums is to leave well enough alone when dealing with any such sensitive social question. There will be many who will argue, following the lack of enthusiasm for the proposed amendments shown in the referendums, that elite opinion and public opinion are now so misaligned that they should tread very cautiously on something so grave as whether people should be assisted to end life in this way. And given that any legislation to put this report into effect would need to be passed before the general election, there will be many in our political system who will quietly be pleased to see it run out of time before it can be passed. This will greatly disappoint those advocates of reform in this area, many of whom have had to confront terrible choices about a loved one’s horrendously painful last days – or who face the prospect for themselves before too long.

But whatever view you take on the matter, or however we as a society decide to go on it, there is one lesson from the referendums that needs to be learned. When really important matters are at stake, we have to have a fully informed and open debate. It needs to be clear about what is involved.

We all need to recognise that every perspective on this has strengths and weaknesses. All points of view – wherever they come from – have to be respected. We cannot have a situation where someone’s view on this is considered less important because of some view they hold on something else. People need to feel absolutely free to say what they think. Now, what follows from that is a responsibility. People who want to assert their views have a responsibility to provide evidence for them. How someone feels about this topic – or any topic for that matter – is no doubt important to them but of limited (and decreasing) value to the rest of us.

In this vital debate, we need clarity and we need argument. We need people on either side, having it out with one another, not afraid to test the arguments. We need interviewers who put hard questions to people they agree with as well as those they disagree with, the better to tease out whether the arguments put forward are strong enough. And we need our citizens – you, me, all of us – to put down our damn phones and talk with one another about how we can, with grace and humanity, address the end of life. It’s not an easy debate, but it has to be had. Let us do it with the dignity, compassion and rigour it deserves.