Life-sucking tentacles of doctor-assisted suicide must have no place in our society

There have been many attempts to make assisted suicide synonymous with dignity. A dignified death without medical assistance to end suffering is not part of the narrative reported by our media.

Yet that is the death that many people I know and love have had, including my late son. Death can be dignified and pain-free – for which those left behind are eternally grateful. It is a “good death”.

Celebrities supporting assisted suicide are being encouraged and lauded by public commentators in order to soften public opinion; as if public opinion needed to be made any more pliable. 

For several years this strategy has been fully supportive of a law to allow active help in dying at a time of the person’s choosing. The public debate has been minimal.

Any other position is now deemed paternalistic and outdated, in parallel with the emergence of autonomy and choice as the dominant philosophies of our time.

But medical opinion in Ireland is strongly opposed to assisted suicide. The colleges of physicians, surgery, palliative care and others have strenuously opposed it. But the most surprising opposition has just come from a group of doctors – usually liberal on these contentious social issues – just a few weeks ago. There has barely been a murmur about it.

The College of Psychiatrists of Ireland (of which I am a member) has just published a very strong position paper opposing this proposed measure. Additionally, some of its members have published a peer-reviewed paper in the International Journal of Law and Psychiatry (Clarke et al) to further discuss the issues at stake.

The college’s position is that physician-assisted suicide/euthanasia (PAS-E) has a specific resonance with psychiatry, as it relates to its attempts at reducing our suicide rate.

The strategies against suicide are bearing fruit in the last few years as our suicide numbers are tumbling.

PAS-E begs the question as to how a nation can speak of its wish to reduce suicide on the one hand while also allowing for assistance with suicide on the other.

Explaining this forked tongue is a logical and moral impossibility since these competing perspectives cannot be reconciled. The paper points out that: “In so far as our society makes strenuous efforts to prevent suicide, acceptance of PAS-E implies acceptance of the notion that some lives are not worth living; this is implicitly discriminatory.”

The 13-page position paper covers all the moral and scientific arguments against physician-assisted suicide/euthanasia (PAS-E).

Physician-assisted suicide (PAS) is the element that proponents tell us will be legislated for. On the other hand, they say they oppose euthanasia and it will be prohibited.

But, as the college paper points out, the dividing lines are blurred.

When people are vulnerable, they may seemingly consent to or request the ending of their lives. But this may be under pressure directly from family, or more subtly, the social attitude to suffering and illness that views these as a burden to be avoided.

No matter what the attempts in law are to limit the choice for assisted suicide to those with terminal illnesses who have full capacity, this becomes eroded as more and more conditions are brought within its ambit.

And at each step, the argument is that this addition is reasonable and restrictive. Belgium is a case in point, as shown in the Irish College’s paper.

There, the law has changed from allowing only competent minors to make this decision, to allowing it for all children with “constant and unbearable suffering”. So any child deemed by another to be suffering interminably falls within the terms of this law. This, unmistakably, is euthanasia.

This paper also discusses the role of the dominant ideology of autonomy in this debate and the belief that one has a right to choose when one dies.

The authors show that autonomy is not a free-for-all with anybody having a right to choose an intervention that is unproven. Interventions in medicine and surgery are restricted so as to maximise benefits and minimise damaging side effects.

The paper cogently argues that the unintended consequences of any action or legislation must be taken into account; legislating for PAS-E falls into this category.

One of these unintended consequences may be a rise in suicide more generally. Studies are currently under way to examine this prospect.

PAS-E was legalised in Canada in 2016. An amendment was introduced in 2021, so that those with psychiatric illness did not suffer discrimination in dying as compared to those with other medical conditions.

Those who deemed life to be not worthy of living were included in the legislation there for assisted suicide. The paper from the College of Psychiatrists points out that mental ill-health, particularly depression, distorts perceptions about the value the sick person places on their own life.

Hopelessness may trigger requests for PAS-E and the paper identifies the value that treatments for depression can have on such negativity.

As the ideology of PAS-E tightens its grip on Europe, we are faced with increasingly grisly options. The latest comes from Austria which, since January 1, 2022, allows pharmacies sell suicide pills to those deemed by doctors to meet the criteria for PAS-E.

Physician-assisted suicide and euthanasia (PAS-E) are bedfellows and their life-sucking tentacles should have no part in Irish society, or in any society anywhere in the world. Ever.

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This piece, written by Prof. Patricia Casey, was originally published on the Independent and has been reprinted with permissions from the author.