Top Doctors come out strongly against Assisted Suicide - palliative care experts speak out

Say 'safeguards' won't work

    

The leading medical experts who provide care to people with terminal illnesses and those at the end of their lives have come out strongly against Assisted Suicide being legalised in Ireland. 

Senior palliative care specialists from the Irish Palliative Medicine Consultants’ Association (IPMCA)  have written to TDs to say that they are opposed to "any form of legislation for assisted dying, assisted suicide or euthanasia in Ireland". 

They say that "the intended and inevitable unintended consequences of the proposed legislation are stark and unthinkable" and that "there are no safeguards that can be put in place that will meaningfully restrict the use and misuse of such legislation."

Amongst the signatories were Chair of the IPMCA Dr Feargal Twomey; Prof Tony O’Brien, Clinical Professor of Palliative Medicine, College of Medicine & Health, University College Cork; and Prof Karen Ryan, UCD Clinical Professor and Consultant in Palliative Medicine. 

The doctors said that their "collective experience" had shown them that, with palliative care, pain could be minimised and managed: "severe physical or psychological distress experienced by a minority can be managed to their satisfaction." 

And they warned that the experience of other countries showed that when euthanasia was legalised for those in pain, it expanded to include those with mental health issues, dementia and even children. 

"International evidence tells us that legislation intended to allow for the killing of adults suffering pain as a result of advanced illness has resulted in the killing of adults with no life-limiting illness, those who have untreated mental health issues, those with dementia, those who are blind, deaf or merely ‘tired of life’ and in the killing of infants and children," they wrote. 

The palliative care experts told TDs they would welcome an opportunity to "share our practical understanding of this difficult issue and to elaborate on our concerns regarding the proposed legislation".  

Meanwhile, the Royal College of Physicians of Ireland (RCPI)  has also affirmed that it "officially opposes the introduction of any legislation supportive of assisted suicide because it is contrary to best medical practice".

The RCPI said it "brought together representatives from a range of medical specialities within RCPI, including Geriatric Medicine, Neurology, Palliative Medicine, Respiratory Medicine, Rehabilitation Medicine, and Psychiatry, to review the matter of Assisted Suicide. The group reviewed arguments on both sides of the debate and examined international evidence from jurisdictions where assisted suicide had been introduced. The group also looked at the positions of medical professional bodies throughout the world on this issue," before reaching that conclusion. 

The medical body, whose working group includes well known advocates for older people and those with terminal illnesses, Consultant Des O'Neill and Hospice Director Dr Regina McQuillan,  said it promoted "a considered and compassionate approach to caring for, and proactively meeting the needs and concerns of patients who may be approaching the end of their life."

While media reporting has focused on politicians' campaigns for euthanasia, it will be seen as significant that, in common with the U.K. and other countries, the medical experts who care for people at the end of their lives have come out so strongly against assisted suicide. 

   

   

The IPMCA letter in full: 

"We write to you as individual specialist medical practitioners and members of the Irish Palliative Medicine Consultants’ Association (IPMCA), to voice our serious concerns regarding the proposal to remove the existing legislative safeguards that protect our citizens in respect of assisted suicide and euthanasia.

      

Key points:

1. We are opposed to any form of legislation for assisted dying, assisted suicide or euthanasia in Ireland;

2. Compassion, advocacy and support are at the heart of the palliative care that is delivered across Ireland to those who are suffering as a result of advanced illness;

3. The intended and inevitable unintended consequences of the proposed legislation are stark and unthinkable;

4. There should be no role for medical practitioners in deciding eligibility for, or in the delivery of, any form of assisted suicide or euthanasia in Ireland.

Based on our collective experience, earned through thousands of care interventions for patients and their families annually, we strongly oppose any proposed changes to the current legislative status quo on the grounds that:

• By virtue of our caring for many patients and their families we have a keen awareness of the suffering experienced by some people. Harnessing this awareness, and with a spirit of deep care, support of and advocacy for our patients, we know that even the severe physical or psychological distress experienced by a minority can be managed to their satisfaction;

• The proposed bill is deeply flawed in several aspects including, most shockingly, that both assisted suicide and euthanasia be permissible;

• Based on international evidence there are no safeguards that can be put in place that will meaningfully restrict the use and misuse of such legislation: 

•  The High Court ruling in the Marie Fleming case was very clear in this regard: Even with the most rigorous systems of legislative checks and safeguards, it would be impossible to ensure that the aged, the disabled, the poor, the unwanted, the rejected, the lonely, the impulsive, the financially compromised and emotionally vulnerable would not avail of this option to avoid a sense of being a burden to their family and society’

• International evidence tells us that legislation intended to allow for the killing of adults suffering pain as a result of advanced illness has resulted in the killing of adults with no life-limiting illness, those who have untreated mental health issues, those with dementia, those who are blind, deaf or merely ‘tired of life’ and in the killing of infants and children

• The proposed legislation will completely alter the traditional doctor–patient relationship, where each party is assured that the doctor will always strive to do the most positive good and will refrain from causing harm;

• It is incongruous to us that while significant health & social care resources are invested to try to prevent, and support those left behind by, the over 400 suicides by citizens of our country each year, this Bill proposes a mechanism by which the state would support citizens to actively end their own lives or legalise that others might deliberately kill them.

  

In particular, we would like to bring to your attention the significant harms that the decriminalisation of assisted suicide would likely have on the most vulnerable in society, as well as on healthcare professionals, patients and their families. We believe that assisted suicide would represent an irreversible, regressive change in healthcare policy in Ireland.

We would welcome the opportunity to share our practical understanding of this difficult issue and to elaborate on our concerns regarding the proposed legislation.