Sufficient supports already in place to die with dignity, HSE tells final Oireachtas meeting

The HSE has told the final meeting of the Committee tasked with examining assisted suicide that sufficient supports, both legal and medical, are already in place in Ireland, to enable people to die in a dignified way.

Representatives from the Department of Health were present at Tuesday morning’s Committee meeting, which is expected to be the last held in public before it reports back to the Houses of the Oireachtas next month. The committee, made up of nine TDs and five Senators, will draft its final report and publish it on 20th March.

The cross-party group will either recommend no change to Irish law; propose legislation to change the law on assisted suicide; recommend a Citizens’ Assembly be establushed, or suggest that a plebiscite – a direct bote of all members of the electorate – is held.

Tuesday’s meeting followed Committee Chair Michael Healy-Rae’s admission last week that it would be “very, very difficult” to reach a consensus on the matter, just weeks before the deadline.

Deputy Healy-Rae said that the report “might be based on a majority, with the minority expressing their view too.”

Speaking today, Dr. Siobhán Ní Bhriain, HSE National Clinical Director for Integrated Careand Consultant Psychiatrist for Older People, provided the committee with some of the issues which “we, as clinicians, consider need further thought.”

She also stressed during her address on behalf of the health service that conscientious objection should be enabled for healthcare workers who do not wish to be involved, should the law be changed in Ireland.

Representing the HSE, Dr Ní Bhriain was joined by Dr. Philip Crowley, HSE National Director of Strategy and Research, and a General Practitioner, and Dr. Feargal Twomey, HSE National Clinical Lead for Palliative Care and Consultant in Palliative Medicine.

The HSE Senior Clinical Team pointed to Ireland’s history of providing palliative care since the 1870s, both through voluntary organisations and the public health service. 

“Palliative Care services provide active and often complex care and support to people with any advanced life-limiting illness, and at any stage of an illness, not just at the end of life. Though palliative care services in Ireland are well developed, there remains further work to be done to develop the service,” Dr Ní Bhriain.

The Chair of the CCO Clinical Forum said that there were a variety of issues for those who “may potentially wish to avail of assisted dying, and those providing it” which needed consideration.

Dr Ní Bhriain said one issue came down to citizens who may be vulnerable, telling the committee that some groups of people “are at particular risk of seeing themselves as a burden – and are at risk of being subject to paternalism and coercion.” 

“These citizens may be particularly at risk of feeling undue pressure to consider assisted dying/suicide,” the senior HSE lead said. “While not an exhaustive list, this does include older people, people with long-term chronic conditions and those with physical or intellectual disabilities.” She further noted that these concerns had also been raised by others who have spoken to the committee.”

Dr Ní Bhriain went on to raise the issue of conscientious objection, stating that the potenrial impact on healthcare workers should be considered. 

She said that the HSE had spoken to staff who had spoken of being involved in experiences that transgressed their “moral or ethical codes.” This, she said, can negatively impact upon the mental health of healthcare workers, and “can lead to feelings of self-blame, shame and a reduced ability to cope with other work-related stressors.”

She continued: 

“The psychological impact of being witness to, or making decisions relating to, assisted dying, or indeed, involvement in the painful and prolonged death of a patient, have the potential to significantly transgress an individual HCW’s core values and their psychological and emotional wellbeing.”

Dr Ní Bhriain added that clinicians should, at the same time, “be able to discuss death, dying and end of life care in a sensitive and non-judgmental way.”

“Conscientious objection should be enabled as part of any legislation,” she stressed.

The HSE clinical director referenced the testimony given by Dr. Anne Doherty before the committee in November, who said that it would be a “travesty” if “assisted dying became a substitute for assistance in living.”

Dr Doherty, an expert in treating mental health for cancer patients told the Joint Committee on Assisted Dying/Assisted Suicide that cancer patients with treatable depression may be impacted by assisted suicide if the procedure is made legal here, due to ireland’s insufficient investment in mental health services.

The doctor raised concerns about how robustly patients would be investigated and treated for a potential mental illness is assisted dying legislation was enacted. 

These are concerns that we share and would apply to other areas of clinical practice, including the diagnoses of other potentially life-limiting conditions such as certain neurological diseases, respiratory diseases and many others,” Dr Ní Bhriain said on Tuesday.

“This in turn leads to issues of patient safety. There is a risk that a person would make a decision to seek assistance with dying, when in fact, more robust investigation or time to consider diagnosis, prognosis and treatment options may result in them opting for another approach to care,” she added.

Dr Ní Bhriain, representing the HSE, said that robust and commensurate safeguarding measures – drawing on the perspective of citizens and research evidence – would “need to be in place” to support anyone considering assisted suicide..

She also pointed out that International evidence:

suggests that in some locations where legislation for assisted dying and euthanasia has been introduced, safeguards change over time, to include lower age thresholds (e.g. the Netherlands) and expansion of eligibility criteria.”

“We believe that all the potential for an intergenerational impact of assisted dying needs consideration,” she noted, adding that there is “consistent research” to support the fact that suicide “has an intergenerational impact by increasing the likelihood that current and subsequent generations will consider and act on suicidal thoughts.”

“There is a risk that assisted dying/suicide could have a similar impact,” Dr Ní Bhriain told politicians. 

 She also said it was true that watching a loved one die in difficult circumstances “can lead to trauma and have an enduring impact.”

Dr Ní Bhriain told the committee that It was the conclusion of the senior clinical group in the HSE that “there are significant supports, both legal and medical, in place in Ireland to enable people to die in a dignified way.”

She expanded by stating that the importance of will and preference is “now enshrined in law.”

“People do have a right to refuse life-sustaining treatment and there is access nationally to palliative care services. The Draft Palliative Care Policy will further enhance and embed palliative care across the spectrum of healthcare provision in Ireland. Legal protections also form a strong part of other areas of clinical care, such as the Mental Health Act.”

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Maira Maynes

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This article was originally published on Gript and is here with permission