Safeguards must be put in place as part of assisted dying laws, committee hears

'Unbearable suffering with no prospect of relief plays a central role in the Netherlands and Belgium, the US states focus on a terminal illness with a time-limited prognosis and Canada, New Zealand and Victoria require both', committee told

The most important question in legislating for assisted dying is whether safeguards can be put in place to protect vulnerable people, the Oireachtas Committee on Assisted Dying has heard.

The commission discussed consent and capacity with Dr Louise Campbell, lecturer in medical ethics in the School of Medicine, University of Galway, and barrister Finn Keyes.

Dr Campbell said: “Safeguards — which include second medical opinions, statutory waiting periods and reporting, review and oversight mechanisms — promote accountability, facilitate due process and ensure the regulatory system functions as it should." 

She called for “balanced, principled scrutiny” of arguments.

“The purpose of regulating medical assistance in dying is twofold: first, to ensure fair and equitable access to the intervention by those who need it, and second, to ensure that anyone who is potentially at risk as a result of the availability of the intervention is protected from harm,” she said.

Eligibility criteria

The legislation will set eligibility criteria.

“Unbearable suffering with no prospect of relief plays a central role in the Netherlands and Belgium, the US states focus on a terminal illness with a time-limited prognosis and Canada, New Zealand and Victoria require both,” she said.

In discussions with Senator Fiona O’Loughlin, she said only two countries offer assisted dying to people whose sole illness was a mental health condition, with this also under consideration for Canada.

“That’s in Belgium and the Netherlands, that’s extremely controversial,” she said. “And it is causing a of debate in Canada as you can imagine.” 

Mr Keyes discussed court decisions around end-of-life dilemmas.

“The circumstances in which a court is required to make decisions about assisted dying arise in cases where the person lacks capacity to make decisions about their care at the end of life,” he said.

“That is, where a person lacks capacity. It may fall to the court to act as a substitute decision-maker, which historically has been under the High Court’s wardship jurisdiction, but going forward will be under the regime established by the Assisted Decision-Making (Capacity) Act 2015.” 

Senator Ronan Mullen raised concerns about an increase in applications for assisted dying in Victoria following recent introduction.

Dr Campbell responded: “There are people who have been waiting for this to come into law to avail of it, so I think that the practice will increase in prevalence when it is legalised. I don’t see that is an ethical concern as such.”