'Substandard end-of-life care' means assisted dying proposals are 'concerning'

People Before Profit TD Gino Kenny told the College of Psychiatrists representatives it was 'unhelpful to conflate assisted dying with suicide'. Picture: Gareth Chaney/ Collins

It is “not possible” to clearly differentiate between suicidal patients and patients who request assisted dying, and we need to find a "better way to substitute these deficiencies than by offering assisted dying", an Oireachtas committee has heard.

The Joint Oireachtas Committee on Assisted Dying heard from representatives of the College of Psychiatrists of Ireland on Tuesday, who said proposals around assisted dying are concerning because Ireland is “already operating in an environment of sub-standard end-of-life care”.

Professor Siobhan MacHale, consultant liaison psychiatrist, said: “We are in agreement that the current status quo — in which we know that an important minority of patients are not receiving the optimal level of specialist palliative care and psychosocial support to allow them to die with dignity — cannot continue.” 

Professor MacHale said the “answer to this is not to end our patients’ lives” but to interrogate each concerning element and to target energies and resources into improving the situation with “evidence-based interventions”.

“Addressing these deficiencies is the necessary next step,” she said. “Not to enable ending the lives of terminally ill people as a way to avoid these challenges. We can do better.” 

In recent months, the committee has been hearing from advocates and experts from a range of fields on these matters. Tuesday's hearing marked the halfway point in its deliberations.

People Before Profit TD Gino Kenny told the College of Psychiatrists representatives it was “unhelpful to conflate assisted dying with suicide”, while Green Party TD Patrick Costello said he did not agree that offering assisted dying was a “way of papering over the cracks” in relation to a lack of other services available to people.

Impossible to limit law

Dr Eric Kelleher, a consultant liaison psychiatrist, said once the law is changed to allow assisted dying in some form, it becomes “impossible to limit it to just one group”.

“Absolutely there are people with terminal illness free of depression and free of mental illness and who would view it a choice,” he said. “I don’t think there’s evidence out there you can safely isolate these groups.” 

Professor Ella Arensman, chief scientist at the National Suicide Research Foundation, said it was “premature to take one stand — black or white” on the issue but added Ireland could learn from the experiences of other countries.

“When we look at the evolution of the development of countries like Netherlands and Belgium, it appeared too frequently that rigorous mental health assessments were not followed through intensively with disastrous or close to disastrous outcomes,” she said.

At the close of the meeting, the committee had been due to hear a video testimonial from Brendan Clarke, who advocates for assisted dying in Ireland. Mr Clarke recently died and had been living with advanced motor neurone disease.

However, due to audio issues in the committee room, the sound from the video was unclear and will be played at next week’s committee meeting to “do it justice”, committee chair Michael Healy-Rae said.