The right to die is one of the issues of our age

In light of the defeat of a bill in England, the debate concerning assisted death for terminally ill people shows no signs of being resolved any time soon, writes TP O’Mahony.            

The right to die is one of the issues of our age

IS THERE a right to die? The Archbishop of Canterbury, Justin Welby, has described this question as one of the “great dilemmas of our age”. And it is a question that will not go away, even in the aftermath of the rejection by the House of Commons on Friday of an assisted dying Bill.

The vote was 330 against with 118 in favour, a far bigger margin than commentators expected. The Private Member’s Bill was introduced by Rob Marris, a Labour MP who argued that it was about ensuring peaceful deaths rather than euthanasia.

His bill would have allowed patients judged as having no more than six months to live, and who had a “clear and settled intention” to end their lives, to be prescribed a lethal dose of drugs.

Two doctors and a family court judge would have to assess the patient’s diagnosis and prognosis, and check that he or she was mentally competent to make a judgment, free of coercion. The patient would then have to administer the lethal medication themselves, with a healthcare professional present.

Before the vote in parliament, the Archbishop of Canterbury and the Archbishop of Westminster, Cardinal Vincent Nichols, were joined by other leaders of faith communities in opposing the bill. In a rare show of unity, the leaders of Britain’s Christian, Jewish, Muslim, and Sikh communities wrote a joint letter to every MP.

Archbishop Welby told the BBC that Britain would cross a “legal and ethical Rubicon” if Parliament voted to permit terminally ill patients to end their lives. In the North, the Archbishop of Armagh, Most Rev Eamon Martin, also wrote to MPs, calling on them to oppose the bill.

In their joint letter, Archbishops Welby, Cardinal Nichols, and the other faith leaders said: “We believe that the best response to individuals’ end-of-life concerns lies in ensuring that all receive compassionate, high-quality palliative care and that this is best pursued under current legislation. A law based on this assisted dying bill would put at risk many more vulnerable people than it seeks to help.”

Later, Archbishop Welby said: “It’s a very big change that is being proposed. If this bill is passed, it will change our whole approach to the value of life. Make no mistake, MPs are being asked to take a huge gamble that a changed law would protect the vulnerable.”

In the end, the MPs decided overwhelmingly not to take this gamble. And the archbishop’s concern for the vulnerable was echoed during the debate in the Commons, where claims were made that evidence from the US states of Oregon and Washington (which have passed laws permitting assisted dying) suggested that between 40% and 60% of those who opted to end their lives said the concern that they would be a burden on their families was a factor in their decision to bring their lives to a premature end.

This is always the big fear whenever legislation to allow assisted dying is proposed. The question always arises — does such legislation represent the beginning of a very slippery slope? Perhaps in no other area of ethics and law is the slippery slope syndrome invoked more persuasively than in regard to end-of-life issues.

And despite the show of unity from faith leaders before Friday’s vote, the arguments about assisted dying do not break down into those based on religion and those considered non-religious. While Archbishop Welby eloquently argued that assisting people to die would dehumanise our society for ever, his predecessor, George Carey, took a very different view.

“There is nothing dignified about experiencing pain at its most awful,” said Dr Carey. “There is nothing sacred about suffering. There is nothing holy about agony. You wouldn’t allow a dog to die in such circumstances. I believe we should give people the right to die.”

In July 2014, when the House of Lords was preparing to vote on a bill on assisted dying, Desmond Tutu, the retired archbishop of Cape Town in South Africa, said a dignified death is our right.

Desmond Tutu

“I do not want my life prolonged artificially,” said Dr Tutu. “I revere the sanctity of life, but not at any cost.”

A year before that, Stephen Hawking spoke in favour of assisted suicide for people with terminal diseases.

The 73-year old cosmologist, who has motor neurone disease, told the BBC: “We don’t let animals suffer, so why humans? I think those who have a terminal illness and are in great pain should have the right to choose to end their lives, and those who help them should be free from prosecution.”

There are those who argue that the right to die already exists, and they point to the fact that it is legal for any adult to refuse particular treatments. In her book Medicine, Ethics and the Law, Deirdre Madden of UCC said the right to refuse medical treatment is considered part of the right to privacy, the right to be left alone.

Dr Madden referred to the Irish Supreme Court ruling in the 1996 case Re a Ward of Court, where Mr Justice Hugh O’Flaherty said: “There is an absolute right in a competent person to refuse medical treatment even if it leads to death.”

Deirdre Madden 

However, on the specific issue of assisted dying, the Irish Supreme Court issued an important ruling on 29 April 2013 in a case brought by 59-year-old Marie Fleming, a former UCD lecturer, who was in the final stages of multiple sclerosis. She wanted help to end her life at a time of her own choosing.

The full seven-judge court ruled that the right to life did not import into the Constitution a right to die, and said there was no express right in the Constitution to commit suicide. Reading the judgment, Chief Justice Susan Denham said there was no constitutional right to commit suicide or for people to arrange for the termination of one’s own life at a time of their own choosing.

However, she added that there was nothing in the judgment to prevent the State from introducing legislative measures, with appropriate safeguards, to deal with cases such as Ms Fleming’s. The latter died months after the ruling, on December 20, 2013.

Unlike Britain and elsewhere, a debate of assisted dying has never really gathered momentum in this country. There is no evidence of any appetite in Dáil Éireann for support for a Private Member’s Bill on assisted dying. Whether there is any enthusiasm among the wider public for a change in the law on end-of-life issues is purely a matter of speculation.

Would the Irish public support a review of our blanket ban on assisted dying so as to allow rational, terminally ill people who decide they do not want to suffer to get help to end their lives?

Even if public opinion is way ahead of the politicians — as it was shown to be in the aftermath of the tragedy of Savita Halappanavar, the 31-year-old Indian woman who died in Galway University Hospital in October 2012 after being denied a life-saving abortion — there is no assurance that legislative change will follow.

At the weekend, and after all that has happened since 2012, the Taoiseach, Enda Kenny, said he will not commit to holding a referendum on repealing the Eighth Amendment to the Constitution if Fine Gael returns to government.

Enda Kenny

On socio-moral issues, our political leaders have shown themselves again and again to be pusillanimous. As Emer O’Toole, visiting lecturer at Royal Holloway, University of London, wrote after the death of Savita Halappanavar, change in Ireland “is made more difficult in a country in which the entire political system, against the will of the electorate, enforces medieval attitudes to abortion”.

Might this not also be true on the issue of assisted dying?

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