Submission of the Irish Catholic Doctors Association on the Dying with Dignity Bill 2020

Submission of the Irish Catholic Doctors Associationto the Committee of Justiceon the Dying with Dignity Bill 2020

The ICDA opposes the introduction of legislation supportive of assisted suicide.

ICDA Position

Preamble :Human Life, Health and Human Solidarity, and Innate Human Dignity

In every state across the world, and in every kind of political system, the care and protection of human life and health is one of the greatest challenges facing the community, the nation, and the political authority. The current Covid-19 pandemic, facilitated unwittingly by the frequency and the scale of international commerce and travel, is a reminder of the fragility of human life and health when a crisis strikes .It is also a sign of how every nation and every people are in some way connected and alike. The protection of human life and health goes beyond national boundaries, with international and global actors taking part in different ways in the response to the pandemic.

What we do and what happens in our homes and in our schools, in our workplaces, and in our sports clubs, affects everyone else. We are not just responsible for ourselves. Covid-19 is a reminder of the importance of human solidarity. The virtue of solidarity obliges us to consider our duties to others and the common good and how our activity may bear on the lives of others. The Covid-19 crisis is also a reminder of the importance of an adequate health system which cares for the most vulnerable. 2020 and indeed 2021 have seen the vulnerability of the elderly in nursing homes where human fallibility, a lack of adequate protection and protocols, and inadequate state planning and assistance conspired to leave the elderly particularly vulnerable.

The Oireachtas has intervened through such measures as The Health (Preservation and Protection and Other Emergency Measures in the Public Interest) Act 2020. The Act gives the Minister for Health the power to make regulations which, even as an unsought side-effect, significantly restrict human liberties and freedoms to travel, to work, and to gather and to socialize with friends and family. So many different dimensions of our lives have been restricted but for the sake of the common good, and there has been substantial compliance with the measures throughout the country.

The precautionary principle has been applied although the side effects are considerable. For the sake of the protection of life and health, work practices, family holiday arrangements, travel arrangements, business, employment, travel and social life have all been curtailed so as to limit the possibility of harm. The point of the legislative measures, still in effect, was to protect the vulnerable. The measures in this bill, Dying With Dignity Bill (24/2020), go in the opposite direction as they facilitate a private right of killing and strike at the heart of the doctor-patient relationship. The bill introduces a potentially lethal disposition every time a doctor encounters a terminally ill patient. This is not at all to suggest that the doctors be the initiator of such a move. The bill puts doctors in this invidious position. Such a potentially fatal step would however be part of the context of every such doctor-patient encounter if the Death With Dignity Bill (24/2020) were to be enacted.

Normally, the killing of a patient is punishable by law. Provided that a terminally ill patient asks a doctor, it will in future be the case that, like abortion, the killing of a patient, in this case a competent adult, is a choice exercised by a patient and a doctor in a surgery or hospital which is, prima facie, beyond the reach of the law. The state by passing legislation has intervened to ensure that the protection of health is a concern for all. For the sake of the protection of life and health, work practices, family holiday arrangements, travel arrangements, business, employment, travel and social life have all been curtailed so as to limit the possibility of harm. This is an example of limitation of individuals’ autonomy for the common good.

The nature of the experience of COVID-19 and the psychological impact of fear and panic was captured well by Pope Francis in his Urbi et Orbi address of March 28th, 2020, to an empty St. Peter’s Square in Rome. Reflecting on the fear which gripped the disciples of Christ when a life threatening storm blew up unexpectedly, as described in the Gospel of Mark, 4:3 , and the similarities with our fears, he said:-

“Thick darkness has gathered over our squares, our streets and our cities; it has taken over our lives, filling everything with a deafening silence and a distressing void, that stops everything as it passes by; we feel it in the air, we notice in people’s gestures, their glances give them away. We find ourselves afraid and lost. Like the disciples in the Gospel we were caught off guard by an unexpected, turbulent storm. We have realized that we are on the same boat, all of us fragile and disoriented, but at the same time important and needed, all of us called to row together, each of us in need of comforting the other. On this boat… are all of us. Just like those disciples, who spoke anxiously with one voice, saying “We are perishing” (v. 38), so we too have realized that we cannot go on thinking of ourselves, but only together can we do this”.

This reminder of solidarity and the need for togetherness so as to achieve our goals and to protect the weak and the vulnerable is essential for any community.

The universal experience of illness confirms the philosopher Hans George Gadamers perception that illness is a time of disequilibrium. Why the concern of others with the sick? It is precisely their dignity which motivates doctors and all who love and care for the sick. Human dignity is something inherent in the human being. However, we know all too well from history that it can be violated through cruelty and indifference.

In 1948, the Preamble of the Universal Declaration of Human Rights recognised “the inherent dignity and of the equal and inalienable rights of all members of the human family” as the foundation of freedom, justice and peace after the events of the Second World War which was a time of barbarous acts which outraged the conscience of mankind, nations recognised the dignity and worth of the human person and in the equal rights of men and women. One of the key drafters and negotiators who prepared the document was Jacques Maritain, for whom dignity was based on the metaphysical or ontological status of the human being which merited recognition in the legal order as well as a moral entitlement.

The roots of human dignity rest in Christian revelation. Kant identifies ‘dignity’ with ‘intrinsic value.’ Presenting his own understanding of ‘[t]his sort of value’ he writes: ‘a thing has intrinsic value if its value is not limited to its usefulness as a means, if it has value in itself’. The deepest insight into our dignity comes with the revelation of God to humanity of His invitation to a life of communion and love. As Cardinal Newman, one of the most important thinkers of the modern age, said of Christian revelation, “Why should God speak, unless He meant to say something?”

The late Constitutional scholar, Donal Barrington, has noted the intense veneration and respect for Almighty God with which our Constitution is infused (Barrington, 1957). The Constitution indeed, in its Preamble, recognises the dignity of the human person and seeking to promote the common good, with due observance of Prudence, Justice, arid Charity, so that the dignity and freedom of the individual may be assured, true social order attained, the unity of our country restored, and concord established with other nations, Do hereby adopt, enact, and give ourselves this Constitution. It also recognised that human history is under the watchful and providential care of God, and that Jesus Christ will reward those who do and pursue the good and avoid evil.

PART A: Policy and Legislative Analysis

The ‘policy Issue’ and the policy and legislative context

1. Define the problem/the policy issue which the Bill is designed to address; to what extent is it an issue requiring attention? What is the scale of the problem and who is affected? What is the evidence base for the Bill?

Assisted suicide and euthanasia are both currently illegal in Ireland.

Legislation to allow for assisted suicide has been in place in some European states including The Netherlands, Belgium, Switzerland, in Canada, and a small minority of US states. Attempts to introduce legislation in the UK and the Scottish parliaments have failed. In recent years there has been limited public debate around the issue in Ireland, though not based on any widespread demand. The Criminal Law (Suicide) Act 1993 decriminalised suicide but assisting a suicide remains illegal. Legally, the rights to privacy and personal autonomy confer a right to refuse medical treatment, even where this might hasten death, but there does not exist the right to have life terminated or death accelerated.

There is no significant demand in Ireland for assisted suicide. Those potentially affected would be those who are terminally ill and currently under palliative care services in Ireland. As doctors, we are aware that the palliative care multidisciplinary teams in Ireland are second to none and provide excellent care to those in need. We are utterly convinced that no-one need die in extreme pain or discomfort, and that proper psychological and spiritual care can overcome depression and despair sometimes experienced by those who are terminally ill.

2. What is the current policy and legislative context, including are there any proposed Government Bills or general schemes designed to address the issue? Have there been previous attempts to address the issue via legislation?

Currently the HSE runs a National Office for Suicide Prevention and has a comprehensive Suicide Prevention Strategy in place. There are several national and local suicide prevention voluntary services in existence also.

We are aware of three cases related to assisted-suicide which have come to the attention of the justice system in Ireland. Suicide kills more people each year than road crashes, and is a source of grievous hurt to family, friends and those affected by the death. Much effort has been directed towards suicide prevention, both by voluntary and state services. It is universally discouraged, and always treated by society with the utmost urgency as a devastating tragedy for both the victim and their relatives, and friends. It is never encouraged or advocated. The incidence of suicide has fallen thanks to great efforts on the part of many individuals and organisations. It is therefore with great dismay and regret that we observe there has also been a movement to promote acceptance of assisted suicide. It has been the subject of a private members Bill in Ireland, as well as a disputed submission to the High Court in 2014 by the then Irish Human Rights Commission. In 2015, John Halligan TD proposed the private member’s so-called Dying with Dignity Bill 2015 in Dáil Éireann. This bill proposed legislation on assisted suicide and voluntary euthanasia but thankfully did not advance through the legislative process at that time.

In our opinion, as citizens and as doctors in practice, we are aware of great efforts to prevent suicide in Ireland, and we are not aware of any significant public demand for assisted suicide. We strongly advise that physician-assisted suicide and euthanasia should not be contemplated or legalised.

3. Is there a wider EU/international context?

If legalised killing of a patient by his or her doctor becomes a reality in this country, it will cause significant change of attitudes in the society at large and on the treatment of the sick individual, although such destructive effects are unlikely to be the intention of members of the Oireachtas. The introduction of such legislation in Ireland will certainly have an influence on legislators in other jurisdictions as the prevalent belief in Western culture today is that the individual’s autonomy or choice in such matters takes precedence over that of the common good.

It would therefore be prudent for all members of the Oireachtas who love their country and the welfare of those living here, to read medical and legal evidence of these unintended effects, e.g.:

The RCPI Position Paper on Assisted Suicide 2017; from the College of Physicians,
The RCPI Supplementary update in Oct 2020 from the College of Physicians,
Letter to Irish Times Mon Oct 5, 2020 on Palliative care and Dying with Dignity from the Irish Palliative Medicine Consultants’ Association (IMPCA);
High Court Judgement (Justice P Kearns) in the Fleming Case, Jan 2013.

RCPI:

The College of Physicians states “There is concern that legalising assisted suicide would lead to significant unintended consequences for healthcare system and society that societal attitudes would gradually change; that there would inevitably be a creep from restrictive to permissive eligibility and potentially to include non-voluntary and involuntary euthanasia. With that, there is the possibility that life would be devalued in society, particularly concerning for vulnerable people-sick, disabled and elderly. This argument includes the idea that people who are very ill or with severe disabilities may feel pressured or request assisted suicide of euthanasia to avoid being a burden to their families, (Ch 7, p.12). Euthanasia and physician assisted suicide violates medical ethics, is incompatible with the doctor’s role as healer … doctors should not kill their patients. (Ch7 p.11).

Palliative Care Consultants:

Seventeen Palliative Care Consultants from all parts of the country signed the letter to the Irish Times that “palliative care and the easing of physical, psychological or spiritual distress … transforms the experiences of living, dying and bereavement for individual patients and their families. We are convinced that as dying with dignity is already present within healthcare in Ireland and no change to our current law is required.”

High Court Judgment on Fleming Case, 10 Jan 2013, (paragraphs 42, 68, 69, 74, 76 quoted below):

In paragraph 42 of this High Court Judgment, Prof George, (Consultant Physician in Guy’s and St Thomas’s hospital, London and is Professor of Palliative Care at Cicely Saunders Institute), “described killing people as a treatment or as a solution as the greatest risk because it changes society fundamentally and that legislation will result in a much more hazardous environment for the vulnerable. Using the example of the Netherlands, he commented that what began as a voluntary euthanasia became in-voluntary for people who were incapable. The issue then affected people with psychiatric disorders. He also warned that once assisted suicide enters the domain of treatment then economic utility is considered. He cited a case from the Remmelink Report in which a patient had non-voluntary euthanasia in order to free up a hospital bed.”

In paragraph 68, Prof George stated “that if physicians were to be permitted to hasten the end of the terminally ill at the request of the patient by taking active steps for this purpose this would be to compromise – perhaps in a fundamental and far reaching way that which is regarded as an essential ingredient of a civilized society committed to the protection of human life and human dignity. It might well send out a subliminal message to particular vulnerable groups such as the disabled and the elderly that in order to avoid consuming scarce resources in an era of shrinking public funds for health care, physician assisted suicide is a ‘normal’ option which any rational patient faced with terminal or degenerative illness should seriously consider.”

In paragraph 69 the Judge includes “other considerations to which the Oireachtas should properly attach great weight. … These factors include obvious and self-evident considerations such as preserving the traditional integrity of the medical profession as healers of the sick and deterring suicide and anything that smacks of the ‘normalization’ of suicide.”

Paragraph 74, the Judge acknowledges “that the State has a profound and overwhelming interest in safeguarding the sanctity of human life … this is after all the preeminent personal right. In this respect Article 40.3.2 commits the State to protecting the sanctity of all human life. This is a normative statement of profound constitutional significance since in conjunction with the equality guarantee of Article 40.1 it commits the State to valuing equally the life of all persons. In the eyes of the Constitution, the last days of the life of an elderly, terminally ill and disabled patient facing death have the same value, possess the same intrinsic human dignity and naturally enjoy the same protection as the life of the healthy young person on the cusp of adulthood and in the prime of their life. These are, concerns which any free and democratic society must strive to protect and uphold.”

Paragraph 76, the Judge states that if this Court were to unravel a thread of this law by even the most limited constitutional adjudication in her favour, it would – or at least, might – open a Pandora’s Box which thereafter would be impossible to close. … But such might well be the unintended effect of such a change, specifically because of the inability of even the most rigorous system of legislative checks and balances to ensure, in particular, that the aged, the disabled, the poor, the unwanted, the rejected, the lonely, the impulsive, the financially compromised and the emotionally vulnerable would not disguise their own personal preferences and elect to hasten death so as to avoid a sense of being a burden on family and society. The safeguards built into any liberalized system would, furthermore, be vulnerable to laxity and complacency and might well prove difficult or even impossible to police adequately.

Policy implications/implementation

4. How is the approach taken in the Bill likely best to address the policy issue?

The policy is to help people commit suicide. The approach taken gives no consideration to the person, who states that it is their desire to commit suicide, coldly identified as “the qualifying person” in the Bill. The policy does not address the humanity of the person; the intrinsic value of each human being regardless of their state in life, their capacities, their intelligence or lack thereof. The Bill does not consider the reasons for a person’s decision to commit suicide. We know that for most people life is always precious, so if they are considering suicide it is usually a call for help born of fear and anguish; fear of pain, of loneliness, fear of being a financial and physical burden, worry about the family they leave behind, their physical and psychological pain, spiritual pain, their relationships etc.

A dignified death is one where all these problems are addressed in a loving way and the person is assured of being accompanied through every stage of their last days. The policy does not seem to have any understanding of the relationship between a doctor and their patient: their commitment to the best care that can be given. The policy would defy the medical maxim ”First do no harm”. It has always been considered unethical, even morally criminal, to deliberately kill a patient even if the patient requests it. It is totally against the notion of the doctor-patient relationship. Making it lawful will not make it ethical. Doctors are committed to caring for all patients and especially those who are most vulnerable. Once doctors are allowed to kill their patients their relationship with all patients will be changed forever. What this Bill proposes is the denial of hope, love, friendship and comfort to the patient. It confirms them in their despair, rejection and abandonment. There is nothing dignified in offering a person a lethal drug. A doctor cannot take part in this unjust act without corrupting themselves. There is no right to suicide. Laws exist to protect life and health. Every sick person has a right to be cared for till natural death.

5. What alternative and/or additional policy, legislative and non-legislative approaches were considered, including those proposed by the Government and what, does the evidence suggest, are the differences between and the merits of each?

This Bill appears to be out of step with Irish society. It is not clear that alternative and/ or additional policy, legislative and non-legislative approaches were considered in preparing this Bill. The approaches that are considered within society, however, are numerous and all aim at lifting the dying, suicidal person out of their depression, despair and pain. The whole thrust of the work done by State bodies and many charitable organisations in Ireland is the prevention of suicide. Consider the Samaritans, Pieta House, Youth Suicide Prevention Ireland, Suicide Awareness, Mental Health and Suicide Support Services, the Hospice movement with its excellent palliative care teams, thousands of trained volunteers, medical teams in the specialties of psychiatry, psychology, pain management, occupational therapy etc. Their common aim is to preserve life and health. The foundation for living together is Solidarity and this is the alternative to what this Bill has on offer: we must offer hope, resolution of worries, ease the suffering, accompany the person to the very end, never letting them feel that they are a burden. On the contrary, we must cherish them. The medical profession is committed to the promotion of life and it is the duty of every doctor to protect the life of every single patient. Assisted suicide has no place in medical practice.

6. Are there Government-sponsored Bills (or General Schemes) which are related to and/or broadly aim to address the same issue? Are there merits in combining them?

There are many initiatives from the government and also many community based schemes which are related to this bill. They of course are related to the prevention of suicide. The government had an all party committee dealing with the rise of suicide in Ireland and issuing recommendations of how to prevent it. This is all very important and laudable. We have many community based projects e.g. Pieta House, Taxi drivers who form groups to monitor known suicide areas. These initiatives have prevented many deaths. Young students from UCG run a roster to monitor the Corrib as there were so many deaths in that area. As one student from that group asked recently how can our government one the one hand decry the number of young suicides and on the other hand look to bring in physician assisted suicide. It pulls the rug from under their feet. This bill will make suicide more acceptable. Holland with its acceptable state killing strategy saw a rise instead of a fall in all other suicides. We should not be even thinking of combining our physician assisted suicide with these projects. These projects trying to prevent suicide all recognise the devastation caused by suicide and are run by people of hope and positivity. We need more help for our young people who are so involved in drugs now. If one takes weed (cannabis) on a regular basis one is far more likely to contemplate suicide (Some say seven times more likely).We should be trying to help these people not promoting a bill helping people to kill themselves. What an example! The people looking for physician assisted suicide are people who have lost all hope and are in a totally negative state of mind. Their agenda and the hope based agenda are incompatible. We should not be thinking or promoting negative strategies and bills like this.

7. What are the specific policy implications of each proposal contained within the Bill (environmental/economic/social/legal)? Has an impact assessment (environmental/economic/social/legal) been published (by Government or a third party) in respect of each proposal contained within the Bill?

We are not aware of any impact assessment published by Government on the effects of this Bill. It is very hard to deliberate on what effect somebody being helped to kill themselves has on these areas. We are categorical that they have no positive effect in any area. This initiative undermines our caring society and environment. Perhaps it will save some money by not having to look after people who are ill and need care. What price a life? It will have a detrimental effect on society: it will add to the sum total of misery and despair. It will cause many legal consequences with court cases etc. We believe all the consequences of this Bill will be negative because society will never get a positive result promoting death and we should not entertain it.

8. Could the Bill, as drafted, have unintended policy consequences, if enacted?

Yes. Experience from jurisdictions where assisted suicide has been legalised has shown that more and more reasons for assisted suicide are accepted, those with less capacity to consent are euthanized, and younger people are assisted to die. The definition of what constitutes ‘terminal illness’ is also very problematic in this bill, and very much open to abuse as stated, as is the ascertaining of mental illness and transient psychological states. Mental capacity is also a very problematic area which is under constant review and flux. This Bill is utterly deficient and inadequate as described. We also refer you to Q.3 The Irish born philosopher, Elizabeth Anscombe, has noted that ‘someone who is murdered suffers a great wrong’, There is little doubt that the patient who decides to ask a doctor to assist in her suicide does suffer a great wrong even if there is a willingness to accept that wrong. It is the case that people can willingly do harm to themselves or be prepared to permit others to do them harm and violence. The law frequently intervenes to protect people even from such deeply held desires. The law against assisted suicide is such a law. The law proposed by Deputy Kenny permits a great wrong.

9. Has the Committee taken due consideration of the opinion of the European Central Bank (ECB) on the Bill, if applicable?

No comment

10. How would the Bill, if enacted, be implemented?

The implementation of euthanasia and physician assisted suicide into the healthcare system in Ireland would be extremely difficult, traumatic and distressing for all who care for the sick, the dying or the handicapped. The College of Physicians (RCPI) “officially opposes any legislation supportive of assisted suicide because is contrary to best medical practice.” (RCPI Position Paper on Assisted Suicide Oct 2017, page 5).

Is this legislation needed? The RCPI also state (p14), “With advances in medicine, in palliative care and in mental health treatments, effective treatments at the end of life are available to the vast majority of people – to ensure that nobody should be suffering either mentally or physically.

Any doctor, nurse or pharmacist, who is ordered by his or her boss, e.g. by a senior doctor or nurse to assist in the act of killing a patient under the legal cloak of physician assisted suicide or euthanasia, should stop and ask themselves, ‘WHAT AM I BEING ASKED TO DO?’

Are you not being asked to kill a patient, another human being? This is murder, premeditated and planned. ‘Thou shall not kill’; is this natural law not inscribed in every human heart? Therefore, any member of staff has a right to object to be involved in such killing on the grounds of conscience. This right is guaranteed in the Constitution in Article 44.2.1 of the Constitution, as follows: The State acknowledges that, “Freedom of conscience and the free profession and practice of religion are, subject to public order and morality, guaranteed to every citizen.”

In the ‘Dying with Dignity Bill’, the section on ‘conscientious objection’ states, “A person who has a conscientious objection referred to in subsection (1) shall make such arrangements for the transfer of care of the qualifying person concerned as may be necessary to enable the qualifying person to avail of assistance in ending his or her life in accordance with this Act.” (Clause 13 (3) p 9). This is not true conscientious objection as it involves co-operation in the act of killing.

According to St Thomas Aquinas, “human law is law inasmuch as it is in conformity with right reason and thus derives from the eternal law, but when a law is contrary to reason it is called an unjust law; but in this case it ceases to a law and becomes instead an act of violence.” In his encyclical Evangelium Vitae, paragraphs 7 & 73, Pope St John Paul 11 states, that any State which made legitimate a request for euthanasia and authorized it to be carried out would be legalizing a case of suicide-murder, contrary to the fundamental principles of absolute respect for life and of the protection of every innocent life. He adds, abortion and euthanasia are thus crimes which no human law can claim to legitimize. There is no obligation in conscience to obey such laws; instead there is a grave and clear obligation to oppose them by conscientious objection.” Remember the first duty of this State is to protect the lives of those who live here.

11. Are there appropriate performance indicators which the Department, or whoever is ultimately charged with implementing the Bill, can use to assess the extent to which it meets its objective? Does it include formal review mechanisms?

We answer thus: “For several years, until I objected, I received from my health insurer a letter that tells me how much it costs the fund to maintain my health care. I dreaded receiving that letter and the psychological reasoning that would seem to have motivated it. Each year I was reminded how much of a burden I am to my community. The fear of being a burden is a major risk to the survival of those who are chronically ill.”

N. Tonti-Filippini, About Bioethics, Volume 2: Caring for people who are sick or dying. Ballan, VIC: Conor Court Publishing, 2012, page 112,

12. Will there be enforcement or compliance costs?

While all governments should be prudent with respect to exchequer costs (e.g. ensuring that the salaries of government ministers and deputies are reasonable and rewarding but not wholly disproportionate to the reasonable salaries of other citizens, that government projects are properly planned and completed within the envisaged contractual budgets), the cost to the exchequer is not the only consideration in shaping public policy, in making laws and in protecting citizens.

The Covid-19 crisis has highlighted, in a particularly sharp way, the vulnerability and fragility of those who are sick. Given the Epiphanic nature of the last year, which revealed both the fragility of the human person and indeed of systems, offers our nation the possibility of committing ourselves to solidarity with the fragile. The primary aim of government is the protection of the human rights of all citizens and indeed denizens, particularly those fundamental goods without which one cannot exercise other rights and duties. Life is the necessary condition of exercising and instantiating all other fundamental goods.

The Dying With Dignity Bill (24/2020) threatens in a particular way those who are vulnerable and facing difficulties. It proposes, through repeal of existing legislation, to permit assisted suicide and permits doctors to kill their patients. It is, in fact, contrary to human dignity and an assault on innocent human life and, in a particular way the life of those, who are seriously ill.

It is not immediately clear what costs to the exchequer are involved or envisaged by those who sponsor this bill or indeed this question. The question suggests that as well as costs which are in some way attributable to the cost of giving care to patients, at a deeper level there is concern with some planning the future of our health system, using such concepts of “quality-adjusted life year” (QALY), a rather crude utilitarian measure sometimes used by those who work in examining the economics of our health system.

The rather crude metric, and we assume some familiarity with it among the members of the committee, allows us to raise a question which is pivotal to the protection of human dignity, about our human fragility. Can we legitimately expect care from others at every point of our lives? This stretches from life before birth to our lives when facing the hastening likelihood of death. It is not possible to put a price on human life. All of us are unique and of inestimable value because we are made in the image and likeness of God, which is the ground of human dignity. Further, how will our health system enable patients in Ireland receive medical care which is proportionate to their illness, conscious of their human dignity, tailored to their unique circumstances, and always respectful of the inviolability of every innocent human life, and respectful of the need to never intentionally attack the bodily life or health of the human person? In a sense, our society is faced with the burden, the gift and the task, of ensuring that each and every human life is given every possible priority.

13. What are the likely financial costs of implementing the proposals in the Bill, and what is the likely overall fiscal impact on the exchequer?

See 12

14. Have cost-benefit analyses (CBA) been provided/published (by Government or a third party) in respect of each proposal contained within the Bill? Will benefits/costs impact on some groups/stakeholders more than others?

See 12&13

PART B – Legal Analysis

15. Is the draft PMB compatible with the Constitution (including the ‘principles and policies’ test)?

We believe this draft document is not compatible with the constitution. Marie Fleming in 2012 took a legal action to be allowed assistance with dying. She challenged the law criminalising assisted suicide. It was first heard in the High Court and subsequently on appeal in the Supreme Court.

The Supreme Court decision in the Marie Flemings case found that the right to die or commit suicide or have one’s life terminated was not to be read into Article 40.3.2 or any articles of the Irish Constitution. Specifically, the court held that the right to life does not entail a right to terminate life or have life terminated. The social order contemplated by the constitution and the values and principals reflected in it are not compatible with this bill. The actions proposed by Marie Fleming would have amounted to positive action to end her life rather than dying a natural death and are therefore not within the boundaries of Article 40.3.2.

16. Is the draft PMB compatible with EU legislation and human rights legislation (ECHR)?

In the Fleming case the court also looked at the Irish law and the Constitution regarding its compatibility with European Convention on Human Rights, particularly Article 8 of the Convention. The court found against Marie Flemings case. It looked at Diane Pretty v United Kingdom.

17. Is there ambiguity in the drafting which could lead to the legislation not achieving its objectives and/or to case law down the line?

There is from the beginning ambiguity of language. Dying by suicide is never considered dying with dignity. We believe assisted suicide is incompatible with human dignity.

18. Are there serious drafting deficiencies or technical drafting errors (e.g. incorrect referencing to Acts etc.)?

No comment

19. Are there potential unintended legal consequences which may stem from the PMB as drafted?

By opening the door even only in limited cases with strict protocols is to use killing as a solution to suffering and will come to be seen as the easier way which will now be endorsed and even funded by the government. Those caring for the sick and suffering and the relatives too may find skipping over of the processes of natural death tempting. What happens to the sick and dying in such a case- already faced with temptation of thinking of themselves as nothing more than a burden may be also tempted to this shortcut to a quick death. The sick and dying may also have to live with the dread of been coerced and pressured to accept this as best for them and feeling too vulnerable to resist it.

This law if passed would create a culture in which the temptation to opt for this way of ending one’s life becomes acceptable. The fact that it’s against the great dignity of mankind would be lost. Our society would even become more violent and degenerate further with lack of life sustaining principals and proper ethics to guide it.

Canadians in 2016 were assured that legalizing euthanasia would only be permitted in extremely limited cases. Now only a few yrs later it is planning to take protection against euthanasia from the mentally ill and those with diminished capacity who are incapable of consenting themselves. Also natural death does not have to be foreseeable so people who are not terminally ill can qualify.

So there is ample evidence of the slippery slope we will go down as a nation once the door is opens even a crack. As in legislating for abortion the laws get relaxed more and more as they become subject to more pressures to allow for more people and more situations to be included resulting in a regime that would be very different from what the first proposers of this bill envisioned.

20. Are appropriate administrative and legal arrangements necessary for compliance and enforcement of the provisions of the Bill included? (e.g. if draft Bill contains a prohibition, whether the necessary criminal sanctions – including the class of fine – are included).

No comment.

Context

We see it useful and appropriate to quote the relevant articles of the Catechism of the Catholic Church regarding assisted suicide and euthanasia (‘voluntary’ or involuntary):-

Euthanasia: 2276 Those whose lives are diminished or weakened deserve special respect. Sick or handicapped persons should be helped to lead lives as normal as possible.

Suicide: 2280 Everyone is responsible for his life before God who has given it to him. It is God who remains the sovereign Master of life. We are obliged to accept life gratefully and preserve it for his honour and the salvation of our souls. We are stewards, not owners, of the life God has entrusted to us. It is not ours to dispose of.

Closing comments

Human dignity is inherent ‘from conception until natural death’. It can never be admitted that any person who is sick, suffering, dying, or fully dependent upon others loses that dignity, even if they themselves believe that to be so. Just as a person in their prime who sadly commits suicide leaves distraught family and friends behind to grieve, probably for many years, having lost sight of the fact that they are actually loved and of great worth in themselves and too many others, the same idea can entrench in one who is gravely ill or incapacitated. Compassion (-which means to ‘suffer with’-) for the one who is ill should never include the affirmation that even for themselves their lives are not worth living, as their very existence is a good in itself to their families and greater society. The Dying With Dignity Bill, 2020 is that it provides little or no context to a patient’s life in the totality of its aspects, spiritual, moral, intellectual, friendships and family. There is a risk that the focus may come to rest entirely on those moments of mental anguish or physical pain for which there is allegedly no relief. It presents merely an unhelpful and dubious choice of relief or continuing suffering.

Through palliative care, which includes psychological and psychiatric input as well as analgesia and symptom-control, health-care professionals, family and friends accompany the person on their journey to death, our natural and inevitable destination. For the terminally ill patient contemplating assisted suicide, palliative-care doctors and nurses should see such a patient in the same way as they would see a physically healthy individual who feels suicidal. They must treat them with all the expertise in their power to convince them that their lives with their innate dignity and worth should not be terminated by anyone, neither themselves nor their doctors.

Assisted suicide is not a ‘private’ choice, but one that affects the character of doctors, and inevitably their treatment of other patients. Once legalized, euthanasia would become a ‘quick fix’ for disposing of ‘difficult’ patients in response to the demands they make on care. Medicine would be robbed of the incentive to find genuinely compassionate management of suffering patients. The advances in hospice medicine and palliative care would be undermined, because too many would think euthanasia a cheaper and less personally demanding solution. Doctors would be mistrusted by patients, who would die in an atmosphere of suspicion. Given the self-selecting nature of such a ‘specialty’ as assisting in suicide, patients could be killed without request, even if this remained illegal. The suicidal would be confirmed in their unobjective estimate of their lives’ value. Furthermore, the non-suicidal chronically ill patient would be disheartened by the public view of lives such as theirs. For all these reasons, it is vitally important that society continue to value the lives of all its members, including those who, in pain or distress, do not see their own lives as worthwhile.

Assisted suicide betrays the suicidal person by accepting their own view of their lives: suicidal people, whatever their physical condition, need and are entitled to our full protection and support, including that of the State. Everyone who participates in the enactment of this bill participates in some way in the deaths of others. We ask was assisted suicide part of the vision of the men and women of 1916? As doctors, we also abhor the fact that monetary value on human life could become a consideration in the matter of life or death.

Conclusion

The ICDA is opposed to the bill. We consider the bill permits assisted suicide and euthanasia, that it is an attack on the lives of the vulnerable, that it is a not too subtle violation of the patient/doctor relationship and that it introduces a false notion of dignity, centred entirely upon a capricious notion of human autonomy which wrongly assumes that human weakness and illness is incompatible with human dignity.

Therefore, on compassionate, ethical and humanitarian grounds the ICDA strongly opposes the introduction of this bill.

28/01/2021