Assisted dying: ‘No slippery slope’ of vulnerable people being forced to end their lives

Concerns regarding a potential “slippery slope” following the adoption of legal assisted dying laws have been “largely overturned” by research, an Oireachtas committee has been told.

The Joint Committee on Assisted Dying convened on Tuesday evening to hear contributions from the experience in the United States where the practice is legal in some states. The committee held its first public meeting in June and has been tasked with reporting to the Dáil and Seanad within nine months of its first public meeting.

Prof Margaret Battin of the department of philosophy at the University of Utah told the committee such original concerns had been raised by various bodies including the American Medical Association and British Medical Association.

The “slippery slope” argument, she explained, related to vulnerable groups that could be forced into ending their lives.

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“The data that we collected from Oregon and the Netherlands showed that this was in fact not true,” she said. “In fact [it was] just the opposite.”

Conversely, the research showed those who sought medical aid in dying were typically affluent, well educated, socially secure, non-vulnerable people.

“That basis of objection has been largely overturned. It doesn’t mean there aren’t any problems in equity but it’s people of privilege who have been getting this service rather than the other way round.”

Dr Mark Komrad, a clinical psychiatrist at Johns Hopkins University of Maryland, argued strongly against the practice, describing it as “neither good medical ethics, nor good public policy”, and said he hoped Ireland could learn from America’s “bad example”.

Although there are 11 US jurisdictions where assisted suicide is permitted, he noted 270 failed attempts to introduce legislation. Nine states have moved to ensure such laws can never be introduced, he said.

“PAS (physician assisted suicide) in the US is anathema to most physicians. The fact is, even among those doctors who endorse these procedures, very few are actually willing to provide them,” he said.

“Lethal prescribing tends to be done by a very few extremely zealous physicians who write scores of lethal scripts, for patients with whom they’ve had a relationship for only one or two days. Last year, one doctor in Oregon wrote 51 scripts.”

Dr Komrad said the practice could “go terribly wrong” regardless of legal safeguards and outlined one example in Colorado where three people with anorexia were prescribed lethal suicide medication despite the law limiting eligibility to terminal illness.

However, his opening statement was criticised by Fianna Fáil TD John Lahart who, considering himself to be “reasonably objective”, said he found it difficult to take seriously.

“Our work is serious here and I found it dramatic and alarming in its presentation as opposed to considered and serious,” he said.

Dr Komrad, in response, said he was a practising psychiatrist who dealt with suicide on a daily basis and was, consequently, passionate about the subject. “I encounter in the trenches the profound implications of this,” he said.

Dr Tom Jeanne – deputy state health officer and epidemiologist at the Oregon Health Authority, which takes a neutral position – said the state’s Death with Dignity Act was the first law of its kind in the world and came into effect in 1997.

Since then, 3,712 people have received lethal prescriptions and 2,454 have died from ingesting the medication. The number of patients and physicians participating has increased but “remains low”, with just 1 per cent of physicians participating last year.

Most patients were aged 65 years or older with a median age of 73. The most common underlying illness was cancer (72 per cent), followed by neurological (11 per cent) and heart disease (7 per cent). The large majority died at home and most were enrolled in hospice care.

The three most frequently reported end-of-life concerns were a decreasing ability to participate in activities that made life enjoyable and loss of autonomy and dignity.

After 26 years of the law, Dr Jeanne said, there have been no cases of abuse nor coercion and no civil or criminal charges.