Assisted dying: ‘Difficult to identify sufficient safeguards to protect vulnerable’, politicians told

It is “difficult to identify what safeguards would be deemed sufficient” to protect vulnerable people when implementing legislation for assisted dying, the National Suicide Research Foundation has said.

The joint Oireachtas committee on assisted dying convened a meeting on Tuesday morning to hear contributions from three different organisations on potential changes to legislation around assisted dying.

The committee is now more than halfway through its deliberations, and has heard multiple opposing views on the issue.

On Tuesday, the National Suicide Research foundation, is an independent unit that investigates the causes of suicide and self-harm in Ireland, made five recommendations to policymakers, the last of which was around safeguards and safety.

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“There is a lack of evidence regarding the effectiveness and standardisation of safeguards in the process of assisted dying. It is difficult to identify what safeguards would be deemed sufficient based on the international experience and where responsibility lies in determining adherence to safeguards,” the organisation said in its opening statement.

The foundation said the profile of individual who die by assisted dying is different from those who die by suicide.

“Those who die by assisted dying are generally older in age and are more likely to be female. However, some potential risk factors are shared by both groups, including living alone, having no children, and not identifying as being religious,” it said.

“Furthermore, the prevalence of psychiatric co-morbidities in individuals who die by assisted dying is difficult to establish, with reported proportions ranging from 3 to 39 per cent. It is likely that the prevalence of mental health conditions such as depression are under-reported and undiagnosed in people who request assisted dying.”

Speaking at the same meeting, Léopold Vanbellingen, a doctor in Law at the University of Leuven and research fellow at the European Institute of Bioethics, an independent research centre in Brussels, said over the past 20 years the institute has developed expertise on the impact of assisted death laws.

“Our major observation is that, despite their alleged safeguards, each of these national laws rapidly tend to pose a threat to the lives of vulnerable people,” he told politicians.

“We can identify at least three categories of victims of this inescapable threat: firstly, elderly people who are dependent; secondly, people suffering from mental illness; thirdly, healthcare practitioners.”

Representing the Irish College of Psychiatrists, Dr Siobhan MacHale, consultant liaison psychiatrist, said the organisation is in agreement that the current status quo in which 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”.

“The answer to this is not to end our patients’ lives, but rather is to interrogate each and every incident of concern, to clarify relevant contributing factors, and to provide the appropriate evidence-based interventions ranging from improved pain control to family support,” she said.

“Where there is no access to the appropriate intervention, or there is a lack of evidence for these, then we must target our energies and resources in these areas.”

Dr MacHale said as psychiatrists, they believe “it is not possible to clearly differentiate between suicidal patients and patients who request assisted dying”.

She added: “Attempting to establish an absolute right to bodily autonomy by legalising assisted dying may undermine other individual and group rights, and, by creating one class of people for whom life is expendable, that particular view may be extended by society to all groups possessing such attributes [such as permanently disabled people].”