Irish Psychiatrist issues warning as physically healthy Dutch and Canadian autistic women are approved for death by euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

As Ireland debates legalizing euthanasia, a leading psychiatrist issued a warning that the recent case of a physically healthy 28-year-old autistic woman in the Netherlands, and a healthy 27-year-old autistic woman in Canada who have been approved for euthanasia could also become a reality in Ireland if euthanasia is legalized.

Maria Maynes was published by RIPT on April 9, 2024 concerning the debate to legalize euthanasia in Ireland. Maynes interviewed Consultant psychiatrist, Professor Patricia Casey, a specialist in Adult Psychiatry. Maynes reportes:

recent cases unfolding worldwide involving physically healthy young people should provide evidence to Irish lawmakers that “the slippery slope exists,” as she expressed particular concern about those with autism choosing assisted suicide or euthanasia.

Last month, this publication also reported on the Canadian case of an unnamed 27-year-old woman, who was also autistic, and had chosen to die by physician assisted suicide. While the father of the unnamed woman tried to intervene through court action, arguing that she did not have the ability to consent to the death under Canada’s MAiD programme, his intervention was unsuccessful.

There have also been cases in Belgium, where Asperger’s (now subsumed under the autistic spectrum) is among the most common conditions for which Belgians seek euthanasia on mental health grounds, alongside personality disorders and depression.

Maynes quoted Casey as stating:

“There is a danger that when young, autistic people see a problem that they will look for what they see is a simple solution, or a trendy solution,” she said.

Casey also stated:

“I was struck by the photograph of 28-year-old Zoraya ter Beek in the Netherlands, who was pictured surreally embraced in the arms of her boyfriend while announcing that she was due to die on May 28th. This photograph conceals the turmoil and nihilism behind her decision and may well be used in the future to promote assisted dying as a calming answer to one’s problems.”

Professor Casey compares the issue to the romanticizing of suicide that was successfully countered by national campaigns. Professor Casey fears that the same type of romanticizing of death by euthanasia will also occur.

Professor Anne Doherty examined the issue of suicide rates in jurisdictions that have legalized euthanasia and assisted suicide. Professor Casey referred to her research and stated:

“Prof Doherty found that the rate of non-assisted suicide increased after assisted suicide was legalised, and I fear we will see exactly the same pattern. I also think it is very nihilistic to say to people, ‘There is no help. Why don’t you go for assisted suicide?’ I mean, it is such a dark thing to say to anybody. I think it should be absolutely taboo, but instead of that, it is now becoming glamorised.”

Professor also commented on the "bracket creep" in countries that have legalized euthanasia and stated:

“This is what has happened in a range of countries. The Netherlands, for instance, didn’t start with euthanasia for young people with mental illness. It legislated initially for those with terminal illness. Similarly in Canada and in Belgium. Now all of those countries are allowing assisted suicide for young people, or for people with mental illness – or a combination of both.”

As for the concern that people with Autism are more susceptible to requesting euthanasia, Casey stated:

“One of the reasons a young person with autism may be more susceptible is due to the fact that a lot of those with autism have unusual interests and hobbies. For example, some would have an interest in the afterlife, or the occult, or similar. We also know that some individuals who are on the autistic spectrum have very fixed beliefs about things, and so can be quite suggestible.”

“Once something has been suggested, the person can fixate on that. I think the interest in unusual things, something we often see in those with ASD, and some of the things that are outside the norm, along with their tendency to fixate on things, would make that person particularly vulnerable. For instance, people with rigid thinking, such as many of those with ASD, find it difficult to consider alternative solutions to problems. And this may render them more than willing to choose this particular pathway to death.”

Professor Casey also commented on the Social Contagion that is likely to happen with euthanasia:

“There will be a social contagion aspect, because as we know, teenagers and young adults are always online now. One person engaging in, or planning, an assisted suicide, will be in touch with others in their group and that contagion effect is very toxic.”

“We must not forget that suicide clusters existed in the recent past, because of social contagion. And it is difficult to escape that prospect in relation to assisted suicide, also.”

Ireland is currently debating the legalization of euthanasia. A recent parliamentary report was released which advocated that euthanasia be legalized for a person diagnosed with a disease, illness or medical condition that is both incurable and irreversible; advanced, progressive, and will likely cause death within six months (or within 12 months in the case of someone with a neuro-degenerative disease, illness or condition; and suffering in a manner that the person “cannot be relieved in a manner that the person finds tolerable.”

The Irish report obviously decided to push for the legalization of euthanasia in a fairly wide open manner.

For further reading, Gordon Friesen, the President of the Euthanasia Prevention Coalition issued a warning to Ireland in his article: If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

Warning to Ireland: If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

By Gordon Friesen
President, Euthanasia Prevention Coalition

Gordon Friesen

Through the years Alex Schadenberg has written many articles (and hosted many others) on the subject of euthanasia in the British cultural diaspora that are published on the EPC blog. By that term, I mean, above all, those countries such as Canada, Australia, and New Zealand whose populations are (or at least recently were) of majority British stock. Most lately Alex has written pieces on the Channel Islands, Scotland, and the UK itself.

Unfortunately this very significant cultural and political group appears to have fully embraced the notion of euthanasia. And because all of its members have a largely common social structure, they appear to be on track to do so in one particular fashion, for which Canada most unhappily provides us with the template.

One final example, Ireland, is found at the heart of British history, being itself one of the "British Isles", but having resolutely rejected British Imperialism all the way back to William the Conqueror! In recent memory, the Irish have literally fought their way out of the Empire, slammed the door on the Commonwealth.

Unfortunately, however, that independent streak is not reflected in their evolving policy on euthanasia.

Over the last half year, the Irish Houses of Parliament (The Oireachtas), have studied euthanasia in a Joint Committee on Assisted Dying. Readers of this blog will be familiar with the names Leonie Herx, Trudo Lemmens, and Heidi Janz, all of whom spoke before the Committee (October 17, 2023: Assisted dying in Canada), and also Mark Komrad (October 3, 2023: Assisted dying in the United States). I personally submitted a pamphlet-length criticism of euthanasia but sadly, these efforts have proved fruitless, as we may plainly see in the recently released Final Report of that body (March 2024).

Conclusions of the Irish Joint Committee on Assisted Dying

In all probability the Irish will soon authorize euthanasia for people "diagnosed with a disease, illness or medical condition... causing suffering to the person that cannot be relieved in a manner that the person finds tolerable".

There are, of course, other requirements, such as an expected death within six months (or 12 for certain conditions); of full mental capacity (including at the time of euthanasia); and of major age. However, as experience has clearly demonstrated in Canada, there can be no logical basis for confidence in any such secondary requirements:

From the moment that we first admit the principle of euthanasia, practised as a cure for suffering, ALL classes of suffering individuals can (and eventually will) gain access to euthanasia through the vehicle of fairness-based judicial litigation and legislative extensions to eliminate discrimination. It might take a year or a few years. But given the assumptions of our commonly shared British sense of Justice, that outcome is reasonably inevitable.

Public responsibility for medical care

Another common assumption throughout the British diaspora is that medical care is a collective responsibility. As a medical treatment, then, euthanasia will be available, as in Canada, throughout the entire medical industry. It will not be a simple liberty. It will be a claimable right (entitlement). And this status is made clear by the fact that (despite individual conscience protection) objecting physicians will be required to make referrals to "participating health care professionals" (and/or) "a national oversight body" to get the job done).

Similarly, again (because medical homicide is to be an entitled medical treatment), there is no doubt that we are talking about true euthanasia and not assisted suicide, since: 

"any potential legislation for assisted dying should provide a means of access to treatment for individuals who require assistance during the administration."

As I have noted in previous articles, it is these two elements (true medical euthanasia employed as a "cure" or "treatment" for suffering) and euthanasia provided as a publicly guaranteed entitlement (rather than a simple liberty), which explain the amazing ten times greater frequency which separates Canada from Oregon-style assisted suicide regimes. And it is therefore the Canadian group to which Ireland will apparently belong.

I must in fairness mention a number of well-intentioned safeguards and social justice measures included by the Irish legislators in their recommendations. These include: ratification of the "Optional Protocol to the United Nations Convention on the Rights of Persons with Disabilities" (UNCRPD); extensive capacity testing; measures to avoid coercion (without, however, recognizing the inevitably coercive effect of the entire projected regime); strict oversight; clinical separation of Palliative Care from assisted death; administrative separation of Palliative Care budgets; increased support of Palliative Care; information and counselling on alternatives to euthanasia, etc., etc....

However, pious assertions regarding care of the "least fortunate" and the "most vulnerable" can do little to change actual budgetary realities. And procedural safeguards (like the three member physician committees) tend to disappear like mist on a summer morning. Or to use a time-honoured Irish colloquialism: They are not worth a Tinker's damn!

Our Irish friends should, therefore, have no illusions: 

If euthanasia is legalized as a cure for suffering, then suffering people will be "cured" with euthanasia!

Indeed, "euthanasia" itself is but a misleading euphemism. The correct term is "medical homicide". And the plainest description is thus:

Suffering people will be killed.

Despite justified criticism, those of us who trace our roots to the British tradition may be rightfully proud of many positive political and social principles diffused around the globe.

Unfortunately, medical euthanasia is not one of them.

Gordon Friesen, April 7, 2024

Irish doctors oppose assisted suicide

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I was fortunate to have the opportunity to speak at the HOPE Ireland conference on Saturday, November 11, 2023. Ireland is currently debating the legalization of assisted suicide.

The Royal College of Physicians of Ireland (RCPI) recently explained their opposition to legalising assisted suicide in a presentation to the Oireachtas Committee on Assisted Dying.

The RCPI is Ireland’s largest post-graduate medical training body and a professional body for medical doctors with over 11,000 Members and Fellows across 29 different medical specialities in over 90 countries. 

The RCPI told the Oireachtas Committee that:

RCPI opposes the introduction of legislation for assisted suicide because it is contrary to best medical practice. Our view is that the potential harms outweigh the arguments in favour of legislation for assisted suicide.

The RCPI explained how legalizing euthanasia and assisted suicide have impacted other jurisdictions:

The impact of legislation for assisted suicide in countries where this has been enacted is now captured in an evolving body of evidence that can inform this committee’s work. I would like to mention the following:

Recent analysis of data from Netherlands, Belgium and Colombia confirms a progressive broadening of the limits initially established by the law for the practice of assisted death in these three countries. 

• There has been extension of age groups, to new-born infants in the Netherlands and to children over 12 in the Netherlands and children of any age in Belgium.
• A report published this week analysing the Oregon Death with Dignity Act confirms that eligibility criteria have expanded since the act was instated, with a 15-day waiting period requirement waived and patients receiving assisted suicide now including those with non-terminal illnesses such arthritis, arteritis, complications from a fall, hernia, sclerosis, ‘stenosis’ and anorexia nervosa.
• In Switzerland, assisted suicide is a legal option even for patients without suffering from a life-limiting disease, unbearable suffering and insufficient treatment options are the only criteria” A review published this month found that in Switzerland, from 2014-2018 the key criteria of “end of life is near” was only met in 43.6% of cases.
• In some jurisdictions, access to assistance to end one’s life has extended to those with psychiatric illnesses. Studies documenting experiences in the Netherlands cites many challenges in assessing irremediable psychiatric suffering. Despite this, 115 cases were recorded in there in 2021.
• Of 53 euthanasia case summaries published by the Dutch Regional Euthanasia Review Committees under the category Multiple Geriatrics Syndromes (example of which are visual impairment, hearing loss, pain, chronic tiredness), none suffered from life-threatening conditions – rather it was a “complex physical, psychological, and existential suffering that changes over time.”

The RCPI presentation refers to the recent report from Denmark's National Ethics Council which voted to oppose assisted suicide:

The risk of harm was considered by Denmark’s National Ethics Council. Earlier this month the Council rejected legalising Euthanasia. 16 of the 17 Council members emphasised that the presence of an offer of euthanasia risks decisively changing ideas about old age, the coming of death, quality of life. Once euthanasia becomes an option, they said, the risk that it will affect the view of certain groups in society is too great.

The RCPI responded to the concern around suffering:

There is much discussion around assisted suicide as a relief from intolerable pain. However other concerns appear to underly requests for assisted suicide. Oregon data for 2022 says that (as in previous years), the three most frequently reported end-of-life concerns were decreasing ability to participate in activities that made life enjoyable (89%), loss of autonomy (86%), and loss of dignity (62%), with inadequate pain control listed only 6th.

The RCPI concluded their presentation with the concern that safeguards fail:

One of our concerns is that any legislation cannot adequately safeguard vulnerable members of society. This is borne out in the Oregon data – there was a notable increase in the number of people citing being a burden on family and friends as among the reasons for requesting assisted suicide - from 30% in the first 5 years to around half since 2017. There was also an increase in the number of people citing financial concerns among the reasons.

A 2023 systematic review looking at assisted suicide among people with dementia has also noted that the wish for euthanasia/assisted suicide arises in situations of burdensome care and fear of future deterioration.”

More articles on this topic:

• Denmark's Ethics Council rejects legalising euthanasia (Link).
• Oregon's assisted suicide law - significant data gaps (Link).

Euthanasia: impossible to police once legal

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

Professor Theo Boer

The Irish Law Society Gazette published an article on September 26, 2023 reporting on the presentation by Professor Theo Boer to the [Irish government] Oireachtas Committee on Assisted Dying.

Dr. Boer, who is from the Netherlands, supported the Netherlands euthanasia law in the past. However, after being a euthanasia case reviewer for 9 years (2005 - 2014) he has come to the conclusion that it is impossible to police the euthanasia law. 

Boer told the Committee:

Loneliness and meaningless are constituent reasons for asking for euthanasia.

Boer gave an example of how the law could not be upheld:

He cited a Dutch case where there was a question over the legitimacy of a signature requesting euthanasia, and from which an ethics committee had to step back, because it did not hold criminal investigatory powers.

“When the doctor was asked ‘are you sure that this signature is the signature of the patient’, the doctor said ‘I was told that it was’.

“So, in the end, we backed off,” Prof Boer said.

Boer commented on the "silent pressure" of euthanasia:

“Once you have a law … it is absolutely impossible to put a police officer in every hospital room or in every bedroom … and look [for] some silent pressure,”

“That is impossible, because that will infringe very much on the privacy of their patient-doctor relationship so there is no solution,”

'Assisted dying' and how it changes society:

‘Assisted dying’ is an umbrella term for two different things that reside under one law in the Netherlands – euthanasia by which the physician uses an infusion or injection to end a patient's life at their request, and secondly a physician-assisted suicide where a medic hands a patient a deadly poison to end their own life, he explained.

In 97 out of 100 assisted deaths in the Netherlands, up from 90 out of 100 in 2002, euthanasia is preferred over assisted suicide with the number strongly rising, he said.

Euthanasia has “sky-rocketed” in the Netherlands, he said.

“The legalisation of euthanasia has done much more than just providing some citizens the liberty to take a way out,” he said.

It has created death as a remedy against "unbearable suffering", he said, and moved society from the presumption of "not killing".

Boer's criticism of euthanasia is based on what he has seen happen: euthanasia has quadrupled in twenty years and in some regions of the Netherlands, 15% - 20% of the people are dying by euthanasia.

The numbers and reasons for euthanasia have expanded in the Netherlands:

“We see a shift to patients who fear years or decades of loneliness, alienation and care dependency,” he said.

In the Netherlands, as in other countries that have legalised assisted dying, this expansion is motivated by a “logic of justice”, he said.

The option of euthanasia expands from terminal cancer patients, to those with chronic illnesses, to anyone suffering from an illness, to non-medical suffering, to legalisation for anyone over the age of 75.

Parents can now request euthanasia for their young children he said. And teens over 16 may opt for euthanasia, simply by informing their parents, but without asking their consent.

The legalisation of euthanasia has altered the whole landscape of dying including the societal view of illness, suffering, ageing, and care dependency,

Psychiatric euthanasia, the grey areas in the law, and legalized euthanasia have not resulted in fewer violent suicides:

A Dutch voluntary society runs an end-of-life clinic that will perform euthanasia without any prior patient-doctor relationship, he said, particularly in psychiatric cases.

There is also a ‘grey zone’ sub section where physicians would describe their own actions as termination of life but do not report it, which accounts for 1500 cases yearly.

Societal pressure, because of positive media reporting about euthanasia, also drives the figures up, he said.

“It is what I call internalised pressure,” the academic said, because the existence of legalised euthanasia impacts those who don't want to feel they are a burden on family or society.

Legalised euthanasia has also not lowered violent suicide rates, which have in fact soared by 35%, he said, far higher than in neighbouring Germany which does not permit euthanasia.

Links to previous articles from Professor Theo Boer:

• Let's not romanticise the Dutch euthanasia experiment (Link).
• Be careful what you wish for when you legalize active killing (Link).
• Legalizing assisted dying can actually increase suicides (Link).
• Rushing toward death: Euthanasia in the Netherlands (Link).
• Dutch ethicist, "Assisted suicide: Don't go there" (Link).

Ireland is establishing a committee to examine euthanasia.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

In July 2021, an Irish euthanasia bill passed in the Irish Dáil ant then stopped by the Oireachtas Committee on Justice based on the language of the bill. The bill was sponsored by People before Profit TD Gino Kenny.

The Journal reported on July 15 that a special Oireachtas Committee will likely begin in October to examine the issue of euthanasia.

The Journal reported that:

The Oireachtas Justice Committee recommended the formation of a special committee on the issue earlier this year, after finding that the proposed legislation had “serious technical issues” and warranted more detailed examination.

The Euthanasia Prevention Coalition urges the Oireachtas Justice Committee to analyze the Canadian experience and then reject euthanasia. Legalizing euthanasia abandons people to death at a vulnerable time of their life.

College of Psychiatrists of Ireland oppose assisted dying.

Press Statement: College of Psychiatrists of Ireland warns against introduction of assisted dying legislation in Ireland - December 20, 2021

(Link to the Press Statement)

The College of Psychiatrists of Ireland (College of Psychiatrists) has warned that physician-assisted suicide and euthanasia (PAS-E) is not compatible with good medical care and that its introduction in Ireland could place vulnerable patients at risk.

PAS-E is also known as “assisted dying” and in the New Year the issue will be the focus of a Special Oireachtas Committee set up to examine the Dying with Dignity Bill (2020).

The College of Psychiatrists is the professional and training body for psychiatrists in Ireland and represents 1,000 professional psychiatrists (both specialists and trainees) across the country. It has today published a position paper on this issue [see editors’ note below] which sets out some key issues regarding the introduction of assisted dying in Ireland. These include:

• Assisted dying is contrary to the efforts of psychiatrists, other mental health staff and the public to prevent deaths by suicide. 
• It is likely to place vulnerable people at risk – many requests for assisted dying stem from issues such as fear of being a burden or fear of death rather than from intractable pain. Improvements in existing services should be deployed to manage these issues.
• While often introduced for patients with terminal illness, once introduced assisted dying is likely to be applied more broadly to other groups, such that the numbers undertaking the procedure grow considerably above expectations; 
• The introduction of assisted dying represents a radical change in Irish law and a long-standing tradition of medical practice, as exemplified in the prohibition of deliberate killing in the Irish Medical Council ethics guidelines;
  

Consultant Liaison Psychiatrist Dr Eric Kelleher is a member of the College of Psychiatrists and contributing author to the position paper on assisted dying.

Speaking today, he said: “We are acutely aware of the sensitivity of this subject, and understand and support the fact that dying with dignity is the goal of all end-of-life care. Strengthening our palliative care and social support networks makes this possible. Not only is assisted dying or euthanasia not necessary for a dignified death, but techniques used to bring about death can themselves result in considerable and protracted suffering”.

“Where assisted dying is available, many requests stem, not from intractable pain, but from such causes as fear, depression, loneliness, and the wish not to burden carers. With adequate resources, including psychiatric care, psychological care, palliative medicine, pain services, and social supports, good end-of-life care is possible,” he said.

Dr Siobhan MacHale, Consultant Liaison Psychiatrist, a member of the College of Psychiatrists and contributing author to the position paper on assisted dying, said: “Once permitted in a jurisdiction, experience has shown that more and more people die from assisted dying. This is usually the result of progressively broadening criteria through legal challenges because, if a right to assisted dying is conceded, there is no logical reason to restrict this to those with a terminal illness.”

She continued: “Both sides of this debate support the goal of dying with dignity, but neither the proposed legislation nor the status quo (as evidenced by both clinical experience and the power of this debate) is sufficient. It is imperative for the Irish people to continue to demonstrate leadership as a liberal and compassionate society in working together to achieve this.”

The College of Psychiatrists of Ireland’s position paper on physician-assisted suicide and euthanasia is available to view in full here.

Issued on behalf of the College of Psychiatrists of Ireland by Gordon MRM
Julian Fleming
Ph: 087 6915147
julian@gordonmrm.ie
Karen McCourt, CPsychI Communications Officer
kmccourt@irishpsychiatry.ie

Great news: Dying with Dignity Bill is dead in Ireland

A message from Hope Ireland

We are very pleased to inform you, our supporters, that the Oireachtas Committee on Justice has refused to progress the Dying with Dignity Bill any further, and recommended a special parliamentary committee examine the whole area of "Assisted Dying". This is now the second time that the DWD Bill has failed to progress to completion through the Dáil - first in 2015, and now again in 2021.

This is a significant victory. It means euthanasia/assisted suicide proponents will be back to square one - and their path is less clear now: they could either reintroduce a "narrower" version of the Bill, or else wait for the Government to set up a special committee to examine the issue. We welcome the Joint Committee on Justice report.

It is interesting to note that the Justice Committee already produced a report on the whole issue of "Assisted Dying" in 2018 - and concluded that it was "not in a position to recommend legislative change at this time."

The DWD Bill 2020 passed Second Stage last October, and since then the Justice Committee had been engaged in "pre-legislative scrutiny" on the Bill, in order to determine whether it should proceed to committee stage. Today's report is clear that the Bill will not be progressing any further.

We have attached the Committee's report on the Bill (here) - it is well worth reading to get a flavour of what were the main arguments in the submissions on both sides of the debate. The report is helpfully divided into legal/personal/medical/religious submissions etc.

Many thanks for all the support over the past number of months. There is so much more I could say, but for now, take a moment to be thankful - we have a victory!

For those who are writing about this victory, the following are helpful points to note:

• A majority of individual medical submissions were against the Bill. Nearly all medical stakeholders were against the Bill.

• The report noted that: "A point that was repeated frequently throughout submissions in all categories was concern that this Bill could result in abuse of the sick and vulnerable, who may perceive themselves to be a burden on their family and feel pressured into opting for assisted dying."

• The report noted that: "In some submissions, elderly people expressed their personal dismay, as they felt that after working hard all of their lives, the prospect of this Bill being passed made them feel as if society was demonstrating that they were of little value"

• Irish Human Rights & Equality Commission criticised the lack of "safeguards" in the Bill (here).

• Over 2500 healthcare professionals signed public letter rejecting the Bill (here).

• Experts in palliative medicine strongly criticised the Bill in principle and in practice (here).

• Disability rights advocates strongly criticised the Bill in the Irish Times (Conor Lynott here and Kathleen Rogers here).

• Euthanasia laws are not safe for people who are at a vulnerable time in their lives.

Again, thank you so much for your support over the past year, and we will keep you updated as developments progress. But for now, take a moment to be thankful - and please use our victory today to help generate a bit of momentum, especially in the UK.

Hope Ireland
Promoting positive care pathways at the end of life

hopeireland.org
www.twitter.com/hopeire1

www.facebook.com/hopeirl/

Does Ireland really want or need euthanasia?

The following letter by Dr Will Johnston was published by the Irish Times on July 5, 2021.

Dr Will Johnston

Sir, – Contrary to the assertion by Alan Tuffery (Letters, June 28th) that expanding the grounds of euthanasia “has always been as a result of public discussion and legislative scrutiny”, as Canadian physicians we are sorry to report this has not been the experience here.

A review of the first five years of our euthanasia laws here was promised by the government. Before it had even begun, earlier this year we expanded our euthanasia legislation targets to include those suffering from mental illness alone. There was precious little meaningful public debate surrounding this significant legislative change, with the voices of the marginalised communities most affected by the new law being ignored.

For example, the most recent expansion of euthanasia eligibility was condemned by the Council of Canadians with Disabilities, yet its concerns had no weight with the ideologues running this issue. The United Nations Special Rapporteur on the Rights of Persons with Disabilities was unequivocal regarding her concerns about the consequences of the Bill. In her testimony to our parliament she said that “even if safeguards would be strengthened to ensure genuine consent, the damage is still done by portraying – not directly but effectively nonetheless – that the lives of persons with disabilities are somehow worth less than others”.

The grass may always appear greener, but it is best to face reality. The “stringent safeguards” once promised for Canadian euthanasia are an empty ritual. Euthanasia numbers bound upwards, 34 per cent higher in 2020 than in 2019. The system is not reliably engaged in suicide prevention. You have an illness – soon a purely mental illness, you want to die, whatever coercion there might be is not perceived, a doctor is found to end your life.

Does Ireland really want or need this? 

Dr Will Johnston
Vancouver Canada

Irish psychiatrists comment on the Irish euthanasia bill and mental illness.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

A letter published on June 22, 2021 in the Irish Times concerns the issue of euthanasia for people with mental illness. 

The authors of the letter are leaders with the Faculty of Liaison Psychiatry, College of Psychiatrists of Ireland. They acknowledge that the Irish euthanasia bill does not permit euthanasia for people with mental illness alone, but based on the Canadian experience they suggest that this would likely be considered in the future. The letter states:

Although those with mental illness alone were initially excluded from accessing physician assisted suicide and euthanasia in 2016, it was subsequently argued that this was discriminatory. Canadian legislators must now determine criteria for those with mental illness, and which suicides are to be assisted and which are to be prevented.

We acknowledge that this is not what the current Dying with Dignity Bill is proposing. However, it does demonstrate how quickly safeguards can be removed and whether legislation can truly protect the most vulnerable. As psychiatrists, we find this deeply concerning.

Mental illness, primarily depression, is common in those with chronic illness and cancer. Certain mental disorders, such as psychotic illnesses and health anxiety, can lead to abnormal beliefs about one’s health or longevity. Feeling suicidal forms part of the diagnostic criteria for borderline personality disorder. If those with such disorders develop a terminal illness as set out in the Bill, they may be especially vulnerable to dying from assisted suicide or euthanasia as a consequence of their mental state.

There is a clear need to invest now in our health service and mental health services to provide timely access to excellent multidisciplinary palliative care, pain services and mental healthcare, so that all patients facing a terminal illness can live and die in dignity. – Yours, etc,

Dr ERIC KELLEHER,
(Vice-Chairman),

Prof ANNE DOHERTY,
(Chairwoman),

Faculty of Liaison Psychiatry, College of Psychiatrists of Ireland, Dublin 2. 

Further information on the Irish euthanasia bill

• Irish "Death with Dignity" bill legalizes euthanasia for people who are not terminally ill (Link). 
• Irish euthanasia bill to be debated (Link).
  

Let's not romanticise the Dutch euthanasia experiment.

Theo Boer responds in the Irish Times to a letter from Corry de Jongh.

Professor Theo Boer

Sir, – I agree with Corry de Jongh that euthanasia is well-monitored in the Netherlands. In 1972 my own (Protestant) church was the first worldwide to support it. However, with hindsight, many regret supporting the law, including me. Since 2006, the numbers have increased incessantly. Last year 7,000 people received euthanasia, and in some neighbourhoods one in every five deaths is preceded by euthanasia. Is this the “last resort” we once advocated?

Given the excellent quality of palliative care in the Netherlands, there is only one explanation: supply creates demand.

Right-to-die societies have successfully made us believe that euthanasia is the most, if not only, dignified death. Let’s not romanticise the Dutch experiment. – Yours, etc,

THEO BOER,
(Professor of healthcare ethics, former member of a euthanasia review committee),
Groningen, The Netherlands.

Irish "Dying with Dignity" Bill legalizes euthanasia for people who are not terminally ill.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Irish Dying with Dignity Bill (Bill 24 of 2020) bill is an example of how imprecise language enables a wider interpretation of a law. Bill 24 uses imprecise language making it appear to legalize assisted suicide for terminally ill people, but in fact the bill also legalizes euthanasia for people who are not terminally ill.

Euthanasia is when one person (usually a physician) directly and intentionally causes the death of another person, usually by lethal injection. Euthanasia is a form of homicide. Assisted suicide is when one person (usually a physician) provides the means (usually by prescription) to another person to assist them in their suicide.

The bill appears to limit the act to terminally ill people, but the definition of terminal illness is imprecise. Bill 24 defines a terminally ill person in this way:

has been diagnosed by a registered medical practitioner as having an incurable and progressive illness which cannot be reversed by treatment, and the person is likely to die as a result of that illness or complications relating thereto (“a terminal illness”)

There are many people with an incurable and progressive illness which cannot be reversed by treatment, such as many people with disabilities, but they are not terminally ill. 

The bill permits both euthanasia and assisted suicide.

Under the heading "Assistance in dying" the bill permits death by lethal prescription, ingested orally or administered by the attending medical practitioner.

When an act is administered by the attending medical practitioner, the act becomes euthanasia. Adminstration is usually done by lethal injection.

There are many problems with the Irish "Dying with Dignity" bill but the primary problem is that it gives medical practitioners the right in law to kill their patients. No amount of safeguards can ever protect people from a medical practitioner who is convinced that a person is better off dead, when the law allows them to kill.

Irish euthanasia bill to be debated.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

The Irish euthanasia bill, that is sponsored by People Before Profit TD Gino Kenny, passed in a second vote in the Dáil by a 81 to 71 vote after the governing party failed to send the bill to a special Oireachtas committee to consider the legislation and report back within 12 months.

On September 29 I published an article assessing the Irish euthanasia bill where I stated:

The Irish "Dying with dignity" euthanasia bill is short but it is crafted to protect medical practitioners who are willing to kill. It is important to note that the Irish bill legalizes both euthanasia (lethal injection) and assisted suicide.

I also stated that the bill falsely claims to be limited to terminally ill people.

The bill claims to be limited to terminally ill people, but the definition of terminal illness: "having an incurable and progressive illness which cannot be reversed by treatment, and the person is likely to die as a result of that illness or complications" does not include a time-frame for death and uses the term likely to cause death.

Therefore the bill is not limited to terminally ill people but rather people with chronic or terminal conditions. There are many people who are not terminally ill but are defined as terminally ill by this bill.

The Irish Central reported that TD Kenny, the sponsor of the bill, said he is hopeful that a report will be put to the Oireachtas early next spring to be legislated for, "or possibly even a referendum."

Irish assisted dying bill is not limited to terminally ill people.

Alex Schadenberg
Executive Director, Euthanasia Prevention Coalition

I recently assessed the Tasmania bill which allows wide-open euthanasia. The Tasmania bill is a massive 122 page spider web of text that appears to have comprehensive safeguards but is actually designed to protect medical practitioners who choose to kill rather than protecting vulnerable people.

The Irish "Dying with dignity" euthanasia bill is short but it also crafted to protect medical practitioners who are willing to kill. It is important to note that the Irish bill legalizes both euthanasia (lethal injection) and assisted suicide. 

The bill first outlines the penalties that medical practitioners could face if they abuse the law, but when reading the law, it appears impossible to charge someone for abusing the law.

Definitions:

Qualifying persons

7. For the purposes of this Act, a person is a qualifying person if he or she—

(a) is terminally ill,

(b) has a clear and settled intention to end his or her own life and has made adeclaration to that effect in accordance with section 9, and

(c) on the day the declaration is made—

    (i) the individual is aged 18 or over, and

    (ii) is a resident on the island of Ireland and has been for not less than one year.

Terminally ill

8. For the purposes of this Act, a person is terminally ill if that person—

(a) has been diagnosed by a registered medical practitioner as having an incurable and progressive illness which cannot be reversed by treatment, and the person is likely to die as a result of that illness or complications relating there to (“a terminal illness”), and

(b) treatment which only relieves the symptoms of an inevitably progressive condition temporarily is not to be regarded for the purposes of paragraph (a) as treatment which can reverse that condition.

The bill claims to be limited to terminally ill people, but the definition of terminal illness: "having an incurable and progressive illness which cannot be reversed by treatment, and the person is likely to die as a result of that illness or complications" does not include a time-frame for death and uses the term likely to cause death.

Therefore the bill is not limited to terminally ill people but rather people with chronic or terminal conditions. There are many people who are not terminally ill but are defined as terminally ill by this bill.

The bill permits death by lethal injection (euthanasia) and death by (self-administering) assisted suicide. Canada legalized euthanasia and assisted suicide but nearly all of the deaths are done by euthanasia. Within four years already two percent of all Canadian deaths are assisted. The promoters of the bill may compare Ireland to Oregon, where assisted suicide but not euthanasia is legal. When euthanasia is also legal the number of deaths will be much higher.

The bill requires the attending physician to be present at the time of administering the lethal drugs. The bill does not require an independent person to be present at the time of administering lethal drugs to ensure that the law is followed.

Similar to other jurisdictions, the Irish bill requires the attending physician to report the death to the "Review Committee." The law uses a "self-reporting" system which is designed to protect medical professionals who are willing to kill. Medical professionals will not self-report possible abuse of the law.

Conscience protection.

The bill does not require medical practitioners object to killing to participate but it does require a "transfer of care."

The Irish "Dying with dignity" euthanasia bill claims to limit euthanasia and assisted suicide to terminally ill people, but in fact it redefines terminal illness to include people with chronic conditions. Many people with chronic conditions are not dying but are defined as terminally ill within the bill.

The bill is designed to provide legal protection for medical practitioners who are willing to kill. The bill starts with legal penalties for abusing the law, but there is no effective mechanism to determine that the law has been abused. The only way to uncover abuse of the law is through the reporting system, but the law employs a self-reporting system which completely protects the doctors who participate in the law.

Ireland must reject the "Dying with Dignity" euthanasia bill and commit to caring and not killing.