Psychiatrists have come out strongly against a proposal to introduce assisted dying in Ireland, saying it is not compatible with good medical care and could place vulnerable patients at risk.
Euthanasia is unnecessary, can result in suffering and may lead to unintended consequences such as a further increase in demand, the College of Psychiatrists of Ireland has warned.
A dignified death, the goal of all end-of-life care, is possible with good palliative care, it argues in a newly-published position paper.
"Not only is euthanasia not necessary for a dignified death, but techniques used to bring about death can themselves result in considerable and protracted suffering," according to Dr Eric Kelleher, one of the authors of the paper.
A proposed new law on assisted dying, the Dying with Dignity Bill, has passed at second stage in the Dáil and is due to come before a special Oireachtas committee in the new year. CervicalCheck campaigner Vicky Phelan, who has a terminal cancer diagnosis, has said she wants to give evidence in support of it.
However, the psychiatrist says any introduction of physician-assisted suicide and euthanasia would represent a "radical change" from long-standing traditions in medical practice. Medical Council guidelines, for example, prohibit deliberate killing by doctors, the paper points out.
“We believe it will place vulnerable people at risk, and we believe that there will be unintended consequences, such as an increase in the numbers requesting euthanasia or assisted suicide,” it adds.
The college, which represents about 1,000 psychiatrists in practice, says where assisted dying is available, many requests stem not from intractable pain but from other causes such as depression, fear, loneliness and a wish not to burden carers.
Resources
“With adequate resources, including psychiatric care, psychological care, palliative medicine, pain services and social supports, good end-of-life care is possible,” Dr Kelleher says.
The intentions of patients towards induced death can often fluctuate over short periods, the paper points out.
Meanwhile, perceived pressures in favour of induced death can be “subtle” and cannot be excluded by testing the person’s mental capacity as is used in psychiatric practice.
“Once permitted in a jurisdiction, experience has shown that more and more people die from assisted dying,” according to co-author Dr Siobhan MacHale. “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.”
Doctors should not be coerced to act against their values in the provision of euthanasia or assisted suicide, according to the paper. It states: “The use of law to address complex ethical issues is problematic and can have unintended consequences.”
Dr MacHale says: “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.”
If you are affected by any issue in this article, Pieta House can be reached at 1800 247247, the Samaritans on 116123 (free) or by emailing jo@samaritans.ie, and Alone’s helpline aimed at supporting older people in the home is available at 0818 222 024
