By 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 as 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 [Parliament] 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 then 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 then 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.”
Editor’s note. This appeared on Mr. Schadenberg blog and is reposted with permission.