Professionals who face death daily share their thoughts on the right to choose to die Sylvia Thompson speaks to four people with different erspectives on assisted suicide and euthanasia
The news of an Irishman who died in Switzerland last year with the assistance of a Swiss right-to-die organisation, and the death on Thursday last of American Terri Schiavo 13 days after her feeding tube was removed, has provoked the debate about assisted suicide and euthanasia.
The carer
Dr Regina McQuillan, medical director of St Francis Hospice and palliative medicine consultant at St Francis Hospice and Beaumont Hospital, Dublin
"We get very few requests for euthanasia or assisted suicide from patients. This might be partly because we are working in a country where both assisted suicide and euthanasia are illegal. That said, we sometimes have requests from patients' families that a patient's life be ended because the patient or family is suffering due to the imminence of death or they perceive the patient is suffering. I do think that people need to know that patients don't have to accept life-prolonging treatment.
I think most people who work in hospices and palliative care services are opposed to both euthanasia or physician-assisted suicide. Personally, I am opposed to both on a number of grounds. Principally, I think it would be impossible to regulate because if euthanasia and assisted suicide were legalised, it makes them permissible.
This would give rise to cases in which people feel their lives are worth living yet they also feel an unconscious pressure to have their life ended because they don't wish to be a burden on the State or on their families. Their choice of whether to live or to die then becomes compromised.
Similarly, if someone with a severe disability opts for euthanasia or assisted suicide, this might make other people with severe disabilities feel pressurised.
I think that, overall, both euthanasia and assisted suicide devalue the life of the terminally ill.
A survey of staff and volunteers in hospices in Britain found that the majority were opposed to euthanasia.
Another survey in the US found that rather than legalising assisted suicide or euthanasia, the answer is to provide better palliative care services to all.
Palliative care services can reduce the symptoms of illness in those who are dying but we can't remove all the suffering - some of this suffering is about dying and leaving people behind."
The psychologist
Ciarán Benson, professor of psychology, University College Dublin
"I have no objection in principle to the idea that there are circumstances in which an individual can legitimately, and with full dignity, choose the time at which they want to end their own life. What those circumstances are need very careful articulation of a kind beyond the scope possible here. For a brilliant cinematic treatment of these issues, and of the humanity involved, I would refer readers to Alejandro Aménabar's wonderful film The Sea Inside.
That said, I do have grave concerns about some of the possible knock-on social psychological effects of institutionally accommodating assisted suicide. Feelings of apparently insoluble hopelessness may be transitory. Impulsive suicidal acts (of the kind, one suspects, operating in some copycat suicides among young people) may have these passing states as their seed-bed. It takes time and life-experience to realise that the awful feelings of the present may pass into memory. Against the backdrop of such personal memories, the tendency to impulsive, irreversible, catastrophic solutions is more likely to be seen for what it is. My concerns would be about how to delineate the psychological boundaries between that small number of cases in which a person may legitimately, calmly and with dignity, choose the time and manner of their own life's ending, and that much larger number of cases where vulnerable people may misjudge the permanence of their present psychological suffering."
The religious
Canon Ben Neill, Anglican priest and rector of St Patrick's Church, Dalkey, Co Dublin
"Christians believe that God is the giver of life, therefore it is sacred. Every person has infinite value from God's perspective.
Human dignity is inherent because it is bestowed by God and is not dependent on physical or mental wellbeing. This is what gives ultimate meaning to our life and to our death.
It is always a tragedy when someone decides to take his or her own life. It is a tragedy for the individual, their family, friends and society.
But, we need to be very gentle and compassionate when dealing with these situations.
When we discuss the issue of assisted suicide, we must remember that we are talking about people who are very fragile, vulnerable and in great physical or mental pain. In many cases, we are also discussing relatives and medical professionals who are desperately seeking to do their best in complex situations. A simple black and white moral principle may be inadequate in such circumstances.
Sometimes we have to agonise and struggle to find the best way forward.
In my pastoral work, I came into contact with someone in great psychological pain who ultimately chose to end her life by assisted suicide. She had previously discussed ending her life by suicide and I tried to encourage her to continue with the expert medical care she was receiving, hoping that she would find healing and a way forward. One of her greatest concerns was whether the church would condemn her if she chose to end her own life. I still feel pain and sadness at the decision she took and I feel angry with those who assisted her in her suicide, but I leave the ultimate judgment to God.
Christians also believe there is a redemptive quality to suffering and that it can lead to a time of growth in people's lives. One could over state this, because suffering can also be very destructive, but we can sometimes learn things in suffering and sorrow that make us better people."
The support worker
Josephine Quinlan, counselling co-ordinator with Console, the Bereaved by Suicide Foundation
"We at Console bear witness to the devastation felt by family members and loved ones in the aftermath of a suicide. The act of suicide leaves a trail of emotional chaos behind. As the sucidologist Shneidman states 'the person who dies by suicide puts his/her psychological skeleton in the survivor's emotional closet'.
Similarly, assisted suicide will leave a deep loss and an overwhelming sense of grief for the survivors (bereaved). Whether the person chooses to die in Switzerland or Ireland, the aftermath is undoubtedly the same. People experience intense feelings of guilt, anger, sadness, loss, feelings of rejection and abandonment. Frequent questions such as 'Why' and 'If only I loved him/her more' arise. The uncontrollable thoughts and feelings often leave survivors wondering if they are going mad. Some survivors, in turn, experience suicidal feelings due to the enormity of their personal despair.
Furthermore, if a person chooses to go abroad to die by assisted suicide who does he/she confide in? Perhaps no one? Perhaps one or a number of loved ones? For some survivors they may feel a sense of relief and comfort that they respected their loved one's wishes, and were by their side as they departed this life.
Yet the possible added complexity of the grieving process for other survivors is a concern for us. What feelings or thoughts arise for these witnesses or confidants? Their loved one is now dead and is no longer present to comfort or abate their concerns or regrets.
Finally, the survivor must cope with the reactions, which can so often include blame and anger from other family members and friends. Yet throughout, they must struggle with their own emotions that arise following their loss."
The Console Helpline for those bereaved by suicide is 1800 201 890