Euthanasia: Not so much a slippery slope as a push off a cliff

Ilora Finlay, one of Europe’s leading palliative care consultants and a cross-bench member of the House of Lords, believes that palliative care has come of age during this global pandemic.

Speaking at a recent Hope Ireland conference called End of Life Matters, she outlined how palliative care services have been working closely with other medical professionals, teaching them how to break bad news gently, or how to support a family where a young parent has died, leaving a child bereaved.

Covid-19 has given us an increased realisation that there is no certainty when it comes to predicting death.  A young, apparently healthy person can die very quickly. Someone can rally and recover whom doctors feared would not survive.

It is ironic that at a time when medicine has been forced to re-discover on a daily basis that it is difficult, if not impossible, to decide when anyone will die, that a euthanasia Bill is at committee stage.

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It is repeatedly said that euthanasia is only for unbearable pain but this is not the case

Baroness Finlay is deeply involved in hospice care right across the UK. She has been in the House of Lords for 20 years.

She has a message for Irish politicians. There is no safe way to introduce euthanasia. The British parliament has rejected bill after bill because they are not safe. It is impossible to protect the vulnerable and the numbers inevitably rise.

She presented what has happened in the Netherlands, Belgium (where under-reporting of up to 40 per cent has been acknowledged) Canada, and Oregon. In each case, numbers have climbed, despite the fact that in each jurisdiction, it was presented as being for rare cases only.

Worryingly, in 2020 being a burden on family, friends and caregivers was given as a reason for opting for euthanasia in over half of cases (53 per cent) in Oregon. In the Netherlands, euthanasia now accounts for 4.2 per cent of all deaths. A significant Dutch lobby wants euthanasia on the grounds of being tired of life. No wonder the vast majority of European countries refuse to legislate for it.

UN special rapporteur on the rights of persons with disabilities expressed concern about a proposed expansion of Canada's assisted dying laws

It is repeatedly said that euthanasia is only for unbearable pain but this is not the case. (Four palliative care doctors at the conference testified to advances in pain management, but unless doctors have specialist training, they do not always have the skills to take advantage of these.)

Prominent anti-suicide campaigner Elma Walsh spoke movingly of how she had feared the hospice stage for her son, Donal who died of cancer in 2013. Instead, it allowed him to live a normal teenage life and looked after his family and friends, too. She fears that legalising assisted suicide will normalise all suicide.

Conor Lynott, a twenty-four year old with a Masters in Library Science who has spastic diplegia cerebral palsy, also spoke at the Hope Ireland conference. He shares the worry of many people with disabilities that an assisted dying bill will remove the focus from helping people to live well and independently, and result in unfair and discriminatory allocation of medical resources.

Liz Carr, the English comedian and actor probably best known for playing Clarissa Mullery, the forensic examiner in Silent Witness, is also a disability activist. In a Guardian article, she says that the lines between being terminally ill and a person with a disability are easily blurred. People come up to her all the time saying how brave she is to go on living because they could not do so if they had her condition. (Carr has arthrogryposis multiplex congenita and is a wheelchair user.)

She believes that offering euthanasia or assisted suicide is motivated by misplaced pity. As she says, “Rather than telling us we have everything to live for – and we do – we are helped to the proverbial cliff edge and offered a push.” She also suggests that we “might try to get end-of-life care right before we throw physician-assisted killing into the mix”.

A recent Canadian case illustrates that Liz Carr and Conor Lynott's fears are justified – it is not so much a slippery slope as a push off a cliff. Roger Foley, who has cerebellar ataxia and needs significant levels of care, is suing the province of Ontario.

Foley alleges that he was given a choice between sub-standard care or of availing of Medical Assistance in Dying. Recently, a UN special rapporteur on the rights of persons with disabilities expressed concern about a proposed expansion of Canada’s assisted dying laws. It may pose a real risk “that those without adequate support networks of friends and family, in older age, living in poverty or who may be further marginalised by their racialised, indigenous, gender identity or other status, will be more vulnerable to being induced to access Medical Assistance in Dying”.

The usual answer to such concerns is an appeal to Irish exceptionalism. It will never happen here. It will be prevented by adequate regulation. The difference is that when it comes to euthanasia or assisted suicide, the inevitable failure of regulations to protect the vulnerable will result in tragic premature deaths which could have been prevented by investing in skilled, compassionate care instead.