Court told of no rise in legal assisted suicide rate among poor or elderly

A US professor of medical ethics has told the High Court that research carried out by her and others has not shown a higher rate of assisted suicide among the elderly, disabled, mentally ill or poor in jurisdictions where assisted suicide is legal.

Prof Margaret Babst Battin, of the University of Utah, also said some research indicated that laws providing for assisted suicide did not lead to unlawful practices affecting vulnerable people but rather brought such practices into the open for regulation. In areas where assisted suicide was permitted, a range of conditions and safeguards were applied, she added.

She agreed yesterday there had been objections to her findings but did not believe any of those “hold adequate water”.

Because of medical advances and people living longer, many of us were now likely to be confronted by having to decide how we died, she also said. It was very important to have options at the end of life; statistics showed that even where assisted suicide was legal, the vast majority of terminally ill people did not die in this way.

Prof Battin was giving evidence via video link to the three-judge High Court in the continuing challenge by Marie Fleming (58), who is terminally ill with multiple sclerosis, to the constitutionality of the absolute ban on assisted suicide here.

Medical ethics

Ms Fleming wants orders allowing her be to lawfully assisted in taking her own life. She also argues that the DPP is required to outline the factors to be taken into account in deciding whether to prosecute cases of assisted suicide.

Prof Battin said she had studied the suicide issue for 30 years, while the debate on assisted suicide had been under way since about the mid-1980s.

The professor’s background field is philosophy, her speciality is medical ethics or bioethics and she has published papers on assisted suicide.

She outlined to Brian Murray SC, for Ms Fleming, conditions and safeguards which must be met before assisted suicide or physician-assisted death was permitted in Oregon.

These included the person’s diagnosis being confirmed by doctors, the person being told of feasible alternatives such as hospice care or pain control, the person reconfirming their wishes after a 15-day interval and a psychiatric evaluation if depression is suspected.

She had conducted research aimed at establishing if there were higher rates of assisted suicide among the elderly, poor or those less well educated, but there was no evidence that was the case, said Prof Battin.

She regarded as “backward” the assumption that legalising assisted suicide caused non-legal practices. She believed legislation instead brought such practices into the open, allowing them to be regulated and controlled more effectively.

Where assisted suicide was unlawful, sometimes patients suffering intractable pain were sedated for months, she said.

This involved people being kept in a state of lowered consciousness or being unconscious. The practice of terminal sedation usually involved nutrition or hydration being withheld and the person dying of starvation or dehydration.

In cross-examination, Michael Cush SC, for the State, told Prof Battin he was instructed that terminal sedation was not carried out in Ireland.

In response she asked:“Are you certain?

Mr Cush said these were his instructions.

Prof Battin agreed that many jurisdictions had rejected the introduction of assisted suicide.

She also agreed that some studies relied upon by her, to argue that there was no evidence to show vulnerable people were disproportionately adversely affected by an assisted suicide regime, had not examined the motivation of those involved. She rejected suggestions it was not possible to empirically evaluate whether there was coercion of persons to take their own lives.