Voluntary euthanasia should be available when requested by a patient, according to an editorial in the journal of the Irish College of General Practitioners. In his column, Dr Leonard Condren, medical editor of Forum, said that the "silence surrounding this issue should be shattered". Dr Condren, a Dublin GP, said euthanasia should be available when requested by a patient who has the mental capacity to understand the full significance of the request, at the time of making that request. "Voluntary euthanasia is the ultimate expression of patient autonomy," said the editorial.
Autonomy is the foundation stone of the doctor-patient relationship, he wrote. "Mutual respect and trust are the bricks and mortar. General practitioners recognise that the patient is the primary decision-maker with respect to their own health and medical care. We may listen and advise but, ultimately, the patient is in control of the decision.
"All our interventions are performed subject to the consent of the patient. It is striking that our acceptance of these fundamental principles begins to unravel if the patient expresses the wish to die."
The hospice movement, he said, has greatly enhanced understanding of care of the dying. However, palliative care specialists acknowledge that not every terminal illness can be rendered free of pain and suffering.
"There is a minority group of terminally ill patients who will continue to suffer without adequate relief.
"Should voluntary euthanasia be considered a valid choice for such individuals?"
Motor neurone disease provided an appropriate disease model to illustrate dilemma, he said. "Annie Lindsell is the human face of this disease. She recently won a High Court action in London which enables her to die with dignity, with the help of her doctor.
"Given our current state of knowledge there are no effective treatments available for this progressive neurological disorder. The patients is trapped within a body which gradually ceases to function. Conscious awareness of the inexorable deterioration is retained to the inevitable end."
Dr Condren said that faced with this "terrifying prospect" he would need to be convinced of a justification for keeping a human being alive, against their will, "when all the dignity, beauty and meaning of life has disappeared. Voluntary euthanasia ought to be a choice for such individuals".
But as the law currently stood individuals had no choice. Their wishes counted for nothing, said Dr Condren: their autonomy had been denied.
Advocating the case of voluntary euthanasia frequently elicited an angry response, he said. In order to protect himself from the charge of proposing a Nazi eugenic solution, Dr Condren said, he wanted to "clarify what I am not advocating".
"I am not proposing the involuntary euthanasia of any individual. It is arrogant to make assumptions about the quality of life of another human being and decide to terminate life.
"I do not advocate `putting down' handicapped babies, the mentally disabled, the elderly, the infirm or the unwanted in our society. Nor do I justify assisting people to commit suicide. Suicide ideation is a psychiatric emergency requiring appropriate treatment. I am suggesting that voluntary euthanasia be considered as a civil liberty."
He said there was no public clamour for euthanasia in the State, but this was not surprising since those who were likely to avail of it were not empowered to ask for it.
"The patient facing a diagnosis of terminal illness is unlikely to risk forfeiting the goodwill of the doctor by making such a request. Terminal illness is a uniquely lonely battle.
"The prevailing mood within this country is that voluntary euthanasia is not a subject for discussion between doctor and patients. It is a taboo subject."