Draft guidelines on assisted suicide were published by the DPP in Britain last week, but there is no trend towards a similar move in Ireland, writes LORNA SIGGINS
PALLIATIVE care professionals say that assisted dying is “not on the agenda” in Ireland following the publication of draft guidelines on the issue in Britain and Northern Ireland last week.
There is “no appetite” for discussing the controversial issue here, according to representative groups. However, there is a hunger to debate end of life issues, the need for death with dignity, and the removal of regional imbalances in providing palliative care, they say.
The draft guidelines on assisted suicide were published by Britain’s Director of Public Prosecutions (DPP) Keir Starmer QC last week, and are effective immediately in England and Wales. Consultation guidelines have also been published in Northern Ireland.
Assisted suicide is currently a criminal offence, both here and in Britain, but the British DPP has discretion over whether it is in the public interest to prosecute. Multiple sclerosis sufferer Debbie Purdy took legal action and recently won a House of Lords appeal on clarification of assisted suicide in relation to the prosecution of relatives. She wished to know in advance if her husband would be prosecuted for assisting with her death.
A number of Britons – reported at over 100 – have travelled abroad to end their lives at the Dignitas clinic in Switzerland, and relatives who have supported them have done so at the risk of arrest.
Among recent Dignitas clients have been British conductor Edward Downes and his wife, Joan, aged 85 and 74 respectively. Downes had lost his sight and was losing his hearing, while his wife Joan, a former ballet dancer, had a terminal illness.
Rugby player Daniel James (23), who was paralysed from the chest down after dislocating his spine in a rugby match, also travelled with his mother to Switzerland.
“I can take you to rugby, I can get the videos in of your rugby, we could do a chart – list one thing to live for every day,” his mother had begged her son, relating this in her subsequent interview with police. Her son kept responding: “You don’t get it, do you. I don’t want to live.”
Last December, Starmer decided against prosecuting James’s parents and a family friend who had been involved in helping the sportsman to travel to Switzerland. In an explanation of his decision, he said that the judgment would form the basis of new guidelines, which would clarify – but would not necessarily change the law.
In an interview with the Guardianlast week, Starmer described how reading the police interview with James's mother "would make you weep". The guidelines are intended to provide some reassurance to compassionate relatives asked by their seriously-ill loved ones to help them end their life. Their implementation may mean that fewer people in this situation will travel abroad.
However, Dignitas-type clinics will still be illegal in Britain, and Starmer has said that the policy “does not in any way permit euthanasia”.
About 500 Irish people are estimated to die by suicide each year, and an estimated 11,000 casualty admissions to hospital relate to suicide attempts, but there is no evidence to date of a trend towards assisted dying, medical professionals say.
Earlier this year, the inquest into the death of Dublin woman Rosemary Toole Gilhooley, who died in what is believed to have been an assisted suicide in 2002, heard that two men from north America had travelled around the country with her in the days before she died.
Gilhooley’s body was found in a house she had rented for a few days in Dublin’s southside, and there were indications that she had taken her own life. The inquest last May heard that she had paid $2,500 (€1,700) to Rev George Exoo and his partner, Thomas McGurrin, both of whom were questioned by police in the US in October 2002 for allegedly assisting her suicide.
Exoo had confirmed that he and his partner were present in the house when Gilhooley died and left half an hour afterwards, but efforts to have him extradited failed in 2007. He declined an invitation by the Dublin City Coroner to attend the inquest.
Dr Regina McQuillan, consultant in palliative medicine and vice-president of the Irish Association of Palliative Consultants (IAPC), says that very few people who are nearing the end of their life in Ireland would discuss euthanasia or assisted suicide options.
“The main priority for people in Ireland is good quality health care, and that includes good quality end of life care,” McQuillan says. “Palliative care is helping people to be as comfortable as possible, and improving their quality of life for the time they have left.”
Irish Hospice Foundation (IHF) chief executive Eugene Murray echoes this view. The IHF philosophy is “neither to shorten nor to hasten end of life”, and its vision is that “no one should have to face death or bereavement without appropriate care and support”.
“Assisted dying, which is currently against the law in Ireland, is a complex issue that raises challenging ethical questions for society,” he says. “The IHF recognises that there is a range of different views across society. We also recognise that individuals and families can find themselves in very different personal situations.”
The IHF is currently hosting an end of life forum, involving workshops and public consultations across the State, and it has also submitted a response to the public consultation by the Law Reform (LRC) Commission on advanced care directives. The LRC published its report, Bioethics: Advanced Care Directives, dealing with this issue earlier this month.
A draft Bill drawn up by the LRC as part of the report is intended to give a legal framework to those who wish to plan their medical treatment, and also to healthcare professionals.
It will permit people to leave instructions, either written or verbal, outlining the treatment which they wish to receive in the event of an accident or incapacitating illness. It also allows for nomination of a representative to carry out their wishes,and permits people to refuse life-saving treatment on religious grounds.
Commenting on the publication on September 16th last, High Court judge Ms Justice Mary Laffoy said she hoped the legislation for advance care directives would be enacted “sooner rather than later”.
- The next IHF end of life forum takes place in Dundalk today, and there will also be a regional forum in Sligo on October 8th, Waterford on October 27th and Tullamore on October 28th. More details are available from the IHF or at www.endoflife.ie