Right to live, right to die?

Few people can lack sympathy for Diane and Brian Pretty, the couple who sought the support of the High Court in London for their…

Few people can lack sympathy for Diane and Brian Pretty, the couple who sought the support of the High Court in London for their bid to allow Diane take her own life. She suffers from motor neurone disease, is paralysed from the neck down and unable to speak, and wanted a guarantee that her husband would not be prosecuted if he helped her to commit suicide.

Whatever one's view of Diane Pretty's response to her condition, it was clear that her husband was motivated by his desire to fulfil her wishes.

The couple were appealing against the refusal of the Director of Public Prosecutions to state that Brian Pretty would not be prosecuted if he helped his wife. In Britain, as in this State, committing suicide is no longer a crime, but assisting a person to commit suicide is. It is punishable by a jail sentence of up to 14 years in the UK and under the Criminal Law (Suicide) Act of 1993, a similar jail term could be applied here.

Diane Pretty claimed, among other things, that she was being discriminated against because of her disability, as she could not commit suicide unaided.

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The High Court refused the couple's request, pointing out it would effectively be a carte blanche to any lay person helping another to die.

It is highly likely that our courts would give the same judgment if the issue arose here. Assisting another to commit suicide is a crime and the Director of Public Prosecutions cannot unilaterally decide not to prosecute certain classes of crimes if they have been designated as crimes by statute.

This is not to say that discretion cannot be exercised in individual cases.

When the Director of Public Prosecutions receives a file from the Garda, he takes a number of things into consideration in his decision on whether or not to prosecute. Obviously, the weight of the evidence and the likelihood of getting a conviction is a major one.

But "public policy" is also taken into account when deciding to mount a prosecution. It may be contrary to public policy to prosecute someone who committed a crime if public opinion considers it inappropriate for someone who had already suffered greatly.

Imagine the following scenario: a person has a terminal illness which means that he or she is in great pain, has no quality of life and no prospect of any improvement, and is daily bombarding the person closest to him or her with requests for help to die. The spouse or partner is so distraught as to be almost demented with stress and grief, and feels there is no way out but to give the person an extra dose of the prescribed sleeping pills or pain-killers. The person dies peacefully, some months before death would have occurred without assistance.

If these circumstances were brought to the attention of the Garda, it might well investigate and send the file to the Director of Public Prosecutions. But, as well as examining the evidence, the DPP would have to consider what purpose would be served by prosecuting a bereaved relative who was already trying to come to terms with their loss and recover from the stress of caring for someone who had been terminally ill.

The situation is somewhat easier for doctors dealing with the terminally ill. It is established practice that, when dealing with such patients, they operate the "double effect" principle. This means that they can prescribe pain-killers to relieve pain, even in amounts which can shorten the person's life, as the primary purpose of the medication is pain-relief.

However, the situation is different for those who are profoundly ill and severely incapacitated, and who are not going to get better - but are not in any pain. They may be extremely distressed, and clearly want to die. While they can refuse medical treatment, nothing else can be done for them within the law.

Where someone is so severely incapacitated as to have no cognitive life whatsoever, and is being kept alive only with artificial feeding and medication, they clearly cannot make a decision on whether or not to accept medical treatment and must rely on close family members to make decisions for them.

This was the situation that confronted the woman who made Irish legal history in the "Ward of Court Right to Die" case six years ago.

She was in a near Permanent Vegetative State for 23 years, after falling into a coma during a minor operation at the age of 22. People in this state (PVS) can breathe and digest food, but cannot see, hear, taste, smell or communicate in any way.

Her family applied to have her artificial feeding and medication terminated in order to allow her to die naturally. In the High Court, Justice Lynch found that the individual's right to privacy had to be combined with the right to life, and that this might encompass, in certain circumstances, the right to die.

The Supreme Court upheld this decision. The Chief Justice at the time, Justice Hamilton, said that the treatment of the woman, involving the implantation of a tube in her abdomen to provide nourishment, was intrusive and was an interference with her bodily integrity. Without this, she would die, and in this regard must be regarded as terminally ill. However, he ruled out as illegal any course of action aimed at terminating life.

Despite the length and complexity of this judgment, the state of the law on this issue is still confusing.

The court made a distinction between voluntary euthanasia and allowing nature to take its course without active medical intervention (which includes allowing a person starve him or herself to death).

But many issues were left unresolved. There is no guidance for the relative in a situation like that of Brian and Diane Pretty. There is none for medical professionals, where the wishes of the person concerned are unknown. Furthermore, the distinction between terminal and chronic illness seemed to be blurred.

As in all such difficult human dilemmas, the courts may have to decide again on the individual facts of the case, and there would be no guarantee that a man in Brian Pretty's position would not face prosecution in this State.