A Dublin woman apparently killed herself with the help of others. But euthanasia is not the answer to treating people who are suffering from terminal illness or living under the cloud of depression, argues Patricia Casey.
The culture of death is surely lapping at our shores. The news yesterday that a woman enlisted the help of professional thanatologists to procure her death adds a new layer to the continuing, and fraught, debate about matters of life and death in which this State is engaged.
It should not surprise us that a case such as this has eventually happened here, as it flows from all the other evidence that life is increasingly becoming devalued while we struggle to understand child murders or the increase in violent crime or our high suicide rate and while we contemplate the perennial life and death question of abortion.
A society which does not believe in the inherent value of every life and which ascribes merit only on an arbitrary basis, dependent on individual preference, is hurtling down the slippery slope of moral relativism.
Those who hold that in some circumstances assisted suicide is preferred to a live of misery and disability forget that the desire for suicide, even among those with life-threatening illnesses, is inversely proportional to their level of depression.
A 1999 study in The Lancet by Chochinov et al from Canada clearly showed the association between depressed mood, pain and desire for death, and this has been replicated by numerous studies of those with terminal illness, demonstrating that when mood is improved by simple measures such as adequate pain relief the desire for death recedes.
Research by Professor Ciaran O'Boyle at the Royal College of Surgeons in Dublin points unequivocally to the danger of justifying euthanasia on the grounds of poor quality of life since the subject's own view of their life quality changes and adapts with the stage of the illness.
Projecting our perception of the merit of that life is not only perilous but is as likely to be driven by our own fear of seeing death and suffering as by genuine compassion.
Nor is there any protection in the claim that only those who wish it should be helped to die.
What if the person has brain damage? What if the individual is passive and feels a burden on the family, seeking death for that reason?
A paper published in 1999 in the Journal of Medical Ethics by Van Delden showed that 20 per cent of those whose lives were ended under the Dutch law on assisted suicide had not given explicit permission for this.
The assumption that doctors can be trusted not to play God with euthanasia is misplaced for a profession which exerts power over life and death on a daily basis.
Of course, the woman who allegedly received help in ending her life is said to have been unsuccessfully treated for depression.
Some may erroneously argue that, since treatment failed, there was no other option for her, and one source is quoted as describing her as irrational. Such simplistic descriptions fail to understand the rational irrationality of despair.
Low mood distorts everything around us - our view of ourselves, the world and the future.
The work of Kay Radfield Jamieson, herself a professor of psychiatry, struck down with manic depression and now an advocate for the aggressive treatment of this condition, is very illuminating.
Writing from personal experience, she very powerfully describes the hopelessness and blackness which pervades everything, the conviction that life is without meaning or purpose during the depressed phase and the transformation to light when treatment takes effect.
One patient recently described the feeling to me as "seeing no light at the end of the tunnel, not even seeing any tunnel".
This woman's death raises some basic questions for psychiatrists: was she being appropriately treated, was she complying with treatment, had a range of treatments been used, was a second opinion sought? Was she so stigmatised by her diagnosis that she opted out of treatment?
There is increasing criticism of psychiatrists for their use of medication to treat depressive illness - perhaps she was a casualty of that vehement anti-psychiatry polemic, or was she in truth one of those rare people who had pervasive and "malignant sadness" from which there was no retreat?
Since under-treatment and non-compliance are the two most common reasons for prolonged depression, these are vitally important questions. However, we are unlikely to know the answers.
If this tragedy is glamorised, or the manner of death idealised, we can assuredly face the prospect of our recently declining suicide rate spiralling upwards again.
Rather, it must be described for what it is - a tragedy for this woman's family, friends and the wider community and a marker of the global devaluation of life.
The bond between doctor and patient is special. It is based on trust, on respect and on the principle of healing and not destruction.
If the calls of those advocating legalisation of assisted suicide ever prevail, it will be a clear indicator that, as a culture, we are reneging on efforts to help the mentally ill, the infirm and the elderly.
We would be issuing a licence to exploit the fears of the depressed and the ill and our doctors would become executioners.
• Dr Patricia Casey is Professor of Psychiatry at the Mater Hospital/UCD