Dr. Thomas Finegan:

I thank Deputy Kenny for his comments. He spoke articulately about the reasons for his particular proposal. He mentioned paternalism and the idea that, unless people can walk in someone’s shoes, people cannot see what he or she is going through. He also spoke about the ideas that euthanasia access was a fundamental right and that the life belongs to the person in question and no one else. All of these points count as the core of the rationale for euthanasia access, but each of them can be turned against the Deputy’s proposed restriction of euthanasia to cases of terminal illness. It fails to see that others have a fundamental right, that their lives are their own, that we have not walked in their shoes and that we are being paternalistic. When we see what the rationale means in principle and where it is oriented to go as a matter of reason, it becomes much less attractive than we might initially think and much more problematic in terms of respecting key goods that we take for granted in healthcare.

It was mentioned that Oregon was a good model. A good paper forthcoming in the BMJ Supportive and Palliative Carejournal has analysed 25 years of the Oregon Death with Dignity Act. One of the matters it highlights is that all reporting from Oregon is self-reporting, which is an issue that the committee may wish to discuss during its session later. As I tried to make clear in my written submission, expansion is happening in Oregon beyond terminal illness into chronic illness and badly misprognosed cases. Importantly, the Oregon Health Authority has admitted – this is relevant to Dr. McKeown O’Donovan’s thesis – that someone with a non-terminal illness who refuses treatment for that illness, thereby translating that chronic illness into a terminal one, will not be refused access to Oregon’s assisted suicide provision. In other words, a law that tries to be structured around terminal illness cannot insist that the person go through treatment of a chronic or any other illness. This means that what was a non-terminal illness becomes terminal because of the refusal to treat it.

That is relevant to Oregon and is also relevant here because of the constitutional right here to refuse medical treatment. The restriction that one exhaust all avenues of respite, which Dr. McKeown O'Donovan advocates, is not present in any jurisdiction I am aware of in the world. I do not think it could be because it runs badly against a core rationale for euthanasia, which is autonomy.