Lynn Ruane (Independent)
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I thank everyone for their presentations. Most of my contribution will probably be to Dr. Mulligan. Even though we are here in respect of those constitutional questions, she has experience in the medical law side of things. I wish to utilise her time here rather than being repetitive on some of the stuff we have already established.

I am beginning to think about the more nitty-gritty stuff in relation to medical law and perhaps ethics. Dr. Mulligan said earlier that life is not always in the person’s best interest. From a legal or medical perspective, how do we determine those best interests? It also ties into the question of whether we are having a conversation only about those who are closest to death because of terminal illness or whether we are looking at best interests in a much larger sense, which I would hope we are and we are not only being narrow in those who are at a certain arbitrary time from dying. I wish to hear a little bit of insight on best interests.

Dr. Mulligan mentioned a directive, for example, some sort of healthcare or other type of directive. I am looking at the other constitutional rights regarding bodily integrity, the rights to freedom and privacy and all these things. I am thinking of autonomy and agency potentially sitting within those, perhaps bodily integrity. I refer to looking at those safeguards in a directive. Let us say we have a man who is in the earliest stages of dementia, Alzheimer’s or some cognitive disease that will progress and he makes a healthcare directive at the most stable part of his illness early on. Perhaps later on, he accumulates some other comorbidities due to ageing or whatever it may be. Say then, in that healthcare directive, he quite clearly stated he wants to die by assisted dying at whatever stage of that disease. Does something happen then when his cognitive functions are reduced so much that his memory has lapsed? In other words, he does not have any memory of making the healthcare directive. From a legal or medical law perspective, what stands there? Does the healthcare directive made when somebody was at their most functioning stand? I hope it does. How does that then tip over into assisted dying versus somebody having to administer something to somebody who is potentially fighting back because they have no memory of it?

My final question is on assistance. When we come to that question of passive and active, I do not see a moral distinction between the two. If we are looking constitutionally, saying vindicate the right to life but then saying that life will be vindicated differently if the rest of society, our doctors or somebody else is engaging with it in a passive way or an active way, how do we get to that distinction between the two? How was that distinction made? Was that because of court judgments? Where does that come from? For me, the ultimate end is the same. However, it feels like we want to wash our hands of having an active role in helping somebody die well rather than saying that if a person passively rejects things, that is fine, we will all turn the other way and allow that person to do that.

It really seems cowardly to me, in some sense. It feels like we just want to let ourselves off without actually really engaging in what is a very important process for someone in those dying moments. How have those differentiations happened?