Malcolm Noonan (Carlow-Kilkenny, Green Party) | Oireachtas source

I apologise on behalf of the Minister for Justice, Deputy McEntee, as she cannot attend today. I welcome the opportunity to speak about this important issue on behalf of the Minister. I thank the committee members, its Chair, Deputy Michael Healy-Rae, and Vice-Chair, Deputy Kenny. We have spoken about this on a few occasions as the committee was ongoing.

This is an important and comprehensive report on assisted dying. How we die is the one thing we all face but we talk so little about it. The committee has done a wonderful job in preparing this report.

The significance of the work undertaken by the committee cannot be overstated. In addressing this most complex and challenging of social questions, its members have consistently demonstrated empathy, sensitivity and understanding. The committee held 24 public meetings over nine months. I watched several of the committee's proceedings. The committee met with over 100 individual witnesses, including national and international experts on law, ethics, medicine, disability and palliative care. Its final report includes 38 recommendations on assisted dying and related issues. The report is thoughtful, thorough and well-researched. I acknowledge and recognise the valuable work of the committee. The nature of the committee’s work and the content of its recommendations require that we adopt a measured and considered approach in our response.

I also acknowledge the bravery and generosity of spirit of those who shared their personal stories with the committee. Through sharing their personal narratives, they have helped the committee to fully understand the lived experience of end-of-life care. I also acknowledge the invaluable input provided by experts and public servants, both from Ireland and other countries. Their integrity, professionalism and willingness to engage with the committee should be commended.

Assisted dying is a complex, challenging and emotively charged issue, as Deputy Kenny said. It requires all of us in this House to navigate fraught medical, ethical and moral issues, as well as significant constitutional and legal concerns. The fundamental nature of the questions it gives rise to, and the challenges they present to our personal and moral perspectives make it a uniquely difficult question for legislators to address. The complexity of the challenge we are confronted with is exemplified by the personal story of Marie Fleming. Ms Fleming, who suffered from multiple sclerosis, challenged the Criminal Law (Suicide) Act 1993, having regard to the provisions of the Irish Constitution and her rights pursuant to the European Convention on Human Rights. While acknowledging the very distressing situation of the appellant, the Supreme Court upheld the constitutionality of the 1993 Act. The court found that there is no constitutional right to arrange for the ending of one’s life at a time of one’s choosing. However, the court noted that its judgment did not prohibit the Oireachtas from legislating for assisted suicide, assuming appropriate safeguards could be introduced. This raises the question, addressed by the committee, of whether we can and should legislate for this complex issue and, if we do, what we must take into consideration when doing so.

As the committee recognised, the issue confronting us is concerned with alleviating suffering and affording meaningful autonomy and dignity to a person with a terminal illness. However, the State also has an obligation to protect life and to value the life of all citizens equally. Before I discuss these two viewpoints, I acknowledge that everyone who expressed their opinions and very deep personal feelings to the committee was well intentioned and was coming from a perspective of utmost concern. It is also worth noting that this topic is one that has touched the lives, or will touch the lives, of everyone sitting in the House today.

On one side of the debate there are those who believe that individuals should be afforded autonomy over the most fundamental issues concerning their own life and death, that is, autonomy naturally extends to the right to die with dignity, particularly so as to avoid any undue suffering, and that when a person is diagnosed with a terminal illness or medical condition that they tragically will not recover from, they should be afforded the right to decide when to say their final farewell on their own terms and in a manner of their own choosing. From this perspective, it is argued that while we all recognise that every human life is valuable, we can also recognise that a person’s quality of life is equally as important. This is a significant factor in any personal decision about life and death. A person’s quality of life will often come down to reducing unnecessary suffering and pain, something that no one wants to see their loved ones go through.

On the other side of the debate, there are those who find the proposal to legislate for assisted dying as morally and ethically unacceptable. From this viewpoint, life has an intrinsic value, and one of the fundamental roles of the State is to protect life. We, as a society, have an extra duty of care to protect those who are vulnerable, particularly the elderly, the seriously ill and persons with disabilities. It is argued that to legislate for assisted dying, however well intentioned, would inevitably send a societal signal that such lives are of intrinsically less worth. Many of those who oppose legislating for assisted dying often contend that society should instead focus on providing high-quality palliative care that can effectively alleviate pain and suffering. We should be doing that too.

There is also a wide range of complex practical issues that arise when considering how to regulate a system that would provide for assisted dying. Will the eligibility criteria be too broad or too narrow? If it is limited to the terminally ill with only six months to live, what about those suffering from chronic and intolerable conditions or who otherwise may have an objectively justified reason to benefit from assisted dying? Will it be possible, or even desirable, to limit the incremental expansion of eligibility criteria over time? How reliably can we determine prognosis of terminal illness? If one of the core principles underlying assisted dying is personal autonomy, can the assessment of capacity be adequately provided for to ensure that decisions are truly voluntary? Equally, will it be possible to ensure in all cases that a person is not subject to coercion or undue influence by family members or other parties? Who is best placed to assess capacity and evidence of coercion? Could legalising assisted dying negatively affect palliative and end-of-life care?

In its final report, the committee recommends that the Government introduce legislation to allow for assisted dying in certain restricted circumstances and with the inclusion of safeguards. The committee’s proposals include strict eligibility criteria. The committee recommends that only a person diagnosed with a disease, illness or medical condition that is both incurable and irreversible, that is progressive and will cause death within six months or, in the case of a person with a neurodegenerative disease, illness or condition, within 12 months and is causing suffering to the person that cannot be relieved in a manner that the person finds tolerable, is eligible to be assessed for assisted dying. Additionally, the committee recommendation provides for certain safeguards. The report proposes that a person must make two formal requests for assisted dying, with a specified interval between each, before two independent witnesses in order to ensure, while affording complete autonomy to the individual, that such a decision is made in a fully informed manner. To ensure that those who are vulnerable would not be disproportionately affected by the implementation of this legislative and policy change, the final report of the committee recommends that any new legislation should provide that a person who is proven guilty of coercion will have committed an offence under that legislation.

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The committee’s recommendations significantly advance the debate in this country on assisted dying. Further analysis, reflection and debate, both within this House and outside of it, is now required.

Assisted dying in this jurisdiction is currently criminalised under section 2(2) of the Criminal Law (Suicide) Act 1993, which provides that a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence. If assisted dying was legalised, the criminal law and the absolute certainty that it provides in outlawing assisted dying in all circumstances would then be disapplied. Such a move requires deep consideration. There would be a consequent need for changes to the law to provide adequate protection against any inducement, incitement, pressure or force being used in respect of assisted dying. Notwithstanding the need to police coercion and undue influence, the central issue of assisted dying would then lie largely outside of the scope of the criminal law. Instead, in practical terms, it would largely fall within the ambit of health as a matter to be addressed by medical practitioners in terms of the prognosis of terminal illness, the assessment of capacity and informed decision-making, the means of death and so on.

I am sure all members share a vision for the highest standard of end-of-life care, which prioritises access to necessary treatment, supports the avoidance of suffering and affords the highest levels of dignity and autonomy.

It is therefore worth noting that the Minister for Health has sought to ensure that there is an excellent palliative care system available in this country, making it clear that we all agree that human dignity must be respected at all stages of each individual’s life, especially surrounding terminal illness and death. Palliative care helps to preserve this dignity, providing an appropriate environment and helping individuals and their families to deal with pain and other distressing symptoms. In this regard, it is apposite that the committee recommends that palliative care and the operation of assisted dying, were the latter introduced, should operate completely separately and independently of each other.

Many people hold strong views and have been, and continue to be, deeply affected by these issues. I understand that some of those people would like to see change quickly. Unfortunately, there are no easy answers or quick solutions in this area. Consideration of this report and its recommendations will take time.

There are other public and professional bodies that voiced their feelings on the matter to the committee through the course of its work that may now be affected by the committee’s recommendations. I have no doubt that those organisations are also carefully examining the report.

The report of the Committee on Assisted Dying is a valuable contribution to the debate on what is a complex and sensitive issue and which engenders strong personal feelings on all sides. On behalf of the Government, I again thank the committee, its Chair and Deputy Chair, for its report and I can assure the House that it is receiving the most careful attention and appraisal.

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