Assisted suicide is an extremely topical subject at the moment garnering a lot of attention from those who advocate for it and those against it. Assisted suicide can be defined as: suicide carried out with the assistance of another person, usually a doctor, provided for someone with a terminal illness or incurable condition. The term euthanasia is used to describe when the fatal dose itself is delivered directly by the doctor. Although very similar for the context of this blog the primary focus will be assisted suicide. . 

In Europe assisted suicide is currently legal in 7 countries: Belgium, The Netherlands, Luxembourg, Germany, Spain, Switzerland and Portugal, and is also legal in several states in the U.S, such as California, Washington and Oregon. In Ireland the Oireachtas is currently considering legalising assisted suicide with various discussions and meetings taking place since last June. A variety of representatives and experts have come to speak against the introduction of the “Assisted Dying” bill. The joint committee is to bring forward their report by March 2024.

On November 7th the committee heard from consultant psychiatrist professor Anne Doherty which brought to light the realities of assisted suicide. In her eloquent testimony Doherty discussed her experience of treating “countless patients” with cancer who experienced suicidal ideation. Professor’s Doherty approach did not favour assisted suicide but rather she stated that suicidal ideation could be treated using “a compassionate approach and the highest possible standard of mental health care”. 

In order to address the perceived ‘need’ for assisted suicide we must ask the question, why do people choose assisted suicide? One study conducted in British Columbia in 2016 utilised 250 assessments for MAID. Researchers found that “…disease-related symptoms were given as the first or second most important reason for requesting assisted death by 67 people (59.8%), while 59 (52.7%) gave loss of autonomy, 55 (49.1%) gave loss of ability to enjoy activities, and 27 (24.1%) gave fear of future suffering.” A 2016 report from the Oregon Health Authority found similar results with the the three most frequently mentioned end-of-life concerns being “…loss of autonomy, decreasing ability to participate in activities that made life enjoyable, and loss of dignity (65.4%). 

In Professor Doherty’s testimony we can see a remedy for these concerns coming from a real place of compassion and concern. It is the responsibility of the government, health care professionals and wider society to ensure that each individual feels a true sense of dignity. We must accompany people through all stages of life and help patients through their helplessness. It should not be the case that we abandon those who fear a loss of dignity or autonomy but rather that we affirm their intrinsic worth as an individual. Our goal should be to improve and develop supports for those who are suffering rather than perpetuating the idea that freedom comes from the ability to end one’s life. 

Silvan Luley of Dignitas addressed the committee stating: “voluntary assisted dying should be legalised as a choice for the Irish alongside other options to soothe suffering and improve quality of life”. They claimed people deserve the choice “on all options of professional care to soothe suffering and end life at their home” 

Is it the duty of doctors or healthcare professionals to “soothe suffering” through assisted suicide? Well, it’s worth noting that in practice pain isn’t as common of a reason for assisted suicide as you might think. Data from Oregon shows that under 1 in 4 patients choose assisted dying due to “inadequate pain control or concern about it” (note the word concern here as well). Recent decades have seen huge advances in pain alleviation or palliative care and though I’m not denying the reality of intense suffering, this suffering can be alleviated with proper pain management. It’s worth asking why these lobby groups are pushing for assisted suicide as a solution rather than trying to advance our palliative care? 

In countries where assisted suicide is legal we see an attitude developing that robs individuals of the ‘choice’ to stay alive. For example in Canada, Rose Finlay who is a quadriplegic and disability activist has expressed her frustration and disgust with the healthcare system there. Finlay, who is based in Ontario, tried to apply for practical and financial support to aid with her disability. Finlay was told that the waiting time for this assistance was 6 – 8 months. However, when she looked at the waiting time for assisted suicide it was only three months. She bluntly stated, “it is easier to let disabled people go than it is to actually give them the assistance that they need”.  

This is becoming a systemic issue in Canada and it places an enormous amount of societal pressure on those who are most vulnerable. The legalisation of assisted suicide makes vulnerable people feel like a liability, promoting the abhorrent idea that if you can’t contribute to society your life is worthless. The whole notion of having this so called “choice” implies a sense of freedom or autonomy but has assisted suicide made individuals like Rose Finlay really free? 

In an age where people are plagued with depression and anxiety, we have to also consider what message legalising assisted dying gives to the suffering. If a sick patient can legally commit suicide because they are undergoing intense suffering, then it’s not too big of a leap for those who are depressed or suffering with mental health issues to think suicide is the right option for them. 

Advocates for assisted suicide claim that assisted suicide solves problems in society: it reduces suffering, improves quality of life and gives patients a choice. However as we can see it causes shocking problems and is not a real solution. Rather than offering a solution to the mental health crisis it tells people to do the very thing we want them to avoid: ending their life, giving a message of hopelessness rather than perseverance. It puts a societal pressure on the vulnerable to end their lives, tragically making them feel like a burden and liability to both their family and the state. We must push back against this intolerable and ableist message. Each individual regardless of age or ability should be safeguarded and protected.