DOCTORS IN IRELAND — BEWARE!
The Dying with Dignity Bill 2020
Doctors world-wide are burning out from the fight with COVID19. Now, Irish doctors have another major battle on their hands — the Dying with Dignity Bill. This will bring the legal, ethical, professional — and for some, moral — challenges of a lifetime.
Before 2015, Euthanasia and Assisted Suicide were illegal, unethical, unprofessional and immoral in Canada. First came the Carter decision from the Supreme Court of Canada in February 2015 and then Parliament legislated for Medical Assistance in Dying [MAiD] June 2016.
That was met with almost no challenge from the medical profession, though we were dumped with the task of killing the patients meeting criteria. The Canadian Medical Association, the Alberta Medical Association and perhaps half of the profession supported MAiD. The other half accepted it with hardly a whimper. There is something badly wrong when Medical Assistance in Dying is universally available in Canada, and expert Palliative Care is not.
Assisted Suicide [AS] and Voluntary Euthanasia [VE] is a world-wide Social Engineering experiment gone wrong. The Netherlands is the poster child of euthanasia gone crazy. Many governments are hell bent on going this route and Ireland is on the cusp of making the same mistake.
Ireland will not become more compassionate, nor more tolerant. A few people will get a brief sense of personal control/autonomy, at enormous cost for society as a whole. Medicine in Ireland will change, forever: now is the time for Irish doctors to fight!
Doctors and the Dying with Dignity Bill
In Ireland, the Dying with Dignity Bill [DDB] suggests that Assisted Suicide [AS] will be the primary tool. Voluntary Euthanasia [VE] appears to be a back-up in exceptional circumstances. (Both AS and VE were legalized in Canada but we now have almost no cases by Assisted Suicide. Pretty much 100% of the time Voluntary Euthanasia is the preferred option.)
Section 7 of the DDB (‘Qualifying persons’) include “…a resident on the island of Ireland and has been for not less than one year.” This includes the citizens of other countries! The most likely non-Irish candidates will be British Citizens from Northern Ireland (but things might get a tad ‘complicated’ if the Republic kills citizens of Russia, China or Iran, etc.!)
Curiously, the Bill does NOT require the attending medical practitioner (or their delegate) to witness the death of the “Qualifying Person.” Indeed, the attending medical practitioner does not even have to witness the ingestion of the poison (“not necessarily in the same room.”) Also the Bill does not specify what must happen in the event of the recipient having a complication when the medical practitioner is no longer available. That is a Gong Show in the making.
A US colleague on Twitter (under the handle of @clinkshrink) directed me to: http://www.guttmacher.us/pas/ This site discusses “…a preliminary mathematical model of the effect of aid-in-dying or assisted suicide laws. Calculation of harm-to-benefit ratios and wrongful death numbers should be considered seriously by policy makers and legislators.”
There is an “Assisted Suicide Wrongful Death Calculator” which leads to the fascinating graph below:
More details on the Bill:
· https://www.catholicarena.com/latest/2020/10/15/dyingwithdignitybill
More Canadian perspective:
· https://www.catholicarena.com/latest/euthanasiabill
SUICIDE ESCALATION
Curiously, the US States providing Assisted Suicide have increased total suicides and suicides increased by over 30% in the Netherlands. Decades of Suicide Prevention will be flushed down the toilet.
That is a dreadful trade.
“I’m the future version of myself who survived to tell you this.”
Garifalia (Lia) Milousis (http://www.TellMeToStay.ca/)
The Slippery Slope
Please click the link to see what happens in the Netherlands.
The Supreme Court of Canada defined the criteria for MAiD, including death being “reasonably foreseeable” but now AS/VE can be provided for any chronic non-terminal illness. Within 2 years, people suffering from mental illnesses will be able to apply. There is a continuing push to include “Mature Minors” (likely down to 12 years-of-age) and consent for MAiD through Prior Directives. Obviously new categories will be pushed (below 12 years of age) once others are achieved. Logically the only end-point is Suicide-on-Demand, for all.
More information at:
https://www.catholicarena.com/latest/slipperslopeireland
Conscientious Objection
The Medical Council of Ireland is explicit in its current guidance to the profession. Section 22.6 of the Guide to Professional Conduct and Ethics for Registered Medical Practitioners states “You must not participate in the deliberate killing of a patient by active means.” In many countries their respective medical council answers directly to the Minister of Health, so it will be interesting to see what happens to 22.6 if AS/VE is legalized.
The DDB has a ‘BUT’ for the conscientious objectors: “A person who has a conscientious objection referred to in subsection (1) shall make such arrangements for the transfer of care of the qualifying person concerned as may be necessary to enable the qualifying person to avail of assistance in ending his or her life in accordance with this Act.” Many doctors consider making “arrangements for the transfer of care…” to be active participation in the provision of SA/VE, therefore unethical and/or immoral.
The Canadian experience is varied because health comes under provincial jurisdiction though the legalization of AS/VE happened federally because of changes to the criminal code. The Supreme Court of Canada stated “In our view, nothing in the declaration of invalidity which we propose to issue would compel physicians to provide assistance in dying.” Despite that proviso, Ontario doctors are still required by their medical college to make an “effective referral” (& that position was confirmed by the Superior Court of Ontario though the justices acknowledged there was religious discrimination!) Thankfully the system in Alberta allows for a patient to directly access MAiD with just one phone call.
ALBERTA BOUND
I had two personal experiences in Alberta which made the Spring of 2016 quite depressing.
· The Spring 2016 Representative Forum of the Alberta Medical Association
I was a representative and presented the first 4 motions at the start of the 1.5-day meeting. One was canned by the speaker as being ‘out of order’ but the surviving motions came to the floor in the last 20 minutes of debate, just before the meeting wrapped-up.
Out of concern that Voluntary Euthanasia could embolden someone to consider INVOLUNTARY Euthanasia, I proposed motion RF16S-10;
“THAT the AMA agrees with the principle of appropriate enforcement
and adequate regulation to protect the ‘Right to Life’
of those at risk from Involuntary Euthanasia.”
The outcome: TABLED INDEFINITELY.
In other words, my colleagues will never — ever — discuss the murder of patients in Alberta. (Curiously the motion made AMA history being the only motion to be ‘Tabled Indefinitely’ since digital records started in 1996!)
· 61# Annual Scientific Assembly of the Alberta College of Family Physicians.
That spring, legislation for AS/VE was still before Parliament so the ACFP invited Dr. Trevor Theman, Registrar of the College of Physicians & Surgeons of Alberta, to give the keynote speech on “Physician Assisted Dying.” [CPSA is our ‘medical council’]
As physicians, we are taught not to base our opinion on isolated cases, but Dr. Theman openly admitted his bias in favour of Euthanasia arising from the tragic case of a personal friend who had died from a brainstem tumour. Dr. Theman played a clip from Dr. Donald (Don) Low’s public video supporting assisted suicide/euthanasia. Sadly, Dr. Low died 8 days after making the video.
He included a separate slide on “Conscientious Objection.” The slide implied that MAiD/AS/VE were “treatment options.” It also came with significant cautions about patient “abandonment” and the “imposition of personal beliefs”: chilling for a Hippocratic doctor.
Dr. Theman gave no guidance as to how the medical profession would cope with such changes to our medical ethics, knowing that we have followed Hippocratic principles for over 2000 years.
Conclusion
Doctors must be a shield against coercion and do our best to prevent non-voluntary & involuntary euthanasia. Our patients must never feel they have a “Duty to Die.” We must treat suicidal patients, not kill them. Doctors and nurses must remain the patient’s advocate, counsellor and caregiver.
Doctors in Ireland should oppose the Dying with Dignity Bill.
Dr. Kevin Hay.
Kevin is a UCD grad and a rural Family Doctor in Alberta, Canada.
You can follow him on Twitter @kevinhay77 (though please be careful on Anti-Social Media!)