Vulnerable ‘at risk’ if assisted dying legalised
THE HSE will today warn that vulnerable people could be at risk of ‘coercion’ if assisted dying is legalised in Ireland.
Dr Siobhán Ní Bhriain, HSE national clinical director for integrated care and consultant psychiatrist for older people, will warn politicians that allowing assisted dying could raise ‘patient safety’ issues.
The Oireachtas Committee on assisted dying will hear from the HSE and the Department of Health today about the impacts of legalising assisted dying in this country. Dr Ní Bhriain will warn legislators that some ‘vulnerable’ citizens are ‘at particular risk of seeing themselves as a burden and are at risk of being subject to paternalism and coercion’.
She will add: ‘These citizens may be particularly at risk of feeling undue pressure to consider assisted dying/suicide’. This includes older people, people with long-term chronic conditions and those with physical or intellectual disabilities. ‘It is the conclusion of the senior clinical group in the HSE that there are significant supports, both legal and medical, in place in Ireland to enable people to die in a dignified way,’ she adds. ‘People do have a right to refuse life-sustaining treatment and there is access nationally to palliative care services.’
Dr Ní Bhriain will also raise concerns about how ‘robustly such people would be investigated and treated for a potential mental illness if there was legislation on assisted dying.’
‘There is a risk that a person would make a decision to seek assistance with dying, when in fact, more robust investigation or time to consider diagnosis, prognosis and treatment options may result in them opting for another approach to care.’ The cross-party committee on assisted dying is coming to the end of nine months of hearings into the matter and will deliver recommendations on how the State should proceed with legislation next month.
The HSE official will also tell politicians that conscientious objection should form part of any legislation that is created around assisted dying. Dr Ní Bhriain is warning of the potential impact of assisted dying on healthcare workers who have to enable it.
The HSE’s staff counselling service who have engaged with healthcare workers when they have been involved in experiences that ‘transgress their moral or ethical codes’, say this can negatively impact on their mental health.
Dr Ní Bhriain will warn that ‘the psychological impact of being witness to, or making decisions relating to, assisted dying, or indeed, involvement in the painful and prolonged death of a patient, have the potential to significantly transgress an individual health care worker’s core values and their psychological and emotional wellbeing’.
The committee are today examining the system that would be needed for assisted dying if it is legalised. Dr Ní Bhriain will speak about the need for ‘robust and commensurate safeguarding measures’ around a new law allowing for assisted dying in Ireland.
‘International evidence suggests that in some locations where legislation for assisted dying and euthanasia has been introduced, safeguards change over time, to include lower age thresholds and expansion of eligibility criteria.’
The Netherlands was the first country in the world to legalise assisted dying under strict conditions in 2002, and last year the law was widened to include terminally ill children between one and 12.
Siobhán McArdle, assistant secretary at the Department of Health, will say that the department does not have a position on assisted dying as there is no legal basis for it currently and they have not carried out any research into the area. Ms McArdle will say ‘palliative care should not in any way be conflated with assisted dying’.
‘There are patient safety issues’