Assisted dying – Your Choice?

David Jamison is writing about those items that catch his attention now looking through an older person’s eyes.  He lives in Belfast and since retiring recently he is trying to make sense of a fast-changing world and trying his best to keep up!

Continuing my occasional series looking at issues that I am revisiting now that I have stopped working I come to the debate around assisted dying.  This was triggered again on hearing yesterday that a parliamentary committee is to recommend the Irish government legislate to introduce assisted dying and euthanasia for those with only six months to a year to live.  The Oireachtas Committee on Assisted Dying will issue a final report, which is expected to urge allowing an assisted death for those diagnosed with a terminal condition that is “incurable, irreversible, progressive and advanced,” and for whom suffering cannot be relieved in a way they find “tolerable”.

A recent report by UK MPs said the UK government must make plans for assisted dying if the law is changed in Scotland, the Isle of Man or Jersey, where new measures on the issue are being considered.  The Commons health and social care committee said legalisation in at least one jurisdiction was looking “increasingly likely” and suggested the government must be “actively involved” in discussions about how to approach differences in the law. The report did not make a recommendation for a vote on the issue.

Over the years I find there is difficulty around the terminology used to describe the process of ending ones life and indeed this varies from Country to Country as does the law surrounding this activity.  I think it would be out of scope for this article to expand on this.  This is perhaps because we struggle to come up with an agreed term with a meaning that is straightforward and unambiguous For clarity though the term Assisted Dying seems best described as “The prescribing of life ending drugs for terminally ill, mentally competent adults to administer themselves after meeting strict legal safeguards.”

Esther Rantzen now 83 years has stage four cancer has has recently said that her motivation in getting involved in this debate is based on having watched the deaths of loved ones around her and seeing how memories of a bad death obliterated happy memories.

I think I am inclined to agree with Esther on this point.  I too have seen many people both young and old but primarily older people living out a life where there is no longer a quality of live in many instances they live in constant pain or discomfort.  A number of  people Ive seen including my own Mother are in the main being kept going by a range of medication as medical advances come on stream.  For me though it is the quality of life in these extended years that is then at issue.

“Playing God” becomes a very emotive topic which I suppose is where the debate moves towards.  Namely, an Ethical arena relating in which the Who, What, Where, Why and When issues come to the fore.  Again from my knowledge most of the Opposition seems to relate to the perception of a great risk that people would feel pressurised into accessing an assisted solution for one reason or another examples could be being a burden on family or society, financial reasons and so on.  There then is the religious view that life is a god given thing that is to be protected at all costs and thus individuals have no say in when they are born or when they die.  This is where assisted dying is mentioned in the same breath as Abortion and same sex relationships. Its when getting into these discussions that the temperature of the debate rapidly becomes high and perhaps the rationality and quality of the discussion falls away.

I think for me this is a freedom of choice issue. In line with some other issues I think that people should be provided with a safeguarded framework within which they are entitled to make informed and voluntary choices about how their life should come to an end.  To look at this from another angle someone may elect to live out their life to a natural end and should be provided as far as is possible with care to do so.  We do after all have the ability currently to have do not resuscitate  requests in place and we can refuse medical treatment and this is by choice.   This is a reflection on the increasingly sophisticated world in which we now find ourselves.  This is in contrast to the past were life expectancy was not as great as it now is.

It is also interesting to consider that if Ireland does move to legislate in favour of providing assisted dying would I as an Irish Passport holder living in the North which would currently not have the same legislation in place, or I would suggest in the foreseeable future, be able to avail of the Irish law on the matter?  This is even more pertinent if Scotland or Wales also legislate the question could then become is this an issue that should be decided at national rather than regional level.

Finally it has come back to my mind that back in 2021 I was involved in a consultative process around Advance Care Planning in Northern Ireland.  Advance Care Planning focuses on what is important to a person and what would be important to them, and what they would prioritise in their future, should they become unable to make decisions for themselves. It is an on-going process of conversations between a person, those important to them and those providing care, support or treatment. Advance Care Planning is an umbrella term with components covering personal, clinical, legal, and financial planning. Advance Care Planning should be an important part of life for all adults. It needs to be encouraged by those providing care, support or treatment, to ensure that people have the opportunity to have timely, realistic and practical conversations about what matters to them. If the person wants to make a record of these conversations and share them they should be supported to do so. The conversations may include for example, mental health crisis planning, Advance Decisions to Refuse Treatment (ADRT) and the person’s view on cardiopulmonary resuscitation (CPR).

This is now released and details are at https://www.health-ni.gov.uk/advance-care-planning-now-and-future

I know, of course, this all is not a subject that is one that would feature in many social discussions but I do think that it is an important one that we all need to face up to at some point perhaps becoming more pertinent and pressing as we get older and life’s changes accelerate and become seemingly more complex.