JAMES KEOGH

PhD candidate, Department of Sociology & Philosophy, University College Cork, Ireland

Assisted dying is slowly turning into a fashionable, liberal cause

12:12PM BST 24 Aug 2015….http://www.telegraph.co.uk/news/uknews/assisted-dying/11820483/Assisted-dying-is-slowly-turning-into-a-fashionable-liberal-cause.html

Britain is inching towards the legalisation of euthanasia. Next month the House of Commons will debate overturning the ban on assisted dying – with the stipulation that the patient must have no more than six months to live, be able to make a “clear and settled intention” and have the approval of two doctors. It sounds foolproof. It’s also backed by a growing number of high profile stories of people so ill, so desperate that it’s hard not to sympathise with their decision to circumvent UK law and go to Dignitas. In an age when the boundaries of personal liberty are being pushed ever further, this seems like a rational and humane reform.

Except that it’s neither. It’s a terrible idea to base law upon individual cases of extreme circumstances. And while liberal reformers plea that they simply want to make the law reflect the realities of human experience, they overlook those human experiences that contradict their argument. Nearly 80 doctors across the country have written to the Telegraph to warn that the proposal could “devalue the most vulnerable in society.” They say that they regularly encounter patients who: “are under pressure from within to remove themselves as a burden on their hard-pressed families.” Sometimes that pressure does not come from within: “We do from time to time come across cases where there are signs of subtle pressures being exerted.” Libertarian reformers are often reluctant to acknowledge the sadder facts of life and the necessity of legal protection for the vulnerable. But these doctors write from positions of experience. Their warning should be heeded.

Millionaire hotelier Peter Smedley named as man whose assisted suicide was filmed by BBCThe Dignitas Clinic in Switzerland  Photo: AFP

Here are two scenarios that MPs should consider when voting on this bill. First, a man is told that he has cancer and it has spread throughout his body. He lives alone. He is frightened. He has never experienced surgery this invasive or pain this traumatic. He doesn’t appreciate that the pain may be controllable – he’s confused and depressed. There’s also no one around to tell him that doctors get things wrong all the time. In panic, he might reach the conclusion that he’s rather be spared months of suffering. He’d rather die.

This man’s choice is a desperate one shaped by pitiful circumstances. What if he had been told by someone who loves him that there’s always hope? What if he’d been made to understand that the pain isn’t always unbearable, that it can be lived with and that he could even be given some relative comfort? Is he really committing assisted suicide because of his physical illness or because of his mental condition?

The second scenario is alluded to in the GPs letter. A woman is told her cancer is getting worse and she might have months to live. Her family are financially overstretched. They’ve never been very fond of her. They are told that they could make adjustments to their house at great expense to keep her at home or they could put her in social care, where they likely won’t visit. The patient is scared. She doesn’t want to be any problem for her family. When she tries to raise the subject they give answers that seem like placating: “Of course we love you. Of course we’ll look after you.” She concludes that she can’t trust her family or else she doesn’t want her last months to be spent living with guilt at having cost them money. So she chooses to die.

This scenario reminds us of something libertarians too often forget: people do not make choices in isolation. That’s not how real human beings work. Their decisions are shaped by their material circumstances and by the attitudes of those around them. Finally, they are shaped by culture.

right to dieThe law is there to protect the dying  Photo: Alamy

Frankly, we run the risk of assisted dying becoming fashionable. That sounds glib, but it’s true. We are being bombarded with false statistics about over-population. We are told that social care is bad and under-funded (true in many cases but a good government could change this). The elderly are not valued but depicted as useless, costly. Wealthy liberals hail assisted suicide as a solution to the problem of pain, although pain is a tragic reality of life.

We aren’t encouraged to leave ourselves open to hope and love. But they are realities of life, too. A friend recently lost his mother. He told me that in the course of her illness, the doctors repeatedly said that it was time to “let nature run its course”. She repeatedly got worse only to recover and enjoy many more weeks with her family. He told me, emotionally, that he was so glad for that extra time. Isn’t it better to leave ourselves open to such wonderful possibilities than it is to choose death?

Assisted dying leaves vulnerable at risk, warns alliance of doctors

12:01AM BST 24 Aug 2015….http://www.telegraph.co.uk/news/uknews/assisted-dying/11819407/Assisted-dying-leaves-vulnerable-at-risk-warns-alliance-of-doctors.html

Allowing doctors to help terminally ill people to take their own lives would ‘devalue the most vulnerable’ in society, a group of physicians has warned.

Next month the House of Commons will debate whether to overturn the ban on assisted suicide.

But a group of nearly 80 doctors across the country has written an open letter to MPs warning that many elderly and disabled people already feel pressured to end their own lives because they think they are a burden to relatives.

“We believe such proposals devalue the most vulnerable in society,” they write in a letter in The Daily Telegraph

“We regularly come across patients who feel a burden to their relatives and to society due to their particular health and social care needs.

“They are under pressure from within to remove themselves as a burden on their hard-pressed families. With an ageing population and with many families today unable to devote themselves to full-time care of a seriously-ill relative, situations like this are not uncommon.”

They also warned that some families would use a change in the law to exert pressure on relatives.

“Most families are loving and caring, but some are not,” they argue.

“We do from time to time come across cases where there are signs of subtle pressures being exerted. These are difficult to prove but they can be very real, and we fear that, if Parliament were to legalise assisted suicide for terminally ill people, they would be given free rein.”

Assisted suicide remains a criminal offence in England and Wales, technically punishable by up to 14 years in prison. But polling has consistently suggested high levels of public support.

The Assisted Dying Bill was brought before the House of Lords by Lord Falconer but it ran out of time before the general election.

However Labour MP Rob Marris, adopted the draft regulations and they are expected to be debated in the House of Commons on September 11.

The new Bill would allow patients to end their lives if they have no more than six months to live and had demonstrated a “clear and settled intention.’ Two doctors must sign off the request and it is likely that a High Court judge will make the final decision under safeguards which were added when it was debated in the House of Lords.

Although MPs discussed assisted dying in a backbench committee debate on the Director of Public Prosecution’s guidelines in 2012, it will be the first time in almost 20 years that the Commons has taken a vote on the topic.

Downing Street has concern that the proposed change in the law would leave vulnerable people feeling pressurised to end their lives but signalled that Conservative MPs would have a free vote on matter.

Earlier this month an alliance of bishops, priests and rabbis broke ranks with the religious establishment to voice support for plans to change the law.

In a letter to The Daily Telegraph, they argue that far from being a sin, helping terminally ill people to commit suicide should be viewed simply as enabling them to “gracefully hand back” their lives to God.

The former Archbishop of Canterbury Lord Carey has also said that assisted suicide was a “profoundly Christian and moral thing” to do.

However the Rev Dr Brendan McCarthy, the Church of England’s national adviser on medical ethics, claimed that dying people would “most certainly” be put at risk by a change in the law.

The campaign group Dignity in Dying, said the new Bill would make Britain a more compassionate country.

But Baroness Finlay of Llandaff, co-chair of the Campaign group Living and Dying Well, which opposes a change, said licensing assisted dying would ‘fly in the face’ of ongoing attempts to discourage suicide.

Bishop of Shrewsbury warns that assisted dying bill would be “law of despair”

31st July….http://www.telegraph.co.uk/news/uknews/assisted-dying/11775785/Bishop-of-Shrewsbury-warns-that-assisted-dying-bill-would-be-law-of-despair.html

A controversial bill that seeks to legalise assisted dying represents the “first step” towards euthanasia, the Roman Catholic Bishop of Shrewsbury has warned.

The Rt Rev Mark Davies said MPs would be introducing a “law of despair” if they voted in favour of proposals to allow doctors to prescribe lethal doses of medication to anyone with only six months to live who showed a “clear and settled intention” to end their life.

He warned that the right to die would quickly become a “duty to die” and that those who should be receiving the utmost care would instead consider themselves an unwanted burden on society.

The bill, introduced by Labour MP Rob Marris, will be granted its second reading on September 11, when a vote will be held. It is the first serious attempt to change the law on assisted suicide.

MPs have not voted on the issue since 1997, when a proposal to allow doctors to help the terminally ill commit suicide was voted down by 234 votes to 89.

But recent polling has consistently suggested high levels of public support for a change in the law to allow assisted dying.

Bishop Davies, speaking to around 800 pilgrims from the Shrewsbury Diocesan in Lourdes, warned that some of the most vulnerable in society would come under huge pressure to end their lives if assisted dying became “the mindset of British society”.

He said: “The proposed law for ‘Assisted Dying’ will remove legal protections for the lives of some of the most vulnerable in our land.

“It is the first step on the road to euthanasia: the medical killing of some of the weakest members of society.”

Bishop of Shrewsbury: Gay marriage is attack on family

He urged pilgrims to make their voices heard, warning that there were just a few weeks before MPs chose between whether “a culture of care or a culture of suicide and eventually of killing”.

“We have good reason to fear that the right to die will quickly become the duty to die,” he added.

“And those who should be most cherished and cared for will increasingly see themselves as an unwanted burden to society.

Pope Francis frequently reminds us how it is the weakest and most vulnerable who can teach us the most important lessons of life. And he warns us that many societies are in danger of discarding them.”

The bill is almost identical to that introduced into the House of Lords by the assisted suicide campaigner Lord Falconer last year.

The former Lord Chancellor took the bill through its initial legislative stages but ran out of parliamentary time ahead of the General Election.

It provoked a highly charged, ten-hour debate and peers unanimously backed amendments giving a High Court judge a role in any system of assisted suicide, an extra safeguard against pressure on vulnerable people.

The bill to be put before the Commons will include those amendments, a move likely to strengthen potential support.

Supreme Court rejects right to die bid but challenges Parliament to review law

The bishop’s views echo concerns raised by David Cameron that the proposed change in the law would leave vulnerable people feeling “unfairly pressurised” into ending their lives.

The Prime Minister’s official spokesman said: “He has concern that legislation in this area might push people towards doing things that they don’t actually want for themselves.”

But he added: “It is an issue of individual conscience and a matter for Parliament to decide, rather than one for Government policy.”

Mr Marris, the MP for Wolverhampton South West, said that people who were suffering and facing imminent death should not be denied medical help to end their lives.

“Alongside the vast majority of the public, I am in favour of terminally ill people who are of sound mind having choice at the end of life,” he said.

The MP chose to put forward proposals on assisted dying after coming top of this year’s ballot for backbench legislation.

O’Rorke to push TDs for new legislation on assisted suicide

May 27th 2015…http://www.irishtimes.com/news/politics/o-rorke-to-push-tds-for-new-legislation-on-assisted-suicide-1.2227024

A woman found not guilty of assisted suicide is to meet TDs today to discuss the need for new legislation in the area.

Gail O’Rorke will be joined by Tom Curran, the partner of the late Marie Fleming who went to the High Court and the Supreme Court to challenge the ban on assisted suicide.

The two will meet Independent TD John Halligan to push for new legislation to be debated.

Mr Halligan said: “It is great to have her support. We will meet TDs to try to garner some support, calling on people to at least have a debate on the legislation.”

Mr Halligan is to introduce the Dying with Dignity Bill in the Dáil in two weeks. He said there needed to be a “dignified, compassionate and thoughtful debate” on the issue.

His Bill, which was drawn up by two barristers, sets out strict criteria before an assisted suicide can take place.

Despite recent cases, law on assisted suicide unlikely to change

May 18th 2015…http://www.irishtimes.com/news/crime-and-law/despite-recent-cases-law-on-assisted-suicide-unlikely-to-change-1.2214153

Gail O’Rorke walked quickly from the Circuit Criminal Court with her husband Barry and into a waiting taxi. Behind her she left four years of pre-trial stress, an acquittal on charges of assisted suicide and a legal headache increasingly shifting toward the political arena.

Under the Criminal Law (Suicide) Act of 1993, it is an offence to help somebody in the pursuit of suicide. O’Rorke’s prosecution on three counts of assisting or attempting to assist in the suicide of her friend Bernadette Forde in 2011 was the first under the legislation.

If there is any confusion as to why it took so long for a case to emerge or why O’Rorke found herself in the dock, then it is merely indicative of far broader systemic uncertainty.

O’Rorke’s trial and the preceding High Court and Supreme Court “right to die” challenges brought by the late Marie Fleming have highlighted disorientation around the law and how it is applied.

Two key words lie at the centre of problems with the laws around assisted suicide: discretion and guidelines. The former is on the part of the Director of Public Prosecutions (DPP) in deciding whom to prosecute, the latter is the missing piece of a puzzle as to how and why such prosecutorial decisions are arrived at.

In 2013, Fleming took a legal action in order to protect her husband Tom Curran should he help her die. She argued that since the DPP had prosecutorial discretion, it should issue a set of guidelines on the law, as is the case in the English and Welsh systems. However, unlike those jurisdictions, the Irish DPP does not have the legal power to publish guidelines.

The High Court ruled against Fleming’s application, which was based on the similar but ultimately successful Debbie Purdy case in the UK, and this was upheld in the Supreme Court. The High Court ruled that the development of such guidelines would indirectly amend the 1993 law, which is a blanket ban, and thus prove unconstitutional. Specifically, it stated that “once guidelines may be characterised as having the effect of outruling a prosecution, they must be seen as altering the existing law and must therefore fall foul of article 15.2 of the Constitution”.

Issue of discretion

While refusing to direct the provision of such guidelines, the High Court pointed to the issue of discretion. Given the specific nature of Fleming’s situation, and that of her husband, the High Court said it felt sure that if it was in line with the Purdy policy in the UK, “the Director [of Public Prosecutions] would exercise her discretion in a humane and sensitive fashion”.

This was essentially a hint that honourable, benevolent motivation in assisting suicide might prompt the State to look the other way. It has, however, been interpreted as something of a double standard.

Dr Catherine O’Sullivan, a lecturer in criminal law at University College Cork (UCC), asks what effect the High Court ruling might have on the public’s “understanding of what the law on assisted suicide now is in Ireland and consequently, on their decision whether to request [or] assist a suicide”.

She also argues that “the legislature is being left off the hook for failing to do its duty to legislate in this controversial area”.

So if the DPP has discretion, and if there has been only one prosecution in 23 years, why was O’Rorke charged?

“We will never know that because the DPP does not give reasons,” says Conor O’Mahony, an academic specialising in constitutional law, also at UCC. “We don’t know what criteria the DPP looks to and that is in a sense the nub of the problem.”

There may be other problems. In 2010, an Irish Times Behaviour & Attitudes poll found that 57 per cent of Irish people were in favour of doctor-assisted suicide for those with severe pain; emerging generations are likely to swell that number.

“The jury result in the [O’Rorke] case hints at that as well. There certainly seems to be a mood among a sizeable section of the public that would rather see the law allow for it,” says O’Mahony. “I think in order for a jury to actually convict, you would have to be looking at a case that is pretty blatant. All you need is to have a few people on the jury to have a strong sympathy with the person who is being prosecuted.

“The judge can direct an acquittal but a judge cannot direct a conviction. That is something that the DPP will now have to be aware of, that securing a conviction in a case like this is not going to be easy.”

If the only way forward is to review how with such difficult cases can be dealt with, then the Supreme Court left that door open in its ruling on the Fleming case when it said there was nothing in it that should be viewed as seeking to prevent the legislature from making a law permitting assisted suicide once it conformed with the Constitution.

This is highly unlikely, at least for the time being. Neither the Department of Justice nor the Oireachtas justice committee is planning on poking a sleeping dog.

“I think the current situation is unsustainable because it leads to a situation where we are likely to see further cases like the Gail O’Rorke case,” says O’Mahony, “[but] there is certainly no appetite for that with the current Government and if I was a betting man, there wouldn’t be with the next government either.”

Confusion about parameters

O’Sullivan expresses a similar view, saying it is “incumbent” on the legislature to legislate. “Until they do, confusion about the parameters of the assisted suicide offence will remain and we will have to wait for a tragic case to force the legislature to act.”

This could mean anything up to and including decriminalisation, where circumstances and safeguards are agreed upon to defend the vulnerable. Ireland appears to be a long way off any such action and for now there seems little in the way of motivation on the part of politicians. In fact, in May 2013, Taoiseach Enda Kenny ruled out any change in the law.

For now, although with some obscurity and debate, the law is straightforward and legal advice can only really flow in one direction. “Basically anyone [considering assisting a suicide] has to presume they will be prosecuted,” O’Mahony adds. “Once you leave an [evidentiary] trail and as long as you have a blanket ban, and in the absence of any guidelines that would indicate what the DPP would be looking at, the only safe course of action is not to do it.”

Gail O’Rorke assisted suicide case: What would I do in her position?

Thurs 30th Apr 2015….http://www.irishtimes.com/opinion/editorial/gail-o-rorke-assisted-suicide-case-what-would-i-do-in-her-position-1.2193916

We cannot know whether the jury in Gail O’Rorke’s trial acquitted her on charges of assisting another to end her life because the case against her was not proven. Or because it did not feel that a “guilty” verdict and the possibility of punishment – up to 14 years in jail – were appropriate for an act they thought she probably had committed and saw essentially as a conscientious act of kindness and mercy, an act even the prosecuting barrister characterised as “out of loyalty, out of love” for her friend.

That probable exercise of discretion is the jury’s prerogative – though advised against by the prosecution – and in rare cases a jury’s willingness to exercise that discretion, to judge the law itself as well as the specific case, allows it temper unjust law with humanity. It is an important rationale for the jury system itself.

Such a decision in this case would beg important questions about the law, specifically the Criminal Law (Suicide) Act, which in 1993 decriminalised suicide but provided for the offence of aiding or procuring the suicide of another. This is a most unusual provision in criminalising the abetting of a legal act, and is now seriously at odds with public opinion, as Tom Curran, whose late partner Marie Fleming went to the Supreme Court on the issue, argued in these pages yesterday. An Irish Times Ipsos/MRBI poll last month found 54 per cent agree there are circumstances where they would be willing to help a family member die.

That is the question the jury was asked rhetorically during the trial – “What would I do if I were in Gail O’Rorke’s position?” It is akin to the question many parents asked themselves in the wake of the X case “What would I do if my daughter became pregnant?” which set in train a profound national recalibration of public attitudes. And what we saw emerge gradually over recent years was a transition from outright opposition to all abortion, or assisted suicide, in principle, to a sharing of new perspectives on both issues which focus on individual personal tragedy and the necessity for humane responses based on the way people really lead their lives. In the real world the black and white of moral absolutes turn grey.

Public opinion apart, there is also the question of whether a law which juries may refuse to enforce is a good law. No more than a law which forces reluctant prosecutors to pursue upstanding citizens who may have just also suffered grievous personal loss. Our blanket ban on assisted suicide should be reviewed to allow rational, terminally ill people who decide they do not want to suffer on to get help from those close to them, while setting out clear guidelines to protect the vulnerable. It has been done elsewhere successfully and without opening “floodgates” of abuse.

The responsibility to protect others like Gail O’Rorke should not be left to the unpredictable mercy of 12 decent men and women.

John Halligan to bring assisted suicide Bill before Dáil

Wed May 29th 2015…http://www.irishtimes.com/news/politics/john-halligan-to-bring-assisted-suicide-bill-before-d%C3%A1il-1.2194292

An Independent TD is to introduce a Bill removing any criminal sanctions against a family member or doctor who assists a suicide.

Waterford TD John Halligan has compiled a dying with dignity Bill to be introduced in the Dáil within weeks. He said there needed to be a “dignified, compassionate and thoughtful debate” on the issue.

“This affects many families and at some point it may affect all of us or a member of our families. You have a right to dignity in life and you have a right to a dignified death.”

The Bill, which was compiled by two barristers, sets out strict criteria before an assisted suicide can take place. The person must have a terminal and incurable illness and must be assessed by at least two doctors before a decision is reached.

The proposed legislation requires the second doctor to be independent and not to have been involved in the patient’s treatment.

Legal capacity

It requires the person seeking assisted suicide to be over 18 and to have the legal capacity to make the request.

Mr Halligan said he believed he had the support of a number of TDs on the Government and Opposition benches.

“This is about a person who is terminally ill and their right to make a decision themselves. Nobody has the right to tell them they must live in horrendous pain. We need to show compassion.” The dying with dignity Bill would remove sanctions against any member of a family who helps a loved one to end their life. It also lays downs that a physician who carries out the act cannot be charged with murder if the provisions in the Bill are followed.

Support

Mr Halligan worked on the legislation with Tom Curran, the partner of Marie Flemingwho took a legal case in the Supreme Court to be allowed to end her life.

“There are a number of TDs who have told me they support this plan. When I raised it with Eamon Gilmore, when he was leader of the Labour Party, he admitted it was time for a national debate on it.

“I hope the Government will not oppose this Bill when I introduce it and allow a conversation to be had on the issue.

“I would also appeal to the Government to allow a free vote on the issue. It is too serious an issue to put a whip on it. We need to show some compassion on the issue.”

The proposed legislation follows the decision by a jury this week to find Gail O’Rorke not guilty of attempting to assist a suicide. Ms O’Rourke had made travel arrangements for her friend Bernadette Forde to go to Zurich.

Bernadette Forde’s last letter

“My name is Bernadette Forde and my date of birth is 16th August, 1959, and I have MS for the past 10 years and it has got very, very bad in the last number of months and I knew that it was getting bad, so I made arrangements to go to Dignitas in Zurich, but my hopes were dashed because the police got to my friend when she went to collect the tickets and I hadn’t realised up until then that Gail and my nephew, Bernard, would have got into difficulty for assisting — although they weren’t assisting they were just going to travel with me to Zurich.

I didn’t want Gail or Mary or anyone around any more if they were going to get into trouble for it. I knew that I needed to do it. I just can’t live with this anymore. My life is shit and I just can’t keep going with everything, going to the loo, with pads, with seats, everything is just a nightmare.

After the Dignitas experience, I realised that I had to do what I needed to do on my own, in case anyone would be implicated. I can’t even talk to anyone. I went online to see what help I could get. I saw a programme on the Late Late and then I found the Exit International website and started looking up what I could do.

I then managed to get a hold of this stuff from Mexico online and it was delivered to me via courier. That took over two weeks to get here. It was just so difficult. I just can’t do any of this anymore or again. Hiding it from friends has been difficult.

It’s just so unfair that I can’t contact or chat to anyone, and I have to be totally alone. But that’s just it. I got stuff from Mexico and I do intend to do it, but I can’t let anyone know. I got this dictaphone online as well, from Peats on Parnell Street. Because my writing is very bad so, as a suicide note might not be possible, so that’s why I’m using this. I have this stuff there for the guards or whatever, along with the receipt and instructions.

I hope it will make my intentions clear to anyone who wants to question it afterwards. It’s me and only me and no one else. I’m just very frustrated it has to be this way. Why is it in Ireland that I can’t get my way to Dignitas?

I just need to say that I have a real frustration and problem with the fact that cheques and withdrawals made from my account were made totally at my request. I’m housebound. I asked a friend to help and I can’t believe they would question her about that.

I got my solicitor to visit my house to find out what was legal and what wasn’t legal. I don’t want Gail or my sister Catherine to do this at my request, who I wanted to give a couple of bob to out of my account — what use is it to me that I can’t access my money?

I’m afraid questions could be asked, but there shouldn’t be a question mark because it’s what I wanted, and what else can I do? So I don’t know. I have to say this bloody country. So, anyways, that’s it. Thank you.”

Bernadette Forde’s death was no way to say goodbye

We tend to judge things by their endings. You can have a bad day, but if it ends well, you go to sleep happy. In fact it’s scientifically proven, in studies about pain, that people’s memories of things and the taste an experience leaves in your mouth are far more heavily influenced by the endings.

For example, you can have a wonderful life but if you have a bad death, well, it pretty much spoils everything, doesn’t it? And everybody is left with bad memories, and those bad memories of your death can overshadow everything else that happened in your life. Without getting too metaphysical, whether we go somewhere or not after our death, you can only imagine how it feels if your last moments of consciousness on this earth are upsetting and troubled, lonely or regretful. It’s not how any of us wants to go.

Humanity has long recognised the importance of a good death, and that is why we have always worked so hard to build comforting rituals around death. A good death is important to everyone involved; those left behind, and not least, the person dying.

The Hospice movement and its advocates talk about something called ‘the dying role’. Indeed, the dying role is often characterised in terms of a play or a drama where everyone has a part to play, and the person who is dying is the central character. The setting is important for example, ideally at home surrounded by loved ones, in a place that is ideally not too sterile and hospital-like. This is important in that it helps to move the person from the so-called sickness role to the dying role. The sickness role is about medicine and trying to make someone better generally. The dying role is more about enhancing the quality of the life that remains, rather than the quantity. Even costumes are important in the death drama, with the dying person endeavouring to wear their own clothes as long as possible, rather than hospital gowns or other vestments of illness.

Of course, the basics of this drama are the elimination of pain and discomfort, but there’s a lot more to it than that. The elimination of pain allows the dying person, and everyone else, to then focus on the important, higher-level issues.

The higher-level issues are mainly about allowing the dying person to find some meaning in the situation. Well-known palliative-care doctor Ira Byock points out in his book Dying Well, that a good death, done well, with all the actors playing their parts right, can be as profound, intimate and precious as the miracle of birth. This might be hard to see from our perspective now, but when you are facing death, and it is even more inevitable than it is for you now, you can see how a good death would seem like the most important thing in the world.

From where we stand, for example, death can seem like a hopeless situation. One of the functions of the dying role is to give hope in this apparently hopeless situation by recalibrating what a person can realistically hope for. So obviously they are not going to get better, but perhaps they would like to try and live long enough for someone’s wedding, perhaps they might simply hope for a good death. The point is that death need not be hopeless and the dying person need not be devoid of hope. Other important aspects of the dying role can be simple things like saying goodbyes, having reconciliations, and maybe trying to get things in order for after you die. This can extend even to trying to help others to cope with the aftermath of your impending death.

Strangely, the only person I have ever had an in-depth conversation with about his own impending death was a 16-year-old. You will remember him. Donal Walsh. It is really only recently that I began to understand so many things about what Donal was doing towards the end of his life. He was fulfilling his dying role. He had realistic hope, not in the sense that he thought he would get better, but in the sense that he was hoping for a painless death.

When I asked him if he had any ambitions left, a bucket list maybe, not to suffer too much in his final weeks was his only one. He was also spending a lot of time preparing his family and friends for his death. And even his anti-suicide message was a way for him to invest his dying with meaning and purpose. It was a textbook dying role, and as far as I know it helped Donal and his family greatly and he had as good a death as a 16-year-old boy can have. I would imagine Donal’s death was as profound and intimate and precious as it could have been for him and his family, and I think that is something that is a huge comfort to them now.

Contrast all that with the death of Bernadette Forde, who sat alone in her apartment and recorded a suicide note on a Dictaphone she had bought especially for that purpose. Bernadette had to record her final words because the MS that had gradually crippled her and made her life unbearable for the previous decade had rendered her unable to write a legible note.

Bernadette Forde was alone when she took the barbiturates she had bought online from Mexico that killed her. But she was not alone because she had no one to be with her. She was alone because the law required that she be alone. That was part of her dying role, to protect those who would be left behind from any culpability in her death.

Not only did she have to be alone, she actually had to send away her closest confidante and friend, to ensure she was in another county when she died.

Ideally, in the dying-role scenario, when the person is moving towards the end and goodbyes have been said, one person, a lover, partner, friend or confidante will sit with them holding their hand, reassuring them, and essentially giving them permission to go.

Bernadette would have had that comfort if, for example, she had been allowed to go to Dignitas.

Indeed, only for Irish law, she would have had that comfort in her own home, which is where she should have had it. But she didn’t have it. She was alone. And she felt that was unfair and she was frustrated about being alone. As she pointed out in her suicide note she couldn’t even discuss her death with anyone. And she died angry and frustrated and despairing about that.

It was no way to go, was it? Alone, angry, frustrated and feeling let down by her country and unable to get the comfort of friends. And will we ever know the loneliness of those final weeks, after she had ordered her death dose, and when she knew what was ahead but could tell no one, or seek comfort from no one. But for Bernadette her life was so “shit” – her word – that even that lonely, bitter death, a death where she was not at peace with the world, was better than living.

I know that this is a complex area and there is a big conversation to be had about the right to die. But no one could look at the death of Bernadette and compare it to the death that we would all like to have and not say that there is something seriously wrong with a country that forces someone to die as Bernadette did.

Helping a person to die – why new compassionate laws are needed

Wed, Apr 29, 2015,    http://www.irishtimes.com/opinion/helping-a-person-to-die-why-new-compassionate-laws-are-needed-1.2192306

Helping another to die is probably the most intensely personal test of individual conscience known to mankind. Most of us are shocked and revolted by murder, suicide and genocide, but when someone we know and love cries out, with justification, for help to die, who among us dares to respond? If we help to accelerate death in these circumstances, are we being ruthless or humane?

Whatever we might answer, in Ireland it is illegal to help another to die – with a punishment, if convicted, of up to 14 years in jail. Notwithstanding this, a recent Irish Times/Ipsos MRBI poll among Irish people found that 54 per cent would do just that. This means that 54 per cent of Irish people would risk 14 years in jail to help someone they love do something that is perfectly legal in Ireland.

That may seem confusing. In Ireland, since 1993, the taking of one’s own life is not illegal, but providing help to someone to take his or her own life is illegal. It is probably the only law that exists where it is illegal to help someone do something that is perfectly legal.

Marie’s challenge

The issue of assisted dying came into focus in Ireland over the past few years. The first was when it was made public that I was prepared to help the person I love, Marie Fleming, to die at a time of her choosing. The second was Marie’s constitutional challenge to the blanket ban on assisting a person to die.

Part of the grounds for that challenge was that a disabled person was unable to do something that was legally available to an able-bodied person. That is, that her disability brought on by her having MS made it physically impossible for her to take her own life. Our Constitution does not allow discrimination on the basis of disability.

The court in its judgment found that there were grounds for discrimination, but that to strike out the law could put vulnerable people in danger.

I agree completely with this view. Vulnerable people need to be protected, but not at the total exclusion of rational, terminally ill people who decide they do not want to suffer on. The court stated that there was nothing preventing the Oireachtas from changing the law to allow assistance to be provided to rational adults while still providing protection to the vulnerable.

That was two years ago. The only thing preventing this happening is the courage, or lack of, on the part of our legislators.

The British lead

The court also stated that it believed the DPP would use the same guidelines issued by the UK DPP in deciding whether to prosecute in the future. In other words, that if a person was a carrying out the wishes of a rational adult with an incurable illness who was making an informed decision to die, and was acting out of compassion for that person, it is unlikely they would be prosecuted.

Why, then, was Gail O’Rorke charged with providing assistance to Bernadette Forde in the act of taking her own life to escape the life that MS had dealt her – a charge that Gail has now been acquitted of?

When this law was brought in in 1993, its intention was to decriminalise suicide and create a new law of assisting a suicide. It allowed anybody in Ireland to take their own life or attempt to do so without they or their family falling foul of the law. But in the way it was drawn up, it excludes the only people who might have a reasonable justification in taking their own lives: rational adults with terminal illnesses who face the prospect of a prolonged, painful death.

We are all human, and sometimes legislators don’t get things right first time out. This surely is one of those times. When more than 80 per cent of Irish people feel that the law is wrong and 54 per cent are prepared to break it to help a loved one end their suffering, it’s certainly time to take notice.

A bill will be coming before the Dáil setting out how the law should be amended to both provide for people such as Marie and Bernadette Forde, and to protect the vulnerable. That will be a chance for the Taoiseach and his Government to show their compassion.

Tom Curran’s partner, Marie Fleming, brought a constitutional challenge to the blanket ban on assisting a person to die