The search for a peaceful death

Juliet Bressan ponders the complexities and sensitivities involved in implementing dying with dignity legislation

Dr Juliet Bressan, GP, Inner City, Dublin

December 16, 2022

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  • It can be very difficult for patients and their loved ones to talk to their GPs about their death, even more so to plan for it.1 This isn’t just a question of medical ethics, or even skillset. All humans dread pain, fear, respiratory distress, delirium, inability to communicate our needs or the loss of our dignified human bodily function at the end of life. 

    Everybody wants a peaceful death. Most people very much dread becoming an unbearable burden on loved ones, or dread causing distress to carers or health staff. Many people, doctors included, understandably would like to have their own trusted doctor to help them to have control over their own death so that it will not be undignified.2

    However, a reasonable need for patient reassurance, when it necessarily becomes a part of legislation, can present a complex dilemma for doctors. The AMA, for example, opposes physician assisted suicide, but 54% of surveyed American AMA members do support its availability.1 This can create conflict between medical authorities and patients, causing difficulty for doctors who wish to adhere to medical guidelines and avoid condemnation by their peers, while also providing their patient with full information on their legal options,1 and doing so without any self-interest of the doctor – an almost impossible conundrum.

    The 2020 Dying with Dignity Bill is a private members bill, on which progress appears to have stalled, with a special Oireachtas Committee now due to examine the issue. The Bill can be read online on the Oireachtas website.3

    It contains sections on important areas of medical practice such as prognostic criteria for terminal Illness, as “irreversible, progressive disease, unresponsive to treatment that is likely to result in death”. The Bill makes the doctor responsible to ensure capacity, guarantees that two doctors must have assessed the patient, one of whom can be the patient’s appointed physician but the other must be a completely independent second opinion. 

    It also insists that all other options must be explored with the patient including that hospice care has been provided. The Bill makes it an offence for anyone to coerce or insist that a doctor should assist a patient to die, or to coerce or persuade a patient to die. It legislates for doctors to exercise conscientious objection, to refer, and for patients to have the right to revoke at any time. It legislates on note-keeping, registration, the legal admission of substances and severe penalties for disobeying the Act, including imprisonment and fines.

    In this month’s Forum, in the first of two articles, we explore difficult and complex ethical issues for GPs which have arisen in other countries where physician-assisted suicide and assisted dying have been legal, so that we can inform ourselves on what could potentially make good or bad law for GPs when the Oireachtas considers legislation on this complex and sensitive issue.3

    If dying with dignity legislation is eventually enacted for Ireland, it will indeed need to be robust enough to thoroughly protect the interests of patients as well as doctors, to ensure that GPs continue to provide compassion, safe referral pathways, guarantee dignity and relieve distress for all our patients at all the stages of their lives.

    © Medmedia Publications/Forum, Journal of the ICGP 2022