Survey reveals changing attitude to assisted dying among trainee Irish medics
Friday, December 2nd, 2011
Research presented at a conference in Cork on Wednesday suggests that there may be growing support for physician assisted suicide and euthanasia among trainee doctors.
66 out of 170 fourth-year medical students at University College Cork answered the online survey conducted by Canadian medical student, Matthew Carere. 58% (around 40 students) supported some form of physician assisted suicide or euthanasia.
Mr Carere presented his findings to a Law Society conference in UCC, entitled Assisted Dying and Euthanasia in Ireland.
“Public opinion towards euthanasia is changing because patients are better informed to make decisions for themselves,” he told the conference.
“Over the past three decades public opinion toward euthanasia is gradually improving. We are moving away from a paternalistic type medicine, respecting more patient autonomy and patients are more well informed.”
Reacting to the poll, Dr Berry Kiely from the Pro Life Campaign said that what people are really concerned about is that they won’t suffer unnecessarily. "The fear people have is that they will be left alive attached to machines, suffering without being any good to themselves or to others,” she told ciNews. “But you don’t need euthanasia to solve that.”
Dr Kiely emphasised that patients have the right to say that they do not want treatment. “No one has the obligation to undergo any form of extraordinary treatment (or indeed any ordinary treatment). They have the right to refuse.” In the case where patients are not able to make a decision because of dementia or another incapacity, it is possible to appoint someone to act on their behalf, or to make a “living will.”
“You can write a living will that in a certain circumstance, if you are not able to take a decision because you have lost consciousness or you have developed dementia, this is what you want,” explained Dr Kiely.
Currently, ethical guidelines of the Irish Medical Organisation prohibit euthanasia and physician assisted suicide. The Guide to Professional Conduct and Ethics for Registered Medical Practitioners states at "You must not participate in the deliberate killing of a patient by active means."
However, Dr Kiely admits that in very rare cases patients do want doctors to assist them to take their own lives. She says asking to legalise, “willed killing,” undermines the basic principle of medicine that a doctor will always act to secure and preserve life to the best of his or her ability.
"If you change that, even in very narrow circumstance, you undermine the principle and this has a negative influence on other people,” she said.
Holland was the first country since the fall of Nazi Germany to legalise euthanasia. In 2002 it was no longer punishable if the attending physician acted in accordance with criteria of due care, i.e. the patient's request, the patient's suffering (unbearable and hopeless), the information provided to the patient, the presence of reasonable alternatives, consultation of another physician and the applied method of ending life.
Each year sees a 10 per cent or greater increase on the previous year, and euthanasia is now used for people with mental illnesses. Even children can ask to be euthanised, but those under 16 must have parental consent.
A recent citizen’s initiative (from 2010) has demanded that all Dutch people over 70 who feel ‘tired of life’, should have the right to professional help in ending it. Opponents of euthanasia in Holland complain that the industry has all but wiped out palliative care.
Dr Els Borst, the former Health Minister and Deputy Prime Minister who guided the law through the Dutch parliament, has said that she regretted that euthanasia was effectively destroying palliative care.
Meanwhile in Ireland, a report on primary palliative care launched Wednesday, has recommended a series of measures to be adopted to enhance the ability of GPs and primary care teams to deliver quality care to people dying in the community.
The report, a collaboration between the Irish Hospice Foundation (IHF), the Health Service Executive (HSE) and the Irish College of General Practitioners (ICGP) recommends:
- Creating a system to identify and respond to patients with palliative care needs in the community
- Developing a palliative care summary to update GP out-of-hours services with relevant background information on the changing needs of dying patients
- Clarifying the extent and means to access advice and information from specialist palliative care on a 24 hour basis
- Encouraging professional bodies involved in training and development of primary health care staff to signpost existing education and training options in palliative care
Some 27,000 people die in Ireland every year. The vast majority, or 90%, their care in the last year of their life is provided for by the GP and primary care team. Unlike other countries, Ireland has no formal framework to support the delivery of palliative care by primary care teams.
Most people want to die at home, “To facilitate this, there is a great need to improve the generalist palliative care that is available in the community. Implementing the recommended initiatives in this report will help to keep more patients with life-limiting disease in the community as their health deteriorates. It is feasible to improve this aspect of care delivery within the current fiscal restrictions,” said Dr Paul Gregan, Chairperson of the Primary Palliative Care National Steering Group.
According to Sharon Foley, CEO of the Irish Hospice Foundation, the person who has an advanced life-limiting disease, and their family must “at all times remain central, be fully informed and have opportunities to engage with and plan the health care they receive.”
by Susan Gately