An expert in palliative care has told the High Court that changing the law on assisted suicide could put pressure on vulnerable people to end their lives.
Dr Tony O’Brien, a palliative care consultant, was giving evidence in the case of Marie Fleming, the Wicklow woman who has taken a landmark case challenging the criminal law on assisted suicide.
Dr O‘Brien said a removal of the absolute ban on helping someone to end their life would "muddy the waters".
He said he was fearful it could make people feel they were a burden on relatives, leading them to decide they wanted to end their lives.
Dr O'Brien said if a person had a right to choose their time of death and should there be a corresponding obligation on a physician to enable them to do so would cause him great alarm and would be entirely inappropriate.
"My understanding of autonomy is that it must be balanced against the needs of society and I see individuals in families who suppress their own health care needs to avoid being a burden and were the law to change these people might seek this relief to ease the burden on those who care about them."
Dr O‘Brien said palliative care when properly used was designed to enhance the life of patients and not to render them comatose, as had been suggested during the case.
He said it would be wrong to suggest there was "a pill for every ill" but palliative care treated the whole person and not just a condition or disease.
He said the greatest level of stress to a person towards the end of life was a spiritual one, an inability to find meaning.
"I cannot prescribe meaning but hopefully I can create a space where they can themselves find meaning."
He denied that it was a common occurrence that the administration of pain killing medication towards the end of life often had the "double effect" of shortening life.
He said attempts to link palliative care to physician assisted suicide was misleading. This simply does not happen, he said.
He said: "You could kill someone with morphine but it is difficult to do so because of the dosages involved. It is much easier to kill someone with paracetamol."
Dr O’Brien also said he was deeply concerned to hear of the pain and suffering being endured by Marie Fleming. He felt adequate palliative care could help to relieve this and would meet the needs expressed by Ms Fleming in her evidence.
He also disagreed with a witness for the plaintiff that hydration and nutrition were routinely withheld from palliative care patients towards the end of life, causing them to die from dehydration or starvation.
He said decisions about hydration and nutrition were separate clinical decisions, which were not connected.
Dr O’Brien said at times it may be more burdensome on a patient to administer fluids towards the very end of life and the decision would be made on a burden to benefit ratio.
He said he had personal experience of patients taking their own lives and those who had attempted suicide, and in both circumstances it left a horrendous legacy for families.
Marie Fleming was diagnosed in 1986 with MS and is in the final stages of the condition.
She is past the point where she could take her own life unaided but wants to establish the right to end her life with assistance.
She is challenging a section of the Criminal Law Suicide Act, which makes it an offence to help someone take their own life.
Ms Fleming claims the section of the act is contrary to the provisions of the Constitution and incompatible with the European Convention on Human Rights.
She has asked the court for a declaration that the section of the act is invalid.
Failing that she wants the DPP to outline the criteria used in deciding on a prosecution in cases of assisted suicide.
Changing law would be 'a reclassification of a form of killing'
Meanwhile, an English consultant in palliative care Professor Robert George said changing the law on assisted suicide would be a reclassification of a form of killing.
He said there was a concern about the idea of creating a "slippery slope" to euthanasia in that "once the ending of life is viewed to be the best option the landscape would be changed completely".
He said it started as voluntary euthanasia in the Netherlands and then became non-voluntary for those for whom it was presumed to be in their best interest, then it moved to people with psychiatric disorders.
Questions would then be asked who needs it and who does not and why could it not be done for children.
Prof George said killing people as a treatment or a solution would change society, making it a much more hazardous one.
Risks to vulnerable people would be high and could not be monitored adequately, he said.
There is a claim that euthanasia and assisted suicide were different things but he did not agree.
He said it did not make any sense to make such a distinction between how it was to be administered.
He also identified what he believed was the "moral hazard" of involving a third party in an act to end a life, adding: "We do not know how people will feel or will be after they have done that."
It would have the effect on the ambient view of what is normal, Prof George said, adding it could be called a slippery slope but could also be called a paradigm shift tending towards increased normalisation.
He said disability groups are among the most stridently opposed to a change in the law in UK.
The majority of doctors’ organisations and groups representing elderly and disabled were opposed to it.
The idea that palliative care doctors medicate people into oblivion was a misconception, he said.
It would be possible for Marie Fleming to have the kind of death she wanted at home with sophisticated pain relief and palliative care, he said.