It was not an auspicious start: a private hour-long meeting last Tuesday evening, in the subterranean Committee Room 1 of Leinster House, at which the key decision was deferred for a week.
Then again, the Oireachtas Joint Committee on Assisted Dying is dealing with a profound moral issue and, maybe, caution was merited.
The immediate question which requires to be answered by the nine TDs and five senators next Tuesday evening is when the Committee should hold its first public hearing.
This is not a mere calendar issue because the political clock starts to countdown once that date is set.
Under the rules of the Oireachtas, a committee like this must issue its final report, including any recommended legislative changes, within nine months of that first public session.
So once the committee meets in public, there's no going back.
Then there’s another time-related problem: the date of the next General Election.
Any legislation on assisted dying, if proposed, would have to pass both Houses of the Oireachtas before the General Election is called.
If the bill is still stuck in the legislative process by the time the Taoiseach heads to the Áras to dissolve the 33rd Dáil, then it simply falls, no matter how much work was involved and how close it was to be passed.
It is then up to another government to tackle the issue or not.
No wonder this is a key decision for a Committee which has already taken far longer to be constituted than had been expected.
The issue is not straightforward either.
Some members, who are concerned that a General Election could be held as early as Autumn 2024, want the first public session next month.
They believe that holding the meeting as soon as possible increases the chances of any proposed legislation actually becoming law.
Deputy Gino Kenny of People Before Profit, who tabled a Private Members Bill on the issue as far back as October 2020, has long called for the Committee to be up-and-running.
However, other Committee members think it is more sensible to start in September as there will be more time to debate the issues.
They point out that both Dáil and Seanad go into recess in mid-July.
Nothing will happen in August. Yet the clock continues to countdown, whether the Oireachtas is sitting or not.
This might explain why the Committee chair, Independent TD Michael Healy-Rae, felt members should have an additional week to mull things over before putting it to a vote.
Once the decision is taken, and a date set, members will move on to agreeing on a workflow for the Committee.
It is expected that the hearings will be broken into six blocks, with the legal issues associated with assisted dying being considered first.
An 18-page scoping exercise, which was drafted by the Committee's Secretariat and seen by RTÉ News, lays out the background to the debate; the terms of reference; a glossary of terms; and intriguingly a list of 24 "potential stakeholders" which the Committee might invite to write a submission or attend a public session.
On the background, the document records how Marie Fleming, a 59-year-old terminally ill woman living with multiple sclerosis, challenged the law criminalising assisted suicide.
She lost her case in 2013, when the Supreme Court ruled that the right to life, under Article 40.3.2 of the Constitution, does not have a corollary right to die.
The ruling means that the law, as amended in 1993, remains unchanged: suicide has been decriminalised, but assisting someone to take their own life is an offence punishable up to 14 years in prison.
It is notable that the Supreme Court described Ms Fleming’s case as "tragic" and chose to make an observation.
It stated that nothing in its judgement should be taken as necessarily implying that it would not be open to the State, in the event that the Oireachtas was satisfied that measures with appropriate safeguards could be introduced, to legislate to deal with a case such as that of Ms Fleming.
There are only eight terms of reference to guide the Oireachtas Joint Committee on Assisted Dying, but one has proven to be controversial
the independent senator Rónán Mullen, suggested at last Tuesday's closed-doors meeting that Term 2 should be amended.
It currently states that "… the Joint Committee shall consider and make recommendations for legislative and/or policy change in relation to a statutory right to assist a person to end their life and a statutory right to receive such assistance."
It is understood Senator Mullen made a presentation to fellow Committee members and argued that Term 2 should be changed to explicitly state that leaving the law as it currently stands is also an option.
Amending a term of reference could well require a vote in the Dáil and Seanad.
Given that could trigger a further delay to the Committee's work, it may not be accepted by members.
In the glossary of terminology, the scoping document seeks to differentiate between the various definitions.
It notes that "euthanasia" involves a doctor or healthcare professional as the person who "acts last" with the intention of ending a life.
This differs from "assisted suicide" in which the person seeking to die "acts last" i.e. they are the one to administer the drug, or the means selected to cause death.
It also provides definitions for palliative care, terminal illness, dying with dignity and right to die.
The document notes that there are at least 27 jurisdictions around the world that already provide for some form of assisted dying and it details the different approaches.
For example, Netherlands and Canada allow both physician-assisted suicide and euthanasia, while the US and Switzerland only allow physician-assisted suicide.
Another point of difference is age.
Most jurisdictions restrict assisted dying to adults, but Belgium provides euthanasia for minors, regardless of age, when specific criteria apply.
When it comes to eligibility, most States restrict the option of assisted dying to people with terminal illnesses; others extend it to those living with "constant and unbearable suffering"; while a small minority include people experiencing prolonged mental anguish.
The scoping exercise also identifies some of the ethical issues involved and suggests Committee members "may wish to examine":
- How to balance the individuals’ autonomy, freedom of choice and control of their own medical decisions with wider societal considerations.
- Whether involvement in assisted suicide, or providing euthanasia, can be compatible with a doctor or healthcare worker's role to "do no harm".
- How to ensure that if assisted dying were to be provided, doctors and other healthcare workers who have moral objections to it are not forced to be involved .
The final five pages of the scoping exercise identifies "potential stakeholders" and their relevant qualifications.
The first entries, as you might expect, include the Department of Justice, the Department of Health and the Irish Human Rights and Equality Commission.
After that, it lists some groups and organisations with specific positions on assisted dying: the Iona Institute and the Pro Life Campaign are synonymous with opposing any legislative changes, whereas End Of Life Ireland and Exit Ireland are supportive of the right to choose.
Various medical representative bodies are listed: the Irish Medical Organisation, Irish Hospital Consultants Association, Irish Nurses and Midwives Organisation, Irish Pharmacy Union, Irish College of General Practitioners, and the Irish Hospice Foundation.
Among the academics identified as potential stakeholders are Prof Mary Donnelly of UCC (Law), Prof Deirdre Madden of UCC (Law), Prof Tony O’Brien of UCC (Palliative Medicine), Prof Penny Lewis of the Law Commission, and Prof Gerard Quinn of NUIG (Disability law).
When the Committee ultimately concludes its work, members must also agree on what happens next.
One option would be to recommend legislative changes.
Should that happen, either the Minister for Health or the Minister for Justice would be responsible for drafting a memorandum on the basis of the Committee report and bringing it to Cabinet.
Another option might be for the members to recommend establishing a Citizens' Assembly on the matter.
A remote possibility would be for the Committee to suggest that a plebiscite is held on the question.
Before all of that, the Oireachtas Joint Committee on Assisted Dying has to decide whether to hold its first public meeting in May or September and if its terms of reference need to be amended.
Those decisions are scheduled to be taken by the 15 Committee members, meeting in private this Tuesday evening, in the basement Committee rooms of Leinster House.
