What is Medical Assistance in Dying?

Medical assistance in dying (MAiD) is one of a number of choices that can be considered in end-of-life care.

It is a process where a medical practitioner helps a patient who wants to voluntarily and intentionally end their life.

This is provided in a regulated and safe environment, typically through an independent medical doctor, with strict oversight of the service. All patients will continue to have access to palliative care services.

Many countries have introduced MAiD in the past two decades. In these countries, MAiD represents a small minority of overall deaths.

Is there a difference between ‘Assisted Dying’ and ‘Medical Assistance in Dying’?

Assisted Dying and MAiD are synonyms.

Medical Assistance in Dying is one of a number of choices that can be considered in end-of-life care. It is a process where a medical practitioner helps a patient who wants to voluntarily and intentionally end their life.

Assisted Dying can be defined as a doctor or nurse practitioner giving a person medication to relieve their suffering by bringing on death; or, the taking of medication by a person to relieve their suffering by bringing on death. This is the definition which was taken in New Zealand.

Medical Assistance in Dying (MAiD) is the term which has been used in Canada since June 2016. The understanding of MAiD in Canada which is regulated and operated by the provinces, includes options of intravenous administration of medications by physicians or nurse practitioners (the most common method), or self-administration of oral medications.

Before the Dying with Dignity Bill came through the Dáil in 2020, what was the status of Assisted Dying in Ireland?

In Ireland, under Section 2 of the Criminal Law (Suicide) Act 1993, anyone who ‘aids, abets, counsels or procures the suicide of another [person]’ can be convicted and imprisoned for up to 14 years.

The Dying with Dignity Bill brought the conversation on Assisted Dying to national attention in 2020.

Several high-profile cases have highlighted the lack of access to MAiD in Ireland.

In 2002, Rosemary Toole Gilhooley died. However, it subsequently transpired that an American Minister, Rev George Exxo admitted to assisting Rosemary in her death in Ireland. His extradition to Ireland was sought, but this was subsequently refused.

Marie Fleming attempted to establish her right to die, by MAiD in Ireland, in 2013. Diagnosed with multiple sclerosis for over 25 years, she gave evidence that she suffered from unbearable and severe pain. She told the Court she was no longer able to control her electric wheelchair, needed help to eat and drink, and had to be washed, dressed and repositioned in her wheelchair and was losing her ability to swallow. She lost her case and the appeal to the Supreme Court- but this acknowledged the ability of the Irish legislature to allow for Assisted Dying through legislation. She died in December 2013.

Is it true that a ‘slippery slope’ will happen if we introduce Assisted Dying?

The fear of a ‘slippery slop’ is often used to distract from a very modest conservative reasonable proposal to give patients with a terminal illness who have intolerable suffering a choice - to avoid suffering. 

Also, those who talk about a slippery slope are often completely opposed to Assisted Dying in all circumstances.

What is proposed in Ireland - like what was discussed in the Dying with Dignity Bill- is similar to Australia and New Zealand - in that it would be created and modified only through legislation. Laws cannot change by accident but only through further legislation. Grounds for accessing MAiD, in Ireland, will therefore be carefully outlined.

Grounds under disability, dementia or mental illness will not ‘slip’ into legislation- because our legislation will be specific. If expansion of eligibility is requested, this would require further debate and legislation.

What about cases where patients lose capacity (e.g. dementia), should Assisted Dying be made available to them?

Dementia is a dreadful and devastating disease.

The issue with dementia is that when this condition becomes ‘terminal’, a patient may lack consent and may be unlikely to have capacity at the time that medical assistance in dying would take place. As a result consent at the time of death might not be possible. Therefore providing for Assisted Dying for individuals who lack capacity at the time of death can be challenging.

Many countries have procedures put in place (including Advanced Care Directives) which allow for individuals to access MAiD, even when they lose capacity at the time of death. Many of these same countries, legislated for MAiD only in cases of preserved-capacity at the time of death initially. Later, when the public saw that procedures were safe and robust, legislation was widened to consider more complex clinical situations, including Assisted Dying when capacity can be lost.

Whilst it is unfair- and perhaps in the future people with dementia should be considered- it is our opinion as a group, that initially, eligibility grounds for MAiD should a) include dementia as a qualifying condition; but b) recommend that capacity to consent is also present at the time of death.

What about patients suffering from mental health conditions- should they be eligible for Assisted Dying?

In our submission to the Oireachtas Justice Committee our group recommended that only physical heath conditions should be included as the qualifying condition, which would meet eligibility under legislation.

Mental health conditions should be specificially excluded as a qualifying condition.

However, patients with a physical condition (e.g. terminal cancer) who have a co-existent mental health conditions (e.g. anxiety or affective symptoms) would of course be eligible under our proposals, as long as they possess capacity and understand the end-of-life options available to them.