In my time of dying

Britain’s Terminally Ill Adults (End of Life) Bill may serve as a catalyst for renewed debate in Ireland and other jurisdictions Marie Kinsella explains

Assisted dying remains one of the most complex and contested issues at the intersection of ethics, medicine, and law.

In Britain, the matter has re-emerged in parliamentary debate through the Terminally Ill Adults (End of Life) Bill.

The proposed legislation seeks to establish a defined legal framework enabling terminally ill individuals, subject to stringent safeguards, to request assistance in ending their lives. 

The bill defines terminal illness as an “inevitably progressive disease” expected to lead to death within six months.

Under the draft scheme, an individual meeting this criterion could apply for assistance, subject to multiple procedural safeguards.

The bill attempts to strike a balance between respecting personal autonomy and protecting vulnerable groups. 

Key legal concerns include:

• Definition of terminal illness: prognosis is not an exact science, and life-expectancy estimates may prove inaccurate. Some parliamentarians suggested supplementing the six-month test with a criterion of ‘intolerable suffering’ to capture cases where the prognosis is uncertain but the suffering severe. 

• Safeguards against coercion: detecting subtle familial or societal pressures remains difficult. Ensuring voluntariness requires robust and independent capacity assessments. 

• Oversight and judicial review: the bill proposes review by a panel (psychiatrist, social worker, and legal expert) rather than by the High Court. Critics argue this may dilute safeguards and reduce transparency.

• Protection of vulnerable groups: concerns have been expressed that people with disabilities, mental￾health conditions, or eating disorders might be placed at risk, despite the bill’s procedural checks. 

• Palliative-care requirements: some in the House of Lords advocated for mandatory referral to palliative-care services before progressing to assisted dying, to ensure all therapeutic options have been explored.

• Regulation and professional opt-outs: questions remain over who would regulate the drugs used, and how to guarantee the independence of review panels. While conscientious objection for doctors is preserved, broader regulatory clarity is needed. 

• Human-rights dimensions: the bill engages articles 2 (right to life) and 8 (right to private life) of the European Convention on Human Rights. The ‘slippery-slope’ argument, that eligibility criteria could expand over time, featured heavily in the debate. 

• Funding implications: hospices and care providers emphasised that regulation, training, and safeguarding would require significant additional resources. 

At present, the bill has not become law. A Select Committee has been convened to gather evidence from medical professionals, patient groups, ethicists, and legal experts before progressing it further.

Stairway to heaven

Ireland’s most prominent assisted-dying case was Fleming v Ireland.

Marie Fleming (now sadly deceased), a woman living with advanced multiple sclerosis, argued that Ireland’s blanket ban on assisted suicide violated her constitutional rights and the European Convention on Human Rights. 

The Supreme Court expressed profound sympathy for Ms Fleming’s circumstances but ultimately upheld the existing prohibition under section 2(2) of the Criminal Law (Suicide) Act 1993.

The court recognised the Oireachtas’s legitimate interest in protecting vulnerable persons from abuse and coercion.

Importantly, the court acknowledged that the Constitution protected autonomy and dignity in decision-making, but it declined to create a constitutional right to assisted dying.

It emphasised that any change in this sensitive area of law was a matter for the legislature, not the judiciary. 

In recent years, Ireland has seen renewed political debate.

The Dying with Dignity Bill 2020 was introduced, but did not progress beyond committee stage, largely due to concerns over inadequate safeguards. 

More recently, an Oireachtas Special Committee has been tasked with examining the issue afresh, suggesting that legislative reform may yet resurface. 

(Don’t fear) the reaper?

Other jurisdictions with shared common-law traditions offer useful comparisons: 

• Canada – the Medical Assistance in Dying (MAiD) regime was introduced in 2016 following the landmark case of Carter v Canada (Attorney General). Initially restricted to individuals with a reasonably foreseeable death, the law has since expanded to include those with intolerable suffering, though debates continue regarding mental-health conditions. 

• New Zealand – in 2020, following a binding referendum, the End of Life Choice Act came into force. It permits assisted dying for adults with a terminal illness likely to end their life within six months, provided strict safeguards are met. 

• Australia – several Australian states, including Victoria, Western Australia, and Queensland, have enacted voluntary assisted-dying legislation, each with variations on eligibility, safeguards, and procedural requirements.

• United States – assisted dying is legal in a number of states, such as Oregon, California, and Washington, under ‘death-with-dignity’ laws. These typically limit eligibility to adults with a prognosis of six months or less to live, and require multiple physician confirmations. 

This illustrates that, while assisted dying remains controversial, carefully regulated frameworks have been adopted across several jurisdictions, often in response to judicial rulings, public referenda, or sustained political advocacy. 

Candle in the wind

The British bill represents the latest attempt to legislate in one of the most sensitive areas of law and ethics.

The House of Lords debates have highlighted the formidable challenges of balancing individual autonomy with the protection of the vulnerable. 

Ireland’s experience in the Fleming case shows how courts have, to date, deferred to the legislature in this domain, while other common-law countries like Canada, New Zealand, Australia, and parts of the US have moved ahead with legal frameworks permitting assisted dying. 

As the UK Select Committee continues to gather evidence, the central issue is whether legislation can be formulated that upholds individual autonomy and dignity while providing robust safeguards against coercion, abuse, and undue societal influence. 

The outcome of this inquiry will not only determine the direction of future law and policy in Britain, but may also serve as a catalyst for renewed debate in Ireland and other jurisdictions. 

Marie Kinsella is a partner and head of healthcare at Philip Lee LLP.