Summer 2021

Dying with Dignity: Summer 2021 | Volume 110

This issue of Studies leads with three essays on questions arising from the introduction of Mr Gino Kenny TD’s Dying with Dignity 2020 bill in Dáil Eireann last autumn. Its anodyne title notwithstanding, the bill is concerned with the highly contentious questions of assisted suicide and euthanasia. As yet, at this time of pandemic and the accompanying restrictions, it has attracted relatively little attention, despite its significance. It has even been suggested with a degree of plausibility by some commentators that its introduction at such a time has been deliberately intended to preclude more thorough scrutiny, thus helping to hasten its passage. The discussion in these pages aims to promote and assist such scrutiny and the ‘respectful, rational and meaningful debate’ which Gino Kenny TD himself called for when introducing his bill.
Underlying assumptions
One of those invited to make a submission about the bill to the Oireachtas Joint Committee on Justice in January was Dr Noreen O’Carroll, who teaches medical ethics at RCSI University of Medicine and Health Sciences. What she writes here, based on her submission, repays close reading. She examines the bill and questions what she sees as its two principal underlying assumptions. The first is that ‘the final stages of terminal illness rob patients of their dignity as human beings’ – hence the bill’s title – and that, ‘to die with dignity’, patients should be permitted ‘to choose the means and time of their own death with assistance from a healthcare professional’. The second assumption is that ‘a death by assisted suicide or euthanasia is flawless, painless and quick’. She firmly challenges both of these assumptions.

In her detailed, evidence-supported rebuttal, among other familiar – but important – points she draws on research in the Netherlands to argue that ‘pain is not the primary reason for patients’ requesting assisted suicide or euthanasia’. Moreover, ‘few of those who choose euthanasia were experiencing pain, but most were depressed’. This points to complex questions of human context and causation which a bill such as the one under consideration does not adequately address. On the question of how – and how easily – the process of assisted suicide or euthanasia actually works, she goes into further, research-based detail on the ‘technical problems, complications and problems with completion’ occurring during both procedures.

It would be unjust to deny the good intentions of Gino Kenny TD and his co-sponsors. Those who propose legislation of this kind in any jurisdiction can be presumed to be well-meaning and moved by compassion, which it would be too easy to disparage. That is not the intention here. At the time of its introduction in the Dáil, Mr Kenny rightly spoke of its subject matter as ‘profoundly difficult… no matter what side you’re on’. But it has to be said that the bill does pose serious dangers and, as Dr O’Carroll insists, ‘is of particular concern, because it proposes radical legislative, medical and social change in Ireland’ in ways her submission goes on to discuss.
Misleading euphemisms
In addition, the espousal of euphemistic language in the bill, according to her its ‘most striking feature’, has the effect of ‘[obscuring] important ethical and empirical distinctions’, which are ‘very influential in swaying public opinion in favour of assisted suicide and euthanasia’. The bill’s ‘misleading’ title has the effect of ‘[dissociating] the choice to take one’s life intentionally, or have one’s life ended deliberately by a healthcare professional, from the experience of “suicide” or “euthanasia”, which is what the bill’s provisions are about’. A further grave implication of the bill, among others, is that it ‘normalises suicide and jeopardizes the suicidal’.

She wonders ‘whether the 81 TDs who voted to progress the Dying with Dignity Bill 2020 have ever heard of, or read Ireland’s national suicide prevention strategy’ – to say nothing of whether many of them have pondered the very serious issues she raised in her submission, before allowing the bill to progress to its next stage.

Another submission to the Oireachtas Joint Committee on Justice early in the year was by Dr Vincent Twomey, Emeritus Professor of Moral Theology in St Patrick’s College, Maynooth, and this is also published here. Like Dr O’Carroll, he is unhappy with the ‘perfunctory’ debate thus far on a matter ‘of such profound magnitude’.

One of his concerns is that ‘the spiralling costs of caring for an ageing population with special needs at the end of their lives’ may influence ‘senior citizens (or even young people with severe disabilities), many of whom don’t want to burden their own families with the costs involved in caring for them, to seek to end their deteriorating physical and psychological condition by assisted suicide’.

He, like Noreen O’Carroll, is critical of the bill’s misleadingly euphemistic anguage and what he sees as its appeal ‘solely to the emotions of legislators and citizens’, at the expense of ‘sober, practical reason and serious consideration of the issues’. He raises the familiar, but cogent argument that hard cases are apt to make bad law, law which ‘will affect the entire population’. He cannot be dismissed as adopting a merely cerebral approach: as he makes clear, he is all too familiar from personal experience with the devastation suicide causes.
He notes ‘the enormous strides in palliative care for the dying’ made in recent years and sees the bill as threatening to undermine ‘that noble practice’ and the hospice movement, ‘which Ireland has gifted to the rest of the world’. Like Dr O’Carroll, he is concerned about the treatment of conscientious objection in the bill and sees this as ‘perhaps the major deficiency’ in the proposed legislation: those medical practitioners unwilling to take part in the procedures envisaged by the bill are obliged to pass the patient on to someone else who will do this.
The global change of attitudes
Vincent Twomey tracks the way in which laws of the kind envisaged by this bill began in other jurisdictions with severe limits, but were gradually broadened over time, a process reflecting a ‘significant change of attitudes… in the so-called developed world’. (We are already familiar with a similar pattern in the case of divorce and abortion legislation).
Crucially, ours is a world ‘characterised by materialism, prosperity, “the good life”, and secularization (with its inbuilt denial of afterlife and so seeing no meaning in life that could help people face suffering and loss)’. That contemporary Ireland belongs to such a world and shares these characteristics, very much including increasing secularisation – with its gains but also its losses, is beyond question. This is the context for the Dying with Dignity Bill’s introduction at this time.
Is the suffering and loss entailed by serious, especially terminal, illness compatible with human dignity? Does it have ‘no meaning that could help people face suffering and loss’, as Professor Twomey puts it? These are the questions which another theologian, Dr Gerry O’Hanlon, addresses in his deeply thoughtful reflection here, called simply ‘Human Suffering and Human Dignity’.

While triggered by the bill, which effectively answers the questions referred to in the negative, his paper does not, as he explains, seek ‘to answer the political question’, but, rather, ‘to expand our horizons, so that we might catch a glimpse of something important which our culture occludes’. While it may indeed be of some help in political discussion, his rich treatment, drawing extensively on theological resources, is more likely, as he says, to ‘invite us into a different existential space when we reflect on our own mortality’.
Among the assumptions underlying the bill, as identified by Noreen O’Carroll, is that ‘the final stages of terminal illness rob patients of their dignity as human beings’, hence the desirability of providing the supposed solutions it specifies. Gerry O’Hanlon probes this assumption and asks: ‘what if pain and suffering, even involuntary, have meaning and value and can be considered compatible with human dignity?’ He proceeds to offer ‘some reflections on how Christians might deepen their own understanding of the relationship between the two’.

The mention of Christians highlights the fact that his treatment is explicitly theological, and not merely philosophical or sociological. The secular humanist assumption underpinning the Dying with Dignity Bill, is that its thinking embodies an objective, scientifically demonstrable view of the human condition (where ‘science’ is taken to mean physical science, with the reductionist implications which follow from that), as opposed to the ‘subjectivity’ of a religious stance. The latter, secular humanism would argue, has ipso facto no rational foundation and can make no legitimate contribution to a discussion such as this. (There are echoes here of the position assumed by Don O’Leary, in his recent book, Biomedical Controversies in Catholic Ireland: A Contemporary History of Divisive Social Issues (2020), critically reviewed in these pages by Dr John Murray). Gerry O’Hanlon’s patient, subtle exploration seeks to argue against such assumptions and the narrow, distorting view they reflect of what religion, and specifically Christianity, is properly about, in aid of much larger perspectives and a richer vision of human existence.
Taking back control?
In Dr O’Carroll’s submission, there is mention of how a man suffering from inoperable cancer told the Irish Times that passing the bill ‘would allow people to take back control of their lives’. O’Hanlon’s paper goes to the heart of the issue at stake here by engaging with the notion of ‘control’ expressed in this comment, and ‘the undoubted influence on us all of the prevailing culture of autonomy as central to dignity’. He argues that a simplistic understanding of autonomy, seen as complete independence from others, is misconceived. He explores the truth that, ‘as inherently relational beings… our autonomy functions best in the context of mutual giving and receiving’. He alludes to ‘the deficiencies of what cultural anthropologists like Charles Taylor and others have noted as the “purely immanent frame of reference” in which many of us moderns live, with an excessive focus on the autonomy of the individual’.
How, then, can we ‘begin to retrieve a more relational view of autonomy, and, even more challenging, one which integrates realities like involuntary pain and suffering?’ Gerry O’Hanlon’s further reflections bring him – helped along the way by the words and witness of the great American Baptist preacher and martyr for civil rights, Martin Luther King – to Christianity’s central mystery and the figure of Jesus Christ. Jesus, he submits, is ‘a man admired by believers and non-believers alike’. Moreover, Jesus ‘comes across as someone who lived life to the full’. Crucially – and this is one of the key points Dr O’Hanlon wishes to make – Jesus’ ‘dignity resided in a humanity which integrated personal authenticity with relationship, and which learned through suffering’.

The founder of Christianity, he says, is ‘the epitome of what it is to be human’, the one who ‘points in a way that surprises us to what human potential is about’. Jesus’ authenticity as a human being is inseparably linked to his relationship with others. And, in what happened to him, his ‘vindication came not just through his own personal resurrection but through the saving value of his suffering and death for others’. In his dying and rising, ‘suffering and pain, because they are constituents of healing love, are revealed to have dignity’.
‘[A]ll human beings’, Gerry O’Hanlon argues, ‘are asked to say our “yes” to what Jesus did on our behalf’. We do this, in turn, ‘through the human quest to live life to the full’, in imitation of him. This means ‘to move towards… conversion, to act according to conscience, to love others’. Such loving ‘involves receiving as well as giving. We can all say our own “yes” to this, to that ultimate point of deciding freely to give ourselves over in death to Jesus Christ’. The writer refers here to Karl Rahner’s understanding of dying and death ‘as our ultimate decision and act of freedom, a handing of ourselves back to God, which remains valid even if we subsequently enter into a phase of dying when effective autonomy has been removed’. Asked towards the end of his own life how he faced death, the German theologian replied arrestingly: ‘With commitment’.

It might be said that, viewed in this way, human beings are defined not so much by the assertion, but by the surrender, of our purported autonomy. We may think of Jesus’ final words on the cross: ‘Father, into your hands I commit my spirit’ (Lk 23:46). The position enunciated here is not some irrational dogma, but the fruit of profound reflection on our common condition, under the illumination of the Gospel. It is what makes Christians who they are and it is the light they are called on by their faith to offer to the world.

Gerry O’Hanlon’s profound reflection, of which the foregoing is a very inadequate account, has brought us some way from any simplistic notions of our human autonomy, or of ‘taking back control’ in the context of our death and dying. The perspective is, undoubtedly, religious, and explicitly Christian. ‘[W]e are’, as the author says, ‘dealing here with a matter of faith and mystery’. But, for believers, this is no contradiction or diminishment of human freedom (nor yet any glorification of suffering). Rather, as the Gospel does and as Gerry O’Hanlon suggests, it invites us to reach towards the most profound understanding of our identity and destiny in creation. For Christians, Jesus reveals in his teaching and in his own embrace of our condition, what the meaning and ultimate purpose is for all humankind of even our most difficult experiences, even suffering and dying.

It is pertinent here to quote some words of the distinguished thinker and theologian, former Archbishop of Canterbury, Dr Rowan Williams. In his foreword to Fr Timothy Radcliffe’s Why Go To Church? (2008), he wrote, with reference to the Eucharist, of ‘how the journey into the heart of Jesus’ self-giving is also a discovery of who we are and who we might become in Jesus’.

The Christian understanding
Such a Christian understanding of the question under consideration here – or indeed any – question – is, regrettably, liable to struggle for a hearing in contemporary Ireland. Public discourse in these times too easily dismisses theology as something esoteric or as mindless dogmatism and, in either case, as more or less irrelevant to real life. That such misunderstanding should prevail in a country with our long and, in many ways, rich Christian past is a sad reflection on the Church and on Christians themselves. There are, we know well enough, many factors in the transformation that has been taking place over the past half-century or more, many of the changes being for the better. But the poverty of Christian self-understanding and the inability of otherwise well-educated Christians, Catholics perhaps in particular, to articulate why and what they believe in the face of challenge, is certainly one highly significant factor in what has happened to the Church as it struggles to speak and be heard.

In his review in the present issue of Studies of journalist Ellen Coyne’s recently published Are You There, God? It’s Me, Ellen (2020), Greg Daly describes this as ‘immensely revealing about Catholicism in modern Ireland and … a serious contender for the most important book on the subject to have been written in recent years’. The young author who, a little earlier in her career, had taken a leading role in the successful 2018 pro-abortion campaign to repeal the 8th Amendment to the Irish Constitution and – like many of her generation – had given up on the Church in which she was raised, is now – as her book indicates – exploring her desire to return to the fold. Daly, while showing much sympathy for her journey and her struggles, criticises the undeveloped understanding of faith which the story reveals and – the point of pertinence here – regards it as ‘a damning indictment of previous generations’ failure to pass on a vibrant, informed and thoughtful faith’. This failure has potentially serious implications for public discussion of the Dying with Dignity Bill, including its passage through the Oireachtas.

Archbishop Williams’ remark about his Dominican fellow-theologian Timothy Radcliffe’s account of the Eucharist in Why Go To Church?, brings to mind recent words of Breda O’Brien, sometime contributor to Studies, about the reaction of Irish politicians to the lengthy closure of churches in the Republic during the current pandemic. Despite appeals from the bishops on behalf of their people, and unlike the situation elsewhere, including the United Kingdom, churches have been deemed, unlike various kinds of retail outlets, not to be ‘essential services’ and have remained shut. Writing in late April in the Irish Times, where she has a regular column, Breda O’Brien observed sternly: ‘… a significant number of the Cabinet were educated in Catholic schools and still do not show a shred of understanding of the significance of the Eucharist for Catholics, much less religious services for Protestants or the need to gather in a mosque for the Muslim community’.

The absence of a genuinely intellectual culture in the Irish Church, at least beyond the confines of the clergy and religious communities – and perhaps largely even there – is one of the tragedies of recent Catholic history in this country (there are, all too regrettably, others). ‘Yes, we have no Bernanos’, as the broadcaster Seán Mac Réamoinn, himself possessed of a rich Catholic cultural understanding, once memorably remarked, alluding to one of the ornaments of French Catholic culture, Georges Bernanos. The latter’s Journal d’un Curé de Campagne (1936), which appeared in English as The Diary of a Country Priest the following year and has been reprinted repeatedly ever since, surely has no equal here. The Church, and indeed the country at large, are the poorer for our lack of such voices at this time and the ‘vibrant, informed and thoughtful faith’ desiderated by Greg Daly above.

Other contributions in Studies
In other contributions in the present issue of Studies, Mary Kenny charts the influential career of the broadcaster Gay Byrne, ‘the “conservative Catholic” who changed Ireland’, as she calls him, which spanned the all-important decades at the end of the last century and the early decades of this one. She quotes one newspaper reader as saying, speaking for many: ‘Anyone writing the social history of the country will have to consider Gay Byrne as one of the key figures in modern Ireland’. Such was the power of television that his ‘sense of the zeitgeist’, as she says herself, ‘became an instrument of social change from the middle 1960s’, soon after the establishment of then Teilifís Éireann on the last day of 1961.

Professor Brendan Walsh completes his survey, begun here in the spring, of the significant contribution made by teaching religious in the period 1940–1970, women religious in particular. One of those he quotes speaks of the nuns who taught her as ‘formidable intellects [with] remarkable minds.. remarkable women, remarkably qualified, exceptionally talented… intellectually, they were very open… quite remarkable women’. Many of them, it might be suggested, were feminists avant la lettre. Against the background of so much change in Ireland since, including the steep decline in religious vocations, itself a symptom of that change, one of his interviewees is led to comment with palpable sadness in the light of what they and their companions had given over generations, ‘nobody will even remember it’.

Professor David Ford supplies the second part of his illuminating examination of Micheal O Siadhail’s magisterial The Five Quintets, published in 2018, a work which opens very large historical and intellectual perspectives that readers may find a welcome relief from the insularity of some at least of the concerns addressed elsewhere in Studies on this occasion. As the reviewer writes, he is ‘concerned with how the poem can help a reader who is seeking a worldview’. His review, over and above the work itself, can be commended to readers on those very welcome and very necessary grounds. Apart from its other striking merits, in its range and quality the poet’s enormously ambitious and religiously insightful undertaking may even be judged to give the lie to Seán Mac Reamoinn’s downbeat assessment of Irish Catholicism quoted earlier.

Anna Burns’ novel Milkman, which won the Man Booker Prize in the year it was published (also 2018), is penetratingly examined here in the context of the author’s work as a whole by Dr Daragh Downes, formerly of the English and now of the German department in Trinity College. It reflects a rather different Ireland, Ireland north of the border in the time of ‘the Troubles’. The reviewer sees it as ‘in part a delightfully unfashionable love letter to fiction itself, and to the counter-cultural power of fiction to offer relief to the lonely psyche wounded from having to live in a “hair-trigger society” in which politics has totalistically and micrologically invaded every action, gesture, word and even thought’. The action of the novel ‘plays out … against the violent and paranoid backdrop of the Troubles, with “state forces” and “defenders-of-the-state” in seemingly perpetual contention with “renouncers-of-the-state”’. ‘This’, as Daragh Downes perceptively observes, ‘is Yeats’ “Great hatred, little room”, writ unbearably large’. He ends his absorbing review with the striking judgment that, ‘[a]long with Donal Ryan, Anna Burns is … the finest living novelist the island of Ireland has produced’.

Finally, Ruth Murphy argues ‘for renewed attention to the work of Irish-British novelist and philosopher Iris Murdoch (1919–1999) and of the contemporary American philosopher Martha Nussbaum (b.1947), whom Murdoch influenced’. She herself is a young Irish doctoral student working in the wonderful setting of St John’s College, Cambridge (experto crede!) – a far cry from the circumstances of Milkman. But she has no wish to abstract from ‘the messy reality in which we live’, not least at the present challenging time. Each of her chosen philosophers ‘helps us to think about the compression of our lives in the experience of confinement’, while ‘this time … gives a new resonance to their philosophy’. The distinctive perspective of women is a central concern in her essay, not least ‘the consequences of Covid for women’. She views the work of Murdoch and Nussbaum as part of ‘a broader current of female philosophers who have sought to narrow philosophy’s social distance, its neglect of our private worlds’. She argues that they ‘can illuminate our path’ through the current crisis.