Hidden Victims: The Legal and Ethical Challenges of Assisted Dying in Ireland

Any form of assisted dying, assisted suicide or euthanasia is currently illegal in Ireland under section 2 of the Criminal Law (Suicide) Act 1993, which states that “a person who aids, abets,  counsels or procures the suicide of another, shall be guilty of an offence”.

This position was affirmed in the 2013 Supreme Court case, Fleming v Ireland and others. In this case, Marie Fleming, who was in the final stages of multiple sclerosis, argued that the blanket ban on assisted suicide breached both her constitutional rights and her rights under the European Convention on Human Rights. The Supreme Court ruled however, that there was no constitutional right to assisted suicide in Ireland and that the prohibition on assisted suicide did not violate the European Convention on Human Rights. In her judgement Denham CJ emphasised the need to safeguard the lives of those who may be vulnerable to abuse in a situation where it was legal for third parties to bring about the deaths of persons in their final days.

In the last few years however, many politicians, activists and interest groups have been campaigning for the legalisation of some form of assisted dying in Ireland. They argue that terminally ill patients or those with severely debilitating, life-limiting conditions should be entitled to access a legally regulated option to end their lives with medical assistance.

The terms euthanasia, assisted suicide, and assisted dying are often used interchangeably in public discourse, but they carry distinct legal and medical meanings. For the purposes of this article, all forms of medically facilitated end-of-life interventions will be considered under the broad umbrella of assisted dying.

Since Fleming, the legal position on assisted dying in Ireland has seen some significant developments. In 2024, the Irish Oireachtas Committee on Justice and Equality published a report recommending the decriminalisation of assisted dying in Ireland while emphasising the need for the creation of a legal framework with strict safeguards. While many of the arguments in favour of assisted dying appear well intentioned, the effect that legalising such a practice could have on vulnerable groups of our society, such as the elderly and those with mental or physical disabilities, is yet to be fully understood. This article aims to examine the societal and ethical challenges that could potentially arise should assisted dying be legalised in Ireland.

Many who advocate for the legalisation of assisted dying maintain that this option would only be open to those with terminal chronic illnesses. However, we have seen in many jurisdictions where such a practice has been legalised, how the eligibility criteria can easily extend beyond its originally intended scope. Belgium and the Netherlands, for example, legalised euthanasia in 2002 for patients experiencing unbearable constant physical or psychological pain to voluntarily end their own lives. Since then, the eligibility requirements in both jurisdictions have expanded to include both minors and those with conditions not limited to terminal illnesses.

In Canada, MAiD (Medical Assistance in Dying) was legalised in 2016 through the enactment of Bill C-14. This Bill legalised the practice of assisted dying for those over the age of 18, who suffer from a "grievous and irremediable” medical condition and whose natural death has become reasonably foreseeable. Following the landmark case of Truchon v. Canada, the Canadian government introduced and enacted Bill C-7, removing the requirement  that death be reasonably foreseeable. In 2024, Bill C-39 further expanded the eligibility criteria, allowing those suffering solely from mental illnesses to avail of MAiD, although its introduction has since been postponed to 2027.

As the eligibility expands, it is often vulnerable groups and those already marginalised - whether by disability, age or mental illness - that are exposed to the risks of coercion, undue influence, or social pressures that can be difficult to detect or regulate. Miriam Colleran and Anne Doherty, writing for the Irish Journal of Medical Science in 2024, warn that assessing coercion is inherently difficult, especially in older or dependent persons. They also caution that extending assisted dying to those with mental health conditions may undermine suicide assisted dying to those with mental health conditions may undermine suicide-prevention efforts, particularly when mental suffering is not clearly distinguished from treatable psychiatric illness. Moreover, without strong, transparent reporting systems and equitable investment in palliative and mental health care, assisted dying could substitute for improving end of life support - leaving the most marginalized exposed to systemic pressures. 

Furthermore, a study by the British Medical Journal for Supportive and Palliative Care, which analysed the practice of assisted dying in the US state of Oregon, found that there was a worrying trend of patients choosing the option of assisted dying for financial reasons or because they felt like a burden to their families.

While the proposed framework for assisted dying in Ireland currently limits eligibility to those with terminal illnesses, experience from other jurisdictions shows that such boundaries can expand over time. This raises legitimate concerns that safeguards meant to protect vulnerable people may erode in practice, and that pressures stemming from illness, inadequate care, or social disadvantage could influence decisions that seem voluntary but are not truly free.

Equally concerning is how the normalisation of such a practice can affect how society views the lives of those with physical or mental disabilities. Many opponents of assisted dying are of the view that legalising assisted dying or euthanasia subtly reinforces ableist ideas, arguing that the lives of those with severe physical or mental disabilities are perceived as less valuable or less deserving of support.

Peter Kearns, a disabled activist and the development officer with the Independent Living Movement Ireland, spoke at the Joint Committee on Assisted Dying in 2024. He warned that introducing assisted dying could lead to disabled people feeling like a burden and constantly asking themselves whether their life was worth living as they grew older. Kearns stressed that the genuine choice should come from the ability to live full, supported and independent lives, rather than only at times of crisis and imminent death.

Many activists and organisations such as Hope Ireland believe that the introduction of euthanasia or assisted suicide would be a regressive step for vulnerable people and that better palliative care should be promoted.

In 2021, UN human rights experts expressed their concerns on the adverse consequences of this practice in relation to disabled people, stating that “Disability should never be a ground or justification to end someone’s life directly or indirectly”. They argued that such legislative provisions would institutionalise and legally authorise ableism, directly violating Article 10 of the UN Convention on the Rights of Persons with Disabilities, which requires states to ensure that persons with disabilities can effectively enjoy their right to life on an equal basis with others.

With the House of Commons passing the Terminally Ill Adults (End of Life) Bill in the United Kingdom, and considering the recent recommendations of the Oireachtas, it appears possible that some form of assisted dying may become available to terminally ill patients in Ireland within the next few years. Although progress is likely to be slow, it is crucial that we consider these potential societal and ethical implications of legalising assisted dying, particularly for vulnerable groups who may feel pressure - either emotionally, socially, or economically - to end their lives prematurely. Ensuring that these voices are not overlooked is essential if Ireland is to avoid repeating the mistakes seen in other jurisdictions.