Humanism Ireland • No 109 • March-April 2008
An Irish Living Will
Michael Irwin
R
ECENTLY, members of the Humanist Association of Ireland and of the Humanist Association of Northern Ireland received a copy of a draft Advance Healthcare Directive form, requesting their comments. This AHD form allows individuals to state the type of medical treatment they would like to receive (usually at the end of life) if they become unable to express their views at that time - for example, if they should develop Alzheimer's disease. An alternative, popular term for an AHD is Living Will - which is "living" because it takes effect before death, and is a "will" because it states someone's wishes. Copies of this draft form were also sent to sixteen organizations in Dublin, ranging trom the Alzheimer's Society to the Medical Council, from the Law Reform Commission to the Irish Patients Association, and from the Irish Council for Bioethics to the Motor Neurone Disease Association, also for their comments - I had been in contact with officials in these various bodies during December. In recent weeks, I have received many comments on this draft AHD form - either using the brief questionnaire at the bottom of the accompanying letter, or, in several instances, quite lengthy e-mails. Many of these responses will be most useful to me in revising the draft in the near future. To be honest, I must tell you that this "Living Will project" began by accident! Last October, I participated in a RTE radio debate, held in the public library in Waterford, on "End-of-Life Issues", and part of the discussion naturally focused on the benefits of AHDs. There, I heard about the excellent report which had been produced, in February 2007, by the Irish Council for Bioethics on "Is It Time for Advance Healthcare Directives?". The following month, I was in Dublin for a similar debate at Trinity College and I met Ann
James, the HAl Secretary, who was also speaking at this event. She gave me a copy of the ICB report. All this led to my presenting the idea of producing an Irish Living Will to the HAI monthly meeting on December 2007. Then, on January 10th, in Belfast, I met with members of Humani, at their regular monthly meeting, and made a similar presentation. My interest in Living Wills began when I was working as a physician with the United Nations, in New York, in the 1980s - these documents were becoming increasingly popular in the States following their introduction in the late 1960s by Luis Kutner, a human rights lawyer in Chicago (incidentally, Kutner was a co-founder of Amnesty International). After my retirement to England in 1993, I became much involved with the development of AHDs in the UK.
It is important to stress that an AHD is not asking doctors or nurses to do anything illegal
Up to that time, the typical Living Will simply allowed patients to refuse medical care which was aimed at prolonging or sustaining their lives. Thus, opponents of AHDs could condemn them as being "suicidally motivated refusals of medical treatment" – that expression was used in a letter which appeared in the Daily Telegraph on April 1, 1998, signed by the Roman Catholic leaders in England, Wales and Scotland. Then, in October 1999, during an interview by the legal correspondent of the British Medical Journal, I stated that "Of course, a Living Will could also express the wish to stay alive with life-prolonging measures for as long as possible". Thus, in the UK, the concept of a prochoice AHD was born. This is the essential part of the draft form which Humanists in Ireland have recently received - because one can EITHER refuse medical interventions aimed at sustaining life,
OR, equally important, one can request medical treatment to be given to continue life for as long as possible. It is important to stress that an AHD is not asking doctors or nurses to do anything illegal. It is everyone's right to accept or refuse medical treatment. And, if death results from the withholding or withdrawing of life-sustaining treatment, it must not be considered as a suicide. The present situation regarding AHDs in Ireland is somewhat different between the North and the South. The Mental Capacity Act adopted by the British parliament in 2005 has given legal support for AHDs in England and Wales, but not in Northern Ireland (the Scottish parliament had approved a similar law in 2000). However, in Northern Ireland, the concept of AHDs has been backed by organizations such as the British Medical Association and the Royal College of Nursing for the past ten years. So far, the equivalent organizations in Dublin have not yet taken any official position on AHDs. Fortunately, throughout Ireland, "common law" or "case law" will give increasing support for AHDs (this is equivalent to the situation which existed in Scotland, England and Wales before the 2000 and 2005 Acts were approved in these countries). I believe that a common AHD form can be produced now for use throughout Ireland – with just minor modifications, such as replacing the "Personal Public Services Number", used in the Republic, with the "National Health Service Number" for use in the North. In designing the draft AHD form which has been sent to Humanists throughout Ireland, I reviewed similar documents from twenty counties around the world (ranging from the United States to Australia, and from the UK to Japan), and I believe I have selected the best elements to produce a fonn which is, to use a modem idiom, "user-friendly", and is not too complicated or legalistic. During March and April, following a review of all the comments and questions I have received, the form will ➤
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Humanism Ireland • No 109 • March-April 2008
will be revised. Then, it can be printed on firmer paper, with text on both sides, and folded into a document which is an A-4 size page. Also, a small card will be available which can be easily carried so that, in an emergency situation, doctors and nurses can be alerted that someone has an AHD. It is important to remember that AHDs are also most useful to family and friends as they have written evidence of someone's wishes regarding essential medical care. Every year, December 10th is celebrated throughout the world as Human Rights Day - for, on December 10, 1948, the Universal Declaration of Human Rights was adopted by the UN General Assembly. A basic human right is always to have personal choice as to the type of medical treatment one wants to receive. On December 10, 2007, at a meeting in Dublin, the Living Wills Trust was established - its present objectives will be to promote the use of AHDs throughout Ireland and to obtain official support for these documents from those organizations in the country mainly interested in them. Although I live in Surrey, I have joined, in recent months, both the Humanist Association of Ireland and the Humanist Association of Northern Ireland. During 2008, I intend to spend whatever time is necessary in Ireland to fulfil the objectives of this Trust. Later in the year, there will be another report in Humanism Ireland to let all of you know how this Irish Living Will project is developing. ❑
Miraculous Prayer
MANY LOCAL PAPERS in Ireland have a profitable sideline in prayers. The two examples here are taken from the twenty or so printed in 'Friday Ad' in Co Cork - at 15 cent per word. They're addressed to 'St Joseph of Cupertino', 'Dear Heart of Jesus' (never the brain of course…), 'The Blessed Virgin', 'O Glorious St Therese' and 'O most beautiful Flower of Mount Carmel' (Sorry, botanists, but this is Mary again). This is a widespread practice and therefore seems to have official hierarchic blessing. It is a sorry task to look at this soberly. There are clearly people out there desperate or naïve enough to believe in this. And this belief may be the only thing that sustains them – yet perhaps also the very thing stopping them from looking reality in the face and trying some action. Hard to say. 'Positive Thinking' and the resulting hope and confidence do certainly deliver a psychological advantage over feelings of powerlessness, despair and depression. But this mental conditioning could of course be done as a conscious exercise, without invoking dead saints and divine body parts. Anyway - let's check out the mechanism: Almighty God is not directly approached: we're still in a monarchical worldview where we work our way through His flunkies – the thousands of people canonised by a succession of popes, the royal mother and His son. Let's not be side-tracked here by the idea of 'trinity' which implies that the mother of god is also His 'bride' - royalty always had somewhat bizarre family trees. But it is worth mentioning that with there being only the one god, it would seem bizarre to ask one aspect of Him to have a word with another aspect. Especially as that whole construction is omniscient anyway… And so all those saintly intercessors are wasting their time as He knows already… You see, the theology behind this is that saints can't do much themselves they have to go through the boss. But He is said to be merciful and compassionate and thus should be expected to do - or let happen - the right things anyway. Another mindboggling conundrum - but that never bothers a Christian – and why would it since the 'Miraculous Prayer' was 'Never found to fail'? Well, I'd rather ask: has it ever been found to work? There are of course stories of miraculous cures – but the very fact they have to be told as so wonderful proves that they're exceptions. And spontaneous remissions and Lotto wins and incredible coincidences do happen –
Lothar Luken
but they happen quite nicely by chance and without ever having been prayed for. And, with those billions of prayers said every day, is the world better everyday by billions of facts over average? I'm afraid not. Actually, life is much closer to extinction now than it was before there were any humans praying on this planet. Then there's the dilemma with mutually exclusive prayers, as for coming first in exams or contests or as for the victories of competing hurling teams or warring nations or militant religions. It just can't work. And doesn't work – for otherwise we should have to conclude that no-one ever prayed for world peace, or the end of famine or AIDS or exploitation or torture… Or shouldn't we rather conclude that no one up there listened? Or cared? Or perhaps simply that there's no one there! And if there was, it would be a rather callous outfit. I mean - if you're 'almighty' and then let something like human history happen… The Inquisition, witch burnings, Auschwitz, Gulag, Dresden, Hiroshima, Vietnam, Rwanda, Lebanon, Iraq – no one praying here? No one taking pity up there? The strange thing, as with so much else, is that so many people do believe in it. But it is a very human attitude, hoping against hope, invoking much-needed help. What makes it so bizarre is its being entangled in the twisted knickers of religious absurdities. And here we should be careful not to simply dismiss things because they've been tainted by association with authoritarian organised religions. We can still enjoy medieval art or the music of Bach or Tibetan overtone singing. But we could also use practices like chanting, praying, Tai Chi, as techniques of 'mental hygiene'. Even if we're not into 'mind-expansion', their calming effect in our stressful times cannot be denied. This is especially true for meditation, something we can do with our minds which has nothing to do with 'god' – though it is usually taught in association with (mostly Eastern) religions. But just as an organ can play wonderful secular music, putting our brains into a contemplative mode for a while can be quite beneficial for our operations in the real world. Tackling life a bit more calmly and wisely will help with those problems god so obviously can't cope with. And it would perhaps, now and then, give those poor lobbyists like Mary and Clare and The Heart and Jude up there a bit of a break. ❑
• Dr Michael Irwin was Medical
Director of the United Nations before he retired and a former Chairman of the Voluntary Euthanasia Society. He is a member of the National Secular Society and sponsors the annual Irwin Prize for “Secularist of the Year”.
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