Check Against Delivery
Private Members Business, Seanad Éireann, 18 October, 2017
Coroners (Amendment) Bill 2016, Second Stage
I welcome the opportunity today to speak on the Private Members Bill introduced by Senator Mac Lochlainn. Senator Mac Lochlainn’s short Bill contains three sections. Its main provision, from my reading of it, is contained in section 2, which would insert a new section in the Coroners Act 1962 to:
(i) provide for the possibility of a verdict of Iatrogenic Suicide as defined by this Bill,
(ii) define Iatrogenic Suicide, and
(iii) provide a safeguard clause to ensure that a verdict of Iatrogenic Suicide does not contravene section 30 of the 1962 Act in the apportioning of civil or criminal liability
The Bill does not seek to address any related or substantive issues with regard to suicide or suicide prevention. Rather, in his Explanatory Memorandum, Senator Mac Lochlainn notes that his proposal “symbolically amends the Act of 1962”. The sole objective of Senator Mac Lochlainn’s Bill, is the introduction of a verdict of iatrogenic suicide (or medically induced suicide), to be available to a coroner at an inquest. The term iatrogenesis, can be interpreted to mean “an event or outcome brought forth by a healer”, and could refer to both good and bad outcomes of a medical intervention or procedure. The Private Members Bill seeks to define ‘iatrogenic suicide’ as the ending of one’s own life; where the effect of medical treatment undertaken by the deceased, including any prescribed medication, is the primary cause of such an action.
Senators will appreciate that it would not be appropriate for me to comment on individual cases where persons taking an antidepressant medication have taken their own lives. These are undoubtedly tragic cases and our hearts must go out to the families involved. However, we must be careful about assuming that there is a causal link. Coroners have arranged for expert medical advice to conduct a review of the research regarding the medication involved and suicidal ideation or suicide. In at least one case, such a report found that no clear association linking death by suicide and use of the medication can be made.
In recent years, there has been considerable discussion in Ireland of suicidal and homicidal thoughts or impulses as potential adverse effects relating to the use of the medication known as Selective Seratonin Re-uptake Inhibitors, or SSRI’s. These are anti-depressant medications, available through prescription only. They are authorised for use in Ireland and across the EU for the treatment of depressive disorders and some anxiety related conditions.
Depression may be associated with an increased risk of suicidal thoughts, self-harm and suicide. This risk may persist, particularly in the early stages of treatment when a patient starts to take an anti-depressant until significant remission of their depression occurs. Healthcare professionals are advised of this risk through the so-called Summary of Product Characteristics, which specifically highlights the need for monitoring of the patient following initiation of therapy. The Leaflets accompanying these products advise that patients, and their care-givers, should be alert for any deterioration of condition, suicidal behaviour or thoughts, or unusual changes in behaviour - and to seek medical advice immediately if these symptoms appear.
The Irish Health Products Regulatory Authority, in conjunction with other EU Medicine Agencies, continuously monitors the safety of medicines. Case reports and other safety data are reviewed and evaluated in terms of their potential impact on the known safety profile of a medicine and, any need for regulatory change to support their continued use. The decision to use a particular medicinal product for an individual patient rests with the healthcare professional involved in their care, taking account of their assessment of that patient’s current clinical condition, medical/medication history, any relevant, underlying risk factors, the condition to be treated, etc.
Cathaoirleach, I accept that the Senator is well-intentioned in proposing this Bill. He previously introduced it in the other House. However, the Government is not in a position to accept the proposed Bill. Let me explain why.
Acceptance of the proposed definition and of a verdict of ‘iatrogenic suicide’, would risk its use by a coroner at inquest, being interpreted as apportioning some liability on the medical practitioner who may have prescribed any form of treatment or medication to the deceased person prior to taking his or her own life.
The coroner's inquest is an inquisitorial process. It is not permitted to consider questions of civil or criminal liability. Section 30 of the Coroners Act 1962 specifically prohibits consideration of civil and criminal liability as follows:
Questions of civil or criminal liability shall not be considered or investigated at an inquest and accordingly every inquest shall be confined to ascertaining the identity of the person in relation to whose death the inquest is being held and how, when, and where the death occurred.
While Senator proposes a safeguard clause, I am of the firm view that it would be unwise to proceed with this Bill given the significant prohibition against any consideration or apportioning of liability at an inquest.
There is also a second consideration arising from the Senator’s Bill, perhaps not intended by him - the risk of engaging the criminal law on assisted suicide. A verdict returned at inquest of iatrogenic suicide, as defined in the Bill, could engage the provisions of the Criminal Law (Suicide) Act 1993. Section 2 of that Act provides that:
“A person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence and shall be liable on conviction on indictment to imprisonment for a term not exceeding fourteen years.”
Any use of this new verdict contemplated in the Bill, would be capable of ascribing criminal liability to a person or persons who would be readily identifiable. While suicide is not a crime, assisted suicide continues to be a crime. Assisted suicide could include iatrogenic suicide, as defined in the Bill.
My Department has received the advice of the Office of the Attorney General on the Bill, and its view is that to introduce a verdict of iatrogenic suicide at inquest would be legally unsound. The Coroners Society of Ireland has indicated that it is very much opposed to this proposal, not least given that it might require coroners to reach verdicts that would infer liability on a doctor.
I believe that a sufficient range of verdicts is available to coroners to draw on in the context of the cases envisaged by this Bill, including those of suicide, open or medical misadventure.
I wish to inform the Seanad that I intend to widen the scope of the coroner’s investigation at inquest along the lines of that proposed in the Coroners Bill 2007. This will help to better fulfil our obligations under the European Convention of Human Rights. The Coroners (Amendment) Bill 2017 is being urgently drafted by the Office of the Parliamentary Counsel. I hope to be in a position to seek Government approval in the near future to publish this Bill.
In conclusion, while I again commend Senator Mac Lochlainn for raising this issue, I must reiterate that, the context in which he places it is not, in the government’s view, appropriate. He raises no wider issues in the Bill that might inform our ongoing debate on suicide. Rather, he proposes what he describes as a symbolic change to the Coroner Act of 1962. However, the effect of the change would be anything but symbolic.
It would risk significant disruption to our coronial system by seeking to introduce determination of liability into the inquest process. The Government, as it works toward both immediate and longer-term reform of the coronial system, will not support such a change.