Dr. Siobhán O'Sullivan:

Deputy Catherine Byrne raised the issue of vulnerable categories. I, too, have concerns about what is proposed in the case of homeless persons and incapacitated adults. For example, some countries operating opt-out systems allow for children, whereas here parents act as advocates for children. We need to look carefully at this issue. The difficulty is that while in a soft opt-out, there may be a family that can act as an advocate for the deceased, there will always be marginalised groups in society which will not have that support. This needs to be recognised. There is a need for the inclusion of safeguards in relation to advocates acting on behalf of such persons. It is an issue that requires serious consideration and I thank the Deputy for rasing it.

On the question of autonomy, it has often be said the soft opt-out system allows greater autonomy because the person's wish - once a person has not objected, it is taken that he or she is happy to be a donor - cannot be overridden by the family and is, therefore, a much better system. However, any opt-out system operating in Europe involves the family. This is for practical reasons as much as anything else because one needs to ask the family practical questions about lifestyle and so on. Most countries operate soft opt-out systems, with Austria being the only country that operates a system in which the family is not involved. There are a huge number of variances in the systems operating across Europe in terms of family involvement. In Norway the family is very important and central to the process, with communication being the key. This is largely because Norway does not operate an opt-out register. As such, talking to the family is one of the only ways to establish whether the deceased person wanted to donate. In Belgium the family must be involved, but nobody is clear on what "involved" means. In other countries authorisation from the family is required. There are a large number of opt-out models which state how a family must be involved. This comes back to my final point, namely, that we must be aware of the ethical norms operating and values. In Ireland the family generally is involved. We need to be aware of how that is going to work and take this into account in our deliberations on how this might translate into legislation.