Professor Penney Lewis:

While the concerns about pressure and the message that society sends by underfunding health and social care for older people and persons with disabilities are valid, they are not concerns that are only about assisted dying. I included a second table in my briefing note, which shows the results of a survey across multiple jurisdictions which do not, unfortunately, include Ireland on the proportion of end-of-life decisions that are to withhold or withdraw treatment compared with, for example, the proportion of cases of euthanasia, assisted suicide and termination of life without request. What the table shows is that, irrespective of whether the jurisdiction is permissive or prohibitive, the numbers of assisted dying cases are tiny compared with the number of cases which involve a decision to withhold or withdraw life sustaining treatment. If we are worried about sending people messages about their life not being worth living or pressuring people to die before they want to or both, we should be worried about those messages and that kind of pressure with regard to all end-of-life decisions. In fact, we should be much more worried about them in respect of the much more prevalent end-of-life decision, which I am sure is being taken in Irish intensive care units, and which takes place in intensive care units in all of the jurisdictions surveyed.

While I agree that the problems the Deputy raises are real, they are not isolated or confined to assisted dying. Most regimes scrutinise assisted dying cases in incredible detail. To take the example of the Netherlands, the Dutch regional committees read a judgment about each case. Decisions to withhold or withdraw life-sustaining treatment, which could be the result of societal pressure or messages that society is sending and pressure by loved ones or people who are less than loved ones, are not scrutinised in the same depth. We need to worry about all of that but we need to worry about it more generally in relation to end-of-life decision making.

On another point, it appears from the evidence available to us that the types of people who request assisted dying tend to be less susceptible than others to pressure from their loved ones.

The stereotypical patient who avails himself or herself of physician-assisted suicide in Oregon is someone who is very independent, has always taken care of himself or herself, does not want to be dependent on others and wants to live life and experience his or her death on his or her terms, not on someone else's. According to the data for Oregon, in every single year the most frequent reasons for requesting assistance are loss of autonomy, loss of dignity and a loss of ability to participate in the activities that made life worth living for that person. It is not about not receiving enough pain control, symptom alleviation or feeling like a burden on others. It tends to be about control, autonomy and dignity. The stereotypical patient is not the person described by these concerns about pressure and the messages that society sends. That does not mean I do not think those are real concerns; I do. However, they are concerns for end-of-life decision-making more generally.