Professor Deirdre Madden:

One of the difficulties I have with this whole area is trying to maintain a logical, defensible and coherent distinction between what we already allow and support, and enable patients to make decisions in respect of, and assisted dying. As the committee has probably heard from other witnesses, we allow people to choose to turn off a ventilator or another life-prolonging technology. We allow an adult with a progressive neurological condition to refuse food and water if that is the only means by which the person can seek to bring about death. We respect somebody's refusal to have chemotherapy. We respect somebody's refusal to have a blood transfusion. We refuse all of these things for adults with capacity as long as they can understand the information they have been given. They can ask questions, reflect on their choices, discuss matters with whomever they wish and communicate their decision in their own time. The law allows all of those cases in which a person refuses medical treatment even though the consequences will be death. We allow drugs and sedatives that reduce pain and discomfort even if we know they speed up death. All proponents for assisted dying seek is the ability for people who are suffering to obtain a prescription for the same kind of medication, only this time to let them hasten the timing of their own death.

One of my favourite authors is Dr. Atul Gawande, who is a surgeon and patient safety advocate and now works in the Biden Administration. He has a book entitled Being Mortal: Medicine and What Matters in the Endthat I respectfully recommend the committee members read. In it, he states we are running up against the difficulty of maintaining a coherent, philosophical distinction between giving people the right to stop external or artificial processes that prolong their lives, which we allow, and giving them the right to stop the natural internal processes that do so. Those incoherent distinctions do not make a lot of sense to patients or their families. They are also lacking in compassion for the small minority of people to whom this might apply. As my colleague, Professor Donnelly, said, the law can do or say whatever we want it to do or say. As a matter of policy, one of the jobs of the Oireachtas is to come up with the framework or the basis on which this should or should not be permitted, and the safeguards that could be built into the system, and the law will follow that course. It is not a matter of the law not being able to do A, B or C. The law can do whatever we want it to do. It is just a matter of terminology.