Professor Deirdre Madden:

I probably cannot add to Professor Donnelly's expertise in assisted decision-making, other than to say issues around transparency, good governance, public reporting of accurate data and all those areas are hugely important to having trust in whatever system is devised, if one is devised, for assisted dying.

I would like to touch on the point Deputy Kenny made about the idea of a good death. It has been spoken about with various groups of people, including the Irish Hospice Foundation, over the years. When we talk about having a good death, we mean we want to not be in physical pain, to have an emotional reaction and psychological coping mechanisms to enable us to die in peace. We hope the impact of our death on our families will be eased by the gentle nature of our passing and that we will be able to work through whatever anxieties and worries we have and die on our own terms. We know - I am sure the committee will hear from people in this situation - that some people are afflicted with devastating illnesses. For them, life may become unbearable and they want nothing more than to have a peaceful death in the company of their families. In a small minority of cases that death is impossible without assistance from a life partner, family member or medical practitioner.

Even with skilled end-of-life care and all the advances in palliative care options we have had and that will hopefully continue to grow, a small number of people do experience a degree of suffering towards the end of their lives that they consider, not anybody else, can only be relieved by ending their own lives or at least knowing they have that option. Many people who seek prescriptions for aid in dying never exercise the option. The knowledge that they have that prescription in their bedside locker gives them comfort that they have control over their own passing at a time and in a place of their own choosing. Many do not actually use it but it provides a sense of control.

The most common concerns of patients choosing aid in dying, to my knowledge, are loss of autonomy, loss of dignity and decreased ability to participate in life activities. These are the things that we need to factor into this balance when we are talking about the framework we want to bring into existence. We need to strike a balance between the right to have assistance in dying, as an aspect of respect for the individual's right to life, of which I would say dying with dignity is a part, and the State's interest in protecting the principle of protecting potentially vulnerable members of society. It is entirely possible for the legal system to devise a process to identify those few people who would fall within that exception.