Dr. Feargal Twomey:

Again, I thank Deputy Kenny. If members of the committee have not heard about the double effect, I am very glad the Deputy has asked that question. I do not subscribe to the principle of double effect. I do not prescribe medicines or have medicines administered that are not prescribed, administered, monitored and adjusted downwards or upwards based on a patient's individual need.

I have never been in a situation where I am concerned that what I am doing is accelerating somebody's death.

On existential distress, I agree with Dr. Lyne that distress comes in various forms, including physical distress that may or may not include pain, psychological distress because I do not want to die or to leave and social distress because I am no longer able to support my family and I fear for my young son who has autism spectrum disorder.

Good palliative care can be provided by any clinician of any discipline. For special palliative care, we adjust medicines and monitor them extremely closely. The idea of not being unduly concerned about doses of medications leading to an acceleration of somebody dying, because they are dying anyway, is not part of my practice, nor is it the practice outside the-----