Professor Robert Landers:

I thank the Cathaoirleach and his committee colleagues for this opportunity to contribute to the committee's considerations in relation to the statutory right to assist a person to end their life or assisted dying. We in the Irish Hospital Consultants Association, IHCA, bring the perspective of healthcare professionals. As healthcare professionals, we are entrusted with the profound responsibility of preserving life, but we also witness the pain and suffering that some patients endure. Hence, we also have a responsibility to enhance and optimise our patients' quality of life. These realities make the subject of assisted dying an intricate one for us, just as it does for so many other people.

The debate on assisted dying raises complex medical, ethical, legal and practical questions that deeply affect our role in patient care. It is therefore not surprising that, just like society as a whole, there is a diversity of views and opinions within the association on the issue of assisted dying. The issue is informed by the lived experiences of consultants, particularly from those caring for the elderly and for persons with progressive incurable illnesses, mental health, addiction, cancer care and pain, among other specialties.

The standpoints will vary. For some, assisted dying offers compassionate relief for those who often experience intractable pain and terminal illness. These can be profound medical situations where we medical professionals are engaged in multiple efforts to cure or alleviate pain. There are times when every effort reaches its limitations. Some will conclude that assisted dying provides a humane means to reduce suffering and offer a degree of control in the face of that suffering. Such realities also confront us with the opposite, equally valid perspective. Much of this is informed by the challenges that are faced every day in the delivery of healthcare services. The challenge of timely access for patients to comprehensive healthcare and social care supports, including pain and symptom control and home supports, is considerable. Today, many patients do not have sufficient access to these services.

From medical professionals, ethics, quality, patient safety and risk in healthcare matter. We see the importance of this every day, as do the members of the committee as public representatives. Ethical considerations must always be paramount in health. The ethical dilemma posed by intentionally ending the life of a patient could hardly be more profound. It challenges our fundamental commitment to preserving life and could potentially erode the trust that patients place in our care. We may find ourselves in a difficult position when asked to assist in a patient's death, straining the doctor-patient relationship to the ultimate limit. Doctors are required to act in the best interests of patients in their care and avoid causing any injury or harm. Section 46.9 of the Irish Medical Council's Guide to Professional Conduct and Ethics explicitly forbids doctors from participating in the deliberate killing of a patient.

Equally, quality, patient safety and risk are essential considerations in healthcare provision. All developments in healthcare are considered in the context of balancing potential risks and benefits. One of the risks of the introduction of any form of assisted dying is the inappropriate death of a person. As we all know, death is irreversible, hence our keenness to contribute to this important and far-reaching discussion. No two patients are the same. Rarely are two medical circumstances the same. Against the backdrop of this reality, the committee members as legislators are informing themselves not just on the merits of legislating for assisted dying but on what factors must feature in reaching any recommendations or conclusions.

Crafting effective safeguards to protect patients and medical practitioners alike, if legislation or policy were to change on this issue, is a central consideration, not least because of the range of potential circumstances. However, the international evidence shows that safeguards in and of themselves may be challenged, altered and sometimes removed. Another consideration is protecting vulnerable patients who may be placed at risk of coercion to end their lives to relieve the burden they perceive is placed on their families, health services or society at large.

A major issue the committee will need to consider in full is safeguards, both for patients and medical professionals; for example, the matter of a cooling-off period after a declaration of assisted dying and a requirement for the patient to be formally advised - in a fashion that is witnessed and recorded - of their right to withdraw from the process at any stage. How would it work? What would it mean for medical professionals? These questions also arise when it comes to oversight, scrutiny or investigation of the process by which declarations are made and applied, as would consideration of this to an independent process to protect patients’ rights. We also must be mindful of freedom of conscience provisions. How would this work in practice and implementation?

Defining the clarity of the definition of "assisted dying" is important. Does it refer to self-administered medication or medication administered by another person? As signalled, rigorous operational guidelines on the eligibility criteria and ensuring informed consent are central considerations. Striking a balance between respecting patient autonomy and safeguarding persons who may be vulnerable is a substantial challenge here.

As is always the case with healthcare, we must consider the issue of resources, both for patients who may wish to choose end of life and for patients who do not wish to end their lives early but feel that they have inadequate supports to enable them to live as they wish. We know internationally that one of the main reasons patients choose assisted dying is a fear of being a burden on others. The severe resource and capacity deficits that exist in our health services may serve to further disadvantage patients suffering from life-limiting or terminal illness and lead them to consider assisted dying and other end-of-life options that could otherwise be avoided with appropriately funded palliative care.

In conclusion, as medical professionals, the debate on assisted dying directly impacts what we do. We see the matter from all sides: compassion, suffering, ethical, medical, legal and practical. In short, this complexity requires thorough examination, consultation with healthcare experts and others, careful consideration and a deep respect for the values that guide our medical profession. To this end, this committee, and all contributions to it, are to be commended and respected. As we navigate this complex terrain, our involvement as medical professionals is pivotal in ensuring that the conversation remains focused on the best interests and well-being of the patients we serve.