Dr. Brendan O'Shea:

In the provision of medical services, it is practically impossible to say that there is enough service in any particular area because there is never enough. There is always a new development. There are always changes and there are always issues that are identified. It is very hard to say that we have enough cardiology, rheumatology, general practice or palliative care. It is important to understand that. In Ireland, by international comparators, we are fortunate in the palliative care we have.

Going back to the issue of the experience of people at end of life, suffering is complex. We can look at it very specifically and we can refer to a very small proportion of people with severe uncontrolled pain. There is another small proportion with intractable severe vomiting or severe progressive shortness of breath. All of these small margins add up to a minority of people for whom the service becomes relevant and important.

For ourselves, we have to consider the legitimacy of not wishing to be a burden. It is certainly an imperative of a kind society that nobody should have to consider this, but, for me, it is a personal decision. We have given some of our personal reflections in our case-handling. I agree with what my colleague said about us all having witnessed deaths that we would not want for ourselves. If our patients do not want those deaths either, we have to listen to that quite carefully. I put it to the Deputy that not wanting to be a burden is a legitimate basis, as evidenced by the data from Canada. This needs to be factored into our thinking.