Lynn Ruane (Independent) | Oireachtas source

I agree with Deputy Kenny in that I believe there is a way to create safeguards but I also accept that sometimes, people will fall through even the strictest of safeguards. That is a conversation that needs to be acknowledged. It needs to not be denied as a reality. I understand that.

I have three questions or comments. Last week, a witness said the conversation is about two ways of dying rather than someone wanting to live or die. It is about people choosing between two different ways of dying because they are within a certain proximity to death. That resonated with me as a concept as regards end of life. I have been both unfortunate and very honoured to be with people in the last moments of their dying process. It can be a very beautiful thing. I have been honoured to witness that and be with people as they died. However, my father spent three days completely unconscious, vomiting blood from his stomach into a tea towel, whereas if he had been assisted to die three days before that, he could have died singing The Drifters with us. That is what I thought of last week. It is beyond the pain question and the suffering question. The other question is how we want that dying moment to happen, and how meaningful it can be with your loved one in still being able to recognise each other in the room as the end of life happens. There is something beautiful about that, which fits into the question around the proximity to death. If we look away from all the other conversations about different types of illnesses, cancers or mental illnesses, we can then consider what the proximity to death is and whether we can, in a very limited circumstance, allow someone to choose which way he or she dies, rather than the fact that he or she is just dying earlier for whatever reason. If we get the safeguards well enough, we can give people that choice at that moment in time, whether it is at the three-day or six-month point, although those can be abstract conversations enough in themselves.

On the issue of capacity and consent, and the fact that an assessment is not being made previous to that on whether someone has a mental health condition or diagnosis and has capacity, is the assessment of capacity rigorous enough such that it answers the previous question? If somebody is in the throes of or is experiencing a mental health diagnosis - I do not mean a mood disorder or a certain low level of depression but a very obvious mental health disorder, whether that is psychosis, schizophrenia or any sort of delusional disorder - it is to be hoped that would be picked up anyway in a consent or capacity assessment. If it is not, why not? It is then about how that assessment of capacity is made rigorous enough that it answers the previous question around where someone's mental health and ability is at.

My final question on research is for Professor Arensman and Dr. Griffin. It was probably them who mentioned suicide intervention being better in Ireland than in other countries.

Now I am wondering how we can review any other country's system in isolation at all. If we look at home care, disability services, culture and attitudes and the stuff around autism, most people in Ireland would be appalled to think that anyone would be given assisted dying because they were autistic. I am wondering then how we even begin to compare a system in Ireland adequately with systems elsewhere when we have to take in culture, attitudes, understanding, awareness and all the other social supports that are in place. We nearly need to look at them all to know whether Ireland would end up in the same position where it is widened too much. Perhaps we would not widen it too much because the culture and attitudes towards particular illnesses here in Ireland are much more compassionate, empathetic and understanding. I am wondering, from a research perspective, how we begin to capture that in a much more holistic sense.