Dr. Edward Mathews:

The Deputy has raised a really important point, which is referenced in our submission. The experience internationally where nurses have been involved in assisted dying services suggests that we have to break the issue into two paradigms. One is the discussion paradigm and the other is the participation and-or care paradigm. Both have been found to be equally burdensome, which I say in a very respectful way, from a professional point of view. The international literature and international experience points very clearly to the requirement, for example, for debriefing sessions, where a professional is asked to provide information to a patient regarding the nature or availability of a service, and then there is the provision of care in respect of that service. Professional debriefing and counselling have been found to be very lacking in other jurisdictions. If there were a decision to change the law in this area, as part of the practice support and employment measures enabling that, we could not simply rely, in the health services in Ireland, on the employee assistance programme and people lifting the telephone if they have an issue. There must be a better system of support, involving peer support and practice supervision, which identifies issues and then provides a tiered pathway to support.

That is not taking away from the point of view of somebody who has a conscientious objection and may need support. That is not the whole of it but it is a very important part of it and it is very important to protect conscientious objection. Equally, however, those who do not have a conscientious objection and who participate in discussions or in the delivery of services require support. There must be a clear roadmap to that and, beyond a roadmap, it must be clearly set out that people will be offered appropriate professional supervision and structured debriefing to allow them to continue to provide services to patients where they are in an end-of-life scenario.