Lynn Ruane (Independent) | Oireachtas source

A conversation we have not yet had, which Senator Mullen and I spoke about last week after the meeting, was referred to by Dr. Hartney when she talked about people being able to live within their homes. In all the weeks we have been here, we have not looked at home care and the inadequacy of its provision in Ireland, with people not having access to it for all sorts of reasons, whether they have lived their whole life with a disability or they need it because of ageing. Professor O'Neill was my father's doctor in Tallaght hospital at one stage when he was dealing with several conditions relating to ageing. I am thinking of some of those issues.

I am also thinking about what Rosaleen said. I should say "Dr. McDonagh"; as we are old friends, she will forgive me for forgetting her title momentarily. I am thinking about the UNCRPD and also the health and equality aspect, looking at the intersection of, say, class, race or Traveller ethnicity. Then I think of the ethics aspect. I am looking at all those pieces and I consider that it is really easy to apply a very obvious ethical framework at the decision-making moment when it is a question of whether a person should be assisted to die. The doctor, in all the ethical glory of the profession, can say, "I think this is unethical and does harm." However, ethical decisions are made daily in the lives of people that result in harm being done by the medical profession. I have worked with many people in addiction who are at different stages of liver cirrhosis and have been refused placement on lists for a liver transplant because they have not managed to get their alcohol use under control. This has resulted in their death; a death they did not want to happen. I worked with a homeless man who did not want to die but the medical profession would not give him Interferon or whatever medication it was for hepatitis. Medical decisions are made every day that are unethical and do harm.

Sometimes, they are about cost. Sometimes, it is about treatment options. Dr. McDonagh pointed out that some people are not offered the range of options that should be available to them. Will she comment further on that? I am wondering where the intersection is with decisions about what is profitable for the medical community in terms of not offering a particular lifesaving treatment, whether because of paternalism or the idea that if people are still in addiction, they will not be put on the liver waiting list, thereby resulting in their death. That might not be Dr. McDonagh's area of medicine but the point I am making is that ethical decisions are being made all day long that slowly and subtly move people closer to their death. When we look at assisted dying, however, there is an idea that there is an easy ethical decision to be made when it comes to whether people can, or cannot, do it.

How do we marry those two things together in our minds, given that when we discuss health inequality and health equity, we must think about how one is blocked from living well in the first place and about how medical decisions result in people's deaths.