Dr. Matthew Dor?:

The Association of Palliative Medicine is the largest representative body of palliative care physicians in Great Britain and Ireland. Indeed, we are one of the largest in the world with a membership of more than 1,300. Thus, we represent those doctors who look after and treat the dying the most out of any medical professional. This is our day job.

This is worth noting because in consistent surveys and polls upwards of 82% of our membership are against this legislation being enacted. Indeed, in our 2022 poll in Scotland, 98% stated that assisted dying should not be part of mainstream healthcare. It is not just our membership, these numbers have been replicated in the 2020 British Medical Association, BMA, survey with 85% of palliative care physicians opposed to it. Our position statement is thus clear: we oppose legislation legalising assisted dying.

Why is palliative medicine against something that is touted as reducing suffering and providing choice? Both are fundamental to our specialty. Why is arguably the most accepting, forward thinking, progressive group of doctors against this legislation? This is surely a pause for thought on today’s topic of protecting palliative care.

Palliative care has an insight, that inevitably there will be "incorrect" deaths with this legislation. What we mean by incorrect deaths is that there will be people who have assisted dying who have, first, an incorrect diagnosis such as in Canada with the misdiagnosis of COPD that happened, or dare I mention the spate of MND misdiagnosis recently or, second, their prognosis is unpredictable. I believe the committee is aware of how poor we are at prognosticating. Third, a person's choice is fluctuating. People change their minds; indeed they naturally need time to adjust to their diagnosis. Fourth, there are those with mental health issues. Indeed only two people in Oregon and 6% in Canada were assessed by a psychiatrist this year. Suicide in Oregon has increased by a third and in no jurisdiction that has legalised assisted dying has its suicide rate gone down. Fifth, elder abuse is real. Some one in five of those aged over 65 have experienced abuse. A law is for everyone, and to ignore the risks of coercion and pressure is disingenuous. Sixth, within Oregon’s own statistics, 48% feel a burden and 6% have financial concerns. In Canada, there is clearly now pressure to consider assisted suicide.

An incorrect death is a death mismatched with the rationale for having an assisted death. It is a consequence of pre-empting the unknowable. As lawmakers, committee members will know laws balance individual liberty against societal safety. We have speed limits because driving over 30 km/h on O’Connell Street risks other people, the pedestrians. All traffic laws, all domestic laws, all criminal laws, - it is why we have prisons - are balancing individual choice versus society. Your individual liberty is limited to how it affects other people. My question to the committee is: what percentage of incorrect,

unnecessary deaths in the population due to the legalisation of assisted suicide would be acceptable? I suggest none.

The answer often touted is, "We will have safeguards" but are they really safeguards? Are they not an arbitrary criteria to find eligibility? In every jurisdiction that has legalised assisted dying for longer than ten years, there has been an extension to that eligibility. To correct a statement in a previous session, Oregon’s law is not stable; it extended access to other states in 2022.

I disagree on many points with Exit International at a previous session. However there is one thing from its submission I wish to quote:

Any framework that creates an exclusive ‘club’ of people with a distinct qualification criteria ends up discriminating against far more people than it will ever help. By its very nature far too many deserving people will find that they do not quite qualify to use such a law: they will not be sick enough, or their diagnosis will have an ambiguous prognosis.

The very proponents for this legislation admit to its arbitrary criteria and thus seek to extend it, and if legalised will succeed, as it becomes a question of equality of access for a "treatment".

In Canada in 2016 it was clearly stated that the country would not end up like Belgium and would be an exception. Do we think Ireland is going to be an exception to this tried and tested international trend?

Ireland founded palliative care and has a great history in leading the way. I am grateful that 90% of specialist palliative care is commissioned here. We must protect and nurture this. Do we want a society in which radical autonomy will inevitably result in incorrect deaths, or do we want to pursue the best end of life care with palliative care through evidence, diligence and compassion?