Professor Nancy Preston:

I do not think palliative care and assisted dying are mutually exclusive. For the research we conducted in Switzerland and the Netherlands, all the bereaved families we interviewed had palliative care input. The people were receiving palliative care at the time they chose the assisted death. It is an uncomfortable relationship for some, and that is where you get more people on the conscientious objection side, but I do not think they are mutually exclusive. It can be difficult for palliative care doctors who are willing to assist a death. They have given anecdotal evidence that they are shunned by their peers because they have become involved. I do not think they are mutually exclusive. Looking at the Benelux countries, their statements on assisted dying are not the same as the international palliative care statements which are completely against it. I think they can operate together, but there will be discomfort.

On the second point the Deputy made about the social impact, what we found really interesting was that it is a taboo. Even within healthcare, everybody we interviewed said it is never a normal death, but a death that stays with you forever. That is just the healthcare workers. That is the impact on them. On the impact on society, in some ways I guess it was there to say it could happen, but in our interviews they just did not talk about it.

It remained a secret, which made it quite difficult to cope with in some ways. However, when we looked at the interviewees' overall bereavement experience and reviewed the literature, it was still pretty good. They really felt they had honoured the person they were supporting. We probably do not know enough about the wider societal impacts. It is not an area we have gone further into.

On the Deputy's question on risk, we already know that, during the Covid pandemic, people with a learning disability or any other sort of disability were more likely to die. The healthcare system makes judgments that are not always in your favour. That is another reason not to want this on a busy ward with lots of beds that are needed and busy clinicians making decisions. The risk is high there. We had a liveable care pathway in the UK that went very wrong. There was nothing really wrong with the pathway but it was not implemented well and there is a fear that, if you implement this badly in mainstream healthcare, you will raise risks. However, there is no evidence to say that it will. The overall numbers in all countries have stayed low but they are particularly low where it is a case of assisted death rather than euthanasia. Have I missed anything?