Dr. Joan McCarthy:

On euthanasia, I agree with my colleagues about the importance of a national conversation on death and dying. It is important to welcome and accept that sincere and reasonable people disagree about euthanasia and assisted suicide. It would be good to welcome any kind of conversation about our fears and worries in this regard and not to be afraid of scaremongering to the effect that every discussion we have about death and dying must be or is about suicide, assisted suicide or euthanasia. It would be good if people were not afraid to say what they believed about it, understood it to be and so on. The kind of courageous journey of a citizen such as Marie Fleming is something that will happen repeatedly because people hold strongly to their wish to be in control of how they die and particularly of when they die when they face highly traumatic illnesses and so on. On the issue of euthanasia and assisted suicide, I also believe it touches on people's underpinning moral values, their religious perspectives and their world views. This of course makes it extremely difficult, profound and emotional. We can honour this and can welcome differences of opinion about it without being obliged to say this commits us to this, that or the other thing. In the meantime, as I stated in my presentation, ordinary and usual things happen in death and dying in respect of breaking bad news, sedation and so on, about which people do not have an understanding. We are just beginning to grasp the importance of recognising and respecting patients' choices regarding ordinary, basic matters, the importance of communicating with patients and so on. Consequently, there are many things we can do but in respect of assisted suicide and euthanasia, one certainly is to not be afraid of embracing the disagreement and the diversity of views pertaining to it - that is, the fact that reasonable and sincere people hold different views on it, the varying levels of evidence extant for the implications of introducing it and so on. The discussion of the issue in the High Court was an example in which reasonable and sincere people discussed evidence in respect of assisted suicide.

I was not sure about the question from Deputy McLellan about the clinical ethics committee being a stand-alone entity. Perhaps I did not express myself clearly, but I am not talking about a stand-alone clinical ethics committee. I am talking about a national network of clinical ethics committees, as well as some support for that national network in the form of a small task force in the HSE, the Department of Health or a large hospital, which would support the translation of ideas among the existing clinical ethics committees. The eighth module of our ethical framework is quite detailed on this issue and was mainly written by Dr. Louise Campbell of NUI Galway, who is a national expert on clinical ethics committees. In addition, Professor David Smith of the Royal College of Surgeons in Ireland has been working closely with clinical ethics committees around the country. Consequently, there is some national expertise in this area and the eighth module of the ethical framework explains what such committees are, how they work internationally and so on, which is helpful for us.