Dr. Joan McCarthy:

Further to what my colleagues have said about the uniqueness of every death, it is important not to sanitise death or consider it in terms of dying in the surroundings of one's family. There are patients who will rage against the dying of the light. There are awkward patients and others with imperfect families or no families. Health professionals have to deal with those kinds of situations. Doctors and nurses must, for example, work with families and patients who are in conflict or despair. Advance directives like think ahead and let me decide, which was developed by a colleague in UCC, Professor William Molloy, support health professionals and families because they make clear what the patients want.

In regard to Deputy Catherine Byrne's question on perceptions of palliative care, the palliative care specialists coming before the committee in the next session will be able to speak to that subject more expertly than I can. The European and Irish associations of palliative care have conducted research demonstrating that the use of palliative care does not hasten death. If anything, it makes people more comfortable with the process of dying. Pain management is something that accompanies the journey of the dying person. It does not push him or her towards death. It is a gift to all of us to be able to draw on that support.

On Deputy Neville's question about euthanasia and assisted suicide, those debates are about the processes involved. We are only beginning to understand what it means to respect people's autonomy. What does it mean for us as a culture to accept people's choices, preferences and individual responses to their life projects and what obligations do these place on health professionals? In very ordinary ways, people exercising choice is something that is difficult to promote. For example, I was disoriented when I came to Leinster House today because I am not used to the system. I was somewhat disempowered by the entire process. In the same way, patients and their families are disempowered when they enter a hospital because they do not know what is going on. In a basic way, we are only beginning to think about how we can enable people to believe they can participate and have a role in making decisions. We need to develop processes that allow us to debate issues like euthanasia and assisted suicide in a reasonable way that allows sincere people to voice their views and consider national and international evidence. We must also think about the impact such debates will have on the goals of medicine and nursing. What are nurses and doctors supposed to be? Important questions arise in regard to solidarity and communal responsibilities, as well as preserving the integrity of doctors and nurses. As the Deputy noted, these issues are going to be a part of our culture but it is important that they do not sabotage the important subjects we need to discuss in the everyday sense of people dying in hospitals, health care settings or, ideally, at home.