Professor Deirdre Madden:

Regarding best interest, which Professor Jones was speaking about, in Ireland as evidenced by the Assisted Decision-Making (Capacity) Act, we have moved away somewhat from looking at what a doctor might decide is in the patient's best interest. We are now trying to support individuals, themselves, to make decisions and have those decisions respected in accordance with their will, preferences, beliefs and values. It is how they choose to live their lives rather than what a doctor might consider to be in their best interest.

Regarding the point about harm which Senator Ruane just mentioned, for me the question of harm is a more subjective issue rather than an objective one. For many people who live in very severely compromised situations, towards the end of their lives they become much more concerned about maintaining their comfort, their quality of life and dignity rather than the length of their life or extending their lives.

Sometimes they reach a point, despite all the best efforts of everybody who is caring for them, at which they decide that the best life possible for them is sufficiently poor that it is worse than no further life at all so they decide to forego any further life-sustaining treatment, that is, medical interventions. There is no objectively correct point at which further treatment for all persons is no longer a benefit but is without value or meaning. For me, there is only the decision of a competent person about what that point means for them. Therefore on harm, it is a subjective determination and assessment for each individual to live his or her life and to end his or her life at a time of his or her own choosing.