Professor Mary Donnelly:

To begin with the pressure, it is difficult to know. We can assume that any kind of a system would have mechanisms to avoid overt pressure, in other words, somebody saying “You must”. Obviously, that is possible and we have heard of situations where people have been pressured into, for example, going into a nursing home, and these kinds of pressures arise. Let us assume that that is not going to be an issue because we will put sufficient mechanisms in place to ensure it does not happen. The concern would be a more subtle kind of pressure so an individual would feel their life is worthless. For that, we absolutely need to have adequate access to palliative care. However, I believe we can avoid those kinds of pressures.

I cannot give the Deputy a practical example that I have seen in my own life or in my own experience of somebody who was pressured in a situation like this or, to be honest, in a situation where we are looking at refusing life-sustaining treatment. I cannot produce an example but that does not mean that I deny that such examples exist.

In terms of advance directives, they have been lawful in Ireland since April 2023, so a person can refuse treatment, including life-sustaining treatment. We have accepted that and it is part of our law. The question the Oireachtas will have to consider is whether something similar should be allowed in regard to looking for something. As the committee has heard over the last five weeks, our law draws a very clear distinction between what it describes as an act - doing something - and an omission. I have some issues about the legitimacy of that distinction but let us leave that aside for the moment. That is what our law does. In that perspective, we have measures, and it is relatively straightforward under the legislation that has just come into effect to make an advance healthcare directive. You do not need a solicitor and you do not need to have an advance assessment of capacity.

I would have a number of questions about how suitable that model would be if simply transposed into an assisted dying context, and I certainly think we would need additional safeguards. I would be pretty careful before moving towards advance decisions for assisted dying. I am not saying they are never appropriate, although I do see a distinction at that very end-of-life stage where people are ending their lives sooner because they are concerned that they will lose capacity. That worries me.