Dr. Brendan O'Shea:

We need to cater for the pressing needs we have at the moment in this regard as an item of service delivery. We need to look to the future, but we particularly have a responsibility to improve things as they are. I had an intense conversation with a Canadian colleague recently on a reflective case presentation involving a gentleman who had a diagnosis of dementia. He and his partner worked through it themselves. They approached their own practitioner. They approached some of the relevant clinicians and specialists, including a geriatrician. Under the Canadian system, that gentleman qualified and had medical assistance in dying, which was very positively reflected on by his partner and by the GP.

At the present time, in considering the Canadian experience, one of the reflections emerging from that case discussion was the categorisation of cases into what the physician called tracks 1 and 2. The track 1 cases were those where there was an obvious pressing need because of unlimited, unrelieved pain, shortness of breath, distress and so on. Those cases, which were obvious and easily fitted the criteria, formed the majority of cases. However, in cases such as this, involving dementia, it is significantly more complex and there are a significantly smaller number of cases. Right now, we urge members of the committee closely to consider putting through legislation to deal with the majority of cases, involving people who have significant and progressive suffering as a result of progressive, metastatic and complex common cancers or who are at end-stage heart failure or end-stage COPD, where there is significant suffering and the prognosis is extremely difficult. At the moment, however, we are not recommending that dementia be considered a primary qualifying condition on its own.