Dr. Andrew Lyne:

I thank the committee for the opportunity to make this submission on behalf of Irish Doctors supporting Medical Assistance in Dying. We represent more than 100 registered medical doctors in Ireland. We believe that voluntary assisted dying is about offering terminally ill patients a choice at the end of their lives.

Medical paternalism, where doctors assume what is in the patient’s best interest, is no longer acceptable. Patients’ choices should be respected and supported where reasonable, with decision-making shared between doctor and patient.

As a society we have empowered individuals through referenda to take control and responsibility of their personal lives. Ireland is now a progressive, caring and compassionate society that respects individual’s rights. Repeated opinion polls in Ireland show that society understands that assisted dying may be a reasonable choice for those with terminal illness. Assisted dying continues to have widespread support among the public in the various jurisdictions where it has been introduced. Public support for assisted dying in Australia is at 78% and at 83% in the state of Victoria, where it has been available for more than six years.

Increasingly, various medical bodies have recognised that there are diverse opinions among doctors on assisted dying and that it is a societal issue rather than a medical one. In the UK, following consultation with its members, the Royal College of Physicians, the Royal College of Surgeons and the British Medical Association have all adopted a neutral stance on assisted dying. In Ireland, the Irish College of General Practitioners, ICGP, has also adopted a neutral stance.

Concern for vulnerable groups is shared by all doctors here today. Studies on assisted dying have repeatedly shown that vulnerable groups are not over-represented in those who choose assisted dying. In fact, people who choose assisted dying tend to have higher incomes, are younger and are more likely to be married and to be living at home.

Palliative care can control and alleviate the symptoms of many patients but it cannot eliminate all pain and suffering for all patients. Other symptoms, including shortness of breath, vomiting and unremitting itch, can be difficult to control. When the symptoms are overwhelming, terminal sedation, where the patient is rendered unconscious, may be used. Terminal sedation is very important to avoid patient distress and suffering but we should also recognise that it strips the patient of all autonomy. They are unconscious and unable to contribute to any decisions in their care.

When we look at the international experience, pain is not the most common motivation for people to request voluntary assisted dying. Loss of being able to live in a meaningful way and loss of ability to perform activities of daily living, such as being able to go to the toilet independently, underlie more than 80% of requests. It is understandable that an individual may choose to end their suffering when they lose their ability to function, there is no prospect of improvement and death is foreseeable.

Many patients with distressing symptoms and incapacity at the end of a terminal illness may never wish for voluntary assisted dying and it is right that their choice of palliative care is well resourced. Other patients will not want to endure the suffering that can occur at the end of a terminal illness and would like to have the choice of voluntary assisted dying.

I turn to my colleague, Dr. O'Shea, for the next part.