Dr. Brendan O'Shea:

The doctor-patient relationship is constantly changing in response to a variety of factors, some of which I perceive as negative and some of which I regard as positive. Certainly all of us on our better days are interested in advance practice. In general practice during the last decade we have been working to have earlier conversations with people about their end-of-life wishes. It is a struggle in the busyness of practice. Again, we refer to the research around advance practice. We are of the view that when people are consulted, they can make up their minds very well about a range of different issues, even difficult ones in respect of death. We are particularly of the view that these conversations are best had earlier. They are best had when the patient is autonomous and before they are exhausted or fatigued. End-of-life planning tools such as Think Ahead can be used to ascertain their intentions, answer their questions and provide relevant information. All of this allows us to have conversations around end of life in a way that is greatly appreciated by the patients and their households and is very effective in reducing uncertainties or unresolved issues as the person enters into the final phases of their illness.

If this is set up in the correct way - we are making a case based on the international practice that family medicine is significantly involved at the heart of it - I am confident that any impact in relation to medical assistance in dying can be handled in such a way that it will be positive and enabling and will not be prejudicial to the doctor-patient relationship. I would also have to add that, as has been the case for termination of pregnancy, I absolutely recognise that whatever system is in place will recognise and respect the position of people who are conscientious objectors and will not be required to engage in medical assistance in dying if that is against their own ethical principles. I am confident we can do this well.