Dr. Brendan O'Shea:

Our group has considered why voluntary assisted dying should be introduced in Ireland, which was addressed by Dr. Lyne. I will move on to how voluntary assisted dying could operate in Ireland, bearing in mind that this session is particularly related to healthcare provision and healthcare professionals. Having engaged closely with the experience of others, including our own colleagues abroad, and the evidence from a number of different health systems where this has been introduced, we have been influenced by the experience in other healthcare systems.

We recommend legislating initially for a conservative approach with continual audit of real-time data and robust review at two years, reporting at no later than two years and six months. We are confident this can be administered and carried out in this manner.

With respect to qualifying criteria, we recommend it should be restricted to adults aged 18 years or older resident in Ireland who evidently have a progressive, incurable, terminal physical illness and a prognosis of less than six than six months or, in cases of advanced terminal illness, those causing progressive physical deterioration. The patient must be able to consent to accessing voluntary assisted dying both at the time of the initial request and at the time when assisted dying might occur as part of service provision.

The initial application should be required to be assessed by two independent healthcare professionals with a training and background in this aspect of healthcare provision. We recommend excluding mental illness and dementia as primary qualifying conditions.

Regarding service provision, we recommend, again with respect to the experience in other health systems, a reflection period of two weeks, with discretion to reduce this to five days in cases where there is significant active poor control of symptoms and evident suffering.

Voluntary assisted dying can be provided either through a choice of self-administered oral medication or through a healthcare professional-administered parenteral or intravenous medication.

With respect to implementation, we recommend the formation of two key groups: the formation of an implementation group that might work over a six- or nine-month period and the formation of a service provision panel, which would be involved in the actual administration of medical assistance in dying. The implementation group should comprise invitees or nominees from some of our fantastic NGOs, perhaps including the Irish Cancer Society, the Irish Hospice Foundation, the Alzheimer Society of Ireland or End of Life Ireland. It should also include involvement from the post-graduate medical training bodies, including the ICGP. In other health systems where this has been introduced, we understand that generally family physicians are closely involved, partly because of our role in delivering continuous care and our presence at the onset of diagnosis right through to dying, death, bereavement and beyond. The HSE should have an involvement in the implementation group, as well as the Irish Medical Organisation, IMO, the Decision Support Service, the IHCA and national general practice information technology, GPIT group. GPIT is particularly important to ensure this process is accurately mapped out and documented and that there is high-quality, relevant data to analyse how the service develops. The service provision panel should include groups of initial applicant assessors and service providers.

We would see service provision being delivered where people largely most want it to be, which is at home, in nursing homes, in the acute hospital setting and beyond. We need to draw on the experience from termination of pregnancy so that the thoughts, values and beliefs of conscientious providers and conscientious objectors are both adequately reflected in how the service is established and set up.

Having considered it closely, this service can be set up successfully and effectively, with absolute respect to the ethical sensitivities required. The service can be delivered well and reflects an evident need for a significant proportion of people who are dying in Ireland.