Dr. Feargal Twomey:

Yes indeed. Once the substantive view of the college has been agreed, whatever view it comes to, we will be happy to share it with the committee.

In terms of my own view, I work in palliative care and I am a doctor in palliative medicine. We are in the no suffering business. Our duty in care is to look after lots of people who are living, and enable them to live as well as they can. I have worked on the definitions for the glossary of terms of palliative care in Ireland. Terminal illness is when you will be dying in the coming hours or days. We see an awful lot of people with incurable illness. We listen to them and their various needs. At Deputy Farrell's invitation I will respond to some comments made by other people present. In any jurisdiction where this has started, it began as a conservative approach. I counsel members of the committee that in the time since the first Private Members' Bill on this issue was tabled in the Houses of the Oireachtas the systematic erosion of safeguards and protections and the relaxation of restrictions in Canada have been quite frightening. I understand the committee may have heard from colleagues in Canada earlier today. I am also concerned about one of the erosions in Oregon in the US and in Canada, where you do not need to have a long-standing relationship with a physician for your physician to be involved in the discussions. In fact, you can fly in from out of state, and in five days meet two doctors you have never met before and in certain circumstances have your life ended, or receive assistance to end it yourself. That erosion of safeguards is challenging.

From personal experience in my day to day work and listening to colleagues, I would say that in Ireland we are excellent at the after death bit. When people die, we are very good at gathering around and supporting. I was at a conference last Friday, and there was incredulity that so many Irish people have rip.ie as their homepage. For many people of a certain generation, it is the first thing they look at. I suggest, without casting any aspersions, that Members of the Oireachtas have at least one team member making sure they are not missing any deaths that have happened in their constituencies, and which they should attend. What we are atrocious at in Ireland is recognising that dying is a normal part of living. We are really poor at recognising that there are limitations to the treatments you can have. We are also poor at recognising that there are limitations to the expectations we can have of that treatment. Much of the fear of dying, the pain of dying or of the pharyngeal secretions and death rattle come from a fear of them happening. They are much less relevant to the actuality of those occurring. In my specialty and in particular in the hospice where I work I see some of the most complex dying happening in our region. Even in that subset of people with advanced illness who are dying, and who may or not be more likely to be in a hospice setting when in a lot of trouble, the incidence of severe distress of any kind is quite small and sustained. I met a lady yesterday in the emergency department of University Hospital Limerick. She was distressed because she is going to die in the coming five days. She has five children under the age of 11. She wants to live as long as she can, but she is not going to be afforded that. I met a person in the hospital last week who spoke about going to Amsterdam for assisted suicide. It was based on a recurrence of her illness, the fact that her son has had the same illness and another son has died from the same illness. She was able to tell me about her distress at the fear of recurrence of the symptoms of previous treatment and the recurrence of a death in the family from a similar diagnosis. Her treating doctor and I were able ask her what her main distress and worry was, and how we could best address it. Luckily for her, this lady has a supportive family around her, and has further options for treatment. However, when I met her the only thing she wanted to ask me was how to get to Amsterdam so she could have her life ended.