Dr. Feargal Twomey:

Gabhaim buíochas le Cathaoirleach agus le baill chomhchoiste an Oireachtais seo as a gcuireadh a thabhairt dom teacht os a gcomhair chun cur leis an obair ollthábhachtach ar son Coláiste Ríoga Lianna na hÉireann. I thank the committee for the opportunity to appear before the committee today to help inform its important work. I am a nominee of the representation of the Royal College of Physicians of Ireland, RCPI, to present and discuss our position on assisted suicide. RCPI is Ireland's largest postgraduate medical training body and a professional body for medical doctors, with more than 11,000 members and fellows across 29 different medical specialties working in more than 90 countries. RCPI trains and supports doctors throughout their careers. You will meet our doctors in our hospitals and other healthcare settings. They are paediatricians, cardiologists, gastroenterologists and obstetricians, to name just a number of the specialties. We have many trainees and members working in palliative medicine, which is my personal area of practice.

RCPI opposes the introduction of legislation for assisted suicide because, in our view, it is contrary to best medical practice. It is our view that the potential harms outweigh the arguments that can be made in favour of legislation for assisted suicide. Second, RCPI promotes a considered and compassionate approach to caring for and proactively meeting needs, concerns and any sources of distress for patients who have a progressive or incurable illness and who may or may not be approaching the end of their natural life. Our college also promotes close adherence to the Irish Medical Council's current Guide to Professional Conduct and Ethics and the registered medical practitioners’ guidance on end-of-life care.

The college's position was adopted by its governing council in December 2017 following recommendations made by an internal expert group which was convened to consider the evidence and the arguments. This position was upheld, based on a further review of the evidence in the interim, in late 2020. These papers have been submitted to the committee and have been included again with this submission.

Every day, doctors like me, alongside GPs, nurses and all allied health and social care professionals deliver compassionate and expert care, including end-of-life care, in hospitals, hospices, GP practices and all other community and domestic settings throughout the country. These efforts are supported by patients but also by their families, friends and those they know and trust. We build relationships of trust over time. We listen closely and deeply to the fears, wishes and concerns of patients and their families and provide both general and, where it is required, specialist palliative care that closely aligns with those wishes.

There have been major advances in promoting high-quality care at the end of life across a spectrum of healthcare provision in Ireland, in particular, through the provision of palliative care services and increased training in palliative care and palliative medicine across the professions. Legislation for assisted suicide threatens to undermine these efforts, risking a shift away from funding, development and delivery of new and existing palliative care services and potentially reducing research in this area. It is important to consider the potential legislation in the context of unmet needs. There is a need for more and better palliative care resources, for example, a greater availability of psychiatric services and treatments. We must focus on meeting these needs. The impact of this legislation for assisted suicide in countries where it has been enacted is now captured in an evolving body of evidence that should, and I am sure does, inform this committee’s work. I understand the committee members will have heard of this from other people who have been before the committee.

Recent analysis of data from the Netherlands, Belgium and Colombia confirms a progressive broadening of the limits that have been initially established by law to the practice of assisted dying, both physician-assisted suicide and euthanasia in these countries. This is also the case in Canada, where safeguards that had supposedly been in place have been systemically eroded over the past nine years. In the Netherlands, there has been an extension of the eligible age groups, including new-born infants, as well as children of any age in Belgium. A recent report analysing the Oregon death with dignity Act since its enactment confirms that eligibility criteria have expanded since that Act was instated. The 15-day waiting period has been waived and patients receive assisted suicide or euthanasia even if they have non-terminal illnesses, such as arthritis, complications from a fall, hernia, stenosis and anorexia. In Switzerland, assisted suicide is a legal option for patients without any life-limiting illness or any evidence of unbearable suffering, and insufficient treatments are the only criteria.

A review, which was published only this month, found that between 2014 and 2018, the key criterion, namely, that end-of-life care is near, was met in only 44% of cases.

In some jurisdictions, access to assistance to end one's life is extended to those with psychiatric illnesses. In the Netherlands, they cite many challenges in accessing assessment for irremediable psychiatric suffering, IPS.