Dr. Eric Kelleher:

It goes back to the earlier point that once the law is changed, and the evidence bears this out in most countries where it has been introduced, it becomes impossible to limit provision to just one group. There are people with terminal illnesses who are free of depression and mental illness and who would view this process as a choice. I do not think there is evidence out there to say one can identify this group safely in isolation. The gaps in data from Oregon, for example, show, I believe, that there is an under-detection of mental illness in those cohorts and, structurally, how the data are recorded reinforces that, unfortunately. This is the case even in countries, such as Australia, that have introduced this type of legislation to include many safeguards, which goes back to Senator Ruane's earlier point.

I am going on with this point, which I hope Senator Mullen will permit me. There is a paper from Professor David Kissane, an Australian psychologist specialising in psycho-oncology and palliative care, in which he shares four stories of de-identified patients who had requested and-or went on to experience an assisted death. A paper describes some of Professor Kissane's findings as follows:

Another de-identified patient, was reported to have been pressured to an EAS [assisted death] by an adult child home on holidays. This caused bereavement challenges for his wife who had anticipated having longer with him. In a further case... the oncologist referred the patient to a psychiatrist, although the patient's family were encouraging the patient to request EAS. The psychiatrist diagnosed clinical depression and commenced treatment with effect.

In another case reported by Professor Kissane, an oncologist patient's symptoms were "under managed by the oncologist who became primarily focussed on the process of EAS distracting away from symptom control".

These cases really illustrate that even when a law on assisted dying is enabled for patients who are felt to have capacity, there are still enormous challenges in terms of those who go forward for the process. I am representing the College of Psychiatrists of Ireland today. As a college, we have not been convinced by the evidence from any jurisdiction that has brought in this type of legislation that it can be safely limited to just one group. Even people who go through the process are exposed to harm.