Dr. Miriam Colleran:

Gabhann Hope Ireland buíochas le baill an choiste as ucht an seans labhairt leis an gcoiste ar an ábhar tábhachtach seo. Hope Ireland is grateful for the opportunity to address this important committee and thanks the members for the comprehensive analysis of the complex subject of assisted dying.

I am a palliative care consultant working mainly with adults with advanced progressive illnesses in a hospice and an acute hospital. I see people for pain and symptom management and to help care for them and support their loved ones with the challenges of progressive serious terminal illnesses. People on all sides of this discussion want to provide caring, compassionate, and person-centred care for persons with advanced progressive illnesses. As Michelle Obama, the former First Lady of the US, said, “Words matter." Hope Ireland agrees with the importance of clarity of language. Assisted dying means different things in different jurisdictions and varies from prescribing a medication for ingestion by a person such as in Oregon, which is called assisted suicide by the Dutch Government, to the doctor or nurse giving the medication to the person that will cause their death as happens in Canada, which is called euthanasia by the Dutch Government. Given that the Dying with Dignity Bill 2020 proposed legalising both forms of assisted dying, I will discuss both in this presentation.

With quality and safety, we are constantly balancing the risks and potential benefits of actions. In the case of assisted dying, the risk is of the inappropriate or wrongful death of a person. This is the ultimate error. When discussing the conflict in Northern Ireland, the peacemaker and Noble Prize winner, John Hume, said in an essay in the London Review of Books, “There is not a single injustice in Northern Ireland today that justifies the taking of a human life.” Under our law, because assisted dying is illegal, there are no wrongful deaths from it. However, there is still a constant need for continued improvement in the care of persons with advanced and progressive illnesses and support for their loved ones. Our fellow Europeans, the Danes, are also considering this issue. They, like us, want to provide compassionate care. In the recent Danish ethical council’s opinion on euthanasia, 16 of the 17 members recommended against the legalisation of euthanasia, stating that:

The members point out that euthanasia risks causing unacceptable changes to basic norms for society, the health care system and human outlook. The very existence of an offer of euthanasia will decisively change our ideas about old age, the coming of death, quality of life and what it means to take others into account. If euthanasia becomes an option, there is too great a risk that it will become an expectation aimed at special groups in society.

A major concern when considering assisted dying is the risk of inappropriate deaths, the risk to persons who may be vulnerable, and that the right to die may become the duty to die. The World Health Organization “estimates that 1 in 6 people over 60 years of age suffers from abuse”, so it is necessary to consider if safeguards proposed are safeguards in practice. This includes the suggested safeguard in the assessment by two medical practitioners. Detecting coercion and abuse is complex, specialist, and challenging work. In the national safeguarding report of 2022, which detail all types of abuse of adults aged 18 and higher, 3% of referrals were from hospital staff and 1% by GPs, respectively. This report states that "psychological and physical abuse remain the main types of abuse reported” and also that for those over 65 years "immediate family members" were the most frequently reported persons causing concern.

I will now hand over to Ms Emer Maguire.