Dr. Sinead Donnelly:

Mar a dúirt mé cheana féin, is ábhar deacair agus tábhachtach an t-ábhar seo, is é seo, cuidiú le daoine lámh a chur ina mbás féin."I am a palliative medicine physician. I trained and worked in Ireland, the USA and Scotland and am now working in Aotearoa, New Zealand. My views today are informed by my extensive experience of the ability of palliative care to satisfactorily address people’s physical and existential needs and fears at the end of life, without ending their lives prematurely. My starting point is that assisted dying is not part of medicine. Assisted dying sets up a conflict within medicine and for palliative care in particular. We cannot expect doctors to be advocates for life and direct providers of immediate death. Whether offering the option of a premature death, or acceding to a patient’s request for such, doctors’ involvement in the decision sends an existential message that the patient’s life is no longer worth living even if doctors see themselves as a neutral party.

In Aotearoa, New Zealand, 1,800 doctors signed an open letter that doctors should not be included in the practice of assisted dying stating that crossing the line to intentionally assist a person to die would fundamentally weaken the doctor-patient relationship which is based on trust and respect. In New Zealand, where legislation mirrored on Canadian law has been in effect for exactly two years, it is far too early to derive lessons. This is particularly so based on the limited data being gathered despite our discussions with the Ministry of Health advising it to collect data similar to Oregon or Canada.

I now refer to the observations made by palliative medicine physicians in our study of the impact of assisted dying on palliative care practice. Patients are being granted euthanasia on

the basis of their request, and the fact they are likely to die within six months. Feedback from one doctor was as follows: "... there was no attempt as far as I could see from the documentation, to explore why and no sign in those notes of intractable suffering". The practice of palliative care has deteriorated, with less engagement on the tough subject of suffering and its meaning for individual patients which is the core work of palliative care. All of this means that true choice for patients and those who work in palliative care has been reduced. Patients with delirium who are deemed lacking in capacity by an experienced palliative medicine doctor are undergoing euthanasia. Many have proceeded with assisted dying on the basis of feeling they are a burden.

There is the example of the man who lived alone, whose sister suggested euthanasia for him. His doctor observed:

He felt completely devastated in the fact that she thought that that might be an option. He proceeded with it but that rift between him and his sister was palpable.

Assisted dying is being chosen by those who live alone. This man's doctor said the following:

A man recently had a cancer diagnosis and lived alone and didn’t have anyone to care for him. An external family member initially said 'We'll do everything we can to support you'. After a week, she put her hands up and said, 'We can’t support you'.

Rather than go to rest home, he chose assisted dying. Coercion is subtle and happening regularly. There are inadequate funds to provide a good palliative care service but assisted dying takes huge resources in time and energy from palliative care. There are concerns about the grief of children and teenagers of parent or grandparents who choose assisted suicide.

Paediatricians have serious concerns about 18 year olds choosing assisted dying when it is known that an 18 year old may have adequate cognitive development but not emotional

development.

I have referred to the negative impact on palliative care. Many are seeking assisted dying because they feel they are a burden. People are requesting and receiving assisted suicide without

objective signs of suffering. People whose capacity to consent is questionable are receiving euthanasia or assisted dying. The vulnerable are being exploited and the standard of palliative care services has diminished.