Dr. Deirdre Collins:

I thank the Cathaoirleach. I will read the statement from the Irish College of General Practitioners on the topic of safeguarding medical professionals. The ICGP welcomes this opportunity to assist the committee in considering the key issues around safeguarding medical professionals. As the Cathaoirleach said, the ICGP delegation comprises Dr. Quinlan, our medical director, Mr. Foy, our chief executive office, and me as chairperson of the board.

The ICGP is the professional body for general practice in Ireland and the representative organisation on education, training and standards. It has more than 4,500 members and associate members, and 1,000 doctors in GP training. The ICGP has initiated engagement and education to identify and support the perspectives of all our GP members.

Safeguarding all medical professionals and all patients is an important strategic objective. Medical professionals and patients will require clear and unambiguous eligibility criteria, embedded conscientious objection, comprehensive oversight and robust professional governance should assisted dying legislation be enacted.

Turning to our member engagement in respect of assisted dying, the ICGP has commenced a process of engagement with our members around the professional, ethical and legal issues arising with assisted dying. We had a keynote address on ethical issues for GPs at our autumn 2023 conference, which was attended by more than 300 general practitioners, and published ethical articles in our members’ journal, Forum. Moreover, assisted dying was the subject of a dedicated ICGP council workshop in February of this year, attended by 37 council members. The workshop considered two key issues, namely, how the ICGP can support all members if assisted dying legislation is introduced, and conscientious objection. Council members at this workshop expressed a wide diversity of views and recommended the ICGP seek our GP members’ views on assisted dying. To do this, the ICGP engaged RedC Research and Marketing to undertake a qualitative exploration of the views and perspectives of our GP members on assisted dying. All ICGP members were invited to participate, with six focus groups across July and August 2023. The ICGP-RedC report, Voluntary Assisted Dying: A Report Based on ICGP Membership Consultation, was published in September 2023, was fully shared with all ICGP members and accompanies this submission.

This report found that most GPs recognise that assisted dying is a societal issue warranting public and professional discussion. GPs value informed professional discussion and clinical education to, in their words, help our patients. While some GPs are vehemently opposed and others are strongly in support of assisted dying, the majority are conflicted in the provision or support of such a service. The report identified that most would not like to get personally involved, that there is more passive acceptance than support or rejection, and that most GPs want the opportunity to discuss this with their peers and, ultimately, with their patients. It clearly identifies the key strategic role of the ICGP to inform and educate doctors, supporting all GPs to have appropriate discussions with their patients.

These engagements enable the ICGP to better understand and represent GP views and perspectives to the Oireachtas. These consultations confirm that the role of the college is to support all our members. There are many safeguarding issues for all clinicians and patients in respect of assisted dying. The key safeguards identified by ICGP members, should legislation be introduced, include, first, safeguarding vulnerable people. Concerns exist regarding patient abuse or coercion, especially of elderly people in nursing homes and those with dementia, and the inclusion and exclusion eligibility criteria must be clear and unambiguous to safeguard all patients and all clinicians.

Second, the legislation must recognise and protect conscientious objection. GPs clearly and unambiguously articulated that there must be no compulsion to participate in any aspect of assisted dying. Third, it must provide comprehensive oversight and robust governance.

Comprehensive oversight and robust governance should encompass every aspect along the assisted dying pathway, spanning eligibility criteria through to monitoring, reporting, and review.

On the safeguarding of palliative care services, GPs were concerned that palliative care might experience resource constraints if assisted dying is legalised. This could impact clinician and patient care options.

The fifth issue is protecting the doctor-patient relationship. This important relationship could be adversely affected, with broader implications for the patient’s family and wider local community.

In summary and conclusion, we welcome today’s opportunity to share the perspectives of our GP community with the Oireachtas Joint Committee on Assisted Dying. The ICGP has commenced a programme of engagement and education to identify and support the diverse perspectives of all our GP members. Safeguarding all medical professionals and all patients is a shared strategic objective. Thank you for inviting us to this Oireachtas meeting.