Professor Desmond O'Neill:

There is a massive importance in terms of the philosophy and framework. Part of the issue of giving liberty to healthcare professionals to manage a space without using algorithms or having everything nailed down is that they will have a code which promotes doing the right thing - which Atul Gawande talks about in the context of virtuous thought and virtuous action - and condoning harmful behaviour. One of my concerns for Ireland is that the over-dominance of the Catholic Church at one stage has left a bad taste and vacuum whereby people have lost ethical articulacy about this. When you lose ethical articulacy, you retreat towards legalism when you say if it is legal, it is probably ethical. For example, under our code, it is unethical to have sexual relationships with a patient, but there is nothing in the law against that. There are clearly things that are different in an ethics code from a legal code. There is always a challenge in a stressed, pressured system whereby if you offer people ways out of difficult and traumatic situations, they will take these shortcuts. We are seeing this already in Canada where people are being offered medical assistance in dying, MAiD, as a potential care option rather than asking them about the ways in which we can deal with their suffering. There is no question that we wish to see suffering not being relieved. We see the increase not only in euthanasia in the Netherlands, from 3.4% in 2017 to over 5% of all deaths now, but also an increase in suicide. It is around how we message and it is around our framework of messaging and discourse for care.