Professor Desmond O'Neill:

I thank the Cathaoirleach and the committee. I am a professor of geriatric medicine, the most widely-published clinician in ethics research in Ireland and contribute to undergraduate, postgraduate and continuing professional development of doctors in ethics, an underdeveloped aspect of healthcare in Ireland. The key focus of euthanasia and assisted suicide is ethics, the code by which society grants liberty of action to healthcare professions in return for a framework that promotes doing the right thing and condemning harmful behaviours. It is separate from law, which is anethical.

I offer a briefer version of my submitted statement, Taking Others Into Account: Towards a positive vision of solidarity and support for our human condition, as it is difficult to compress a complex a complex ethical argument into five minutes. I take my opening quote from the recent policy statement by the National Centre for Ethics in Denmark, arising from a progressive, liberal and pluralist society, the sort of Nordic society to which we often turn for leadership and insight into excellence in care. Based on a broad committee on ethics, care and philosophy, the centre said:

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.

The whole impetus of medicine is a recognition of our common shared vulnerabilities, strengths and solidarity in a fabric of mutual support. This is supported by an ethos of hope, competence, and supporting our fellow citizens from suffering and despair to the greatest extent possible. A challenge to this solidarity arises from many sources, from emerging neoliberal and capitalist discourses which seek to separate and prioritise the individual over the collective good, to prejudices against disability and ageing, to eugenic impulses which resurface periodically even in modern societies. A particular prejudice is associated with conditions affecting memory, such as dementia, despite increasing knowledge both of quality of life but also how best to engage and support those affected.

A striking example of how good care can be subverted by a sentimental approach to euthanasia as seen in the movie "Million Dollar Baby". We are asked to sympathise with the killing of the quadriplegic woman boxer by her coach, but this arises at the end of an extraordinary catalogue of missed therapeutic opportunities. Her pressure sores and an infected leg that led to an amputation are indicators of substandard care by any standards. She clearly had a severe untreated depression and unresolved family strife, and no effort was made to provide a more domestic and personalised environment in her care facility.

The impact of this erosion on the social support framework was most notable in a recent case where a nursing home doctor in the Netherlands failed to recognise the refusal of euthanasia by a person living with dementia arising from a prior advance directive. As doctors, we recognise that people change with the course of their illnesses. Failing to read these signals, the doctor sedated the patient without her knowledge and consent and had her family physically restrain her while she was euthanised. In terms of tolerance for this major breach of trust and solidarity, what is worrying is that the professions and courts in the Netherlands sided with the doctor rather than the person who had been killed. It is this erosion of the wider caring and solidarity contract that is most corrosive in permitting assisted suicide and euthanasia.

An oft-heard refrain is that of control in the face of terminal illness, failing to recognise both the advances in recognition of consent for, and refusal of, treatment and advances in support and care. While autonomy is important, it is exercised in the embrace of others and mediated by other principles such as justice, doing good, not doing harm - not only to the person, but also to those around him or her - and the impact on the social contract.

An equal issue is that of dignity. It is aspects of the care and settings that may be undignified rather than the person, and the collective impulse of medicine over millennia has been to improve the knowledge, skills and attitudes of staff and to develop more appropriate care settings.

The negative impacts of assisted suicide and euthanasia in Canada, Oregon and the Netherlands in practical terms and in the erosion of a positive supportive approach to care have been eloquently described to the committee by Professor Harvey Chochinov, among others, echoed by the position paper of the Royal College of Physicians of Ireland, which was widely circulated among 14,000 specialists and raised concerns about the impact of assisted suicide and euthanasia on principles and standards of care, suicide prevention, combating discrimination and failing to learn from past and present adverse experiences.

To ask doctors to run counter to this by killing patients short-circuits and undermines our impetus to care, comfort and support and damages not only the framework of care, but also our shared humanity. Current and future patients need to be reassured that the response of the healthcare professions to distress and pain is one of solidarity, compassion and care, addressing needs at a range of levels while respecting wishes to the greatest extent possible. They should be reassured by not only the evidence that death is widely experienced as occurring with dignity within current paradigms, but also by the existing and ongoing development of care paradigms, training and research to continuously enlarge the framework within which the final period of our lives is spent.