Reverend Dr. David Bruce:

I thank the committee for the opportunity to present the views of the Presbyterian Church in Ireland to it.

The Sixth Commandment in the Bible to not kill is clear and has been present as a cornerstone of judicial systems across the world for thousands of years. There are exceptions to this prohibition, of course, but they are few and subject to rigorous regulation. For people of faith, the starting point here is that human life is special – we may even say "sacred" – and that its preservation, dignity and protection are moral values that we cherish. The question of assisted dying goes to the heart of this important moral principle. Killing is wrong. This is killing. Therefore, as those who respect both the Bible as the Word of God and the Hippocratic principles, we simply do not do it and this is a place the medical profession ought not be asked to go, notwithstanding the deeply complex pastoral issues surrounding, for example, coping with the latter stages of degenerative disease or incapacity through trauma. The Hippocratic oath contains these words: “I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it”.

Parliaments and assemblies in London and Edinburgh have repeatedly rejected changing the law in this area. Those legislatures have not been persuaded that the current law is even in need of change or that the proposed safeguards in their draft Bills would be effective in protecting vulnerable people from harm.

The medical speciality of palliative care, mentioned by the previous witness, exists to help support patients with conditions, which cannot be cured and who need help in managing their physical, emotional or spiritual symptoms. This surely encapsulates the vision of the founder of the hospice movement, Dame Cicely Saunders. In our internal research it is significant to us that palliative care practitioners themselves have been the most adamant of medical specialties opposing a change in the current law.

I now speak to the ethical dilemma. In ethical terms, this exposes the tension between the competing rights of liberty and personal autonomy. We reference the European Convention of Human Rights, in particular Article 8, respect for a person's private life, and the Article 2 right that everyone's right to life shall be protected by law. A change in the law could surely cause a large and vulnerable group of citizens to be exposed to exploitation by reason of depressive illness, lack of capacity or agency, unscrupulous coercion or manipulation by relatives or others to end their lives prematurely. It is our view these rights are foundational. Most people can agree that for an individual to arrive at a point where they believe there is no other option but to seek the ending of their life suggests considerable emotional, physical or spiritual turmoil and suffering. The first response to this dilemma, in my view as a Christian minister, ought to be the mainstreaming and strengthening of palliative care services to support those nearing the end of their lives or addressing this dilemma.

To conclude I briefly highlight two areas of specific concern. The first is safeguarding. The language any legislation uses to gatekeep the practice of assisted dying will speak of a person's settled wish to die, or their mental capacity to understand, and so on. Many members of the medical profession expressed to us their deep unease that such decisions to accede to a request for assisted dying essentially became a matter of their subjective opinion as medical practitioners - difficult to defend in a tribunal or the High Court. Doctors are neither social workers nor detectives. If a society really wants to make assisted dying available, this process surely needs to be administered and these judgments made by the courts or a dedicated commission accountable to the courts. Doctors will have a role to play as professional advisers on strictly medical aspects of a request. However, if they are made the judges in such matters this will fundamentally change the doctor-patient relationship, as other witnesses have mentioned.

I turn lastly to euthanasia, because in those countries where physician administered euthanasia has been legalised, it has been shown to result in a factor of ten times more deaths than physician assisted suicide. In Holland and Canada, where both are legalised, 96% of hastened deaths are due to physician administered euthanasia. The settled position of the Presbyterian Church in Ireland is that human life is sacred, that our human right to life needs to be protected, and that a change to the law in this regard would be detrimental to the life of the nation. There are surely better ways to address the turmoil of those caught in such a terrible dilemma, in specific terms the mainstreaming and strengthening of palliative care services to support those nearing the end of their lives or addressing what to them seems to be intolerable. These are the marks of a mature and caring society.