Professor Max Watson:

I am grateful for the invitation to address the committee. I do not envy the committee its task. As guardians of potential legislative change, the committee faces a thankless task which involves sifting opinions from facts and blind convictions from evidence. The committee has to be mindful of opinion polls that claim to represent the will of the people of Ireland and the risk that legal change could permanently alter the fundamental nature of Irish healthcare. Whatever the committee does will not be universally appreciated.

I am here as a palliative care doctor and professor who has worked for more than 35 years in a variety of roles, including here in Dublin with the Irish Hospice Foundation and in Northern Ireland, London, Nepal and India, where I hold an academic appointment. Throughout my career, I have been focused on how to support people as they live the last part of their lives.

I begin by acknowledging that this goal of improving and supporting people in the last phase of life is a challenge for us all and a goal we share. Even defining a good death is not easy, and the different assessments of a death - "He fought right to the end", "He suffered horribly" or "It was such a peaceful passing" - betray the investments that different people bring to observing even the same death and society's death anxiety. The definitive studies from beyond the grave have not been done. Palliative care itself is often misunderstood. People think it is only about death and dying but it is actually about living well to the end. I work with Dame Cicely Saunders, and her famous affirmation has been our creed:

You matter because you are you, and you matter to the end of your life. We will do all we can not only to help you die peacefully, but also to live until you die.

I have been involved in an estimated 8,000 deaths during my career in palliative care. I have engaged with a variety of politicians in different countries in the process of trying to improve end-of-life care but I have never felt that need here in Ireland. Today we are focused on protecting and improving palliative care. I am grateful that the committee understands the potential impact of legislative change on palliative care in Ireland. Other jurisdictions assume that palliative care and assisted dying go hand in glove. They do not.

Palliative care and care of the elderly services are the specialties consistently most opposed to such change. This could be because, at its core, palliative care is about neither hastening death or unnecessarily prolonging life. Doctors generally enjoy fixing things. Having to accept a world where not everything can be fixed and daily facing mortality with our patients is initially very counterintuitive. However, this is the reality we have embraced, since the patient, David Tasma, requested more from Cicely Saunders than traditional medical care. He said, “I only want what is in your heart and mind.” Palliative care is not just about giving drugs for pain or other symptoms. Our scalpel is building honest relationships and being with people as accompanists in the last phase of life. This work parallels that of a midwife. To anticipate systematised, regulated, rights-focused death protocols being forced into our operating theatre undermines the fundamental of what and who our patients have taught us and need us to be.

I worry that if assisted dying becomes the default option, legislation will severely limit patient choice. Currently, I can discuss a patient's fears and options when they ask me about ending their life. In the event of legislative change, I will not be able to do so for fear of being accused of applying the worst kind of medical paternalism, namely, inappropriate influence on the vulnerable.

I do not think the Spice Girls have been asked to speak to this committee, but their question is the most crucial one the committee must face - "Tell me what you want, what you really, really want" to achieve from changing or from not changing legislation on physician assisted dying. Is it to make it a right for Irish people to autonomously be able to seek help to end their lives at a time of their own choosing or Is it to improve the number of people who are enabled to live well until they die knowing that they will neither be abandoned nor have their suffering ignored? What is it that we as a society really, really want? I do not have faith that legislative change can bring about the latter because I have not seen the evidence that legalising physician assisted dying could improve the quality of dying in Ireland. There is evidence that greater palliative care integration could, really, really make a difference to our goal.