Dr. Regina McQuillan:

I thank the Chair and the committee. We very much appreciate the opportunity to appear before the committee today and to provide evidence on behalf of the Irish Palliative Medicines Consultants Association. The issues we seek to address today are ones to which our group has devoted significant time and resources to discuss, understand and form a position on.

We respect all views on assisted suicide and euthanasia and we will continue to engage with all parties on this basis. Only through a respectful and open dialogue can we begin to reduce the stigma and fears about death, a process that we will all be affected by at some point in our lives. In this regard, we welcome this discussion about end of life. The IPMCA is the official representative association for consultants in palliative medicine in Ireland. The members of the association care for approximately 28,000 patients and their families annually as they face the challenges and losses that arise when the end of life approaches.

We work hard daily to provide compassionate, respectful and reassuring care seeking to ensure each person we meet has their needs addressed, guided by their individual values, wishes and concerns. We do this by listening to each person we meet and building trust with them and those important to them. Each person comes with a unique perspective on life and will place differing emphasis on what is important to them as they face death.

The IPMCA is fundamentally opposed to the introduction of assisted dying, assisted suicide, or euthanasia. Our members believe that any shift from the current legislative status quowould represent a regressive change to patient care in Ireland. Our position is informed by our extensive clinical and personal experiences as well as the international evidence that has emerged over time as other jurisdictions have adopted assisted dying legislation in recent decades.

To summarise our position, we oppose any change to the status quofor the following reasons: many commonly held perceptions about the end of life are different from the reality we see every day. Death is sad for patients and their families, but most physical and psychological suffering can be well-managed by comprehensive expert care. We believe it would significantly and negatively impact the trusted relationship that exists between doctors and their patients, particularly in the area of palliative care, as patients sometimes fear referral to palliative care because of our role in end of life care. Meaningful and long-lasting safeguards are impossible to construct. The logical premise of assisted dying is to respect autonomy and to reduce suffering. This has led to its extension of assisted dying to other people, including mature minors, and the inclusion of other causes of suffering as part of the inclusion criteria for assisted dying. While we respect the autonomy of the individual in every encounter, this should be equally balanced against, and protective of, the needs of the wider population - including the wider population of people who are living with a serious illness. Introducing assisted dying is a societal statement about the value of life that will impact on others, not just those who request it. The wish to die is common and usually transient. It is influenced by many factors including mainly psychosocial reasons, which can often be addressed with the right care

In line with the topic of today’s hearing, protecting and enhancing the provision of palliative care, it is also important to note that regardless of the outcome of this process, assisted dying should never be considered a substitute for the provision of good palliative care. The two should not be associated, nor should it be assumed that assisted dying best fits with palliative care. People fear death, and because palliative care is associated with life-limiting illnesses and end of life care, people sometimes fear referral to palliative care. This can be a barrier to people receiving care that is focused on helping people live as well as possible until they die. If we are also actively involved in providing assisted dying, developing and maintaining trust would be extremely difficult. It is not that palliative care services that would suffer in these sorts of situations but that the services are meaningless if not helping patients.

It is the patients who will suffer. Far more must be done to deliver equitable service provision throughout Ireland. The pioneering national palliative care policy of 2001 has lapsed, and the publication of a new one is awaited.

Finally, we fully acknowledge that these are complex, nuanced and highly emotive issues and understand that considering legislation in this area is very difficult. It is a great challenge and one we wish to play a significant role in informing. We look forward to addressing the committee's questions.