The Joint Oireachtas Committee on Assisted Dying is holding its final public meeting before its 14 members draft their final report which is due to be published on 20 March.
The HSE National Clinical Director for Integrated Care, Dr Siobhán Ní Bhriain, flagged six areas which the committee needs to consider, including vulnerable citizens, impact on healthcare workers, and patient safety.
Dr Ní Bhriain said: "It is the conclusion of the senior clinical group in the HSE that there are significant supports, both legal and medical, in place in Ireland to enable people to die in a dignified way."
She added: "People do have a right to refuse life-sustaining treatment and there is access nationally to palliative care services."
But she emphasised that the HSE adopts "a neutral position" on assisted dying, and so could not say whether it should be designated "a healthcare matter" or dealt with outside the medical system.
There "is currently no legal basis for assisted dying in Ireland", noted Siobhán McArdle, the Assistant Secretary at the Department of Health, adding that the department "does not have a policy position" as it "falls outside of existing health policy".
She said that if assisted dying is introduced in Ireland, research of other jurisdictions would need to be undertaken to learn from established practices and determine what model could be used.
'Room for improvement'
Several committee members asked about the interaction between medics giving palliative care and those who provide psychological support.
Ms McArdle said that the psychotherapeutic support given to those in palliative care leaves "room for improvement".
We "could always do with more", she said.
Dr Ní Bhriain agreed that psychological support for those nearing the end of life was very important.
As a consultant psychiatrist for older people, Dr Ní Bhriain told the committee that she "will frequently bring palliative care colleagues in" to support the care she is giving, but said that most of the psychological support is given by her team.
"We liaise closely with mental health services," Dr Fearghal Twomey, National Clinical Lead for Palliative Care with the HSE, said.
He also noted that there is "definitely evidence" of the impact on health staff in the Netherlands, including social workers, arising from their involvement in assisted dying.
Ms McArdle said that a new implementation document on mental health policy will be published "in the next couple of months".
Final report: four options
In its final report, it is open to the committee to recommend: no change; propose legislation; recommend a Citizens' Assembly; or suggest that a plebiscite be held.
Committee chair, Independent TD Michael Healy-Rae, told RTÉ News that compiling a report will be "very, very difficult" and he acknowledged that it might be impossible to agree on a unanimous position.
"The report might be based on a majority, with a minority expressing their view too."
In a preparatory document, the committee was informed that there are at least 27 jurisdictions around the world that already provide some form of assisted dying.
It noted that euthanasia involves a doctor, or healthcare professional, as the person who "acts last" with the intention of ending a life.
This differs from "assisted suicide" in which the person seeking to die "acts last" i.e. they are the one to administer the drug, or the means selected to cause death.
Over the course of two dozen public sessions since last summer, the committee has engaged with national and international witnesses about the morality and the mechanics of the issue.
As the committee meets in public session for the final time Janie Lazar, Chair of End of Life Ireland, said that the organisation has seen "from recent research that people in Ireland support giving someone the right to choose the manner in which they die and to do so in a peaceful and dignified manner.
Ms Lazar, who gave evidence at the committee last year, said: "As public hearings close and work begins on preparing the Committee's report, we strongly urge its members to recognise and endorse this compassion by recommending the introduction of a programme of assisted dying.
"So many people for whom a programme of assisted dying would be relevant have no time to wait or waste.
"They and their families need the support of their public representatives to face and prepare for the end of their lives in peace and with dignity."
The HSE also told the hearings that any new law on assisted dying should allow for conscientious objection by healthcare workers who do not wish to be involved.
Politicians also heard how the committee, over the last nine months, has heard from health experts, theologians, legals expert, NGOs and others on the matter.
Senator Ronan Mullen said there were ways to tackle the issue without changing the law.
"I deeply believe if we address peoples' fears and concerns about dying, not just pain and the fear of pain, we can actaully address this issue in a way that doesn't require an assisted suicide or euthanasia regime," he said.
However, People Before Profit TD Gino Kenny said a change in the law was needed.
Mr Kenny said: "Most people who'll die, will die peacefully, but there are a cohort of people that don't die peacefully and they should have a choice in realtion to end of life care."
He said if that means changing the law, then that's some "we hopefully will do".
At the end of today's meeting, chair Michael Healy-Rae said the issue being considered could not be more serious.
He said: "We're not talking about roads or water facilities. We're talking about life...and there is nothing more sensitive and important."
Mr Healy-Rae added the committee will now spend the "next few weeks" finalising its report.
