TDs and Senators have been warned of "a growing number of grotesque examples of unnecessary deaths" resulting from legalised euthanasia.
The Joint Oireachtas Committee on Assisted Dying met this morning to hear from experts from Ireland, the UK and the United States.
Chief Executive of UK Humanists Against Assisted Suicide and Euthanasia Professor Kevin Yuill told the committee that the case for euthanasia "is based on fear".
"In every country where it has been legalised for a reasonable length of time, cases have increased rapidly and the criteria for eligibility have expanded," he said.
Canada, which legalised euthanasia in 2016, "is the most dramatic example", Prof Yuill told the committee.
There, "many" seek euthanasia "for problems of homelessness, poverty, and inadequate medical resources".
Almost a fifth of those who chose euthanasia in 2021 cited either loneliness, social isolation or both as a reason for choosing to die, he said.
Mental illness becomes an eligibility criterion in March 2024.
Urging lawmakers to keep Irish legislation as it is, he pointed to what he called "a growing number of grotesque examples of unnecessary deaths".
Along with "awful stories emerging from Canada, there have been at least eight cases in the Netherlands where the only illness was autism and the reason was intolerable disruption to their daily routines," Prof Yuill said.
"We believe that it is wrong for the state to kill citizens, whether as punishment for a crime or simply because peoples' lives are wretched," he said.
"If he's saying that in Canada, somebody - because they're in a situation of homelessness - can avail of assisted dying, that is literally trivialising the whole debate, and it's deeply disrespectful to the issue," Gino Kenny, Solidarity-PBP TD, said.
"It doesn't stand up," he insisted, saying that the claim "is extremely selective".
Prof Yuill insisted he stood over his comments.
Slippery slope 'not inevitable'
Dr Annie McKeown O'Donovan rejected these arguments.
She wrote a doctoral thesis examining the ethics of assisted dying and argued that it can be introduced "in Ireland within strict, ethically defensible parameters".
Allowing a person with a terminal condition to voluntarily die "could be seen as part of compassionate palliative care", she said.
Dr McKeown O'Donovan conceded that "empirical evidence" reveals that euthanasia has resulted a "slippery slope" in some jurisdictions.
But she insisted that this is not always the case, and "is not inevitable" in Ireland if "strict and considered safeguards" are introduced.
"The patient must be capable of administering the medication to themselves," she said, noting that this "makes sure that it's an instance of assisted dying as opposed to euthanasia".
Helping someone to die should remain illegal, she added.
"That the patient is suffering and tolerate from an irremediable progression of chronic or terminal illness such that they're imminently dying. This is a very, very narrow window and this of course".
No such thing as 'very limited euthanasia'
Dr Thomas Finegan, Assistant Professor at Mary Immaculate College in Dublin, and board member of the Iona Institute, said that euthanasia "is a violation of the intrinsic value of life" and "a violation of persons".
He noted that some advocates of euthanasia insist that "choices for death are morally protected by the respect owed to individual autonomy".
But he warned that to allow euthanasia on this basis - "the autonomy rationale" - results in "no consistent, non-arbitrary justification for limiting euthanasia access".
Any refusal could be deemed to be "unfair discrimination", Dr Finegan claimed.
He argued that "the real, principled moral choice is not between 'no euthanasia' and 'very limited euthanasia'".
The committee, and the country, must choose "between 'no euthanasia' and 'largely unrestricted euthanasia'", he said.
There is, he insisted, no alternative to this severe choice.
"There is no stable middle ground."
Legislation 'specifically prohibits euthanasia'
Dr Tom Jeanne, with the Public Health Division of the Oregon Health Authority, noted that the Oregon Death with Dignity Act was enacted in 1997, and that nine other US states and the District of Columbia have passed similar legislation since then.
It "allows terminally ill patients to end their lives through voluntary self administration of a lethal dose of medications prescribed by a physician for that purpose," he told the committee.
The legislation "specifically prohibits euthanasia", and categorises any attempt to coerce someone into taking their lives as a grade one felony offence.
To date, Dr Jeanne said, 3,712 people have received prescriptions under the act, two thirds of whom (2,454 people) "have died from ingesting the medications".
The remaining third died from their underlying illness.
While the number of patients and physicians participating in the act has increased "it remains low, with fewer than 0.6% of Oregon decedents and about 1% of physicians participating in 2022".
Dr Jeanne said three quarters of patients who used the act were aged 65 or older, and the median age at death was 73 years.
The most common underlying illness was cancer (72%), followed by neurological disease (11%) and heart disease (7%).
Nearly all (96%) were white; 93% died at home and 92% were enrolled in hospice care.
All patients had some form of health insurance; most "had at least some college education, and financial implications of treatment were reported as a concern by only 5% of participants," Dr Jeanne said.
American psychiatrist Mark Komrad appealed to Ireland to "learn from our bad example", and declared assisted dying to be "bad medical ethics" and "poor public policy".
He pointed to "inadequate and mutating guidelines that eventually push beyond the limited scope of the
original laws" and "flimsy safeguards".
Mr Komrad also claimed that there are "physicians who do not follow the law", and who demonstrated an "inability to distinguish those for whom suicide should be provided from those for whom it should be prevented".
The Oireachtas Committee of TDs and Senators has been tasked to carry out an in-depth study of the issues and it can recommend legislative changes.
Specifically, it is exploring how assisted dying might operate in Ireland and examine what safeguards would need to be put in place.
Politicians are also looking at the constitutional, legal, and ethical issues involved and will seek to identify any possible unintended consequences.
The terms of reference state that the committee will consider all "relevant considerations arising from the provision of a statutory right to provide assistance to a person to end their life and the statutory right to receive such assistance".