The Oireachtas Committee on Assisted Dying sat on Tuesday to examine whether Ireland should introduce legislation for voluntary assisted dying.
The practice is currently legal in several countries including the Netherlands, Belgium Luxembourg, Canada, and New Zealand.
The joint committee of 14 TDs and senators is being chaired by Independent TD Michael Healy-Rae.
As part of The Conversation from RTÉ's Upfront with Katie Hannon, we asked two people to join our WhatsApp group to discuss whether Ireland introduce legislation for assisted dying.
Dr Patricia Casey is a professor of psychiatry at UCD and consultant psychiatrist at the Mater Hospital in Dublin.
Dr Brendan O'Shea is an assistant professor for General Practice in Trinity College Dublin and a spokesperson for the Irish Doctors Supporting Medical Assistance in Dying.
Dr Brendan O'Shea
Hi Patricia.
Dr Patricia Casey
Hi Brendan.
Dr Patricia Casey
I don't think Ireland should introduce physician assisted suicide (PAS). It is dangerous for patients and betrays the calling of doctors to first do no harm.
Dr Brendan O'Shea
There are absolutely risks involved in legislation for the provision of Voluntary Assisted Dying (VAD) including Medical Assisted Dying (MAID). And there is a need to do so, and we can manage these risks.
Dr Patricia Casey
If we can manage then we will be the first country to do so. What risks do you see Brendan and how can we successfully manage them?
Dr Brendan O'Shea
I believe that in the countries where MAID has been considered and introduced, that health care professionals involved have engaged well with people and their households in large numbers, and that we certainly wouldn't be the first country to do this well.
One way we can sequence this is to legislate, establish an implementation group to define evidence-based guidelines, deliver education and public messaging to healthcare professionals and the public and establish the service with audit and review built in.
The risks include effective safeguarding for vulnerable patients, and adequate time for patients, their careers and households to reflect and inform themselves regarding the choice and process and we can address these.
Dr Patricia Casey
That's not answering the question. This is a process to deliver MAiD. Indeed, most countries have these in their laws. What safeguards will there be to prevent extensions to include children, people with mental illness and people who simply believe they have lived long enough?
Dr Brendan O'Shea
I think it is answering the question to a significant extent. Like many things we do in healthcare, MAiD/VAD is complex. As a GP, in my view it would be best to initially legislate for a conservative service likely to address the very evident needs of a proportion of people at end of life, particularly those with unresolved suffering arising from the major progressive cancers, cardiovascular and respiratory conditions that many people die from, and a small proportion of whom have unrelieved suffering associated with their diagnosis.
And who have formulated a desire to avail themselves of MAID/VAD. If you wish to hear directly from some of the households affected, I would strongly recommend last week's session with Patient Voices evident at the Oireachtas Committee.
Dr Patricia Casey
What can you do in real terms to reassure people that this will not extend in a few short years to the groups I mentioned above. What can you do to prevent people feeling pressured? These are the likely unintended consequences of something you and this group believe to be necessary.
Dr Brendan O'Shea
It's not what can I or any other doctor do Patricia, it's what all of us can do, and particularly with strong patient input, and particularly through some of our voluntary organisations - we can do this effectively, safely and well, with appropriate inputs also from the Oireachtas, the HSE as well as our Postgraduate Training Bodies.
Establishing a system for provision of VAD/MAiD is not really a decision for doctors, it's a decision for people, and particularly those concerned with incurable progressive illnesses and with unrelieved suffering. The ICGP is by far the largest Medical Postgraduate Training College. Separately, GPs have a particular perspective on dying, death and bereavement, as we are often with people right through the process and so this is reflected in our perspective.
I would refer you to Irish Doctors Supporting Medical Assistance in Dying (www.maid.ie) for some GP perspectives. We can do this, do it well, and a proportion of people and their households will benefit.
Dr Patricia Casey
We have put a lot of effort into reducing suicide in Ireland with some success in the last few years but more to be done. We cannot now turn around and say with one hand we want to reduce our rate and the other say assisted suicide is good. It's contradictory. There is evidence that assisted suicide gives out the wrong message and leads to a rise in suicide - see Doherty et al BJ Psych Open 2022. Thanks, Brendan.
Dr Brendan O'Shea
Thanks, Patricia.
