David Cullinane (Waterford, Sinn Fein)

I welcome the opportunity to speak on this important issue. I was a member of the committee for a very short time when I replaced one of my party colleagues. The committee did its work diligently, sat for a long time and we had extensive discussions, disagreements and arguments on a range of issues. As has been pointed out, there was a majority committee report and a minority report, which I accept that some people took exception to. I had no objection whatsoever in principle to people who had a different view publishing their own report. Then, let us have a discussion and I hope a very sensitive debate on what is a very sensitive issue.

My party, Sinn Féin, would resource a national approach to end-of-life care, including palliative care and bereavement.

This would focus on equity of access across palliative care in the home, nursing homes and primary care settings, including out-of-hours and night supports. We would work to ensure more people could spend the rest of their time in the best care setting for them in a way that is planned with them regardless of their wealth. End-of-life care would be an important part of a statutory home care scheme. Sinn Féin is committed to supporting family carers, including with the abolition of the means test for the carer's allowance. Bereavement and grief can be exceptionally difficult. Sinn Féin would implement a consistent approach to bereavement care, with links to HSE primary care and counselling. The Assisted Decision-Making (Capacity) Act must be considered and incorporated in any new policy. End-of-life care planning is a critical aspect of the care trajectory. This legislation holds a key role for informing this work.

My party acknowledges the final report of the Oireachtas Joint Committee on Assisted Dying and the minority report which was also published by a number of members of the committee. The committee recommended legislating for assisted dying only in certain restricted circumstances, with very clear definitions and a review after three years. It called for an updated palliative care strategy to be published to deliver accessible and equitable access to services throughout the State in advance of assisted dying. This has since been published. It called for an independent national body for assisted dying to be responsible for assisted dying services with full oversight. The committee set out a number of recommended safeguards, including accessing decision-making capacity, protecting against coercion and far greater end-of-life care and supports. This is very important to point out.

While this is a very sensitive issue and a very delicate issue, and there are many different opinions in society and among the public at large, it is also the case that many tragic cases of people with very difficult illnesses have been raised on the floor of the Dáil, where these individuals wanted to access end-of-life care at a point of their choosing and to end their life at a point of their choosing. Because of the laws of the land they were unable to do so. It is an extremely emotive and difficult issue for many people. In my view, the vast majority of citizens understand the complexity and the differing range of views. They also understand there are illnesses where people have horrendous deaths and families watch people die horrendously, unfortunately, in very difficult circumstances. People want to be compassionate. Anything with regard to what would be done on assisted dying can in no way take away from palliative care. The two are completely separate. It is very important for us to make this point. Palliative care is very important. Palliative care has to be valued, supported and implemented and available to as many people as possible.

I watched my own mother die of cancer over the course of 12 months. She had stomach cancer and was in great pain. I could see in her eyes in the last couple of months that the life had gone from her. She existed and she was there, I could speak to her and I could talk to her, but the life was gone. We could see it in her eyes. She said to me several times it was no existence for her. It is an awful thing to have to watch your mother, your father or a loved one go through a very difficult illness. We were very supportive of my Mam and appreciative of the palliative care services that she got. She was in Harold's Cross hospice and got the very best of care in very difficult circumstances. She had her family around her when she eventually died in the privacy of a room. The family was present when she died. Those services are invaluable for families. Palliative care is very important. I do not believe we should ever confuse assisted dying with palliative care. We have to see them completely separately.

We also have to accept this is about the choice of citizens. There are some people who will never ever choose the option of assisted dying and that is absolutely their fundamental right. Then there are going to be citizens who will want this option because of the very difficult illness they might be going through. What the committee did was to look at the very limited circumstances in which this would be made available. We had very lengthy discussions about coercion because nobody should be coerced, whether it is done subtly or more proactively, and whether it is done by a family member or a healthcare professional. There have to be robust protections against any level of coercion. In the very difficult cases raised in the Dáil, and I will not name names but we know of many of those difficult cases that were raised, coercion was not what was at play. It was a plea from the individuals themselves that, such was the quality of their lives and the difficulties they were going through, they wanted to die at a time of their choosing. Their pain was intolerable and no amount of palliative care was going to deal with that for them. This is simply the reality of some illnesses. I do not believe any legislation introduced that does not protect against coercion should ever be considered by the Oireachtas or should ever be supported by the Oireachtas. We must also include assessing decision-making capacity. We must also support and make sure we have far greater end-of-life care and supports for citizens.

The best way to proceed on this issue is to have extensive pre-legislative scrutiny. There is a majority report, and there is a majority of Members of the Oireachtas who support proceeding with assisted dying in the very limited circumstances set out in the report. Even within this there are differences of opinion. We need to come at this issue very carefully. We need to look at making sure we have the very best legal safeguards. We need to make sure all of the unintended consequences and intended consequences are dealt with and gone through. We need to make sure it is not something that will open the door to coercion or open the door to this being made widely available to include other illnesses. It should never be made available on the grounds of mental health. It should never be made available on the grounds of disability. I have heard some people say this. Under no circumstances would I ever support assisted dying being made available to people on these grounds. The committee, very intelligently, diligently and sensitively, looked at the illnesses where this could be a possibility, where people in a desperate situation are asking the Oireachtas to do more, to look at this and to put in place a legal framework that would work for them and their families.

I value every person's opinion on this issue, including people who completely oppose it. Everybody is coming at it from the right perspective and from their own perspective and their own experiences and values. People have come to me and told me their loved ones were suffering and going through the most horrendous death. They were appealing to the State to do more. The Ceann Comhairle was here when the cases were raised on the floor of the Dáil. It is very difficult to look the family members of these people in the eye and say we will never look at this and that it is impossible to legislate for it. I do not believe it is impossible. It is possible to have all of the safeguards which people have raised, and all of the protections that need to be in it, and have a very robust legal framework that would make this possible. My party's commitment is that if we were in government we would have to proceed cautiously and carefully. We have to look at very extensive pre-legislative scrutiny to ensure we get this right. I would not want to pass legislation that would get this wrong and would create problems for anybody. I want to get this right and I welcome the opportunity to take part in the debate.

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