Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The report was to have been presented by the Chair of the committee, Deputy Michael Healy-Rae, but he has asked Deputy Nolan to attend in his stead. She has 15 minutes. She needs to move the motion. After that, we will hear the response of the Minister of State, Deputy Noonan. We have two hours in total for this matter.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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There is a point of order here. Is it possible for somebody other than the Chair or the Vice Chair to move a motion? I say this on the basis that I was the proposer of the motion. This is the first I have heard of this, with no disrespect to Deputy Nolan.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I am at a loss. It is normally the Chair or Vice Chair of a committee who presents its report. That is absolutely correct. I was not aware, until I came here today, that neither the Chair - I do not even know who the Vice Chair-----

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I was the Vice Chair.

Carol Nolan (Laois-Offaly, Independent)
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To clarify, I am merely speaking to the motion. My colleagues are not here today.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputy Kenny should then move the motion and speak first. We will then come to Deputy Nolan.

Carol Nolan (Laois-Offaly, Independent)
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That is fair.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I apologise. I did not even realise Deputy Kenny was Vice Chair of the committee. The floor is his.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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I move:

That Dáil Éireann shall take note of the Report of the Joint Committee on Assisted Dying entitled "Final Report of the Joint Committee on Assisted Dying", copies of which were laid before Dáil Éireann on 21st March, 2024.

I thank everybody on the committee who was involved in this. It was a very thorough committee on a complex issue, but it was well worth doing. The committee ran for nine months. It had more than 100 witnesses and met, I think, 26 times. It heard from a broad spectrum in the debate. It heard from those who live in jurisdictions where assisted dying is legal and functional. The committee heard from a broad spectrum in this debate, as I said, in the areas of law, ethics, medicine, disability, palliative care, psychiatry and, more importantly, those with personal experience of being in a situation where they want to choose how they die. At the heart of this debate are personal choice and one's own mortality. That is very fundamental to every human being. I understand people in this Chamber and in our families, and members of the public, will oppose assisted dying under any guise, but it is a fundamental human right that a person should have a say in how he or she dies. We heard conflicting opinions from the medical profession, which is conflicted on this issue. There are those in that profession who oppose and support assisted dying. There is that broad spectrum in the debate. There are also people who are neutral on the idea of assisted dying who came before the committee, namely, representatives from the Irish College of General Practitioners, the Irish Hospice Foundation and the Irish Nurses and Midwives Organisation. They all had a neutral position on assisted dying.

The report has 38 recommendations overall. It should be said that 11 out of the 14 members of the committee supported legislative change. The key recommendations around that change concern eligibility, safeguards, capacity, ethical oversight, and a legal framework for how assisted dying could be administered. There is also provision for a clause for those in medicine who have a conscientious objection. It is very important that we deal with that. We were unanimous regarding palliative care in Ireland, which is very good. There should be more funding for palliative care. We all agreed with that. We also agreed that in certain situations, for somebody who is coming to the end of his or her life, palliative care will not ameliorate some of the pain and some of the management of that person's death. Again, that is fundamental to where people are moving. The report was very comprehensive and thorough.

On public opinion, if we had this debate 15 years ago, mine would be a very minority view in terms of where we are. However, things have moved on for the good in Ireland. It is not perfect by any means, but people have moved on regarding social issues, including women's healthcare and marriage equality. This is one of those issues that stops us in our tracks and ask us individually and collectively what we would do in a situation where one of our loved ones is coming to the end of his or her life. Opinion has shifted. Recent opinion polls in the past four or five years have indicated a clear majority would support assisted dying in Ireland and legislation for it. We see that the report's recommendations reflect public opinion. That is indicative of where we are at in this country. We are humanely looking at ways that this could affect individuals and their loved ones. It is very important.

The cutting edge of those who have been public about their own situation, including people such as Marie Fleming, Gaynor French, Brendan Clarke and Vicky Phelan, has changed opinions. The late Vicky Phelan was truly an amazing person in many different ways. It was such a tragedy when she passed away nearly two years ago. Vicky was quite vocal in supporting choice in end-of-life care. She was instrumental to how this debate went a number of years ago. She was really instrumental in how things have moved on.

On other jurisdictions, in Britain, a Private Members' Bill was submitted yesterday by a member of the Labour Party, Kim Leadbeater. She has put forward legislation similar to the Voluntary Assisted Dying Bill I put forward a number of months ago. On 29 November, there will be a long debate and a free vote on this issue in Britain, which could be enormous for where that country goes with assisted dying. That is a good thing. Somebody a lot of us admired and grew up with, Esther Rantzen, has terminal lung cancer. She said something very profound about this issue on her podcast recently. She said that most people are not afraid of dying but of how they die. Esther is very vocal about supporting assisted dying and is in a situation where she wants a choice and a say in how she dies. Again, that is a very fundamental human right.

In the past number of years, I have spoken to many people who support assisted dying and have been in extremely difficult circumstances as regards their health or that of a loved one.

This is an issue we should not be divisive about. We should listen to all sides. I have tried to listen to all sides as best as possible. I disagree with some of the terminology that people will use, but I understand that it is a person's right to object to assisted dying for many reasons, including ethical, moral and medical reasons. That is their choice. I believe assisted dying is a fundamental human right. It is a right to choice, an end-of-life choice, and people should have that right.

The report is very good. This issue has been ongoing for the last 12 years. I am proud that we have got it this far. The Dying with Dignity Bill received a Second Reading in 2020 and had the special committee. I understand, however, that it will probably be next to impossible to legislate for assisted dying during this Government's term and the next Government will have to deal with it. I hope people will read the report and it is legislated for in Ireland. That would be a very good day for those who are terminally ill and for those who want to forgo certain days, weeks or months of their lives.

This is the most profound choice and issue we have had to grapple with for a long time. In grappling with this issue, I think about the person. It may not be for you. You may never choose that. You may never be in a situation where you want to choose this path but think about somebody who could be in that situation. Think about the person who could be suffering needlessly and is going through a terrible death. I have seen at first hand somebody wanting to die and they cannot. In that situation, the person should have a choice. The only way to make that happen is for legislators such as us to change the law.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I apologise on behalf of the Minister for Justice, Deputy McEntee, as she cannot attend today. I welcome the opportunity to speak about this important issue on behalf of the Minister. I thank the committee members, its Chair, Deputy Michael Healy-Rae, and Vice-Chair, Deputy Kenny. We have spoken about this on a few occasions as the committee was ongoing.

This is an important and comprehensive report on assisted dying. How we die is the one thing we all face but we talk so little about it. The committee has done a wonderful job in preparing this report.

The significance of the work undertaken by the committee cannot be overstated. In addressing this most complex and challenging of social questions, its members have consistently demonstrated empathy, sensitivity and understanding. The committee held 24 public meetings over nine months. I watched several of the committee's proceedings. The committee met with over 100 individual witnesses, including national and international experts on law, ethics, medicine, disability and palliative care. Its final report includes 38 recommendations on assisted dying and related issues. The report is thoughtful, thorough and well-researched. I acknowledge and recognise the valuable work of the committee. The nature of the committee’s work and the content of its recommendations require that we adopt a measured and considered approach in our response.

I also acknowledge the bravery and generosity of spirit of those who shared their personal stories with the committee. Through sharing their personal narratives, they have helped the committee to fully understand the lived experience of end-of-life care. I also acknowledge the invaluable input provided by experts and public servants, both from Ireland and other countries. Their integrity, professionalism and willingness to engage with the committee should be commended.

Assisted dying is a complex, challenging and emotively charged issue, as Deputy Kenny said. It requires all of us in this House to navigate fraught medical, ethical and moral issues, as well as significant constitutional and legal concerns. The fundamental nature of the questions it gives rise to, and the challenges they present to our personal and moral perspectives make it a uniquely difficult question for legislators to address. The complexity of the challenge we are confronted with is exemplified by the personal story of Marie Fleming. Ms Fleming, who suffered from multiple sclerosis, challenged the Criminal Law (Suicide) Act 1993, having regard to the provisions of the Irish Constitution and her rights pursuant to the European Convention on Human Rights. While acknowledging the very distressing situation of the appellant, the Supreme Court upheld the constitutionality of the 1993 Act. The court found that there is no constitutional right to arrange for the ending of one’s life at a time of one’s choosing. However, the court noted that its judgment did not prohibit the Oireachtas from legislating for assisted suicide, assuming appropriate safeguards could be introduced. This raises the question, addressed by the committee, of whether we can and should legislate for this complex issue and, if we do, what we must take into consideration when doing so.

As the committee recognised, the issue confronting us is concerned with alleviating suffering and affording meaningful autonomy and dignity to a person with a terminal illness. However, the State also has an obligation to protect life and to value the life of all citizens equally. Before I discuss these two viewpoints, I acknowledge that everyone who expressed their opinions and very deep personal feelings to the committee was well intentioned and was coming from a perspective of utmost concern. It is also worth noting that this topic is one that has touched the lives, or will touch the lives, of everyone sitting in the House today.

On one side of the debate there are those who believe that individuals should be afforded autonomy over the most fundamental issues concerning their own life and death, that is, autonomy naturally extends to the right to die with dignity, particularly so as to avoid any undue suffering, and that when a person is diagnosed with a terminal illness or medical condition that they tragically will not recover from, they should be afforded the right to decide when to say their final farewell on their own terms and in a manner of their own choosing. From this perspective, it is argued that while we all recognise that every human life is valuable, we can also recognise that a person’s quality of life is equally as important. This is a significant factor in any personal decision about life and death. A person’s quality of life will often come down to reducing unnecessary suffering and pain, something that no one wants to see their loved ones go through.

On the other side of the debate, there are those who find the proposal to legislate for assisted dying as morally and ethically unacceptable. From this viewpoint, life has an intrinsic value, and one of the fundamental roles of the State is to protect life. We, as a society, have an extra duty of care to protect those who are vulnerable, particularly the elderly, the seriously ill and persons with disabilities. It is argued that to legislate for assisted dying, however well intentioned, would inevitably send a societal signal that such lives are of intrinsically less worth. Many of those who oppose legislating for assisted dying often contend that society should instead focus on providing high-quality palliative care that can effectively alleviate pain and suffering. We should be doing that too.

There is also a wide range of complex practical issues that arise when considering how to regulate a system that would provide for assisted dying. Will the eligibility criteria be too broad or too narrow? If it is limited to the terminally ill with only six months to live, what about those suffering from chronic and intolerable conditions or who otherwise may have an objectively justified reason to benefit from assisted dying? Will it be possible, or even desirable, to limit the incremental expansion of eligibility criteria over time? How reliably can we determine prognosis of terminal illness? If one of the core principles underlying assisted dying is personal autonomy, can the assessment of capacity be adequately provided for to ensure that decisions are truly voluntary? Equally, will it be possible to ensure in all cases that a person is not subject to coercion or undue influence by family members or other parties? Who is best placed to assess capacity and evidence of coercion? Could legalising assisted dying negatively affect palliative and end-of-life care?

In its final report, the committee recommends that the Government introduce legislation to allow for assisted dying in certain restricted circumstances and with the inclusion of safeguards. The committee’s proposals include strict eligibility criteria. The committee recommends that only a person diagnosed with a disease, illness or medical condition that is both incurable and irreversible, that is progressive and will cause death within six months or, in the case of a person with a neurodegenerative disease, illness or condition, within 12 months and is causing suffering to the person that cannot be relieved in a manner that the person finds tolerable, is eligible to be assessed for assisted dying. Additionally, the committee recommendation provides for certain safeguards. The report proposes that a person must make two formal requests for assisted dying, with a specified interval between each, before two independent witnesses in order to ensure, while affording complete autonomy to the individual, that such a decision is made in a fully informed manner. To ensure that those who are vulnerable would not be disproportionately affected by the implementation of this legislative and policy change, the final report of the committee recommends that any new legislation should provide that a person who is proven guilty of coercion will have committed an offence under that legislation.

4 o’clock

The committee’s recommendations significantly advance the debate in this country on assisted dying. Further analysis, reflection and debate, both within this House and outside of it, is now required.

Assisted dying in this jurisdiction is currently criminalised under section 2(2) of the Criminal Law (Suicide) Act 1993, which provides that a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, shall be guilty of an offence. If assisted dying was legalised, the criminal law and the absolute certainty that it provides in outlawing assisted dying in all circumstances would then be disapplied. Such a move requires deep consideration. There would be a consequent need for changes to the law to provide adequate protection against any inducement, incitement, pressure or force being used in respect of assisted dying. Notwithstanding the need to police coercion and undue influence, the central issue of assisted dying would then lie largely outside of the scope of the criminal law. Instead, in practical terms, it would largely fall within the ambit of health as a matter to be addressed by medical practitioners in terms of the prognosis of terminal illness, the assessment of capacity and informed decision-making, the means of death and so on.

I am sure all members share a vision for the highest standard of end-of-life care, which prioritises access to necessary treatment, supports the avoidance of suffering and affords the highest levels of dignity and autonomy.

It is therefore worth noting that the Minister for Health has sought to ensure that there is an excellent palliative care system available in this country, making it clear that we all agree that human dignity must be respected at all stages of each individual’s life, especially surrounding terminal illness and death. Palliative care helps to preserve this dignity, providing an appropriate environment and helping individuals and their families to deal with pain and other distressing symptoms. In this regard, it is apposite that the committee recommends that palliative care and the operation of assisted dying, were the latter introduced, should operate completely separately and independently of each other.

Many people hold strong views and have been, and continue to be, deeply affected by these issues. I understand that some of those people would like to see change quickly. Unfortunately, there are no easy answers or quick solutions in this area. Consideration of this report and its recommendations will take time.

There are other public and professional bodies that voiced their feelings on the matter to the committee through the course of its work that may now be affected by the committee’s recommendations. I have no doubt that those organisations are also carefully examining the report.

The report of the Committee on Assisted Dying is a valuable contribution to the debate on what is a complex and sensitive issue and which engenders strong personal feelings on all sides. On behalf of the Government, I again thank the committee, its Chair and Deputy Chair, for its report and I can assure the House that it is receiving the most careful attention and appraisal.

Peadar Tóibín (Meath West, Aontú)
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This is an enormously difficult issue. Many people have seen their loved ones die in extraordinarily difficult situations and many people will be motivated by compassion on this issue. I have no doubt but that some of the campaigners who are looking for assisted suicide are also motivated by compassion. I have no doubt that is the case. However, I believe the introduction of assisted suicide is a very dangerous step and one that crosses a significant Rubicon in terms of the protection of the most vulnerable people in Ireland.

Assisted suicide is an outlier internationally. Only a small number of countries and jurisdictions have legalised it. Many progressive countries, such as the Nordic countries, have refused to introduce it due to the massive pressure it puts on older people. In countries which have introduced assisted suicide, the numbers availing of it start off low but very quickly, when the law normalises the practice, the numbers radically increase. In some countries thousands of people end their lives through assisted suicide every year. In Canada in 2022, nearly 14,000 people ended their lives through assisted suicide. That was a jump of 30% on 2021. Nearly one in 20 deaths recorded in that country was as a result of assisted suicide. Some 463 of these assisted suicides were by people who did not have a terminal illness and who did not face death. One in 20 deaths in Belgium are now the result of assisted suicide. The introduction of assisted suicide into Ireland would radically change our life-affirming culture and the protection of people who are very vulnerable.

If one crosses the Rubicon to make it legal for one adult to help another adult end their life it is impossible, I believe, to put a limit to that action in future. Many of the countries which have legalised assisted suicide have done it for strict reasons but they have radically increased the circumstances in which assisted suicide can be availed of even to include cases of assisted suicide for children or for people who do not have a terminal illness. There are cases where that has happened in the likes of Belgium, where a child has availed of assisted suicide. People in other countries have had assisted suicide for mental health issues. While mental health is a massively impactful issue on people’s lives, it is not an issue without hope or an opportunity for people to respond to treatments and to benefit from them. There have been incredible cases in Canada in recent times. A woman with a disability plead unsuccessfully for housing, having been refused the housing, then decided to go through assisted suicide. There is another woman with a disability, a chronic health condition, who has sought housing, been refused and now she is in the final stages of approval to end her life. Promoters of assisted suicide will say there are some examples in some jurisdictions where the breadth of access does not increase and they are right. There are exceptions to the rules and there are jurisdictions which have not increased access. Deputy Gino Kenny, in fairness to him, approaches this particular issue with compassion. I have no doubt about that. I also think he is very honest in the way he approaches this. However, he did say in his speech that he believes that choosing how you die is a human right. I might be wrong in this, but I would think that Deputy Kenny’s breadth of access would go way beyond the committee’s report on this issue and may just be a human right in every single case. I may be wrong in that but there are proponents -----

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Yes, the Deputy is wrong.

Peadar Tóibín (Meath West, Aontú)
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Okay. Apologies for that.

I was disappointed that the committee ignored much of the scientific professional expert advice. Assisted suicide goes against the advice of the majority of consultants in palliative care. No group works with greater compassion or greater experience and with greater knowledge than those who are working in palliative care. Their association opposes moves to introduce assisted suicide. The Association for Palliative Care Medicine in Britain has opposed previous efforts to introduce assisted suicide. Disability rights groups in Britain have opposed changes to the law introducing assisted suicide stating that it would provide an illusionary choice if disabled people were not offered the proper support. The British Medical Association has stated that what we need is improvements in palliative care to allow for people to die with dignity. I met the Irish Palliative Medicine Consultants Association. Its consideration around assisted suicide is motivated by the fear that people, when they are told that they have a terminal illness or uncontrollable pain, will at that point choose assisted suicide but modern medicine has great opportunity for people to be able to control pain and to control fear as well.

There was a large study by the European Association for Palliative Care. It found 20% of those surveyed reported seriously considering assisted suicide for themselves when they found out their bad news of a terminal diagnosis but follow-up interviews found the majority of these patients had changed their minds after six months because distress, fear and anxiety are frequently transitory states of mind and can be radically lowered by good palliative care. The international experience clearly demonstrates that when assisted suicide is introduced it puts a phenomenal burden on many people in society. People who are older in other countries that have introduced assisted suicide often report that they feel they are a burden and feel that they should not be a burden any more and as a result they choose this.

One study in Washington State in the United States shows that for 56% of the people who selected assisted suicide, one of the top three reasons was they felt they were a burden.

Here lies the problem. We cannot legislate for one person. Any law we bring in, even if it is for a very difficult situation motivated by compassion, is a law that will affect thousands of other individuals. In addition, when assisted suicide is introduced, it very much confuses the message around suicide in general. It is impossible to say that suicide is never the right choice and to also say that suicide is sometimes the right choice. In many jurisdictions where assisted suicide has been introduced, suicide among the general public also increases.

On investment in this issue, we should have assisted living. It is important to say that in some jurisdictions, because of the introduction of assisted suicide, help for older people and for people with serious disabilities has actually reduced. I am thinking of Canada, for example, which has the lowest investment in palliative care in the areas where assisted suicide is fully legal.

In California, a medical insurance company provides funding for assisted suicide but does not provide funding for chemotherapy, for example. Ireland has a poor level of investment in helping older people and the vulnerable. ALONE, for example, received 26,000 calls seeking support in the past year.

Today I met with representatives of Care Champions outside the gates of the Dáil. Care Champions is a campaign trying to get the Government to carry out a proper investigation into how Covid-19 was handled in this country, and to help people in nursing homes and hospitals. It is very important to realise that this country has significantly let down older people and people who are close to end of life just in the past five years. The HSE diverted staff and support from nursing homes into hospitals during the Covid-19 crisis. Many people, especially older people, died in horrendous circumstances by themselves in nursing homes and hospitals during that time.

While I understand that compassion is a motivation among some people who campaigned for this, I have no doubt that we are living in a very harsh society that has difficulty investing to support people who are in very difficult circumstances. Given the record of this country during Covid-19, I have very little trust in what will happen around assisted suicide in the future.

Finally, I do not believe that there is a foolproof system whereby we can be fully sure that if people choose assisted suicide, they are doing so completely on their own basis. This may be the case in certain cases but in many cases, the feeling that they are under pressure not to be a burden can be an internal feeling or can be an external feeling. I cannot see how we can foolproof and ensure that those people are protected in the future.

Carol Nolan (Laois-Offaly, Independent)
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I am going to be very blunt about this motion and this report. Quite simply, the adoption of the recommendations contained in this report would represent the crossing of an ethical and legislative Rubicon that is almost too terrifying to even contemplate. If adopted, the Oireachtas will have opened up a Pandora’s Box where the likelihood of grave injustices being visited upon one of the most vulnerable groups in our society will move from grim possibility to absolute certainty. The recommendation to proceed with legislation in this area, contrary to the overwhelming concerns of palliative care experts and hospice providers, is breathtaking in its arrogance, apparent indifference and wilful cruelty. Given the clear and unambiguous international experience, there can be no excuses from Members to say they were operating in good faith or that they were hoping for the best. We know what the outcome of permissive law in this will achieve; the untimely, unfair and cruel and intentional infliction of premature death where care and compassion should have been offered.

This Dáil must reject this report. It must not allow what is essentially a monstrous dereliction of care to become embedded in our understanding of medicine and our treatment of the vulnerable. Once this line is crossed, I am sure that members will in time come to see it as one of the single worst decisions they have ever taken. I will quote from Jane Lazar of End-of-Life Ireland on this report.

We’re asking you as legislators, to honour a person who has a terminal or life limiting diagnosis. Because time alone, or ‘foreseeable death’ ought not be the sole basis for calculating eligibility criteria...

I ask Members to consider the dire situation this will create for those with dementia, reduced capacity, young children or the those who are in poverty and cannot afford medical care that ought to be theirs by right. We have seen, in every single jurisdiction where so called "cautious law" in this area is introduced, that it quickly expands to include the most wide ranging categories of people.

I would also like to quote from the minority report on this issue. Page 3 of the minority report states:

What was most surprising was that at the end of the hearings, there were no committee meetings to discuss the import of the evidence received. Rather, following the final public Committee meeting a draft report was prepared by the secretariat together with possible recommendations, and committee members were given three working days to submit amendments. At the first private meeting to discuss this draft Report, some committee members moved quickly for a vote on the first recommendation that ‘the Government introduce legislation allowing for assisted dying, in certain circumstances as set out in the recommendations of this report. That vote was held despite calls for prior full deliberation on all [of] the evidence presented, as summarised in the draft Report. One amendment to that wording ultimately prevailed – the addition of the word ‘restrictive.’

Thus, without any committee discussion of the over seventy hours of oral testimony nor of the many private submissions, there was a rush to vote on the substantive issue. At that point the Committee members had not fully clarified for themselves what was meant by assisted dying, as evidenced by a proposed amendment to the draft Report – that clarification only subsequently emerged after debate during the second private meeting on the draft Report.

I ask this very serious question. Why are we determined to replicate the moral and ethical horrors that legislation of this kind ushers in everywhere that it has been supported? Where is our sense of the sacredness of human life gone? What is the real agenda here? Why are we determined to simply dismiss the pleas of palliative care professionals and set ourselves up as gods on the issue of life and death? This report must be rejected outright. It is an affront to every ethical and medical protection that exists for the vulnerable and for the sick. It will be to our lasting shame if this report is adopted.

David Cullinane (Waterford, Sinn Fein)
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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.

Bernard Durkan (Kildare North, Fine Gael)
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I have listened with interest to the debate. I have debates of this nature in the past, as we all have. I have to say I have a deep concern about the legalisation of termination of anybody's life. We have had many discussions on all sides of this principle over the years. It was brought to a head for me when I was asked a long time ago, long before I came into the age bracket I am in now, whether I believed in mercy killing. I do not now and I did not then. What worries me most is the degree to which assisted dying has taken off in countries where it is permitted. I would be very worried about the number of interests, and I would like to know the number of interests, that had an input into the situation that prevails in those countries.

In many discussions, we were told that people initially reject such assisted dying concepts but then eventually come around to them. I recognise there are people who have particular illnesses and situations where families see their loved ones in pain, suffering and agony. There are ways and means now through palliative care, as has been mentioned by several speakers, in which these particular types of traumas for people can be alleviated to a great extent by modern medicine without the termination of the lives of the people concerned.

The nature of this proposal puts an end to any hopes such people might have of new medicines, procedures or help coming on the scene and goes along a line of finality. Several speakers mentioned that palliative care should be discussed separately. It should, but palliative care is the first issue that must be taken into account to ensure everything possible is done to make life as comfortable as possible for people who have terminal illnesses and are distressed in the course of them, and especially where their families are distressed because they have to watch while the person's life ebbs away.

There is obviously an air of finality about it. If something were to happen that might have proven to have been of benefit to sufferers at a later stage, perhaps six months, one year, two years or ten years later, whatever it might be, there is no recourse to going back; it is irreversible. That is a worrying factor. What is also worrying, and Members referred to these issues already, is that people are a little uneasy about this proposal, even those in favour of it. I know everything is being done to reassure people it is absolutely painless and so on and so forth. It is the principle one must worry about, the principle of helping someone to die when what we need to emphasise is helping someone to live and doing everything possible in the course of our public lives to try to ensure people have the greatest chance possible of living and availing of palliative care and the modern medicines and procedures that are becoming available. Let us remember, there are many procedures to which the public now has access in our hospitals. I know we hear complaints from time to time that we do not have access in the way we should - I am not so sure about that aspect - but there are procedures available to the public now that were not there some years ago.

Let us consider the situation where a person has availed of assisted dying or has been convinced that assisted dying is the answer to their problem. It is too late then. One cannot go back; it is all over. I am not so sure that people might not think maybe they were rash in that, maybe they were too quick to come to a decision, and maybe they took the easy way out. I again go back to the countries wherein legislation of this kind has been introduced, albeit on a limited basis. The numbers in some countries, however, would not indicate to me any limit in respect of the basis on which it is being availed of. I cannot understand how it took off so quickly and what other reasons and considerations were taken into account. As a Member of this House, of the health committee and, previously, of a major health board, I have to put the emphasis on preserving life, insofar as we can, and on using modern medicines, palliative care and care in general to assist the person who has terminal illness that is painful. That is not to say we do not understand - we do understand - and one can always see it in the relatives faced with that particular problem and who may be in a quandary as to whether they should proceed in one way or another.

I have to come down every time on the side of recognising that all is not lost just yet and everything is possible in the modern age. It may be a conclusion at a particular time to ease the suffering of patient, but not in the event of an alternative arising, which can and will arise in many cases, and will happen in time, whether it be long or short, to ensure the person suffering from the illness has a possibility of seeing out their life with reasonable ease to a conclusion that does not carry in it a possibility of somebody deciding to ease their pain where the methodology is also terminal. I am opposed to that. I have had this discussion with the proposer of the motion and I just cannot bring myself to support it in any way, shape or form.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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I thank all the Deputies for their contributions. As we have seen from the debate, it is a very complex and emotive but hugely important issue we as legislators have a responsibility to debate and tease out. This is what this report is about. Again, I respect the points made by Deputy Nolan and the issuance of the minority report. All the Deputies have spoken about the need for evenly balanced palliative care across the country and that there would not be geographic disadvantage in this regard. This is greatly important too. I again thank all the Deputies for bringing their own perspectives to this debate in a measured way and one that is respectful of all views on this important issue.

I thank Deputy Gino Kenny for moving this motion. He has long been an advocate for the introduction of assisted dying in this jurisdiction. His support for this position reflects a sincere and humanitarian objective to minimise human suffering and distress at the end of life. I also express my sincere gratitude to the chair of the committee, Deputy Michael Healy-Rae, and to its members who worked tirelessly on this sensitive and complex topic. The recommendations set out in the committee's final report are a serious and considered attempt to address this complex and sensitive issue. Equally, these proposals merit serious and deliberative consideration. The committee heard from a multitude of groups for and against legislating for assisted dying. These include those who have watched family members in pain, who have terminal illness diagnoses themselves and those who advocate for the most vulnerable members of society. They have all courageously voiced their opinions and feelings to the committee and we commend them on their contributions, just as we commend the committee on dealing with their stories in such a sensitive and empathetic manner.

I also thank all the Members of the House who participated in this evening's debate. It has been a worthwhile, informed, considered and respectful debate. I again mention the end-of-life care available to all of us in this country and to underline that the Minister for Health is deeply committed to the provision of high-quality and accessible palliative care services and to ensuring the best care is available to everyone where and when they need it. Ireland has been considered an international leader in palliative end-of-life care for several years. In the most recent cross-country comparative analysis, conducted in 2021, Ireland was placed second out of 81 countries for the quality of its end-of-life care. This does not, however, leave space for complacency. The new national adult palliative care strategy, which addresses one of the committee's recommendations, was published on 10 September 2024. The new policy will reflect the many developments in end-of-life care and international best practice as well as setting out a vision and a roadmap to meet future service needs. This is particularly important given the projected increase in Ireland's older population and the number of people with life-limiting conditions who would benefit from palliative care.

Services will be developed to shift care provision to the community in line with Sláintecare and geographic variations in the provision of specialist palliative care services will also be addressed. I think this evening of my good friend Susie Long. When she was living in Kilkenny, the palliative care services were not so well-developed and she thankfully found Our Lady's Hospice in Harold's Cross to be a haven in the final few weeks of her life. Equal access to palliative care should be right across the country. I witnessed the care my dad got more recently, this year, and there was a marked difference in the palliative care services available both at home or in hospital settings, which is to be welcomed.

The recommendations of this report require careful scrutiny and consideration so there is a distance to go yet. We need to consideration that. The recommendations present us all with opportunities and challenges in terms of how we further debate this. Deputy Cullinane in his considered response said as much about the need for all to respect all views both what came through the committee and its reporting and interviews; and the recommendations that have come forward.

On behalf of the Minister, I thank all of the committee members along with the Chair and vice chair, and all who shared and continue to share their personal stories and advocate for others - advocate for empathy, care, love and compassion.

Debate adjourned.