Joint Committee on Assisted Dying debate -
Tuesday, 24 Oct 2023

Assisted Dying and the Ethics of Autonomy: Discussion

An Cathaoirleach

Apologies have been received from Senators Hoey, Seery Kearney and O'Loughlin.

Parliamentary privilege is considered to apply to the utterances of members participating online in a committee meeting when their participation is from within the parliamentary precincts. There can be no assurances in relation to participation online from outside the parliamentary precincts and members should be mindful of this when contributing. This committee discusses dying, including suicide. Support information can be found on the committee's web page.

Our agenda item today is engagement on the topic of assisted dying and the ethics of autonomy. We welcome Professor William Binchy BL, legal adviser to the Pro-Life Campaign, Mr. Lloyd Riley, director of policy and research at Dignity in Dying and Mr. Andrew Copson, chief executive of Humanists UK, which incorporates Northern Ireland Humanists, who is joining us online. We are very grateful to them all for appearing to share their knowledge with the committee. The format for this meeting is members will ask questions after the witnesses make their opening statements. A member may ask an individual witness a question or address it to all the witnesses. Please do not think I am horrible about this, but I have to try to keep to time. Each witness's opening statement is an agreed five minutes and each committee member has seven minutes for the opening slot, which includes the witnesses' time for a response, so we have to keep it lively. It is good for all of us to be kept on our toes.

I invite Professor Binchy to make his opening statement.

Professor William Binchy

I thank the Cathaoirleach. I believe members have the opening statement with them, so I will speak to it rather than reading it if that is okay.

By way of introduction, I will say why I am here. I am here because I hope I can give a perspective based on old age. I have been a barrister for a number of years and an academic for a number of years. I was a member of the Irish Human Rights Commission for ten years and I worked in law reform for about 18 years, specifically on legislative matters directly related to family law, including the Family Law (Maintenance of Spouses and Children) Act and the Family Home Protection Act. I was subsequently in the Law Reform Commission for many years. I have an interest in human rights independently of having had that position with the human rights commission; I am interested in human rights essentially around the world. I have a strong interest in the development of human rights in Africa and a number of Asian countries, including Timor-Leste. That is my background. I say that simply because it is important for the committee to know we have to keep a world view on this, rather than simply focusing on the immediate question that is before the Oireachtas.

It is important to have the wider perspective. I am suggesting that at the core of the Universal Declaration of Human Rights, the core of all human rights international instruments, is the very simple notion, which is contestable and unproven if I may say, namely, the inherent dignity of every human being. Every human being has equal worth and dignity not because the law gives it to them; they have have it even if the law takes it away from them. Every human being has equal dignity and worth. That is the core value upon which we should approach this particular question, which is the question of whether there should be intentional taking of human life.

That value judgment resonates throughout society. It is fair to say that the argument for assisted dying, assisted suicide or assisted termination of life, however one describes it, is effectively based on autonomy. I suggest to the committee that we all love and respect autonomy - we like our own and we respect it in others - but autonomy, like every single entitlement, has its limits. The right to autonomy ends when it causes damage to others.

In this particular context where we speak about tragic matters, when someone takes their own life, we understand that it may have been an autonomous decision but it resonates through society - through the family, through the friends, through the school people and through the workplace. It is a tragedy and we recognise the huge impact that an autonomous decision to take one's life involves. That is what we are talking about in the context of medical perspective, which is the area in which this particular issue arises.

The argument that I suggest to the committee is worth considering is that there are really two limits or two issues that could be considered here. The first is the logic of assisted termination of life by a person who is autonomous and, on all reckoning, is shortly going to die. If that is accepted as a principle, what is the logical consequence of that? The logical consequence of that means it is very hard to say “What about a case where the person is not going to die imminently but is going to die shortly?” If you say “What about a case where a person is not going to die shortly but, on the contrary, is going to live for really rather a long time in circumstances where they want to die?”, is that not logically causing more pain to that individual rather than denying them the entitlement? The logic of accepting autonomy in the stark cases of imminent death flows over logically to make it logically impossible to deny the arguments in favour of extending the scope of entitlement further. If we have any doubt about that, we can simply look at the experience in countries that have taken this step and we see that that logic does not last very long. It extends outwards and is continuing to extend outwards.

What about a case of a person who is lacking autonomy? They are remarkably unhappy with their life at this moment and that is clear, but they lack autonomy. Are there any circumstances in which it would be appropriate that a person with a mental disability should be entitled to end their life or entitled to have their life ended? Unless one comes forward with good arguments such that we will not do it, the logic is that, yes, there are arguments. If we belief that life is futile, if we believe that it is better to be dead than alive, then in those circumstances there are very strong arguments for extending the scope of the entitlement to terminate life very widely to those who wish to die, not necessarily for medical reasons at all, and for those who cannot exercise that autonomous choice because they lack autonomy but are still in a situation where the judgment of the doctors or, indeed, of society is to ask “Is this life worth continuing?”

The core value here arises from the wisdom of generations. Society is a cold word, and if it is the individual versus society, then I am on the side of the individual. However, if you take society not as meaning the cold abstraction of some notion of a political entity, but rather the accumulated wisdom of generations over millennia who all, every generation, have addressed this particular question, the judgment of millennia is that the taking of human life is something that should not happen, even taking human life where the person who is proposing the taking of human life is proposing it for that person himself or herself.

When we think of the flow-through consequences, the right to autonomy is restricted, if we like, by the damage that it may cause others, and there are many others, although you or I do not know who they are because they are those people - older people, people with disabilities, people who are in a vulnerable situation - who feel that they are a burden to society. On that basis, we know from the experience of other countries that such people do, in fact, end their lives. That is the price. That is the challenge.

Mr. Lloyd Riley

I thank the committee and the secretariat for the invitation to today's session and for the warm welcome in Dublin. I would like to use my opening statement to share with the committee three lessons I have learned while campaigning on this issue in the hope that they will help to inform its deliberations.

The first is the question of whether we should change the law on assisted dying. I do not think this should necessarily be seen as a question of whether we should create new rights for dying people.

The questions are as follows. Do we want to acknowledge and remove the barriers that are currently in place and prevent dying people from exercising control over how their lives end? Do we want to make end-of-life care fit for the 21st century? Do we want to unshackle dying people from a medical paternalism that has been imposed on them without their consent? In that sense this debate has much in common with other changes that societies around the world have grappled with in recent decades. These are changes that challenged the role of the State in decisions people want to make about their own lives. In Ireland, like in other countries, this has manifested itself in debates around abortion, marriage, contraception and divorce.

Second, it is an error to consider a blanket ban on assisted dying in the current situation as a satisfactory holding position, from which we can tread water and look at any suggestions for a new way forward with a disproportionate sense of fear. The most dangerous thing we can do in this debate is nothing because doing nothing will not stop dying people from wanting to exercise the choice over how their lives end. It does not eradicate demand for assisted dying. It simply forces people to take matters into their own hands, whether that be by travelling to a different country that respects their wishes or embarking on arguably an even more challenging journey to plan a violent death at home. Doing nothing sends a social message that there is a level of suffering that we are willing to accept as collateral damage for upholding a status quo which, from the polls I have seen in Ireland, and I know is definitely the case in the UK, show the majority of people in this country do not want. The most extreme policy position that members are likely to hear today, and I know they have heard in previous sessions, is the idea that they, as legislators, should do nothing on this issue.

Finally, it is wrong to give equal weight to real harm and harm that is speculative. What I mean by that is it is imperative that the voices and real experiences of the people most affected by this issue are front and centre of the debate and are not drowned out by theoretical discussion. Dignity in Dying does all it can to make sure those voices are heard, the voices of Julie, whose husband was denied a peaceful death in Switzerland because his doctor was too scared to write the medical report he needed to get there; Barbara, whose 89-year-old father was found hanging in his garage; Susan, traumatised by her daughter’s death in a hospice when the clinicians said they had exhausted all their options to relieve her pain; Paul, who received a call at work to say his dying father had been found alone, having taken his own life; Anne, who, in her time of most acute grief, was confronted by a group of police officers banging on her door; and Emil, who cannot get the sound of his dying mum's screams out of his mind. The suffering of their loved ones was real. Their pain is still real and I know that because I have met them, sat and talked to them, and I have looked in their eyes and seen it.

The picture painted by those who oppose law change invariably hinges on what-ifs, hypotheticals and worse-case scenarios - "possibly", "could" or "might". I do not doubt that their concerns are well meaning or that we should not proceed with due caution. However, the truth is the potential for harm that they want to draw to the committee's attention is not borne out by the reality of how assisted dying works in practice. I believe the quality of this debate can be improved by acknowledging that this is about reducing excessive restrictions not expanding freedoms, that the current situation cannot be considered safe and that real suffering should carry more weight than suffering that is imagined.

As the committee will have heard in other sessions, nearly 30 jurisdictions around the world encompassing over 250 million people have acknowledged those things and gone on to change their laws. Those laws are safe, compassionate and popular and are often a catalyst for improving end-of-life care for everyone. There is a growing body of evidence to show that this is far preferable than the consequences of inaction, which props up policies that are dangerous, cruel, out of date and out of touch with the people members represent. I know that everyone in this room is united in trying to find the best way forward and provide the best possible care for dying people but I firmly believe that cannot be achieved without legal reform.

An Cathaoirleach

I thank Mr. Riley. I invite Mr. Copson to give his presentation. I thank him for joining us online.

Mr. Andrew Copson

I am the chief executive of Humanists UK, of which Northern Ireland Humanists is a national section. We work together with our sister organisation, the Humanist Association of Ireland, which also supports assisted dying on the same basis.

In my role as president of Humanists International, I also have insight and experience of other jurisdictions where assisted dying has been made legal. Humanist organisations around the world almost universally supported that and I have spent the past 20 years on policy work on assisted dying and its intersection with human rights.

As an organisation, Humanists UK and Northern Ireland Humanists have advocated for assisted dying for more than 100 years. The aim of humanist organisations is a more tolerant world where rational thinking and kindness will prevail in human affairs. We work for a better society based on our belief that this is the one life we have. Our work and our policies are always directed towards making sure all people will have happier more fulfilled and better lives. That is the perspective in which our view on assisted dying is grounded, specifically in reason and compassion. Our policy in recent times has been shaped by real life individuals who have fought for a law to give them the right to make important decisions over their own bodies, their treatment and, ultimately, their own deaths. In the UK context, where European convention rights are justiciable in UK courts, we supported our members, Noel Conway, Omid T, Paul Lamb, and Tony Nicklinson, in four separate cases attempting to overhaul the law on assisted

dying on human rights grounds. In all of these cases, the individual had an incurable condition, had received or been offered palliative care and their quality of life had fallen below what they found to be acceptable. We feel they should have had the option of an assisted death.

All life is valuable but humanists, and I believe many other people, believe that quality of life is perhaps the most important thing when making decisions about life and death. This is actually for us and for many people, also the heart of human dignity. We should value human beings' personal autonomy and defend the right of individuals who have come to rational, settled decisions about their own bodies to be able to carry out their own wishes. Autonomy is not the only ethical case for assisted dying. Human dignity is part of that case. Specifically, the dignity of choice is of central concern to us. Dying is part of life and to the same extent that everyone deserves dignity and choice in other aspects of their lives we also all deserve that same dignity and choice in dying.

Our support for assisted dying must be contextualised in changing societal views, outlooks on life, and religious beliefs. Of course, the demographics of Irish society are changing just like the belief demographics of every part of the western world. They will continue to change as citizen's deeply held beliefs change and they will be diverse. In the context of that diversity of ethical view one of the best ways - really the only way - for liberal democratic institutions to adapt is to give increasing choice, the right for every person to follow their own conscience as long as it does not harm others. This choice of assisted death does not harm others. It does not impose or restrict the rights of others whose views differ. I am not aware of any international jurisdiction that does not allow doctors the right to

conscientiously object to assisted dying, as long as that objection does not prevent an individual from accessing their rights and their proper care. The current status quo, as we have also heard, puts real families who are in real situations today in a very painful position. They essentially have three options. They watch their loved one suffer, they take matters into their own hands, sometimes in a brutal way that is brutalising for everyone involved, or they spend extortionate amounts fleeing their own country to a jurisdiction such as Switzerland where it is possible to have an assisted death. I have read very moving testimony and I am sure the committee has also from the Humanist Association Ireland and from Irish people in this position and I think that to knowingly continue to confine people to those three options is itself immoral.

The myth that palliative care will be negatively impacted by growing choice has been debunked time and time again. Palliative Care Australia asked this question before their country legalised assisted dying and they concluded that "in [all] jurisdictions where assisted dying is available, the palliative care sector has further advanced [and developed]". Annual reports from Spain, the Netherlands, Belgium, and Canada repeatedly show the same thing, which is that the massive majority of people who use assisted dying laws are over 70, nearly all have already received or have access to, good palliative care and they are using the law in precisely the way I have outlined, which is to take control over the very end of their lives.

Finally, who should qualify for assisted dying? This was also touched on by Professor Binchy. I believe, and polls show that a majority of people in Ireland believe, that eligibility for assisted dying should be based on reducing unnecessary suffering. Rather than being based solely on a doctor’s prognosis of how long he or she has to live, it should be up to the individual to determine when his or her quality of life falls below what he or she deems to be tolerable. He or she should be in control and should be allowed that option.

Individuals with neurological degenerative conditions can potentially live for years with unnecessary pain and suffering. There are other incurable physical conditions that make people’s lives intolerable but that will not lead to death in the foreseeable future. These people deserve a choice. Adults of sound mind who are intolerably suffering from an incurable physical condition and who have a clear and settled wish to die should have the option of an assisted death. Austria, Canada, Belgium, Luxembourg, the Netherlands, Colombia, Switzerland and Spain have all legalised assisted dying for people in both of these categories. Ireland would be joining a growing number of compassionate nations if it introduced this change.

Deputy Patrick Costello

I thank our witnesses and welcome them to the committee. I will start with a couple of questions for Mr. Copson and Mr. Riley. Some of the points that have been made by Professor Binchy and by others who have appeared before the committee focus on the interaction with others, the limits of personal autonomy and the idea that, in exercising a personal choice, you cause harm to wider society. Will Mr. Copson and Mr. Riley explore those points? How would they respond to them?

Mr. Copson also mentioned changing societal values. I will ask about something Professor Binchy mentioned, that is, the concern raised by others who have appeared before the committee that eligibility may be expanded and the so-called slippery slope. If Mr. Copson would also speak to those issues it would be very useful.

In his opening statement, Professor Binchy said:

If a person takes his or her own life, this is not simply a private matter. It resonates through society, deeply affecting family members and friends,

Any death, loss or bereavement will have that ripple effect. Surely, it is about the bereavement itself rather than the nature of the death. This leads me to be concerned that, in focusing on the effect of that autonomous decision, Professor Binchy is focusing on the wrong part. It is not the autonomous decision but the death and bereavement. One of the things that has been spoken about in these meetings is the inherent worth and dignity of the person. Humans have an inherent worth and dignity, which we all have a corresponding obligation to respect. As has been said, pre-empting my question, dying is an essential part of life. If we have got to a point in life where there is no dignity, do we not need to respect that inherent dignity by accepting that death is part of life, that both are part of the one spectrum and that the best way to respect that inherent worth and dignity may be to respect individual autonomy as to when one's life ends?

I will ask Mr. Riley and Mr. Copson to respond first, followed by Professor Binchy.

Mr. Lloyd Riley

I thank the Deputy for the questions. With regard to autonomy, it is important to see that the question of assisted dying does not exist in a vacuum. If we look at end-of-life practices across the board, we see that people can already make autonomous decisions that will result in their deaths. They can refuse potentially life-saving treatment or to have such treatment withdrawn. They can also stop eating and drinking, ending their lives in that way, often with the support of a clinician who provides sedatives and pain relief. There are therefore already ethically complex questions involved in end-of-life care. It is important to recognise that assisted dying would sit alongside that. We can learn a lot of lessons. Those decisions are safeguarded. How do we know that somebody is not being pressured into refusing chemotherapy? If people are already travelling to Switzerland for an assisted death or taking matters into their own hands under the law as it stands, how do we know what social message that is sending to potentially vulnerable people? This must be looked at as a whole. The countries that have legalised assisted dying have shown that.

If one looks at the committee in Victoria, the first Australian state to legalise assisted dying, it was very clear that it did not think the dangers in the existing legal framework could be justified. It recognised that the evidence from overseas showed that putting in place the safeguards of legislation is much safer for potentially vulnerable people. That is how to mitigate harm and look at autonomous decisions within a broader context.

Mr. Andrew Copson

Clearly, autonomy has limits - that is absolutely right. No person is an island. We are all embedded in human relationships in our personal relationships, families and in society. Our choices have consequences for other people, as does what happens to us. That is obviously true. No one should be tempted to mistake the argument for autonomy as an argument for pure, unfettered and rampant individualism. The fact that none of us are totally free individuals, no man is an island and we are all connected to others cuts both ways in this argument. As we already heard, the suffering we experience at the end of life and that thousands of people are experiencing at the end of life also has effects on those who love us. The unnecessary suffering we experience not only harms us, but it harms our family, friends and the medical practitioners around us - all of us. That cuts both ways. Personally, the argument for autonomy is an important part of the case for compassionate laws on assisted dying but it is not the most important.

I would prefer to prioritise values like care, compassion and dignity. This world is full of suffering and it always will be; the only choice each of us can make - legislators have a particularly powerful position in this context - is whether we will mitigate that suffering, how to mitigate that suffering and what actions we can take to do so. The case is inarguable that to take action to give legal recognition for assisted dying in all of the circumstances I mentioned is to mitigate suffering. To allow the current situation to continue is to sign up for great and increasing suffering both at the present time and in the long term.

Regarding changing social values and what has been referred to by some as the "slippery slope", my view, as I already outlined, which is also the view of the majority of people in Ireland, according to polls, is that assisted dying should be made legal both for the terminally ill and those who are incurably suffering. Far from being a slippery slope, that is what I am signing up for and advocating right now. Both of those categories of persons should be eligible for assisted dying. To look around the world where laws have been introduced, the law in Oregon, for example, has been unchanged for 25 years. There are also real-life, practical examples that the so-called "slippery slope" is not inevitable. Not only is it not inevitable but it is not very likely. After all, this process members are going through now as parliamentarians demonstrates, presumably, how the law in the future would expand as well. Slippery slopes only exist if people, legislators and medical practitioners are negligent. We can trust our political processes a bit more than that. If assisted dying laws expand, I would trust and have confidence that it is as a result of evidence examined by legislators in sessions like this. That is our duty to all make that is the case.

Professor William Binchy

I think Deputy Costello made two points. I disagree with him in saying that when a person takes their own life, the only concern of family, neighbours, friends, school children and employees is that the person is dead. My experience is completely to the contrary in that regard. I am absolutely certain that a person taking their own life has a huge impact. There are a lot of records to show that. I respectfully disagree with him on that. It is a tragedy-----

Deputy Patrick Costello

I did not say it did not have any impact. That is not what I said.

Professor William Binchy

I understood Deputy Costello to have said that or that it was minimal and that the dominant concern was that people died, rather than that they had died by taking their own life. In cases in which people die by taking their own lives, the impact is unquestionably focused on that fact. That is my personal experience, I am sad to say. I am sure it is the experience of most people.

The second aspect which I think the Deputy mentioned was that surely it is a question of autonomy and respect for life and how should we respect life that has no dignity. I again respectfully disagree with the Deputy because I think everyone has dignity regardless of their physical or mental circumstances or age. In circumstances in which they need a huge amount of care and support from others, their dignity is absolutely preserved in that situation.

Their inherent dignity and worth is there. I accept they may have a sense of loss of dignity. I would respectfully say that it is members' role as legislators to be concerned for the social good, the common good and the good of everyone. They should focus on the good of everyone in these circumstances, as I am sure they do. I am not suggesting this personally. Legislators should support the approach that maximises protection for all. The "slippery slope" is an expression I do not like. It is a mean kind of expression. I would prefer members to adopt the notion of going through a door and closing it firmly behind them. If they close the door firmly behind the proposition that taking innocent human life by anybody, including the person himself or herself, is something society should not tolerate, then in this new room everything is possible.

An Cathaoirleach

I thank Professor Binchy.

Professor William Binchy

If I may, I will say one last thing that is relevant to what Mr. Copson said. Mr. Copson would argue that people should be entitled to take their own life, and I think the expression he used was that the quality of life is the most important.

In case there is concern that this is just a concern that is not grounded in fact, we can take the Oregon Death with Dignity Act, which is put forward here by a number of proponents of death with dignity proposals. They say that Act is fine. I refer members to the report in 2020 in which more than half the people who took their own life - 130 out of 245 - identified their being a burden on family, friends and caregivers as a reason, although not the only reason, they chose to take their life.

Deputy Emer Higgins

I thank all the witnesses for being here. This is an extremely complex topic and debate. It is always good to hear from people who are so invested in this area.

I have a question for each witness. I will start with Mr. Copson who spoke about Australian research showing the palliative care sector had been further advanced in areas where assisted dying is available. I ask him to quantify that for us and explain how it got to the point where the palliative care sector has been advanced in tandem with legislation. I think he was citing international examples and not only the case of Australia.

Professor Binchy's testimony has been that the ending of life in all cases is wrong. He spoke of the impact suicide in particular has on family, friends, schools and communities. Mr. Riley approached the issue through a slightly different lens focusing on the more nuanced topic of assisted dying. He spoke about the impact the prolonged pain and suffering of a loved one has on their family, friends and community. I am interested in hearing his perspective on this and how we balance those two ripple effects from an ethical perspective when someone wants to die due to intolerable pain and suffering.

Mr. Riley made a big statement that doing nothing is the most extreme policy position and potentially quite a dangerous one for us to adopt as a committee. I argue that implementing assisted dying without adequate safeguards would be a much more extreme and potentially dangerous position. We are talking about autonomy and there are circumstances in which people's autonomy can potentially be manipulated. Will Mr. Riley talk to us about the position Dignity and Dying takes on safeguards?

In summation, I wish to hear from Mr. Copson on palliative care, Professor Binchy on the balance and Mr. Riley on safeguards.

Mr. Andrew Copson

The report from Palliative Care Australia from 2018 is substantive. I can provide additional details of the report to the committee if it does not already have it. It surveyed all of the in-scope jurisdictions at that time, that is, the ones that had assisted dying.

Deputy Emer Higgins

I am sorry to interrupt but what has been done? Is it actual investment? Is it new policies? What do we need to do to invest further in the sector?

Mr. Andrew Copson

I understand. Certainly there needs to be investment. If we take the case of Belgium, for example, it linked assisted dying to end-of-life care and options and its palliative care ranking improved significantly as a result.

Certainly, any jurisdiction that considers the introduction of assisted dying needs to think about safeguards, which are vital - as the question to the other witness indicated - and also investment in palliative care, which should always go up. Investment in palliative care should go up regardless of the introduction or otherwise of assisted dying. In the six years since Canada legalised assisted dying, the country has seen the largest increase in expenditure on palliative care ever made in the history of palliative care. In the various jurisdictions where this has occurred, it is not just as a result of government and medical decisions but also as a result of conversations about assisted dying having pushed the whole question of end-of-life care further up the agenda, which is healthy in society in general.

Professor William Binchy

The Deputy asked the question as to what to do in a situation where a person wants to die. She added the proviso that there is intolerable pain and suffering but she did not, as it happens, mention that the person was in the process of dying and that death was inevitable. She talked about a close friend or family member for whom life is bleak and miserable. There are many of those people in the world. If the situation is outside the context that she mentioned, which is the pain and suffering context, and the person is just utterly depressed with life or unhappy with his or her situation, I think most people would seek to do the very best they could to support the person in terms of love, support and suggestions. What we would not do is countenance the person taking his or her own life. If it is outside the medical context, we would not countenance the taking of his or her life, or at least I do not think so. If someone said he or she was feeling suicidal, is at the end of the line and wants to take his or her own life, very few people would be disposed to provide assistance in those circumstances. Most people would not be so disposed. If we bring it into the medical context, the way that this process of changing the law has occurred, generally, is to take a case where a person is on the point of death, or will die within a very short period of time, within six months or something like that, where death is certain and the argument of futility is put at its strongest in a case like that.

An Cathaoirleach

I am sorry to interrupt but I have to allow time for Mr. Riley to respond.

Professor William Binchy

I am sorry; I am too verbose. I apologise but I would just simply say that in those circumstances, the wider concerns I mentioned earlier about what actually happens when we introduce a law like this are relevant. We find that vulnerable people are actually ending their lives or, worse still, are having their lives ended.

Mr. Lloyd Riley

I thank Deputy Higgins for her questions. In reference to her comment on my statement about policy positions we might hear today, I agree with the Deputy that nobody is suggesting that we should pass an assisted dying law with zero safeguards. I thank the Deputy for asking about Dignity in Dying's position. As indicated by Mr. Copson, our position is different from that of other campaign groups. We very much see assisted dying in an end-of-life context. I am sure that is a phrase the committee has heard in previous sessions in regard to how Canada's legislation differs from that which pertains in US states and Australian states. That is where Dignity in Dying sits. We campaign for an assisted dying law for terminally ill, mentally competent adults. These are the core eligibility criteria that we believe should be in legislation. We believe there is a principled difference between a dying person exercising control over a death that is imminent and inevitable and somebody shortening his or her life, potentially by many years. That is our position.

In terms of safeguards, the Oregon model has been in place for 25 years but no two pieces of assisted dying legislation are the same. It is about learning best practice not just from Oregon but from the ten states that followed its lead and from states in Australia and New Zealand.

Senator Lynn Ruane

I thank the witnesses for attending. As I only have a few minutes, I will ask three questions. Dignity has been mentioned a few times today and has been consistently raised in the more general conversation. What does Professor Binchy understand by dignity? What is dignity? When we look at this historically over time, right back to Rousseau and Kant, many different thinkers have addressed how we morally impose ideas of dignity and what dignity actually means. Is it a mental state? If we are saying it is inherent and that people have dignity and inherent worth, what exactly does that mean for one's existence?

I know that Professor Binchy is a legal adviser to the Pro Life Campaign and I am aware of the issues that organisation has been involved with over the years. In terms of my work in relation to poverty and women who are struggling on one-parent family payments, I have never seen the Pro Life Campaign featuring in that or in any of the other work I do in terms of trying to validate people's worth, dignity and value and promoting a life that is flourishing. The same is true in relation to mental health. What does dignity actually mean, beyond the philosophical context I referred to? What does it mean for the Pro Life Campaign? It seems to me that for that organisation, it is about life for life's sake and imposing control over people's agency and autonomy. I would like some insight into what Professor Binchy means by dignity and inherent worth.

My next question relates to the issue of real harm versus speculative harm. This is something we really need to consider. Most of us in this room are in the extremely privileged position of not having to think about our death right now. That does not mean we will not meet our death unexpectedly but we do not have to think about it. We are speaking here about people's pain, suffering and about how close or not close they are to their death but we are doing so from an extremely privileged position. We actually do not know what type of decision we would make in that moment, in the context of people's lives and the things they are facing. I invite Mr. Riley to tell us how we get a bit closer to hearing those voices. He mentioned different people in his contribution but those people are not here anymore. How do we actually hear from people who are having to make those decisions or are near the stage of having to do so? That is a crucial part that is missing from this process although I understand that if someone is at that stage, he or she is potentially not in a position to be in this room. There may be an onus on us as a committee to get a clearer picture through personal testimonies. Mr. Riley has given us testimony and I ask him to speak to that in the context of real harm versus speculative harm.

We keep talking about suicide and perhaps in a later session we should look at the impact of suicide. Professor Binchy is correct when he says that suicide has an enormous impact. It ranks higher than violent death or murder in communities in terms of how many people it actually ripples out to and impacts. However, there is a difference between suicide and a rational end to life. So many suicides happen as a response to some type of external pressure, to environmental conditions or as some sort of reaction to life, although not in all cases and some are very untimely. Are we missing a beat in terms of understanding the difference between unexpected suicide that comes out of the blue, that families are completely shocked by and did not anticipate or see coming as against somebody sitting down and rationally engaging with family and loved ones, choosing the how, choosing the conversations he or she will have, and being able to say goodbye in person. The impacts of those two scenarios, I imagine, will be very different. The impact of the death is, of course, going to be traumatic regardless but suicide in the conditions we are discussing, in communities across this country, has to be measured differently from death in an environment where somebody is able to engage with his or family near the end of his or her life about how that life ends. Even though there are impacts in both scenarios, we may be missing something in terms of understanding the difference between them.

An Cathaoirleach

Thank you, Senator. I invite Professor Binchy to respond first.

Professor William Binchy

The Senator raised a lot of very interesting points there. I will pick up on her last point and the idea of separating untimely suicide in response to sudden social pressures or even ongoing social pressures, on the one hand, and the person who calmly decides to take his or her own life, on the other. One can make that distinction and some cases would fall within that distinction but the tragedy is that following the introduction of the kind of measure that is being considered here by the committee, what one actually discovers is that the people about whom the Senator is concerned, those in the first category, are very eligible and are actually delivered for the taking, not just of assisted suicide but what turns into a form of euthanasia. The point that I would stress relates to the logic of going through that door and closing it behind one. We have two people here who are very nice and who are concerned advocates but one of the gentlemen - I hope I am right in saying this and am not misrepresenting Mr. Copson's position - is not someone who proposes that death be imminent, in any sense.

I would just address the Senator on the point about the Pro Life Campaign. If she reads the literature of the Pro Life Campaign which is available on the Internet, she will see the Pro Life Campaign is very much a social justice organisation. If I may speak personally, myself and my friends are strong supporters of Travellers' rights and have been over the years. I am getting old at this stage but I think the Senator’s colleagues will give verification of that particular proposition. When it came to asylum seekers and changing the law here, in terms of constitutional change against their interests, I was opposing the matter. I think her idea is a misconception because she has been listening to the propaganda, sadly, in that area.

Senator Lynn Ruane

No, sorry. I am not talking about Professor Binchy personally. I said the Pro Life Campaign. It is not propaganda. No one has ever turned up for anything I have done, or debate in the Chamber, on poverty or anything. They have never been there.

Professor William Binchy

The poverty people do not necessarily turn up at a pro-life issue. The pro-life people, as an organisation or campaign, does not necessarily represent itself specifically on social justice issues outside issues where life is central. What I am saying to the Senator is-----

Senator Lynn Ruane

Pro-life is central is to people whose life is being determined by extreme poverty, addiction issues and stuff like that. Is that not pro life?

Professor William Binchy

Absolutely and completely. I am sure the Senator heard me a little earlier in my opening remarks that these are precisely the people who are at risk if a change in the law is made. If a change in the law is made, it is the vulnerable people who, over time, have been shown to be at issue.

An Cathaoirleach

Thank you.

Senator Lynn Ruane

To clarify, statistically, the other countries are saying that it is wealthy, privileged white people who are most likely to avail of assisted dying. Other countries are reporting differently in relation to the vulnerability of the groups. I want to put that on the record.

Professor William Binchy

Again, if one chooses to read the literature, may I refer the Senator to one article, if this is okay Chair, because that is a specific rider? If the Senator reads an article written this year and published in Palliative & Supportive Care by Coelho et al. on “The realities of Medical Assistance in Dying in Canada” she will find the people who are dying are not the rich and privileged. Of course they include the rich and privileged - there is no question about that - but they extend to the kind of people the Senator is rightly concerned about, the vulnerable people, people with mental illness and people with housing issues who are unable to find accommodation. Those are the people who, already in Canada, are being subjected to the law.

An Cathaoirleach

The other two witnesses will have to given their responses in the second round because I must go now to Senator Mullen.

Senator Rónán Mullen

I welcome Mr. Copson, Mr. Riley and Professor Binchy. Speaking as a supporter of the Pro Life Campaign’s good work over many years, I do not think Professor Binchy or anyone else has to meet Senator Ruane’s test of who is a good person, a caring person or who is not.

Deputy Emer Higgins

I do not think that is fair.

Senator Lynn Ruane

I did not say that. That is a complete misrepresentation.

Senator Rónán Mullen

We all have different causes we support under different flags and headings and I just felt that was an unnecessarily ad hominem contribution.

An Cathaoirleach

I know you did not mean that in the way it came out because to be fair to the Senator-----

Senator Rónán Mullen

No, I did. I meant it word for word. If I may proceed with my question-----

Senator Lynn Ruane

He proves his own point on care, does he not?

Senator Rónán Mullen

We all support different causes under different headings. That is my point. We should not have to answer other people's personal tests on these issues.

I listened to Mr. Copson. He spoke of the right to follow one's own conscience as long as it does not harm others. When he says the case is inarguable for legal change, I wonder are there any humanists who would oppose euthanasia or assisted suicide on the grounds that it might harm others. I am thinking of the people who feel a burden as a result of the change in the law because certain categories of people may now have their lives ended in the eyes of the state. Professor Binchy mentioned that more than half of people in Oregon, which is oft touted as a place we should imitate, include that they are a burden on their family, friends and caregivers as a reason. I find that a very significant piece of evidence. The reality is that euthanasia has become a runaway train in places like the Netherlands and Belgium and it is 5%, 6% and even 7% in some parts of Canada. The reality is that while some people may have access to palliative care the ability to have one's own life ended and the change that brings about socially, as pointed out by Professor Theo Boer from the Netherlands who was previously a supporter of the Dutch law. Is Mr. Copson reckoning with the unseen pain of others as a result of a change in the law? Is that not what we are dealing with here? Are there members of the humanists who would oppose euthanasia on the grounds of the harm it might cause others down the line?

The next question is for Professor Binchy about an issue that has arisen. He has spoken about suicide.

A core argument among those worried about a change in the law is that it will become harder to fight suicide. Is suicide a right? It is not criminalised in our country now. Does that mean it is some kind of right? Would changing the law around euthanasia and assisted suicide with regard to one category of people make it harder to see suicide as something that is always a tragedy and always to be discouraged?

I have a question for Mr. Riley. He talked about unshackling dying people from paternalism but is what he is proposing not paternalism in that doctors will decide whether a person is sufficiently ill and mentally competent to fall into this category? How long can such a category stand once people start pointing to it as a form of discrimination?

Mr. Andrew Copson

I will answer the factual question on the views of humanists first. It is nice to see the views of humanists taken so seriously. I believe I am right in saying that the last poll in the UK showed that more than 96% of humanists supported assisted dying. That obviously implies that 4% of humanists are unsure. All humanist organisations in every country, apart from one where things are different for unrelated political reasons, support assisted dying. As I said at the beginning, my own organisation, Humanists UK, has supported assisted dying since the 1920s, for almost 100 years. It is, therefore, a firm and settled conclusion. Having said that, other humanist opinions are available but they are minority opinions. I disagree with the premises of all the Senator's questions but I cannot hope to address them in the limited time I have. Some people say that being a burden to others is a factor influencing their choice of an assisted death but the data show that this is one of a long list of reasons and that it usually comes fairly far down on that list. In addition, is there actually anything wrong with that being part of a person's complicated decision process? I would not want to be a burden to my family and that would be my choice. There is nothing wrong with that if it is part of a person's complicated range of reasons.

I do not believe access to palliative care can be dismissed as cavalierly as the Senator has done. The evidence is very clear that there is increased access to palliative care, that people take advantage of it and that the great majority of people who have assisted deaths have had access to very good and world-beating palliative care. The Senator's dismissal is, therefore, completely irrelevant.

Professor William Binchy

Senator Mullen asked a question about the right to suicide. He may have got to the core of the issue, which is that this matter is presented in terms of a dignified death and a right to die. There is a proposition that there is a right to terminate one's life where one has an imminent medical condition. What I have been attempting to say to the committee over the past half hour or so is that, if one accepts the logic of that particular proposition, one is inevitably driven to the logic that there is a right to suicide. If there is a right to suicide in limited circumstances, arguments based on discrimination and equality arise as to whether this right to suicide should be extended further. If we find the notion of suicide something we cannot support and a notion from which we recoil but nonetheless embrace the notion of a right to a dignified death, we must ask ourselves what is the logic of that position and what restrictions we are going to put in. In that context, the restrictions become remarkably important and the logic of restrictions being possible becomes important. If we are in the business of being wise about human nature, we know that, if the people who are involved in scrutinising these matters are supportive of death in these circumstances, it is likely that they will have a broad and liberal understanding of where the line should be drawn.

Mr. Lloyd Riley

I just need to correct two things that both Professor Binchy and Senator Mullen have stated that are absolutely inaccurate. The figure from Oregon's data report, which Professor Binchy can look at, as I see it on his desk, is not about feeling a burden being a reason that people request an assisted death. That is usually documented in the paperwork by the person's physician; rather, it is an end-of-life concern that is expressed.

Senator Rónán Mullen

By whom?

Mr. Lloyd Riley

In the opinion of the doctor, it is an end-of-life concern of the person who has requested an assisted death.

Senator Rónán Mullen

To be clear, it is not that the person who is ending his or her life reports feeling a burden as a reason but rather that the doctor reports it as an issue in his or her life. Is that correct?

Mr. Lloyd Riley

It can be two things. It might be that it has come up in conversation with the doctor but it is recorded as an end-of-life concern rather than as a reason. I will say why that is important.

Senator Rónán Mullen

I would be interested to hear.

Mr. Lloyd Riley

The research shows that all dying people have a fear of being a burden as an end-of-life concern. It is not unique to assisted dying. There is no evidence to suggest it is driving people towards an assisted dying request.

Senator Rónán Mullen

Is Mr. Copson wishing away-----

Mr. Lloyd Riley

Sorry, if I could finish my point. It is a measurement-----

Senator Rónán Mullen

Is Mr Copson wishing away a very troubling issue there?

Mr. Lloyd Riley

If I could finish my point, it shows that this is not a driver for assisted dying. This is a measurement of end-of-life concerns across the board and this is what the research-----

Senator Rónán Mullen

Sounds like a massive piece of spin.

Mr. Lloyd Riley

The other inaccurate thing being said is this equation of suicide and assisted dying. That is simply not true and it is why suicide is not recorded as the cause of death in places where this is legal. There was a suicide in my family about 15 years ago. I know how those events can tear through people's lives in the way Professor Binchy described. The research on grief from bereaved relatives whose loved one has had an assisted death is quite different. It shows there are lower levels of complex grief and lower levels of post traumatic stress disorder. We really need to start pulling these issues apart. I am not unreasonable, I know why they brush up against each other, but when one zooms in they are very different.

An Cathaoirleach

I thank Mr. Riley. Deputy Lahart is next.

Deputy John Lahart

I thank the witnesses. I really enjoyed their contributions. On the Northern Ireland humanist contribution, I am fascinated by the evidence in the statement on religion and non-practising of religion and connecting it with decisions around this. It is a topic worthy of consideration by the committee. My question is for all the witnesses. Do they think there are philosophical or, more importantly, theological values that subliminally underlie and underpin the way we think about this issue? In layman’s terms, in Christianity, say, suffering was made bearable on the basis that there is another life or a hereafter and if we can only offer this pain up then it will be worth it and there will be a great reward. It seems from some of our previous witnesses that that is not simply a theological concept but also a philosophical one quite removed from theology. I would welcome the witnesses input on that.

Looking at Canada, the context seems to have been removed from assistance in dying to assisted dying. Some of the evidence we received, which was contradicted by other evidence, said that what started out as a law that permitted those who were dying and were terminally ill to received assistance in that has now moved, in a slippery slope kind of argument, and that people who have no symptoms of imminent demise are able to choose assisted dying. I get the slippery slope aspect. I think we all do and it is one of the interesting areas here.

Professor Binchy has been a frequent visitor here over the years. He has a considerable legal mind and I have great respect for him. The slippery slope seems to be his strongest argument. Given the evidence this committee has received in relation to palliative care not always being successful and medicine not always being able to deal with the intolerable pain and suffering of individuals, are there simply no circumstances in which Professor Binchy would see that assisted dying, because of the slippery slope possibilities, is the humane thing to do and that, if we could legislate for it in the most narrow way, that it would be acceptable to him?

Mr. Andrew Copson

To directly answer the first question, there is some evidence that people’s at least implicit theological assumptions influence their views on assisted dying and specifically on the value of pain and suffering.

Although most religious people also support assisted dying, they are less likely to support it than non-religious people. Deputy Lahart is right that the value some people place on suffering, especially some people of a Christian world view, may well influence that. On the other hand, if someone is in my position, he or she believes this life is the only one we have and that suffering and pain have no value, especially at the end of life. He or she is, therefore, going to come to the same conclusion as me. I believe that was the only specific question that was directed at me.

Professor William Binchy

I will just pick up on what Mr. Copson just said, which is that pain has no value at the end of life. The argument absolutely is not that life should continue inevitably and indefinitely regardless of pain. That is absolutely not my position. My position is that, in circumstances where pain is extreme and cannot be dealt with by medical methods, it is legitimate, on the basis of the principle of double effect, to engage in pain relief. If that results in the death of the individual concerned, the intention was not to kill the person but to engage in pain relief. That is the nature of palliative care. However, the committee's function is that of a legislature and it is fair to say that legislators have to ask themselves, if we confront that case and find it difficult to consider, what will happen if we say yes in the case of extreme pain at the end of life. I believe they will have got this answer from my two fellow speakers here today, which is that it rolls out. We are in a new room, have closed the door behind us and are now in a debate as to how far we should go. We deprecate Canada and say that we will engage in best practice in our country but we know that what we have done in those circumstances is to accept a fundamentally new understanding of the nature of human life and dignity. We have said that certain people would be better off dead than alive.

Senator Lynn Ruane

People's contributions are again being misrepresented. Nobody has said that people are better off dead. I am not comfortable with some of the comments being made. It is misrepresentation and it is not fair. The people whose views are being misrepresented should be allowed to come back in to clarify them.

An Cathaoirleach

I will permit that if time allows but we will hear from Mr. Riley first.

Deputy John Lahart

It is my time.

An Cathaoirleach

Of course it is but I am trying to work within it.

Mr. Lloyd Riley

I echo Senator Ruane's thoughts. Sadly, they are not surprising. I do not believe we have made any judgment that people would be better off dead. The whole point of this debate is to give people the ability to make a judgment themselves as to when their lives have become intolerable and when they want to exercise this option as a mechanism of control, alongside a range of other end-of-life options they have available to them. I do not believe anything we have heard today has justified the assertion that a slippery slope, or the different phrase that Professor Binchy prefers, is inevitable. It simply has not happened in the jurisdictions we are looking at. Canada is quite a unique situation. I know the committee had a session last week in which members heard about the supreme court of Canada's ruling. That teaches us that legislatures need to get ahead of this issue. Rather than waiting for the courts to take action, they should draft legislation that aligns with the values of their societies.

Mr. Andrew Copson

I agree with the comments made just now about the misrepresentation of some views. I specifically echo what has just been heard from the witness from Dignity in Dying. I have never heard anyone who advocates for assisted dying make the claim that some other person's life was objectively of less value; it is quite the opposite. Instead, we are valuing people's own personal choices as to how they feel and their quality of life. To me, that is the height of human dignity and in no way dilutes it. On the so-called slippery slope as regards Canada, a sleight of hand is often involved when people talk about Canada. Some try to give the impression that what was an assisted dying law for terminally ill people in limited circumstances suddenly slid down this slope and that it is now a free-for-all for everyone. There is lots that could be said about that but the first thing that should be said is that, at the very beginning, the assisted dying law in Canada was not designed only to cover the terminally ill but followed on from a 2015 court case taken by Kay Carter, who was suffering from degenerative spinal stenosis and who was not terminally ill herself. We should argue these points on the principles rather than invoking this slippery-slope or closed door-open door argument.

Deputy John Lahart

I kind of feel picked on now so I will just clarify where I am coming from. We have very limited time here and the slippery slope encapsulates a much broader and more complex argument.

One of the things I noted in the Canadian evidence is that Canada is in a different space culturally from Ireland. We may be in that space in 20 or 30 years. The "slippery slope" is a loose but legitimate phrase. As a legislator, it certainly is something I would like to avoid in the consideration of legislation on this issue. If we legislate for one thing, I do not want it to become something else in five or ten years.

Deputy Pa Daly

Cuirim fáilte roimh na finnéithe chuig an gcoiste. I have a question for Mr. Riley. Why did he pick a timeframe of six months? He said provision should be available to people whose death is reasonably predicted within the next six months. For people with a diagnosis of terminal cancer, for example, if they ask how long they have left - if they do not ask, they may never be told - the answer might be that, without treatment, they are reasonably likely to die within the next six months. Would they fall into the category of eligibility or would that be precluded because, if treatment is received, they might survive for a year or two? Why did Mr. Riley pick six months as opposed to two or three months, say, or two weeks?

My second question, also for Mr. Riley, concerns the slippery slope issue and the broadening of categories of eligibility. We heard from witnesses from The Netherlands on this point. Is he saying that the categories of people who are entitled to apply for assisted dying have not been broadened in some jurisdictions over the past 20 or 25 years?

I also have a question for Mr. Copson. I apologise for missing his opening statement as I had to attend to other business. However, I have read it. He is of the view that if people's quality of life has fallen below what they feel to be acceptable, they should have the option of an assisted death and that the best way to cater for different people's beliefs is to give each person the right to choose his or her own path. His position is that it should be up to individuals to determine whether their quality of life falls below what they deem to be tolerable. To clarify, is his position, in effect, based on the autonomy of the person such that if people subjectively feel their life has fallen below a quality of life they consider acceptable, they should have the right to assisted dying?

Mr. Lloyd Riley

I thank the Deputy for his questions. The position of Dignity in Dying is that provision should be available for terminally ill adults who are mentally competent. The six-month timeframe comes into it primarily based on legislation that has been tabled in Westminster, which would apply in England and Wales. The six-month timeframe for terminal illness is established in law as issuing benefits to terminally ill people. Doctors are used to making an estimate of a prognosis. It is also taken from the Oregon model of legislation that has been enacted throughout the US. In Australia, some states have gone with six months, some 12 months and others have adopted a mix of the two. I am not necessarily saying the timeframe in legislation must be six months. We campaign in different jurisdictions across the UK. Scotland, for example, has a slightly different definition of "terminal illness".

Regarding treatment, we should never force anyone to undergo treatment. That would just be wrong. If someone is given a cancer diagnosis, does not want further treatment and has a prognosis of six months until death, if that accords with the timeframe in legislation, then, yes, that person would be eligible for an assisted death.

Regarding the redefining and broadening of categories, it is helpful to look at two sets of legislation. In my opening statement, I mentioned nearly 30 jurisdictions in which legislation has been enacted. They can be broadly separated into two groups. Countries that have gone down the route of a criterion of terminal illness include states in the US and Australia and they make up a slight majority of the legislation that has been written into statute books. None of those laws have changed beyond their initial criteria. That might be disputed. If someone can provide the name of the jurisdiction that disproves the claim I have made, I would be interested to hear it. Another group of countries, including The Netherlands and Canada, have gone beyond the terminal illness criterion. By definition, their categories of eligibility are more open to interpretation. That is where we see potential for what might be called a broadening or refining of the initial scope of the legislation. Those are the two broad groups of existing legislative provision.

Mr. Andrew Copson

As I said in my opening statement, the position I continue to support is that the person's feeling about his or her quality of life - we might call it a subjective view; of course, everyone's feelings are subjective - should be the deciding ethical factor. In addition, jurisdictions will put in medical and other safeguards around that. A reduction in quality of life that is the result of an incurable physical illness, which is another crucial qualification, should be the ethical factor.

Deputy Pa Daly

Going back to Mr. Riley, I had a conversation recently with someone involved in life assurance who spoke about a difficulty in getting doctors and consultants to say there is a limited period of life left, for example, that a person has six months to live. Does he think there will be difficulties in this regard or that it will easy for consultants to write, for instance, that a person will survive for six months without qualifying that in some way? Will this issue affect the legislation? There may be situations where a doctor says he or she thinks a person will live for less than six months without any treatment but that if an oral scheme of palliative care is administrated, the person will live for longer. How would such people fall under the legislation?

Mr. Lloyd Riley

As I said, forcing people to undergo treatment is not an option and, therefore, I do not think that would necessarily come into it. In terms of seeking guarantees, prognosis is not, of course, an exact science. The research shows doctors are more likely to overestimate than underestimate. This question rests on a false premise that people who access assisted dying want to die. That definitely is not my experience of people who considered this choice or of bereaved relatives who know someone who has been through the process. Nobody is in a race to self-administer the medication in places where this is legal. They do not get to the day the six months expires and then take it. If people are well at that point, want to carry on living and, for whatever clinical reason, the prognosis was not quite accurate, they will carry on living and that should not be seen as a bad thing.

Deputy Gino Kenny

I welcome the witnesses. My first question is for Professor Binchy. Does he think the taking of one's life is a sin?

Professor William Binchy

I do not think in those terms.

Deputy Gino Kenny

Does he not think that if someone is in that position-----

Professor William Binchy

"Sin" is not part of my lexicon.

Deputy Gino Kenny

Does Professor Binchy acknowledge that over the past 30 years, there have been huge societal changes in Ireland, including changes in regard to divorce, marriage equality and women's right to choose? They have all been progressive changes. Things have changed dramatically in Ireland. We are trying to wrestle with the question of people's autonomy and choice regarding their own life. Why would Professor Binchy be against that? Why would he object, in a situation where a person is terminally ill and coming to the end of life, to that person wanting to have a say in how he or she dies? I am not focusing only on Professor Binchy. I am asking why anybody would tell such a person he or she must go through a pretty torturous death for all sorts of reasons. Why should somebody have a veto over that person's choice?

Professor William Binchy

If somebody comes to a person and says, "My marriage has collapsed, I am out of a job, life is bleak and I want to take my own life", the argument could be made that there is no reason the second person should say to the first, "No, do not do it."

Deputy Gino Kenny

That is a completely different set of circumstances. Professor Binchy is conflating issues that are not relevant.

Professor William Binchy

The Deputy got to the core of the matter with his question. In a situation where a person goes to a medical person and says he or she has a medical condition, life is meaningless and he or she wants to end it now, the Deputy asks how anybody could say "No" in those circumstances.

When I put to the Deputy the case of a person who does not have a medical condition but has a situational condition, for example, a family breakdown, no job and housing difficulties, he says it is an entirely different question. Respectfully-----

Deputy Gino Kenny

No. I would persuade them not to take that action, of course. In fact, it has happened many times since I have been a representative where somebody has said-----

Professor William Binchy

Why would you-----

Deputy Gino Kenny

I would say that they need intervention and so forth. It is disingenuous to conflate the two issues.

Professor William Binchy

Tell me again because I did not quite hear. Why would the Deputy say, “I have a solution for you. You must not take your own life” in one case but not in the other? I did not quite hear the reason he said that.

Deputy Gino Kenny

We are talking about two different issues. We are talking about societal issues and an issue where somebody is coming to the end of life and-----

Professor William Binchy

I hear the-----

Deputy Gino Kenny

-----they should have a choice.

Professor William Binchy

I hear the factual difference but are they different?

Deputy Gino Kenny

There is a major difference.

Professor William Binchy

Are they different? Let us say there are two friends of the Deputy. The first friend has a health condition that is impacting on them. The circumstances are that the friend is suffering from a health condition. The second friend is suffering because of a situational condition - an interpersonal family situation where the family has broken down. The Deputy says they are different. Of course those are different cases but they are not different in the issue arising, which is what the Deputy would do, as a friend, in those circumstances.

Deputy Gino Kenny

I will tell Professor Binchy what I would do. If a person came to me saying that their marriage had broken down and all that kind of crisis, I would tell them that if they were threatening to take their own life, they should not do it. I would tell they could seek help and all that. I will go to absolute circumstances to make that not happen. If somebody – this has happened recently – who is terminally ill and coming to the end of their life said that they wanted me to change the law on assisted dying, what would Professor Binchy want me to say to them? Should I say “No” because people have an antiquated view that somebody should have to suffer? That is rubbish and he knows that it is rubbish.

Professor William Binchy

I do not think the Deputy has been hearing what I have been saying.

Deputy Gino Kenny

I had a very recent experience of a close friend who said they do not want to go through a certain period of their life. What does I say to that person?

Professor William Binchy

As I said to the Deputy, what if he has another close friend who says they do not want to go through another period of their life? The Deputy is not quite heeding or acknowledging the centrality and identity of the two cases. In both cases, a person is suffering situationally and wants to end their life. I do not think one can, from a point of view of logical consistency, put forward the proposal that legislators should allow for the termination of one person’s life without logically addressing the other person’s life. If life is-----

Deputy Gino Kenny

That is not logical at all.

Professor William Binchy

With respect-----

Deputy Gino Kenny

Those are two different circumstances. Conflating the issues is disingenuous and dangerous. Let us move on.

Professor William Binchy

It is not conflating the issue; it is identifying exactly the implications of what the Deputy's proposal would involve. The Deputy’s proposal would involve someone coming to him and saying that they have a medical condition such that they want to die now. I understand the Deputy to say that in those circumstances, he would support legislation to say “Yes”. Let us say somebody else comes to the Deputy saying that they have situation that is causing them untold suffering that is not medical but interpersonal, financial or whatever. It may be simply philosophical in that they do not like life anymore. There are such people, tragically, who want to end their lives. The whole range of why people take their lives is wide-ranging. It covers cases, some of which are medical and some of which are not. The point I am trying to get to the Deputy that he is not accepting delivery of is they have a common denominator.

Deputy Gino Kenny

I am accepting-----

Professor William Binchy

The Deputy is also interrupting me.

Deputy Gino Kenny

No. I am asking the questions here.

Professor William Binchy

The Deputy is interrupting

Deputy Gino Kenny

I am asking the questions here.

Professor William Binchy

Respectfully, the Deputy is interrupting. If the he would give me an opportunity to say-----

Deputy Gino Kenny

No. Professor Binchy is not moving from his-----

Professor William Binchy

I will be gone in 20 minutes but the Deputy will still be here legislating this issue, so I wish-----

Deputy Gino Kenny

The law will change. I can guarantee that.

Professor William Binchy

Honestly, rather than interrupting me, I wish the Deputy would hear what I have to say. I refer to the logic of introducing a law that states that a person can take their own life and the logic of denying people beyond the limited category that Mr. Riley mentioned. Mr. Riley is interesting in what he said. When the question was put to him about a person who, with medical care, would last considerably longer than six months, but without medical care would die within six months, I understood he said that we do not want to impose medical treatment on people against their consent.

Mr. Lloyd Riley

Treatment and care are different things.

Professor William Binchy

I refer to treatment. We do not want to impose medical treatment on people without their consent. We all agree with that, right? However, there are many people who are maintained by medicine who will live for a long time, but without medicine will die.

In those circumstances, as I understand Mr. Riley’s position, they are entitled to die now.

An Cathaoirleach

I have to move on. I call Deputy Troy.

Deputy Robert Troy

I thank our three witnesses, who I was listening to on my monitor upstairs. I just got the opportunity to come down now.

I have a couple of questions. Many questions have been asked already. In Professor Binchy’s opening statement, he mentioned the damaging effects of physician-assisted suicide. Could he elaborate on what those effects are and what he means by “the rights and interests of others” that would be affected by assisted dying? He also mentioned that if assisted dying were to be introduced by way of legislation, there is the possibility of legally requiring healthcare professionals to engage in an activity against their will. Could he foresee a system whereby conscientious objection could be introduced, similar to what was introduced in respect of the repeal of the eighth amendment, where professionals with a conscientious objection could refrain from participating in a practice that goes against their conscience?

In Mr. Copson’s opening statement, he stated that assisted dying should be based on an individual’s determination that their suffering or quality of life is intolerable and it should not require a terminal prognosis. Who determines what is intolerable? Is it intolerable from a medical perspective, from a psychological perspective or because of societal issues because some person might find themselves at a particular stage in their life? That gives rise to the impact that would have on suicide and how we frame and support people who are in an intolerable position and contemplating suicide. How would we work to encourage people to refrain from taking their own life in that position? I am interested in Mr. Copson’s views on that.

Professor William Binchy

I will be brief. I think I have been too long with too many other answers. The argument is that if you accept the principle of assisted suicide or assisted death in circumstances of imminent death, it is logically impossible to resist arguments based on discrimination and equality to extending it further. We have speakers here who do not have the same position among themselves. It is a question of where they would draw the line. We look around the world and we see the trend over the past 20 years is expansionary. That is logical and entirely consistent with the step. Once you say it is okay and there should be a death in these circumstances, how can we deny it to people who are seven months away? How can we deny it to people who are in the situation I mentioned to Deputy Kenny, that is, a situation of gross personal pain but not related to medicine? Those are the same kinds of case. Those are the people you have to protect. They are unknown as yet, but they are the people who will become a burden and who will perceive themselves to be a burden on society and will come under pressure and indeed cultural pressure. You have had your time, it is time for you now to exit from the stage.

Mr. Andrew Copson

There is no evidence of what we have just heard happening in any of the jurisdictions where assisted dying for incurable suffering has been legalised at all, anywhere or ever. To answer the direct question, intolerable suffering is quality of life going below what one would want for oneself, but as a consequence of an incurable physical condition, which is the important point. It is not just any suffering that a person might be experiencing on any grounds at any point in their lives but rather it is incurable suffering. That is the logical difference that the last witness was asking for when he was grilling the member of the committee on why he would persuade a friend who was depressed rather than a friend who was terminally ill not to kill themselves, where the other is allowed to kill themselves. The logical difference between the two is incurability. Incurably suffering from a physical condition that will never improve and has no prospect of improving, whether that person is terminally ill or not, is what should qualify for assisted death.

That, in my view, is what should qualify them for assisted death.

Deputy Robert Troy

It is exclusively for a physical illness, based on what Mr. Copson is proposing.

Mr. Andrew Copson

That is my perspective and our policy. That is also true of most of the jurisdictions that permit assisted dying for terminally ill and non-terminally ill people.

Deputy Robert Troy

I have a question based on what the previous speaker said. It contradicts what Professor Binchy said with regard to what has been shown about countries where assisted dying has been introduced and how the provisions regarding what is allowed and covered under the legislation have expanded. Mr. Riley said that is definitely untrue. Could he give me an example of three countries which have introduced assisted dying where, after a decade, there has been no expansion whatsoever?

Mr. Andrew Copson

In Oregon, the law has been unchanged for almost the entire time it has been in place. In Canada, from the beginning, the law applied to non-terminally ill people as well as terminally ill people. I think Switzerland has been the same since it began there. Laws do, of course, change, but they change as a result of democratically determined medical decisions that are based on the same sort of evidential bases that the committee is taking now. Not all change in human life or even politics is slippery slope change. The committee is debating change even now. I certainly was not saying that nothing ever changes but that the negative social consequences Professor Binchy spoke of, as if they were rampant and prevalent in all jurisdictions where assisted dying of any sort has been introduced, have no evidential basis. Switzerland has definitely been essentially the same. Those are the three examples.

Senator Lynn Ruane

I will be concise. Professor Binchy said in his response to Deputy Gino Kenny that sin is not in his lexicon. I am wondering what it is, in Professor Binchy's words, when somebody who is incurable ends his or her life. I ask that in the framework that we are discussing. I also ask him not to try to undermine that by putting forward the idea that we have a view that is not logical, as he keeps saying. He can say that all he wants but it does not make it true. It is logical that one can create frameworks where one cohort of people can avail of something and another cannot. We do it in other areas of medicine. We do it when we decide who is even eligible for chemotherapy and how advanced in stages their condition is. Medical decisions are made every day that categorise groups. I am not denying that morally, philosophically and, at a human rights level, we can argue that it is discrimination, but we still make those distinctions in categories. It is logical to say that we would not have it in the case of Deputy Kenny's friend whose marriage broke down and would have it in the case of somebody who is incurably unwell. It undermines the suffering of those people at the end of their life to make such comparisons. When Professor Binchy says that sin is not in his lexicon, from the perspective of his moral judgment, what is it to end one's life regardless of situation?

Professor William Binchy

I speak in terms of human rights. I am not ever communicating in religious language at all.

Senator Lynn Ruane

If it is not a sin, what is it?

Professor William Binchy

We have limits to autonomy. There are certain things we should not do.

Senator Lynn Ruane

If it is not a sin, what is it? Professor Binchy says it should not be done.

Professor William Binchy

There are certain restrictions to what-----

Senator Lynn Ruane

Sin is a transgression. It is a moral imposition of what we feel.

Professor William Binchy

If I may have an opportunity to speak, it is something that, in the light of common understanding of how rights exist and the rights of others exist-----

Senator Lynn Ruane

What is the right of the others?

Professor William Binchy

I would like to hear the Senator or I would like to speak.

Senator Lynn Ruane

I have a certain amount of time and Professor Binchy keeps talking in long sentences instead of answering direct questions.

Professor William Binchy

I will keep them short if the Senator would prefer.

Senator Lynn Ruane

What is the right that Professor Binchy is talking to?

Professor William Binchy

Will the Senator allow me to speak perhaps without interrupting me? This is actually a waste of her time.

Senator Lynn Ruane

Much of it has been.

Professor William Binchy

The Senator referred to logic. Could I ask her a question, perhaps?

Senator Lynn Ruane

No. I am asking Professor Binchy a question. He said he is talking in human rights terms, not religious terms. I ask him to tell me what those human rights terms are. What human rights terms is he talking about?

Professor William Binchy

Mr. Copson mentioned that no man is an island. It is an old-fashioned expression but it means that we are all intertwined humanly.

Senator Lynn Ruane

The social contract, yes. Just answer the question. Is it right or wrong to end one's life, no matter what?

Professor William Binchy

It is not right to end one's life.

Senator Lynn Ruane

It is not right, so it is a sin.

Professor William Binchy

No. Sorry, that is not what-----

Senator Lynn Ruane

So what is it?

Professor William Binchy

It is not right. If the Senator gives me an opportunity to speak without interruption, if that is possible, for the short time she has, it is not right to end one's life. There are limits to what one can do. There are limits to autonomy. This is the point I am making. One has to be concerned for others.

Senator Lynn Ruane

What is the concern for Professor Binchy if I decide to die at the end of my life?

Professor William Binchy

If I choose-----

Senator Lynn Ruane

How does it impact Professor Binchy's life? How does my death impact his life as a white, privileged man? He will not even think of me.

Professor William Binchy

Honestly, Senator-----

Senator Lynn Ruane

It is not true that it all impacts other people. It does not. It impacts the immediate people around a person and if one puts in the safeguards, then one protects the people who are most vulnerable. It is not fair to keep saying that it is logical. Professor Binchy believes it is a divine right to protect life. It is better if we can have that conversation, if Professor Binchy believes it is a divine right to protect life, because then we can stop having pretend arguments about logic, human rights and all these things, and just get to the crux of it. It is okay if that is the belief, but there is no point in trying to make out that Deputy Gino Kenny is somehow drawing a comparison between someone's marriage ending and somebody having terminal cancer. It is very unfair to do that. It is an extremely unfair comparison to make.

Senator Rónán Mullen

I think this is more for YouTube than for getting information.

Senator Lynn Ruane

I do not actually put videos on YouTube, if Senator Mullen wants to look. I would appreciate if he started respecting my contribution. Just because he does not like it does not mean he has to dismiss it.

Senator Rónán Mullen

Will Senator Ruane lead by example?

An Cathaoirleach

We will stop for a second. We will pause and Professor Binchy will respond.

Professor William Binchy

It is not that I want to dominate the floor or anything like that but it would help if I was given an opportunity to speak. I am more than happy to listen to the Senator speaking.

An Cathaoirleach

Professor Binchy is speaking uninterrupted now.

Professor William Binchy

Okay. Senator Ruane mentioned the logic of the situation. She mentioned people who she might know or have known in her life who situationally took their own lives.

Senator Lynn Ruane

Professor Binchy is just repeating what he said. I am sorry. He is after doing this so many times today-----

An Cathaoirleach

I want to give Professor Binchy-----

Senator Lynn Ruane

He is just repeating what he said to Deputy Kenny.

An Cathaoirleach

He is our guest here today. He is a witness. I want to give him-----

Senator Lynn Ruane

Advance the conversation instead of trying to throw red herrings-----

An Cathaoirleach

We are over time but I want, with all justice, to hear Professor Binchy's response.

Professor William Binchy

It is rather difficult dialoguing with Senator Ruane because of the fact-----

Senator Lynn Ruane

Now Professor Binchy knows how Deputy Kenny felt, does he not?

Professor William Binchy

The Senator interrupts a little bit. If I may make the point uninterrupted, that would be helpful. The point I made and will continue to make is that one cannot logically distinguish. Even Senator Ruane is subject to logic. We are all subject to logic. It is not something one should repel as being cold and abstract. One has to operate on the basis of the logic of legislation. If the logic of legislation is that certain consequences follow, for the Senator to engage in legislation-----

Senator Lynn Ruane

So logic is based on legislation?

Professor William Binchy

Legislation does have a logic to it.

Senator Lynn Ruane

So drafters of legislation can rewrite legislation in a logically sound way to accommodate the end of people's lives and end-of-life care. So once the legislation exists, the logic exists.

Professor William Binchy

If the Senator gives me a chance to explain what I am trying to say, I will say legislation has a logic. If legislation provides for a particular entitlement to do something for a certain group of people and denies it to another group of people-----

Senator Lynn Ruane

It does it anyway.

Professor William Binchy

-----logically, the argument will be made, and it will have logical force, that the other group of people are entitled similarly to what the first group of people is.

Senator Lynn Ruane

It does not, because it does not give an inherent right.

Senator Rónán Mullen

First of all, I have no difficulty accepting what I think was the clarification. I do not think anybody intended to suggest otherwise. Nobody is saying that advocates of euthanasia or assisted dying are saying that other people are better off dead than alive. I think what they are saying is that if those people think they are better off dead than alive, then that is okay. However, I think that changes the world for many vulnerable people. The reassurances that we are getting here today include that Canada started with a radical law, so we will not call that an opening of the door or a slippery slope. I put it to our guests that Canada's law did not change out of a vacuum. It is part of a context where more permissive laws are developing. I refer to the reassurance that there is palliative care even where there is assisted dying.

My experience, having done a report for the Council of Europe, was that experts in palliative care very much saw assisted dying and euthanasia as having no part of that discussion. It is the white and the rich who go for this. They are the first in the queue. That offers no reassurance around the concern that many people have that, over time, the most vulnerable people in an inadequately resourced health system will not be the ones who have the most recourse to this option.

I say to Professor Binchy that Deputy Gino Kenny's point was to ask if there is a difference between those who are not getting better and those who may get better. I cannot understand how people who argue on the autonomy ground would make that distinction because it is discrimination for someone to be deprived of this new choice for any reason. Some people argue for limited euthanasia, whether for a principled or strategic reason, and those arguments may vary. Is there some kind of an argument of difference there?

Is it the case that support for a law change to allow for euthanasia and assisted dying is lowest among those who are disabled and elderly? If so, do the witnesses have a view as to why that might be the case?

Professor William Binchy

I ask the Senator to remind me of his direct question. Of course one can make distinctions. One can make distinctions in cases where there is a projection of six months of life remaining. One can make distinctions in respect of incurable conditions and conditions from which a patient may get better. One can absolutely make those distinctions. The question is whether the making of those distinctions has logical force. The reason I mention logic is that if something has a logic to it, the logic will out. That is the point. One cannot resist logic. One might wish to resist it but one cannot do so. If the logic is that an individual choice to die is to be supported in circumstances where a person is incurably and terminally ill, one will move to incurably ill.

I will, if I may, make a wider point about the human condition. Before we are born and when we are born, we are absolutely defenceless and dependent on the support of other people. During most people's live, if they are fortunate, they have a period of independence when they are physically and mentally well and do not depend directly on others. When they are children, they depend on their parents but during their adult years, if things go right, they will go through a period of independence. As they get older, they will move into dependency mode. In those circumstances, they will have conditions that are incurable and will not get better. Undoubtedly they will lose their capacity to see and hear. They will lose various faculties. Committee members will remember the description of a person's life in "The Seven Ages of Man". In that period, people will start to become more dependent on others. There is the insight of society over generations, and I try to stress this point and I know I have made it two or three times now. We are talking about the accumulated wisdom of societies. That means people who have been in intimate relationships and family relationships over generations and millennia. The insight is that we should care for each other. The purpose of legislation is to produce laws that are truly caring. Such legislation does not introduce a law with logic in it that means it will extend outwards. What we are hearing today is negotiation by advocates for change. They are telling us where they, as negotiators, will draw the line. We cannot negotiate with the logic that underlies the impact of the change that is made. We know that from the experience of other countries. To say that we are distinct and it will be different here is, I am afraid to say, a process of negotiation and trying to engineer an outcome.

Deputy John Lahart

A colleague has said that a narrow form of assisted dying might be pursued for a principled or strategic reason. I accept the "principled" part of that but the "strategic reason" implies that someone might choose a narrow form of assisted dying in order to open the gates to a more liberal, progressive - that may not be an accurate term - or broad access programme. All I can do is to speak for myself. I oscillate between the pros and cons of this issue. This has been an informative exercise for me. The witnesses from whom the committee has heard have been extraordinary in the testimony and insight they have given us. I am not coming to this debate in a strategic way.

I am minded today, and have been minded in the past while, to think that a very narrow legislative approach can be considered without intending ever to open any floodgates or to provide a slippery slope. I do not accept the logic. If it is in the legislators' minds to restrict it, and I am not saying it is but am speaking only for myself, I do not see that the automatic conclusion is that it will become more widespread or more liberal. Professor Binchy is saying the difficulty is that if a change is made, compelling arguments are likely to be made for extensions to other cases. There is also a possibility that they are unlikely to be made. There is also the possibility that they are likely to be resisted. I wish the professor would imbue legislators with the power and intelligence to know the difference. That is the first point I want to make.

There has been reference to the connection between different societies' outlook on this issue and religious values. I am not entirely comfortable with that. I am a person with religious values who is quite open to the consideration of this issue and to teasing it inside out. There are many other people like me.

On the humanist approach, Mr. Copson, in his opening statement, said: "We should value human beings' personal autonomy and defend the right of individuals who have come to rational, settled decisions about their own bodies to be able to carry out their own wishes." Under what circumstances? Are there limits to that? Is Mr. Copson talking about people who are terminally ill? Is that argument restricted completely to people who are terminally ill?

Mr. Lloyd Riley

It is nice to be given the floor with some time remaining on the clock, which has not always been the case. I would like to pick up on the point about logic, which was a point I did not expect to hear so often, especially in contributions that seem to be setting out such an illogical position. Where is the logic in raising these claims about vulnerable people? I also challenge the point made by Senator Mullen about elderly and disabled people. Some people in those groups might be vulnerable but others in those groups would find that generalisation incredibly patronising. Why are we advocating the protection of those people with safeguards when we turn a blind eye to the fact that people are already exercising this choice? They are travelling to other countries to do this. We do not seem to be stopping them at Dublin Airport and preventing them from going. People are taking matters into their own hands. I know people have discharged themselves from hospices to go and die in their gardens without any safeguards, regulation or oversight. Where is the concern for potentially vulnerable people there? Those are extremely illogical positions to be putting forward and we need to scrutinise them. I am more than happy to put Senator Mullen in touch with hospices in Australia and New Zealand that are providing assisted dying services as part of a range of end-of-life care options to support dying people in their communities.

Mr. Andrew Copson

Assuming the question earlier about disabled people was asked in good faith, a recent report by the University of Glasgow found no negative effect on disabled people. It was quite an extensive report that we can share with the committee. I do not know about opinion polling in Ireland but in the UK, 88% of people with disabilities support assisted dying. Of course, many of the campaigners for assisted dying have been people with disabilities, such as the people I mentioned in my opening statement as having taken human rights based cases for the right to an assisted death. That is also true in Canada. I agree with Mr. Riley when he says we should not patronise and stereotype people with disabilities or older people.

On the question asked by Deputy Lahart, my point is not limited to the terminally ill. I agree that there is no logical distinction between those who are terminally ill and those who are incurably suffering but are not terminally ill. Assisted dying laws that limit themselves to the terminally ill permit larger amounts of unnecessary and incurable suffering than laws which admit both terminally ill and incurably suffering people. That is a genuine distinction between the two advocates for assisted dying before the committee today.

Senator Rónán Mullen

Does Mr. Copson refer to mental and physical illness when he talks about people who are incurably suffering?

Mr. Andrew Copson

Did I refer to mental illness?

Senator Rónán Mullen

I am asking Mr. Copson if he is referring to mental and physical illness.

Mr. Andrew Copson

Not at all. As in the written statement and as in our policy, it is physical suffering - incurable, physical conditions.

An Cathaoirleach

I call Deputy Gino Kenny.

Deputy Gino Kenny

I have a couple of questions for Mr. Riley and Mr. Copson. In Britain, an MSP in Scotland - I cannot think of his name - is trying to bring forward legislation. What are their views on that and where it would go? A number of cases in Britain in the last five to ten years caught my attention. I particularly remember Noel Conway's case. It was absolutely grotesque what that man had to go through. It was barbaric that that man had to go through the courts for a right to have a say in his own life. Hopefully, Britain, and different jurisdictions, can change their legislation. I think public opinion is similar to here in its desire to change the law.

Mr. Lloyd Riley

I thank the Deputy for mentioning Noel. He was a formidable campaigner. I wish he had been in this room because I think members would have had some quite interesting discussions with him. It ties back to the first question which I did not get a chance to answer which was on how we speak to dying people. They often come to us because they face the injustice of the current law and they want to change it. It is vital that the committee speaks to them. If it cannot get them into this room, it should go and find them. It should go to them and speak to them. That has to be part of this process.

To clarify, Liam McArthur is a Liberal Democrat not SNP member. I just want to put that on the record.

Deputy Gino Kenny

Sorry, I said MSP. He is a Member of the Scottish Parliament.

Mr. Lloyd Riley

His proposals were for terminally ill mentally competent adults would apply in Scotland. It is a devolved issue. They went out for public consultation last year. There was a record number of responses and 80% support, as reflective of public opinion polls. There was support from MSPs to bring forward a Bill. That is being drafted and will be brought forward in due course.

Scotland is not the only place. Next week I am going to the Isle of Man. It is having a Second Reading of legislation. I mention also Jersey and Guernsey. In Westminster, although there is no legislation on the table, a health committee is looking at this issue. I am conscious that I have come over from the UK today but it is fair to say our neighbourhood of nations is looking at this. France had a citizens' assembly and is looking at legislation. This issue is not going to go away. Whatever the outcome or recommendations this committee comes up with, I hope it will move the debate forward because anything less than that is just kicking the can down the road for someone else.

An Cathaoirleach

I call Professor Binchy.

Professor William Binchy

We are mentioning cases of individuals-----

Deputy Gino Kenny

My question was not to-----

An Cathaoirleach

In the interest of balance, I thought that if we were finishing the three-----

Deputy Gino Kenny

No, my question was to Mr. Copson.

An Cathaoirleach

Okay. I call Mr. Copson.

Deputy Gino Kenny

I did not address it to Professor Binchy. I mean no disrespect but he can speak after.

Mr. Andrew Copson

Certainly, I agree. The point about jurisdictions within these islands turning slowly their minds towards legal recognition is very true. Obviously, there is the Bill in Scotland. I regret that it limits itself to the terminally ill. In contrast, I very strongly support the proposal in Jersey which will come about in the next couple of years to give assisted dying to both the terminally ill and the incurably suffering. Of course, France is about to do the same. We will be surrounded by friendly liberal democratic jurisdictions which have taken the right principled steps in relation to this very soon.

I agree completely about the bravery, courage and selflessness of the campaigners, especially those who are suffering enormously themselves. Noel was an incredible man. Tony Nicklinson, who had locked-in syndrome, took his case all the way to the Supreme Court in the UK and had a ruling that found that the continuing denial of his right to a medically-assisted death was a breach of his human rights under the European Convention, which I think is worth this committee exploring further. There is a strong human rights case for assisted dying.

Deputy Gino Kenny

Can I can ask one supplementary question which is important?

An Cathaoirleach

Yes. A final question.

Deputy Gino Kenny

Maybe Mr. Riley can answer this. If there was a legal directive or legal challenge in relation to an individual and they won in a British Court, would that influence the British Government to change the legislation?

Mr. Lloyd Riley

The UK Supreme Court does not have the same power as the Canadian Supreme Court, for example, so it could not demand the Government change the law but it could certainly put pressure on Parliament to act and declare that the current law is unsatisfactory.

I think we have moved away from that, to be honest. Public opinion is so strong across the UK that legislators realise they cannot keep ducking the issue. There use to be a kind of trifecta of timidity between the courts, Parliament and doctors. Doctors' opinion has shifted dramatically in recent years. The British Medical Association and many royal colleges have dropped their opposition. Doctors have realised that the current situation is unsustainable. They do not want to be out there campaigning against something their dying patients want. I think Parliament is getting there and that is where we will see the action. That is the best way to do it. It is better that the legislature takes the lead on this and finds a law that aligns with the attitudes and values of society.

Deputy Gino Kenny

I always thought it was absolutely terrible that people who were looking to change the law, who were dying, had to go in front of a court. It is absolutely dreadful stuff.

Mr. Lloyd Riley

It will keep happening.

Deputy Robert Troy

Sorry, maybe I should know this but this relates to campaigners who are having to go to, say, the highest court in the UK or maybe even Europe, the European Court of Human Rights. Were we to introduce a restrictive model of assisted dying in Ireland and were preventing other people from being able to avail of that model, would we be liable or open to a challenge being made to the European Court of Human Rights to say we were being somewhat discriminatory to people we are excluding from availing of assisted dying?

An Cathaoirleach

I call Professor Binchy.

Professor William Binchy

The best way of dealing with that type of argument is to have a situation that you do not facilitate some degree of assisted dying. The court has worked on the basis that if there is some degree of assisted dying, it can engage with articles based on discrimination. Therefore, the best way, from Ireland's point of view, of not being in a situation that the European Court of Human Rights would produce a decision which would require Ireland to do something it did not want is not to introduce this law. The very introduction of this law allows the court to heed arguments, and it has done so in a number of other contexts, based on discrimination in this area.

An Cathaoirleach

I call Mr. Copson.

Mr. Andrew Copson

I would actually agree with that last point but I would put it the other way. Human rights are nothing to be afraid of. If a human rights court says your law is incompatible with human rights and that it should be expanded for the benefit of the human rights of people, that is probably something you should welcome when it happens in your jurisdiction. Governments often do no like being challenged on the basis of human rights and nor do parliaments but if human rights courts find on the basis of the human rights treaties, which we in Europe have signed up to, that a law is discriminatory, then my position is that it should be welcomed as an expansion of the human rights of people who are otherwise suffering. I think it would be possible.

Mr. Lloyd Riley

The European courts have been quite clear that it is up to jurisdictions to legislate for this in whatever way they want, including the option of not legislating. I do not accept that then they would suddenly turn to a position where they would change legislation to bring it into line with a certain logic. Not legislating does not do away with the issue. I return to the point I expressed in my opening statement that doing nothing is not a sustainable position. That does not lead to avoiding any difficult circumstances. It leads to more legal cases; more dying people suffering against their wishes; events such as traumatic, violent deaths or travelling to Switzerland; and tearing families apart. It does not solve this issue and that is the question before the committee. That is what it needs to act on in a constructive way.

An Cathaoirleach

Thank you very much.

Mr. Lloyd Riley

I just want to say I have been very impressed with the work of this committee. I have watched previous sessions. I think the people of Ireland should be proud that the committee is having this conversation in the way it is having it but it is crucial in terms of what comes next that it moves the debate forward.

An Cathaoirleach

On my behalf and that of the members and the secretariat, I thank Mr. Riley, Mr. Copson and Professor Binchy for what has been a very lively, interesting and factual session. We really appreciate their time. We thank Mr. Copson for coming online and making that effort.

The joint committee adjourned at 1 p.m. until 10.30 a.m. on Tuesday, 7 November 2023.