Joint Committee on Assisted Dying debate -
Tuesday, 5 Dec 2023

Religious, Faith-Based and other Philosophical Perspectives on Assisted Dying: Discussion

An Cathaoirleach

Apologies have been received from Senators Ruane 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 they are contributing.

This committee discusses dying, including suicide, and support information can be found on the committee's web page. The topic for discussion this evening is the perspective of religious, faith-based and other philosophical groups on assisted dying.

I warmly welcome Reverend Steven Foster from the Methodist Church in Ireland, who is joining us online, Reverend Dr. David Bruce and Dr. Rebecca Stevenson from the Presbyterian Church in Ireland, whom I believe are also joining us online, Ms Petra Conroy and Dr. Margaret Naughton from the Irish Catholic Bishops' Conference, Reverend Dr. Rory Corbett from the Church of Ireland, Mr. Neil Ward, chair of the Humanist Association of Ireland, and from the Irish Muslim Peace and Integration Council, Shaykh Dr. Umar Al-Qadri, chairperson, and Dr. Ibraheem Tunau. I thank them for attending and joining us online. I appreciate that their time is valuable.

The questions and answers format of this meeting will see members asking questions after all of the witnesses have given their opening statements. A member can ask an individual witness a question or address a question more generally to all of the witnesses. I ask that the witnesses keep each of their opening statements to the agreed five minutes, as doing so will be important.

I invite Reverend Foster to make his opening statement.

Reverend Steven Foster

The Methodist Church in Ireland, through the Council on Social Responsibility, which I co-chair, has outlined its detailed position on physician-assisted suicide in its paper of 2013. In October 2020, we articulated our concern in regard to the then proposed Dying with Dignity Bill. Primarily, our concern is that all in society should be able to thrive. In the reality of the human experience of suffering, we want to see all supports and resources possible being provided for those with illness and-or disability and the root causes of injustice addressed.

To die with dignity touches upon our pastoral heart. We hate to see anyone suffering. We recognise the aspiration of those who would wish to see an end to their own suffering or of those around them. There are many heartbreaking circumstances for those who may wish for this. We are committed to compassion for those who are suffering and are passionate about human dignity.

At the heart of this discussion are the variations of human experience of life. We hold the journeys and experiences of those who have suffered most with great care. Marie Fleming, Brendan Clarke, from whom the committee has heard, and others have enabled us to gain deeper understanding of the suffering involved. We are thankful for their willingness to share their lives with us for our better understanding, even in the face of intense personal challenge.

We have a particular regard and concern for those who are the most vulnerable in society. This is at the core of our thinking on various matters. Those who are suffering terminal illness are certainly in a vulnerable state. This principle is primarily at work in us being against the introduction of an assistance in dying Bill, and the following is a summary of some of our specific concerns.

In such a setting, the management of a patient would in some way at least include the awareness of assistance in dying as an option. This affects the feeling of worth of those involved and could be interpreted as a duty to die. To allow choice can effectively encourage choice. No one should be made to feel a burden to society.

Assistance in dying undermines our societal efforts and commitment to saving life. This has particular resonance in regard to the prevalence of suicide. The clear message as a society that we need to be sending out to people is that we are interested in them having all the means necessary for good mental health and social health and opportunities to thrive. Public discussion on this underlines the need for renewed investment in palliative care, screening and mental health support services. We are concerned that, if assistance in dying were introduced, it would undermine the need for excellence in palliative care and its resourcing.

Conscientious objection would have to be a part of any potential legislation. However, it is still possible that a physician would be required to highlight its availability. If assisted dying is to be introduced, it is crucial that its option only be introduced at the request of the patient so as not to influence vulnerable patients. Crucially, an availability of assistance in dying changes the doctor-patient relationship.

While this meeting is not specifically about the Dying with Dignity Bill 2015, it rightly described a terminally ill person, which was a qualification in that Bill, as "having an incurable and progressive illness which cannot be reversed by treatment, and the person is likely to die as a result of that illness or complications relating thereto". However, we are concerned that such a Bill would lead to confusion over the nature of where we should intervene. Given the severe suffering involved in chronic mental illness, other non-life-limiting illnesses and certain disabilities, would a line be crossed that would be difficult to define afterwards? The introduction of assisted dying would open up more questions. The public discussion and Bills are seeking to address real experiences of suffering. However, our society is full of suffering in many circumstances. If assistance in dying were made law for those with irreversible, incurable and progressive illnesses, it seems to us that others would regard themselves as having the same right to die as those to whom any such law was addressed, for example, someone who was suffering severe and intractable mental illness but who was not physically unwell or terminally ill. This would raise further questions for the future and could leave us as a society, as well as the medical profession, more uncertain about the sanctity of life.

An Cathaoirleach

I thank Reverend Foster, but-----

Reverend Steven Foster

We are committed to the relief of suffering and, more fundamentally where it is possible, uprooting the root causes of suffering. We will continue to engage in wider society about this, the issues people face and seeking the common good.

An Cathaoirleach

I thank Reverend Foster. I do not mean to be rude by interrupting him, but I have to try to keep witnesses to the five minutes. I ask that everyone look at the clocks and keep to the time.

I invite Reverend Dr. Bruce to make his opening statement.

Reverend Dr. David Bruce

I thank the committee for the opportunity to present the views of the Presbyterian Church in Ireland to it.

The Sixth Commandment in the Bible to not kill is clear and has been present as a cornerstone of judicial systems across the world for thousands of years. There are exceptions to this prohibition, of course, but they are few and subject to rigorous regulation. For people of faith, the starting point here is that human life is special – we may even say "sacred" – and that its preservation, dignity and protection are moral values that we cherish. The question of assisted dying goes to the heart of this important moral principle. Killing is wrong. This is killing. Therefore, as those who respect both the Bible as the Word of God and the Hippocratic principles, we simply do not do it and this is a place the medical profession ought not be asked to go, notwithstanding the deeply complex pastoral issues surrounding, for example, coping with the latter stages of degenerative disease or incapacity through trauma. The Hippocratic oath contains these words: “I will use my power to help the sick to the best of my ability and judgement; I will abstain from harming or wronging any man by it”.

Parliaments and assemblies in London and Edinburgh have repeatedly rejected changing the law in this area. Those legislatures have not been persuaded that the current law is even in need of change or that the proposed safeguards in their draft Bills would be effective in protecting vulnerable people from harm.

The medical speciality of palliative care, mentioned by the previous witness, exists to help support patients with conditions, which cannot be cured and who need help in managing their physical, emotional or spiritual symptoms. This surely encapsulates the vision of the founder of the hospice movement, Dame Cicely Saunders. In our internal research it is significant to us that palliative care practitioners themselves have been the most adamant of medical specialties opposing a change in the current law.

I now speak to the ethical dilemma. In ethical terms, this exposes the tension between the competing rights of liberty and personal autonomy. We reference the European Convention of Human Rights, in particular Article 8, respect for a person's private life, and the Article 2 right that everyone's right to life shall be protected by law. A change in the law could surely cause a large and vulnerable group of citizens to be exposed to exploitation by reason of depressive illness, lack of capacity or agency, unscrupulous coercion or manipulation by relatives or others to end their lives prematurely. It is our view these rights are foundational. Most people can agree that for an individual to arrive at a point where they believe there is no other option but to seek the ending of their life suggests considerable emotional, physical or spiritual turmoil and suffering. The first response to this dilemma, in my view as a Christian minister, ought to be the mainstreaming and strengthening of palliative care services to support those nearing the end of their lives or addressing this dilemma.

To conclude I briefly highlight two areas of specific concern. The first is safeguarding. The language any legislation uses to gatekeep the practice of assisted dying will speak of a person's settled wish to die, or their mental capacity to understand, and so on. Many members of the medical profession expressed to us their deep unease that such decisions to accede to a request for assisted dying essentially became a matter of their subjective opinion as medical practitioners - difficult to defend in a tribunal or the High Court. Doctors are neither social workers nor detectives. If a society really wants to make assisted dying available, this process surely needs to be administered and these judgments made by the courts or a dedicated commission accountable to the courts. Doctors will have a role to play as professional advisers on strictly medical aspects of a request. However, if they are made the judges in such matters this will fundamentally change the doctor-patient relationship, as other witnesses have mentioned.

I turn lastly to euthanasia, because in those countries where physician administered euthanasia has been legalised, it has been shown to result in a factor of ten times more deaths than physician assisted suicide. In Holland and Canada, where both are legalised, 96% of hastened deaths are due to physician administered euthanasia. The settled position of the Presbyterian Church in Ireland is that human life is sacred, that our human right to life needs to be protected, and that a change to the law in this regard would be detrimental to the life of the nation. There are surely better ways to address the turmoil of those caught in such a terrible dilemma, in specific terms the mainstreaming and strengthening of palliative care services to support those nearing the end of their lives or addressing what to them seems to be intolerable. These are the marks of a mature and caring society.

Ms Petra Conroy

We thank the committee for inviting us. The Catholic Church, following the example of Jesus himself, regards the service of those who are sick and dying as an integral part of its mission. A key focus of the ministry of priests and lay chaplains, both in hospitals and in parish communities, is the accompaniment of people who are dying. This pastoral care of the sick also brings us into close contact with family members and friends who, despite their own sadness, often play an essential role in contributing to the well-being of those who are dying. Their participation also contributes to a healthy grieving process following the death of their loved one. Death is a natural part of the human condition. We do not propose the use of extraordinary or aggressive treatments to prolong life in a way, which conflicts with the reason or dignity of the person. Our focus is on how people might be helped to experience a good death. We are opposed to the deliberate ending of human life, both for reasons of faith and for reasons connected with the defence of the common good, and they are closely tied. Our Christian faith, which is shared by a significant proportion of the Irish people, teaches us life is a gift, which we hold in trust. The life and death of each of us has its impact on others and there is no such thing as a life without meaning or value. The common good is the good of each and of all, and it is the responsibility of the State to uphold it.

It is our understanding that the primary focus of this Oireachtas committee is on how the State can best fulfil its responsibility for the common good. People across Ireland are already helped, ethically and legally, to approach death with dignity, within the interdisciplinary framework of good palliative care. Assisted suicide is something very different and we believe it would undermine the common good in several ways.

First, our experience of palliative care as a Christian community has shown us, that in the final weeks of terminal illness, many people can be helped to experience human and spiritual growth. Faced with the reality of their own mortality, they can and do come to understand themselves better, and engage in a new way with family members and friends. This can be a time when old hurts are healed and people find inner peace. This process is supported through palliative and pastoral care, which places the focus on the needs of the whole person. A decision to end life prematurely, by contrast, cuts off any prospect of growth or healing and represents a failure of hope.

Second, what begins as a limited right tends to become a societal norm. Assisted suicide does not simply affect the person who dies in this way. It affects their family, loved ones and all of society. It sends out a message to others who are terminally ill that they should also consider their continued existence as perhaps an unbearable burden on themselves, their families, or on the healthcare system. While the legalisation of assisted suicide is sometimes represented as compassionate care, it is a failure to respond to the very real challenge of caring holistically for terminally ill patients as they approach the end of their lives.

Third, doctors and nurses are given privileged access to the human body and to the use of drugs, so that they can serve life and health. Assisted suicide presumes that doctors and nurses will be directly involved in the taking of human life. We believe this undermines the essential relationship of trust on which good healthcare is founded. We are aware that proposals to legalise assisted suicide generally claim to respect the right of healthcare professionals to conscientious objection. However, that respect is invariably undermined by the assumption healthcare professionals with a conscientious objection will be willing to refer their patients to a colleague who will perform a procedure they themselves believe to be unethical. The legalisation of assisted suicide would undermine the ethos of healthcare, as well as the ethical concept of non-maleficence - do no harm.

Fourth, we know from studying experience in other countries that assisted suicide, once legalised in limited cases, quickly expands beyond people who are terminally ill, to include others with poor health or physical or intellectual disability. This has happened in Belgium, the Netherlands, Canada and Oregon in the United States. Our own High Court, in its judgment in Fleming v. Ireland, supports this position. It stated:

The fact that such a strikingly high level of legally assisted deaths without explicit request occurs in countries such as Belgium, the Netherlands and Switzerland without any obvious official or even popular concern speaks for itself as to the risks involved in any such liberalisation.

These, in summary, are some of our principal objections to the legalisation of assisted suicide. We ask the committee not to recommend this legalisation, but rather to advocate strongly for greater investment in the provision of palliative care across Ireland, as well as better awareness of its scope and purpose, which is often poorly understood.

Reverend Dr. Rory Corbett

The committee has received a statement from the archbishop of Dublin, and covering that is a statement of the position of our church and society commission, which I am representing. By way of background, I was a hospital consultant for more than 30 years and have been ordained in the Church of Ireland for almost 20 years. In this statement, we start from the position that assisted dying still remains a euphemism for a process that is either suicide or of killing by a third party. In our opinion, we consider assisted dying under two headings - the pastoral and ethical basis of the principle, and the ethical issues arising from the process of any procedure that might be considered.

In our written submission, we base the ethical judgment on scripture, which is consistent with arguments from non-faith groups as well as other faiths, and is based on the core principles of affirming life, caring for the vulnerable, caring in cohesive society and autonomy. In terms of affirming life, this acknowledges both the right to life and subsequent legal protection of life and the foundations not only of human rights law, but also much of the criminal code. Beyond this legal underpinning is an acceptance that each life has purchase, purpose, value and meaning. It is part of the Christian tradition to assert that every person's life is of intrinsic value, although we can also get there from a secular position in that our healthcare is predicated on the intrinsic value of somebody, as shown, for instance, in the attempt to resuscitate a person who has collapsed or the time, money and energy we expend on the prevention of suicide programmes, premature baby care or those living with dementia. At the same time, quality of life can be misused to suggest that a person's life can be decided by others, an assessment of what a person can do and what they can contribute to society, but not what they are.

On caring for the vulnerable, all I would say is that a civilised society should do this, but experience does not support it. We see that in child abuse, domestic abuse and elder abuse and the effect of the Covid crisis on that. We should be a caring and cohesive society. Relationship is at the heart of it, and for a Christian, the relationship with God is an essential part of their life. We cannot act in total isolation. As John Wyatt, the ethicist, has put it, however compassionate our motives may be, when we assist in the killing of another human being we damage our own humanity. We must continue to build on that cohesive and compassionate society.

With regard to autonomy, individuals are made in the image of God and we must treat every person with respect and dignity. When it comes to the value of every human life, individual free choice may have to take second place to achieve it.

We must ask why we are having this consultation at this time. The usual argument is that of care and compassion for those with life-limiting and terminal conditions to deal with the themes of intractable pain, loss of control of bodily function and loss of meaningful activity, and that if you argue against it, you are lacking in care and compassion. Others have already alluded to the fact that there are alternatives to assisted dying, particularly through palliative care, and are agreed that this is not the way to deal with the situation. What this consultation is indirectly highlighting is the inadequacy of hospice, palliative and end-of-life care available to the population at large. A major BMA review some years ago, talking with GPs and hospital doctors, nurses, patients and their families, showed how poor the system was for communication, and how patients who were unknown to out-of-hours doctors and palliative nurses were unable to get medical advice or drugs out of hours. The international experience has been alluded to by others, which has shown problems in management and oversight. The issue of the slippery slope has very much reared its head with events in Europe, where jurisdictions have moved from just providing the procedure in cases of terminal illness and for those close to death to extending it to cases where there is no medical illness and no desire to live longer, even for minors. Surely, the ultimate attribute of a civilised society is to care for everyone equally. Is Ireland prepared to open this ultimate Pandora's box? If so, what follows?

Finally, what does not appear to have been considered so far in the doctor consultations is the ethics of who is to carry out the assessments and procedure. It is suggested that it will be carried out by two separate doctors. One can speak to the medical situation and the fact that it meets the regulations. What about the second, who knows nothing about the background deception? Why not choose a priest, who may have had much more contact in the later stages and who may know the situation, which may involve coercion? On this point, I would like to refer to the words of the president of the UK Supreme Court, who said:

The vulnerability to pressure of the old or terminally ill is a more formidable problem. The problem is not that people may decide to kill themselves who are not fully competent mentally. I am prepared to accept that mental competence is capable of objective assessment by health professionals. The real difficulty is that even the mentally competent may have reasons for deciding to kill themselves which reflect either overt pressure on them by others or their own assumptions about what others may think ...

Why not have a societal team set up to make these assessments? Why not a judicial review? Why the automatic assumption that the procedure should and will be carried out by a doctor? It has been suggested by some in other places that there should be others with expertise to do it and that doctors should be left out of it. It is suggested that where it is being chosen for a non-medical reason, it is a societal duty and not a medical duty. As a final question, I ask each member the following: if you were to put this into law, would each of you be prepared to carry out the procedure that at the moment you propose to ask doctors to carry out?

Mr. Neil Ward

The Humanist Association of Ireland, HAI, is grateful for the opportunity to make a statement on the question of introducing assisted dying legislation in Ireland. The committee has already heard from our sister organisation, Humanists UK, and we hold a similar position. The HAI represents the non-religious community in Ireland, and advocates for a society which respects the separation of church and State. Of course, we respect those for whom assisted dying is incompatible with their religious beliefs. Those who do not agree with assisted dying will not opt for an assisted death. However, for those of us who do not hold religious beliefs, the question of whether assisted dying should be permitted in law is framed in ethical rather than religious terms.

The humanist position is based on reason and compassion, and on the value we place on personal autonomy. Palliative care plays an important role in helping the dying to have a peaceful death, but for some unfortunate people, pain-relieving measures are not effective. In some cases, death comes only after a long period of unbearable suffering arising from an incurable and progressive medical condition. The HAI supports assisted dying for people who are suffering from a terminal, incurable or progressive condition and feel that their quality of life is so unbearable that they want a painless death at a time of their choosing. The key argument is the value we place on the autonomy of the individual. When close to death or suffering from a progressive incurable illness, we believe the individual should have the right to choose to end their life. To be denied this right means that many people suffer an end which is determined by the decisions of others. In some cases, an unbearable situation forces people to attempt suicide, which often brings more pain and suffering for the individuals and their families. Our position also recognises that the law is inconsistent as it stands. People are legally permitted to refuse treatment, even when such refusal will result in death. In the case of people who are unconscious or in a coma, and therefore unable to express their wishes, treatment is sometimes withdrawn or withheld. Why, therefore, should an assisted death be denied to those who are competent and able to express the wish for it?

Apart from the religious argument which should not be the determinant of our laws, the main argument against assisted dying is the slippery slope argument. This holds that the controls on assisted dying will inevitably be loosened over time and people, particularly those in vulnerable groups, will be pressurised into agreeing to an assisted death. There have been a number of extensive and well-respected studies to see if there is such a trend in jurisdictions where assisted dying is permitted, and no evidence of a slippery slope has yet been found. It is the HAI’s contention that a well-regulated and monitored system poses no danger to individuals or vulnerable groups.

The committee will have heard haunting testimony from a number of people who either wished to avail of assisted dying, but were unable to do so, or who had a loved one who managed to avail of an assisted death in another jurisdiction. One of our members, Garret Ahern, has spoken movingly to the committee of his experience of accompanying his wife to Belgium so she could avail of an assisted death when the pain from her incurable cancer could no longer be managed effectively. It is wrong that only those with the means and courage to travel to a foreign country are able to exercise this choice.

The HAI believes that we in Ireland should join the increasing number of countries that have legislated for assisted dying for the terminally ill and incurably suffering. Evidence shows that the majority of people who choose to die have exhausted the palliative care measures available to them. Others know that they may have an assisted death but choose not to. These individuals testify to the peace of mind that they gain by knowing this option was available to them. We all would like a natural, peaceful death. When that option is not a possibility, which of us would not like to know that if our suffering became unbearable, the option of an assisted, painless death will be open to us? The majority of Irish people support legalising assisted dying. Let us make this a reality.

Shaykh Dr. Umar Al-Qadri

Ladies and gentlemen, distinguished members of the parliamentary Joint Committee on Assisted Dying, esteemed colleagues and honourable guests, a chairde agus assalamu alaikum, it is a profound honour for me to address this esteemed gathering today, offering insights into the Islamic viewpoint on assisted dying.

In the vast tapestry of ethical considerations surrounding end-of-life decisions, the Islamic perspective is woven with threads of sanctity, endurance and conscientious objection. In Islam, the unambiguous prohibition against suicide or assisted dying is unequivocally expressed in the holy Koran, which states, "Do not kill yourselves, for verily God has been to you most merciful" and, "Take not life which God has made sacred." The hadith, words of the prophet Muhammad, peace be upon him, further reinforces this stance, asserting Islam's united opposition to euthanasia, assisted suicide and assisted dying, categorically denouncing these acts as tantamount to murder.

The sanctity of human life is a foundational principle in Islam, echoed in the holy Koran and various hadiths. Our faith emphasises the importance of endurance and patience in the face of hardship, recognising suffering as an opportunity for spiritual growth. It is within this framework that we approach the complex issue of assisted dying. Islam acknowledges the right to conscientious objection, respecting the autonomy of medical professionals and patients in end-of-life decisions. However, our concerns lie in the potential consequences of legalising assisted dying. We fear it may lead individuals to choose death without addressing the underlying causes of their health issues, including mental health. Moreover, there is a concern that vulnerable populations, such as people with disabilities or the elderly, may feel pressurised to opt for assisted death to avoid being perceived as burdensome.

The Islamic perspective also urges consideration of the potential neglect of long-term care and chronic diseases in the elderly if assisted death is legalised. We believe in the importance of a healthcare system that prioritises comprehensive care and addresses the root causes of suffering. In our brief on the Islamic perspective, committee members will find a more detailed exploration of these principles and concerns. It is our sincere hope that this document will serve as a valuable resource for the committee as it navigates the intricate terrain of legislation related to assisted dying.

Islamic rulings allow for the forgoing of medical care under specific circumstances, distinguishing between life support and ancillary interventions. We emphasise the importance of a nuanced approach, granting flexibility to clinicians in assessing treatment futility. Decisions on withholding or withdrawing medical care are guided by conditions justifying these actions, such as terminal or inevitable death.

Regarding pain control in palliative care, Islamic rulings advocate endurance for non-terminal patients experiencing severe pain. However, during the final stage of illness, severe pain becomes an acceptable indication for withholding or discontinuing care. In these instances, the emphasis should be on pain relief medication and methods to ease the patient's suffering.

I extend my gratitude for the opportunity to share the Islamic perspective on assisted dying. I thank committee members for their time and attention, and for their commitment to understanding the nuanced considerations surrounding assisted dying. Shukran and go raibh míle maith agaibh.

Deputy Pa Daly

I will ask a question of the humanist association. Mr. Ward maintains there is no evidence of a slippery slope. People from the Netherlands were before the committee and I was struck by what they said. They said that people do not want to die but do not want to live in the manner they are living. They told us there has been an increase in the number of people taking their own lives in the Netherlands. Is Mr. Ward maintaining there has been no increase?

Mr. Neil Ward

What we are saying is that the slippery slope argument is that once you legislate for assisted dying in specific circumstances, you will naturally extend that to other conditions. That is what we are saying has not happened. We regard the slippery slope argument as a pessimistic view of legislation and regulation. Realistically, once the law is robust and sets the criteria, there is no evidence they are expanded by legislators thereafter. It is more about looking at the legislation than the effect on the population.

Deputy Pa Daly

Would Mr. Ward accept that in some countries, there have been expansions? There have, for example, been arguments to include people with mental health difficulties and allow them to have-----

Mr. Neil Ward

To be honest, that is a little outside my experience in these matters. When I referred to the slippery slope argument, it was more in the context of legislative activity rather than the human behaviour that naturally follows.

Deputy Pa Daly

The humanist association's sister organisation in England stated it would support assisted dying for people suffering from a terminal, incurable or progressive condition. Has Mr. Ward any view on the definition of a terminal illness? Take, for example, people who have a form of cancer that would mean, with treatment, it would take ten years to die. Would such people qualify in those circumstances?

Mr. Neil Ward

We are basing our argument on what is currently incurable. Whereas a cure may be possible in the future, unless it is in clinical trial within the timeframes, and I have heard six months referred to quite a lot, we certainly-----

Deputy Pa Daly

If people are diagnosed with serious and incurable illnesses but are told that if they get treatment, they might survive but if they do not get the treatment, they will pass away within-----

Mr. Neil Ward

We would not regard that as incurable if there is a treatment available. I am talking about an instance where no treatment is available to relieve their suffering.

Deputy Pa Daly

What about situations where people are told they may survive for 18 months with treatment? Would Mr. Ward be in favour of assisted dying in those circumstances? People might be told they have a particular illness but can survive, with treatment, for 18 months. Does Mr. Ward have any view on the number of months that-----

Mr. Neil Ward

No. What we are saying is that when people are reporting their current situation as intolerable, if they are suffering and in intolerable pain at a particular time, that is when they may want to avail of assisted dying.

Deputy Pa Daly

Does that include intolerable mental anguish?

Mr. Neil Ward

At this stage, we are locating that as an incurable physical condition.

Deputy Pa Daly

What does Mr. Ward mean by "at this stage"? Does he mean there may be scope for expansion of that?

Mr. Neil Ward

I have looked over previous debates at this committee and people have talked about all sorts of things. We have only debated the issue so far and I am not mandated to go beyond that.

Deputy Pa Daly

I will ask the following more broadly of the other witnesses. Consider a situation where somebody is in severe pain as the result of a motor neuron disease for which there is no cure. Perhaps that person is approaching the last three or four months of their lives, has had counselling and as much treatment as they are going to get. Let us say such a person has three months left to live. Having dealt with people in those circumstances, do our guests think there are circumstances in which they would be in favour of allowing the option of assisted dying? Is it just a blanket "No"? That question is also aimed at the witnesses joining us online.

Ms Petra Conroy

I will take that one and then pass it on. One of the things at the heart of this is that every person is to be considered equal, no matter whether they are a TD, the chairperson of a committee or somebody who has suffered a stroke and cannot speak or respond. That principle of equality and equal dignity of everybody is at the heart of this. If I present to somebody as having thoughts of taking my own life, I will be wrapped in a raft of care. If it is a physical condition, all of that will be looked after, I will be given psychological support and my faith community will support me. If, in a few years’ time I develop motor neurone disease or I have a stroke or something and I want to end my own life, there is a different reaction. That is a fundamental inequality. You are creating two different categories and that is dangerous. I am very taken, at the same time, because the alternative is not too bad for me if I am suffering. The alternative is the very impressive other witnesses who were here, who were calling out that they could help people to have a good death, even in that situation.

Deputy Pa Daly

I have a question for contributors who have had experience of pastoral care on both sides of the Border. Have they found any difference in palliative care between the northern jurisdiction and this State? In general, have they seen differences in the level of palliative care? I come from Kerry, where palliative care is excellent in the hospital there. Have they found a discrepancy in the standard of palliative care or the options available, for example, the wraparound package of counselling and other types of supports?

Dr. Margaret Naughton

As Pa said, we are lucky that we have great services in Kerry and people are cared for very well across the board – physically, emotionally and spiritually. However, unfortunately, there are disparities across the country with regard to pastoral care provision. Some hospitals do not have chaplains but that is a discussion for another day. As someone who has worked in pastoral care for 13 years, I think of a patient who once said to me that I must have seen many an eye close. Unfortunately, I have seen many people die over the past 13 years. From my experience, people are facilitated to die very well in our hospitals, even where there are limitations in terms of resources, palliative care and pastoral care.

Going back to the question, unfortunately, when you start having a piecemeal or an à la carte approach where it is okay for one person to have assisted suicide versus someone who is not, you are opening up a dangerous door. We are here to have a conversation tonight, but once we start opening up that it is right for one person to have assisted suicide but not another person, we are opening up the door to basically making it a reality for everybody. We very much resist that. Limitations in resources, psychological support and spiritual support is not a justification on any level to implement assisted suicide in this country. We are trying very well to meet the need that is there. From my perspective and experience, people are facilitated - irrespective of whether it is motor neurone disease, cancer or whatever it happens to be - to die very well. We do whatever we can to facilitate a person’s death and do it as well as we can.

An Cathaoirleach

Does Dr. Rory Corbett wish to come in?

Reverend Dr. Rory Corbett

I will come in, in as much as I was not in palliative medicine. The impression I got whenever I discussed things with colleagues in general terms is that the position north and south of the Border seems to be very similar. Domiciliary end-of-life care is the problem because there is a whole network, which I alluded to, of communication between all the different people providing the care. For example, there are issues around lack of a communication, who is holding the final responsibility, who is holding the prescription pad and who is there at 3 a.m. when the palliative care nurse is in the house and needs advice about a change of drug. It seems that despite all the modern communication systems, it is all written on paper but nobody is passing it. For example, it goes in the post but does not get to the GP or the patient may have it and forget to give it to the nurse and so forth.

Regarding hospital care, things should be better but still they are very short of good palliative care consultants and staff to look after the patients. Medical staff are often slow to call them in to help as well. We have a long way to go in palliative care. I think it is behind so much of the demands for alternative let-outs.

Senator Mary Seery Kearney

I thank the witnesses for their contributions. I have enormous respect for their views and their entitlement to hold them, and am sympathetic with an awful lot of what I have heard this evening. However, our history as a State and as legislators has been to espouse a just society. We need to legislate not even necessarily for what the majority thinks but for what is needed for a minority. Over the course of our history, we have legislated for divorce, marriage equality, fertility treatments, how we provide for fertility treatments and abortion. In this room, there are people who hold diverse views. In the list I have given, I will never need to avail of marriage equality because I am happily married to my husband for 22 years, but I believe that others have that right. Not all witnesses would agree with that and not all would even recognise my marriage because my husband was divorced. As legislators, we have to separate our faith and a faith-based perspective and consider the needs of the minority who would require us to care for them and give consideration to them.

I do not necessarily have a question but merely an observation. This is a necessary and important meeting because this is the end of life. I do not necessarily think there is a conflict between valuing the sanctity of life and, within that sanctity, valuing the right of a person who knows they will die to choose the manner, means and circumstances of that death. Therein lies a challenge. I may or may not ever choose this road but I am not sure that I can stand in the way of a person who feels they wish to. I feel my duty as a legislator is to ensure that those who do not want to choose it, while it is an option for others, are safeguarded in those perspective. I am not sure what there is to discuss but I am open to feedback and observation.

Ms Petra Conroy

We are here not to propose, in my case, Catholic doctrine onto the State. Everybody in this room is trying together to see what the common good is. We have made many points, such as I believe I was made by God. However, you do not have to be a person of faith to understand and value human life. This can be seen from the pre-Christian Hippocratic oath, from the post-Christian World Medical Association and from most medical ethics associations in the world. The following is not a faith thing either: if I say I want to take my own life and then later on, when I am old and incapacitated, I say I want to take my own life, the two responses are completely different. People can evaluate that from any perspective; it does not require a faith perspective. My faith feeds into it but those things are - no more than the preferential option for the poor with Brother Kevin because it is coming from his Catholic faith - values shared by society. There is the issue of equality, and what I do will have an effect. If I decide from my autonomy that I want to end my own life, that has effects.

For instance, I can think of a story, and in these situations one has to think of one's own loved ones. My father died a few years ago. He was in great health all of his life and he found it very hard to find himself with cancer at the end of his days. There were two very different situations. His oncologist really was looking out for him. He knew he was an older man and he was not going to live forever but he was always about a programme of treatment without suggesting anything radical. That really empowered my father. Then, in one ancillary element, he got another side effect. He was in another unit that obviously only saw him as an old man at the end of his life. They were not concerned about his nutrition. This was in a hospital in Ireland, and there was an attitude of constantly bringing up do not resuscitate, DNR, in a very inappropriate way. It was a very different attitude, and nothing we could say changed the attitude. There is that view of putting somebody into a category where they have less dignity because they have certain conditions. That is not a religious situation; I would think that is an equality situation.

Senator Mary Seery Kearney

I would condemn a situation like that around any patient but I do not think that there is necessarily an either-or. By having the option of assisted dying, it does not mean that person would not be enveloped in the care that is absolutely essential to their dignity right up until and including that moment where they exercise that right to know they will die in two months' time, unconsciously with pain management, or they will choose to say goodbye to their loved ones and have an ending of their choice.

Ms Petra Conroy

That is where we would probably differ. I am sorry to take all of the Senator's time but I would say that once two different categories of people have been introduced, one is putting somebody who would never choose that option in a position where they know they belong to that group of people, and that if I, in a moment of pain or whatever, ask for that, I will not be given that raft of care. It does affect people and categorise them into two different groups.

An Cathaoirleach

I have more witnesses. The Rev. Dr. Bruce is online. Does he want to come in briefly?

Reverend Dr. David Bruce

I want to make a quick comment about protocols and the texture of the palliative care that is offered. Anecdotally, my own father was in the situation where he had a stroke. He was debilitated and in the latter stages of his life. I was in a position of refereeing a conversation between various interests with regard to his final days. It was hugely empowering for me to encounter a registrar on the ward who was able to say, on the basis of protocols that she was implementing, that a particular course of action that would have accelerated my father's demise was unethical. I hugely admired her courage in being able to say that but was hugely grateful for the fact that protocols originally based on the Liverpool care pathway were being implemented by her in a compassionate and caring way. It gave her a framework to respond wisely and well to a family in distress. I simply want to point out the importance of a structured set of protocols that are constantly evolving, changing and improving as technology advances, and as we learn our way through this practice of palliative care. From a pastoral point of view and being at the receiving end as a family member, I am simply pointing out that this was a huge blessing to us.

My colleague Dr. Stevenson would like to say something about the slippery slope argument because it has been referenced several times in the discussion.

Dr. Rebecca Stevenson

I wanted to add that there has been concerning evidence coming out of countries like Canada where medical assistance in dying, MAID, is now being extended to people with mental health issues. This is coming in 2024. There have been reports of families stating that they have loved ones who are opting into assisted death without fully understanding what they are doing. I will echo what the Rev. Dr. Bruce said. It is important that the proper protocols are in place.

While we are coming here from a faith-based organisation, we are doing research. Whether we want to admit it or not, people of faith have impacted culture for generations. Legislators with faith have had a huge impact on cultures and have advocated for minorities. One only has to think of people like William Wilberforce, who advocated for victims of modern slavery. We are talking about changing the culture. It is not just that we are coming from a religious space but we are coming from a space of having done the research.

Senator Mary Seery Kearney

With due respect, faith has not always influenced the behaviour of our State to the better of its people. As a member of the Joint Oireachtas Committee on Children, Equality, Disability, Integration and Youth having to deal with mother and baby homes and other situations, we have seen it to the forefront of those unfortunate decisions over years, and the hardship they caused. I am not sure I buy that argument. I also did not reference the slippery slope, the point being that we as legislators have a requirement to consider those who we may never agree with. We may never choose the options they are asking us to consider. That is not with regard to my own faith or anything like that. We need to give consideration and make sure that view is in the room and not excluded.

Shaykh Dr. Umar Al-Qadri

I agree with what the Senator says and I know where she is coming from. The Islamic perspective that I am sharing here is not because we believe that this is what the law should be. We were asked and invited to come and share an Islamic perspective but we believe in a pluralist approach, where there should be religious freedom and people should be entitled to have the opportunity to choose what they like. We are in favour of choice in that sense but we have some concerns. These are not just concerns from the Islamic perspective but also just as general people. Our concerns are that if we legalise assisted death, there will be individuals with health issues like depression who will choose death. At the same time, this may increase pressure on people with disabilities or elderly people, who may think that right now they are a burden on their families and the State, and this is probably why it is best for them to die. Third, if we do legalise assisted death, what about the healthcare system? Is it not the case somehow that the healthcare system will invest much less in treatment and other ways to minimise pain, and then say, "You know what? We have this option. Let us just go for this option". This is the perspective we are coming from.

In the case of Muslim doctors, as long as there is consent to subjection and as long as that is applicable, from an Islamic perspective we have no issue with it. That is the main concern. We are not here to say that the State should be run by faith. We are saying that this is our perspective but the State should be a pluralist one. It should be a state where we acknowledge and accept diversity, and also give everybody the choice to practice upon their faith and build values.

An Cathaoirleach

I briefly want to bring in the Rev. Foster. He has indicated for a while.

Reverend Steven Foster

I believe in the separation of church and state. We do not want to get too much into binaries in some of these discussions about religion. When it comes to my faith, and Jesus coming alongside the marginalised, that informs me about my passion for the marginalised and those who would be sidelined or easily overlooked. My ethical concerns are hard to separate in that sense, given that Jesus's greatest conflict was with religious leaders. We fully acknowledge religious harm where it has obviously happened.

With regard to how we seek to work out our faith, in our committee we talked this through more fully in 2020 but even as we were emailing this past week, I could hear the tensions. I have people close to me for whom this is a whole lot more personal than it is for me. My fellow Methodists and other Christians are seeking to work out our faith in a real-world sense without saying that we all have the exact same views on everything.

That is just to underline the complexity and yet the clarity of compassion for all and how we are seeking to work it out.

Deputy Gino Kenny

I welcome the witnesses to the committee. In 2022, there was a census done in Ireland. I will read out the breakdown of those who identified as a religion. Some 68% identified as Roman Catholic, 1.8% identified as Muslim and 14% identified as non-religious. Altogether there were 73% who identified themselves as of the Christian faith. Obviously that has changed over a number of decades. There have been numerous opinion polls in the last number of years that consistently show 75% of people support legislative change. If that is a cross-section of society, that would include people of the Christian faith. I am sure people of the Christian faith would support legislative change around assisted dying if 75% of public opinion shows support assisted dying or legislative change.

Ireland has made huge social strides in the last 25 years and the Catholic Church has been against each of those strides. The Catholic Church was against contraception. It is incredible really. It was against divorce, marriage equality and a woman's right to choose. In each of those strides, where there has been legislative change or a referendum, it has been on the wrong side of that history and evolution. Assisted dying is one of those issues to which people among the religious hierarchy are opposed. I understand and respect the witnesses' views but I believe those views should be separate from issues such as assisted dying because it is a very personal thing. Even if it is a personal thing, it still needs to be thrashed out in relation to legislative change. Given that public opinion clearly states that it would support legislative change around assisted dying, how come all the religious organisations are out of step with public opinion?

Ms Petra Conroy

As I was saying earlier, the main case we would put forward here is that we are trying to talk about the common good of all society. The point I was making earlier is not based on religious faith. The idea is that suicide prevention and helping people to decide not to take their own life should be applied to everybody equally. That is not a religious point of view. It is compatible with a religious point of view but I am not here asking the Deputy to go to mass every Sunday or anything. That is a principle I would hope anybody could see. I am here representing a Catholic position but it is something that is aimed at trying to support the common good of all society. It is not about imposing a Catholic view. It is about the idea that if you want to prevent people who are presenting for whatever reason with the desire to end their life, you offer that raft of support and that should be offered equally to everybody. It is not a religious point of view. The idea that-----

Deputy Gino Kenny

That is not contentious. Conflating the issue of suicide and assisted dying is very regrettable. People keep doing it and it is just not helpful at all.

Ms Petra Conroy

I understand that is one of the issues that is under debate, that is, whether you can really distinguish. I have been trying to say, "Somebody who wants to take their own life". Under the current suicide prevention supports, there is a certain set of supports but if I am able to present my case in a rational and calm way, there is an idea that I am not suicidal. It is very hard to distinguish. If somebody wants to take their own life, there is a raft of reasons they might want to. My point is that they should be equally supported. That is not a religious point of view. For instance, if somebody has six months to live as a result of cancer and the State says that person can end their own life, everybody who has six months to live as a result of cancer knows they are in a situation where if they ask their doctor-----

Deputy Gino Kenny

Not everybody is going to choose assisted dying.

Ms Petra Conroy

No, but that is what I mean. They already know they are in that category.

Deputy Gino Kenny

Does Ms Conroy not think people should at least have that choice?

Ms Petra Conroy

I think we should treat people equally.

Deputy Gino Kenny

Does she think people should have a say in how they die?

Ms Petra Conroy

If I go to my doctor and ask for something much less contentious such as antibiotics, and that is my wish and I want antibiotics for myself, the doctor will take into account whether that is good for me or whether what I have is a virus and the antibiotics will not help me but he will also take into account the whole of society and how giving me antibiotics will affect that. Likewise, deciding that a certain category of people can be supported in ending their life affects other people who might never decide that but they know they are in a different category, in a second-class category.

My point is that those arguments are not based on religion. I am not presenting a religious case. I am presenting a case that I think a person from any background could either agree with or disagree with but I am not presenting a Catholic view.

Deputy Gino Kenny

I presume you are morally against assisted dying because it is against God's teaching-----

Ms Petra Conroy

I am against it for the reasons I am saying-----

Deputy Gino Kenny

-----and I respect that.

Ms Petra Conroy

I am against it for the reasons I am saying, that is, that people should be treated equally and everybody has an equal value. They are arguments I would think are not specifically religious.

Dr. Margaret Naughton

Something I think we forget about when it comes to dying, illness and all that is that people are very vulnerable. Sometimes we underestimate how vulnerable people are when they are sick and they are faced with a terminal diagnosis. Sometimes the option to end their own life is seen as maybe an easy way out or a solution to the problem. What we are offering at the moment is compassionate care. We are seeing the vulnerability and addressing the vulnerability. You can go into all sorts of theological and philosophical debates here but for me it is about how we understand human suffering and how we help people when they are suffering to address their pain of all descriptions, including physical, emotional and spiritual. We are not here pushing any particular agenda. Yes, we are representing a particular viewpoint but we are open to conversation around this. I would suggest that we go back to the vulnerability of the human condition when we are faced with illness.

I will share one very short insight into my own experience. When I was a very young woman, I faced my own mortality. I found myself in a position where I probably wanted to die. Am I glad that the option of assisted dying was not available to me? Absolutely, because if I look at my life in the last 20 years and all the things I have achieved, all the experiences I have had-----

Deputy Gino Kenny

I am sorry but how would Dr. Naughton have had that choice in her life? Assisted dying was not legislated for but if assisted dying is, hopefully, legislated for in Ireland, we are talking about a small cohort of people who have a terminal diagnosis and have a time-limiting condition. We are not talking about somebody has mental health difficulties. We are not talking about that. We are talking about quite strict criteria. That is what I am saying. That is what we are talking about.

Dr. Margaret Naughton

This goes back to some of what was said earlier about the slippery slope. This is the reality that once you open the door to this type of-----

Deputy Gino Kenny

Can you show me the evidence of that?

Dr. Margaret Naughton

There are speakers who have been in who have already addressed issues of slippery slopes.

Deputy Gino Kenny

If you can present the evidence-----

An Cathaoirleach

We are going to go on to Senator Mullen.

Senator Rónán Mullen

As regards the slippery slope, I would refer the Deputy back to Professor Theo Boer. I note my friend here from the humanist association.

Even in Oregon today certainly the numbers have expanded, which is suggestive of a slippery slope in terms of attitude and a rise in the number of people who feel they are a burden. I believe there was a rise of 53% in the past year in Oregon where it is an issue of concern that they feel a burden. That is a dramatic change. There have been dramatic changes in the law in the Netherlands where they are contemplating legalising euthanasia on the grounds of simply old age, and on the basis that from the age of 73 there is a completion of life. There is also Canada and the runaway train there. I am afraid it is hard to find the slope that is not slippery if we look across the world, even in the conservative regimes. My friend Gino was anxious to mention New Zealand, but it has only been there a wet week and yet they are trumpeting how successful it is. It is far too early to say, as the fellow said when asked what he thought of the French Revolution 200 years on. It is certainly too early to say in these countries. We must look at the countries where it has been long established, and what we see, as Professor Theo Boer has told us, is a shaking of social attitudes where people think about themselves and their illness in a new way. This is the idea that many experts have been trying to get across. We cannot just talk about one person's autonomy to the exclusion of everybody else's needs. Autonomy is worked out with the eye on other people's vulnerability as well. Other people are made vulnerable when it becomes a choice for some to have their lives ended. This is the point that many experts have been trying to emphasise over and over again.

Can I say how impressed I am by our Muslim friends and the wisdom that came from them this evening just in the way they listed the issues and particularly the risk of potential of neglect of long-term care, people feeling the pressure of being a burden or being perceived as such, and people choosing death without addressing the underlying causes. They have brought out for us how voices of faith can bring a light to these issues that can illuminate for other people too. It is not that what they say can only be understood through the lens of faith; it is precisely the opposite. It is through a vision of life - a philosophy, really - that they bring to the table. This is why I cannot quite understand why my friends Gino and Mary Seery Kearney seem to feel that faith has to be sanitised or put into some kind of hermetically sealed container. Surely everybody brings a background to their understanding of these issues, whether it is our personal experience of being loved or not loved, whether it is our political agenda, or whether it is our non-belief in a higher power. There is no neutrality here. There are only voices seeking to persuade each other. It is quite possible that people of faith also have something to say that can be grasped by other people. If he thinks about it, Gino agrees with that. If people like Fr. Peter McVerry or Sr. Stanislaus say life is sacred and to remember we are all God's children, then one is going to be attracted by that message. It may not be your way of saying it but it concretises the sense that there is something more to a human being than just matter.

I will say one word of caution to my Muslim friends and I hope they do not think I am being insulting or mocking. They referred to pain control in palliative care and that Islamic rulings advocate endurance for non-terminal patients experiencing severe pain. This would not be good for sales of Lemsip, and as a frequent suffer from man flu, I would be inclined to discourage that particular attitude to non-severe pain.

On the issues, I want to ask our voices of faith here, and I do not really mind who picks up on this, if they believe there is a prejudice against the faith perspective offering an analysis on this that might be taken up by people of all faiths and none? Is there a kind of prejudice that perhaps is not there towards other people's background baggage? Do the witnesses believe that maybe this is part of our own particular history in Ireland? Is this something we have to get over? Are we really saying that only atheistic or agnostic philosophers can bring objectivity or wisdom to this debate? Is it not also sub-rational to say, if the majority of people are for this, then why are you on the wrong side of history? Again, to my friend Gino I would say if the opinion polls show, and they seem to, that the majority of people think we have now taken enough immigrants into Ireland, does he accept that this-----

Deputy Gino Kenny

No, come on now. That is bad.

Senator Rónán Mullen

I am just asking-----

Deputy Gino Kenny

That is bad.

Senator Rónán Mullen

The Deputy can see where the logic is going. One does not necessarily-----

Deputy Gino Kenny

That is bad. I know where the Senator's logic is going.

Senator Rónán Mullen

Is it not fair to say that we do not just look at opinion polls to find out where we should go and that issues have to be looked at on their merit? Is it really Gino's case that human rights are something that can be put to the vote? I will ask the witnesses this instead of asking Gino because I can ask him in the bar afterwards.

An Cathaoirleach

Perhaps we could go back to Dr. Corbett because I want to broaden it out to our witnesses online. Would Dr. Corbett like to come in on that?

Reverend Dr. Rory Corbett

I will respond. Listening to what has been said, and coming from faith we have been invited as faith organisations, what interested me given what has just been said is how much we appear all to concentrate on the secular side and say what we are proposing entirely mirrors what the secular world is saying in terms of human dignity and human authority, etc., rather than the value of people and the value of community and so forth. There is a feeling that anyone who is prepared to espouse faith strongly, and I do not mean to be insulting, in this sort of situation feels inhibited. With a different audience we could have been taking a very different line but still coming back to the same point on it. Yes, I am surprised but also impressed at how, without any collaboration, all seem to take a similar approach, which has been to emphasise how what we are proposing is seriously matched by the worries and anxiety of the secular world. We are seeing it through the courts and the decisions they are handing down and we are seeing it in what is going on around the world. Just looking at it, we are seeing changes all the time.

Looking back at this whole debate, the original debate started with an organisation called the Euthanasia Society. "Euthanasia" then suddenly became a bad word because of its implications that we were actually were killing somebody and people did not like that. Then it became dying in dignity, death in dignity, and now it is assisted dying or physician-assisted dying. There is a slippage in terminology. There has definitely been slippage in the what is allowed legally in various countries. We do feel inhibited to get up and trumpet too loudly, be it in the marketplace or more quietly in the confines of a parliamentary establishment.

An Cathaoirleach

I will now call in Dr. Bruce.

Reverend Dr. David Bruce

I thank the Cathaoirleach. It has been a very interesting exchange and particularly about the change to the texture of dialogue within contemporary Ireland. The job that members in the room have to do as legislators has changed markedly from the days of de Valera, if I may say so. As a Presbyterian, I am not saying this is necessarily a bad thing, but that is a separate discussion.

The voice of considered faith has been marginalised. I sense that. For a time I was moderator of our General Assembly and was involved in the public square conferences with other church leaders, including the two archbishops and the president of the Methodist Church. We often spoke in the public square together and - I say this as a good thing - we found that we had to very carefully choose our language, recognising that the comments we made, while in a previous generation may have simply been accepted or possibly privately disagreed with, were not the matter for very significant scrutiny. We often found ourselves having to significantly justify what we said. I do not believe this is necessarily a bad thing but it signifies a very significant change in Irish life.

Previously, one of the representatives indicated the number of what he describes as progressive steps that have taken place and he enumerated those. From a faith perspective, and unashamedly so, I would not necessarily consider those to be progressive steps but would wish to offer a faith perspective and acknowledge that from the perspective of the word of God, which we believe to be the Bible, there is a set of public theology principles that are set aside to our peril. I appreciate as a Christian saying this into a secular environment that it paints a large target on my back, but so be it. That is the nature of being a Christian in a pluralist and secular environment.

The feeling of a person, in my case as a church leader, working in this environment at the moment is that we have been pushed to the side. Consequently, the tone, the posture and the language we use must be nuanced and carefully chosen as we speak on this. Therefore, we see this exchange as a privilege. I come into this room knowing that I have no right to be here. I come here because I have been invited. I accept and honour the fact that this joint committee wants to hear a faith perspective. I am very grateful for that and do not presume. I am grateful that the committee has given us the space to offer it.

An Cathaoirleach

I call on Reverend Foster before we go to the next round.

Reverend Steven Foster

I do not have much to say. The Methodist Church has not been against all of the legislative changes mentioned earlier. We consider each area of public life and I hope grapple with it well because it is all about people. As I seek to be active in County Galway, where I am, my concern is to acknowledge that religion as we have known it has not necessarily been a genuine expression of a Jesus movement. The Methodist Church is seeking to grapple well with any of these topics with variation in different areas.

An Cathaoirleach

We now have a shorter round, starting with Deputy Gino Kenny.

Deputy Gino Kenny

I just make an observation more than anything else. As I said in my previous contribution, Ireland is changing in how it views religion overall. We have a more pluralist society which is a good thing. Over 65% of the population still identify as Catholic - I am not sure whether all those people go to church. Regardless of our religion, we will all definitely experience loved ones dying. That is just part of life.

I think we can all agree we do not want our loved ones to have to suffer. However, there are people who suffer when they die. Modern medicine is incredible. It keeps us alive, but it does not ameliorate all the suffering that one can suffer with a very complicated ending to life. This committee is trying to establish whether someone facing a very difficult ending can, with the help of a doctor and with the help of legislators, have a choice as to how that life ends. In those circumstances, I believe a person should have a choice and say in how they actually die. It is a very democratic and fundamental thing. Regardless of their religion if somebody does not want to go through weeks of pain, who is to say that person has to go through that because of medical or religious reasons? Nobody should have to go through that scenario.

In that scenario someone should have a say or a choice and in order to do that we need to change the legislation. It is as simple as that. I believe the majority of people in Ireland would support legislative change on assisted dying because they want to prevent suffering and want to give people a say in how they actually die. Why would anybody be against that? I do not understand why anybody would be against that.

An Cathaoirleach

I will bring in Mr. Ward because he has not spoken for a while.

Mr. Neil Ward

I agree with everything Deputy Kenny has just said. We who have no religion do not believe in an afterlife, in which case this life is the only one we have. We believe in living it to ethical standards. I personally believe in living a considered life and trying to do the best I can within the sense of reason that I possess. However, if someone is diagnosed with a terminal illness and is in a lot of pain, the family are very limited in their options of ending that person's suffering, especially in this country. At the moment one option is possibly to assist illegally in suicide. Only those with the means to do so may travel. That is the way we see it. We believe that we should have agency over our own lives especially when it comes with great suffering. That is really all we are concerned about here.

Shaykh Dr. Umar Al-Qadri

It would be wrong for us to put all religions in one particular box. The Islamic stance on abortion, for example, is that it is permissible. That is exactly what I stated a few years ago. Islam recognises divorce. At the same time our stance on marriage equality was that it is not a religious matter. This is not about the religious Islamic marriage; it is about marrying in a secular state. In all those situations, our perspective has always been to make sure that we protect vulnerable people. Whether they are women or men, gays or lesbians, it is the vulnerable people who need to be protected. In this particular situation, we are opposing any change in legislation because we are concerned about vulnerable people - people with mental health issues including depression. If we open the door, we might call it a slippery slope or whatever.

I am originally from the Netherlands and moved here 20 years ago. As an imam, I am still connected to the Dutch Muslim community. I came across a case where a person was suffering from depression and his family members were not meeting him. He had children but the children did not want to have any contact with him. In that particular situation, he decided he wanted to end his life. He was put in contact with me and we had a discussion. I happened to be in the Netherlands to meet my brothers and I met this patient. I gave him some pastoral care and eventually he decided not to proceed. Today in 2023, probably four years later, this particular individual again has a connection, a relationship, with his children who had abandoned him previously. At least he has an ending where he met his family members. Given that the legislation allows for this, if he had chosen to proceed with assisted dying, he would have regretted it. He said, "It was a good decision. Thank God I had this pastoral care."

I personally think it is about the vulnerable people. If there is change in legislation, we need to ensure that vulnerable people are looked after. That is the most important thing.

Senator Rónán Mullen

Is it Mr. Ward's position that if one takes as a starting point non-belief in God or in higher power, there is no rational basis for opposing euthanasia or assisted suicide? Most of the arguments this evening and indeed over recent weeks do not advert to or appear to depend on religious faith at all.

Are there not humanists who would differ from that position and who would be worried about, for example, people coming to feel they were a burden or that autonomy is inter-relational and cannot be absolutely isolated to the person's own individual choice, demand, etc.? Is there any scope within humanist thinking for opposing euthanasia or assisted suicide?

Mr. Neil Ward

As with all of us, I have that rational debate running through me. As I have stated quite clearly tonight, this is not about assisted suicide. This is not about people wanting to leave the planet for the very simple fact that they just want to die. Our position is based firmly on when people have intolerable suffering-----

Senator Rónán Mullen

I understand that.

Mr. Neil Ward

-----of an incurable medical condition.

Senator Rónán Mullen

Is that even in circumstances where it is argued that some other methods, such as, for example, palliative care are better? At out earlier session, we talked about palliative sedation. Is it possible in that case that there are people who believe, without having a religious basis for their argument, that other people might be hurt by opening the door even to that extent? Is that an argument Mr. Ward believes can be rationally made?

Mr. Neil Ward

Yes, I am sure it is.

Senator Rónán Mullen

I thank Mr. Ward. I wish to focus on Dr. Corbett and Dr. Bruce to some degree. I am fascinated by what Dr. Corbett said about how people are heading for the ground of common point of view with secular arguments. I heard then what Dr. Bruce had to say. However, is it not reasonable to state that there is no contest and that all people have the right to make whatever arguments they want, regardless of whether they speak from a certain perspective or through the lens of a particular faith? Is there not a distinction between arguments which depend strongly on shared faith, which may not bring a majority of society with you, and what we might call common-good thinking or perspectives that people of faith might be strongly inspired by and can share with those of all faiths and none who believe in goodwill? Does it not make more sense in a parliamentary context to hew to those kind of arguments which a wider community can share?

Reverend Dr. Rory Corbett

Going back to what was discussed earlier, part of the problem is what we, as people of faith, perceive as the way we are received and the way we are heard by the secular world, if I may put it like that. I am sure all of us could have taken a much stronger theological view on it. You have got to choose who you are arguing something with. I know I am speaking for myself, and I do not want to move outside the debate particularly, but I think most people will argue that is what the audience is. It will change with the audience. The audience I would have when talking to a first-year student as opposed to a post-doctoral student would be very different. In the same way, talking to a lay secular audience rather than a faith-based audience-----

Senator Rónán Mullen

Is there anything wrong with that distinction?

Reverend Dr. Rory Corbett

I do not know that there is. One is going to choose it. If we are able to say our faith base is producing a result and that the secular world has come to it from a slightly different direction, at least we are coming to it and saying that this is what it should be. I leave it to Dr. Bruce to expand that point better for me.

Reverend Dr. David Bruce

I do not know whether I can expand better. In my childhood in Northern Ireland - members will gather from my accent that I am from just outside Belfast - it used to be that the swings in the local park were chained up on a Sunday. That was something which caused me great grief, as members can probably imagine. There is an example of the apparent imposition of what might be perceived as the law of God, misinterpreted, in my view, but nonetheless perceived as that, and therefore being imposed legislatively by local government by chaining up the swings on a Sunday because it is the Lord's day, and those sort of things should not be done. Thankfully, we have moved on.

That was a misinterpretation of the nature of the relationship between church and state, and certainly between the Legislature and the people. The Parliament of which members are part, the Oireachtas and the Dáil, is not a church, and we should not be expected to treat it as a church. Members should not welcome it if we tried to do so. If I am referring back to de Valera's vision of Ireland, so be it. In my view as a Presbyterian, that was a flawed vision. The reformed position from a Presbyterian perspective would be that God reveals his will in a general sense to all people everywhere for the common good. We call it common grace. The seasons follow each other, the earth is fruitful and provides for us. These things are common to all people but then God reveals himself specifically to his people, to those who choose to follow him and provides them with a set of ethical principles to follow, again in his belief, in his expressed will, that those people would be agents of transformation and for the betterment of society as a whole. That is probably the way we see the church slotting into the wider society.

I found it fascinating to listen to the discussion this evening and recognise the inherent tensions in what we are saying here. Most of us have been invited as religious representatives and have spoken from a perspective of being, as it were, "in the house looking outwards". I hope what we have said is more than just doctrinal principles, that it applies to all people everywhere and carries the tone and the tenor of common grace for the common good. That is certainly the spirit in which I would offer my comments and concerns about any change to the law in relation to assisted dying. I said earlier that it is the mark of a mature and caring society that we care for the vulnerable, that we treat each other equally and that we ensure that those who are on the fringes and at deep points of vulnerability are protected. It is incumbent on us, as legislators and as a state, to ensure that this is put in place.

An Cathaoirleach

I thank Dr. Bruce. Before we finish, I have to say that I was very much looking forward to this evening because I wanted to hear what the representatives of the religious groups, and those of no religious faith, had to say. We have had an engaging debate which will be helpful to us in the serious job we have to do. I have always and I always will have the belief that from the moment of conception to the moment of death there is one boss, there is one God. When it comes to the time of death, I always had this idea in my head, and I still have it, that when people who might not believe in God are under pressure and perhaps drawing their last breaths, they would seek assistance or comfort from God or somebody, what we call "their own God", if they believe in some God. I have seen first-hand what happens at the times of the most upset and most upheaval people experience in their lives. I do not want to embarrass the individual involved, but I have to say that Dr. Margaret Theresa Naughton has done. I have dealt with families afterwards who said straight up that because of her work and the way she dealt with their loved ones in their final days, it made what was a very upsetting, said and unhappy time bearable. In some cases when the person was old, it made the passing nice, if people know what I mean by that. I accept that it is a very unusual thing to say about parting with someone that you do not want to part with. My grandmother died when she was 96. She looked me straight in the eye and said "If I could only turn back the clock ten years". She would have loved to have another ten years. She meant it. She was fighting for time, but she could not get it. She believed that God was taking her. She was not happy that he was taking her, but she went with it because she had no choice.

It is most important for people of whatever religion or none who are there to comfort somebody at that time. It is also most important for the families to know, believe and understand that there was somebody, who they may not have known beforehand, who literally came in and sat by the bedside and spoke, listened and prayed with the person and that it brought them a sense of comfort and of fulfilment of their life that I believe is a special gift. I believe the people who are dealing with people who are dying in those types of settings have a gift from God. These people have been given a special talent to comfort people at their hour of most despair and can bring a peace upon them which not everybody can do.

With that, I want to sincerely thank Reverend Steven Foster, Reverend Dr. David Bruce, Dr. Rebecca Stevenson, Ms Petra Conroy, Dr. Margaret Naughton, the Reverend Dr. Rory Corbett, Mr. Neil Ward and Shaykh Dr. Umar Al-Qadri for coming to the meeting today and for engaging with us. I realise that many of them made a great effort and personal sacrifices to be with us and I am very grateful for that. On behalf of the secretariat and the committee members, we thank them.

The joint committee adjourned at 8.52 p.m. until 10.30 a.m. on Tuesday, 12 December 2023.