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Shortfalls in Palliative Care Must be Addressed in Advance of Any Legislation Around Assisted Dying

assisted dying

It is imperative the Government address shortfalls on palliative care in advance of any national debate on assisted dying according to Irish Hospice Foundation (IHF) who have published their submission made to the Justice Committee on the Dying With Dignity Bill 2020.

The organisation believes that fundamental supports for persons nearing end-of-life are not universally in place across Ireland and any move to legislate for assisted dying would be premature until this is addressed. Palliative care supports are required to underpin any future decision to legislate on the matter and as it currently stands several counties have no access to specialist palliative care inpatient unit or hospice beds. Laois, Offaly, Longford, Westmeath, Louth and Meath, have no beds, no planned beds and no funds to build any specialist inpatient or hospice unit.

As a thought leader on dying, death and bereavement IHF believes that there has not yet been a sufficiently detailed and diverse debate and consultation in Ireland on Assisted Dying. The coming months provide an opportunity for open and inclusive debate on the matter and all voices must be heard.

Irish Hospice Foundation believes that central to any discussion on the matter is respect for the diversity of opinions that exist to enable an informed decision which will have implications for the society we live in. Our primary concern is that all voices are heard and that nobody is deterred from contributing to this debate.

The primary focus of our organisation will remain on advocating the best standards of hospice and palliative care for those facing end-of-life. This is a task that encompasses physical, psychological, practical and spiritual needs of thousands throughout Ireland each and every year.

The main points of Irish Hospice Foundation’s submission are:

  • Potential direct impact of 740 deaths a year.
  • We strongly believe that fundamental supports for persons nearing end-of-life are not universally in place across Ireland. These supports would be required to underpin any future decision to legislate for Assisted Dying.
  • The absolute requirement for rigorous research to establish an evidence base for any legislation along with a deep consultation with citizens, as happened in other countries which have considered this matter.
  • Assisted Dying, albeit performed for compassionate reasons, will hasten death, which is against a core principle of the palliative care movement that palliative care should neither hasten nor prolong death (Source WHO).
  • The debate to date on Assisted Dying in Ireland, whilst being driven by very genuine and passionate interests, has not, in our expert opinion, been robust or thorough. Many voices, both national and international, have not been heard. More worryingly, the voice of Irish people, particularly older persons (whom this Bill will impact the most) and people with a disability have not been part of robust public debate.
  • We are concerned that Assisted Dying will not in any way be seen as more ‘cost-effective’ approach to addressing the needs of those facing end-of-life.
  • We have also long called for the State to support citizens to think about, talk about and record their preferences for end-of-life and healthcare. This is legally strengthened by Assisted Decision Making (Capacity) Act 2015 (ADMA). However, this Bill has not yet been fully commenced. We contest that existing laws and mechanisms, well advanced but not yet fully complete or universally implemented, designed to enable persons record their presences for care at end of life, and which support patient autonomy and decision making must be enacted as a matter of priority.
  • A much more comprehensive and robust Bill will need to be developed, to better protect and safeguard people on the island of Ireland against serious risks associated with Assisted Dying legislation.
    • It must provide for a series of robust and carefully designed, carefully applied and monitored safeguards.
    • The title is misleading as it suggest that dignity in death can only be achieved through Assisted Dying. The title of the bill should more accurately be called “The Assisted Dying Bill”.