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IHCA President Prof Robert Landers

Lack of resources may push patients towards assisted dying, committee hears

By Editorial Staff 20th October 2023

Medical groups on both sides of the debate address Oireachtas meeting

There is a risk that a lack of resources in other areas of healthcare may push people into choosing to be medically assisted in their death – should new legislation permit it, the president of the Irish Hospital Consultants Association (IHCA) has warned.

Prof Robert Landers made the comments this week in a meeting of the Oireachtas joint committee on assisted dying, which is examining legislative proposals that would permit voluntary assisted dying in Ireland in certain circumstances.

While the IHCA has adopted a neutral stance in the ongoing debate around the issue, Prof Landers did express concerns that a lack of resources and healthcare staffing could push patients into taking what for them could be an ‘inappropriate action’.

“What we were doing as an association is outlining the limitations of current capacity and resources within the health system,” he told the committee. “We are outlining the risk that people may choose assisted dying because of a lack of capacity or resource elsewhere in the health service.

“If we are that short of palliative care consultants, and we know we are short of mental health professionals, physicians for the elderly, diagnostic physicians, hospital beds and beds in the community, we do not want people taking what could be an inappropriate option because of a lack of proper resources elsewhere in the system.”

Dr Feargal Twomey, clinical lead for palliative care at the Royal College of Physicians of Ireland (RCPI), expressed the body’s opposition to the introduction of legislation for assisted dying.

“There have been major advances in promoting high-quality care at the end of life across a spectrum of healthcare provision in Ireland, in particular, through the provision of palliative care services and increased training in palliative care and palliative medicine across the professions,” he told the committee.

“Legislation for assisted suicide threatens to undermine these efforts, risking a shift away from funding, development and delivery of new and existing palliative care services and potentially reducing research in this area.”

The committee also heard from Irish Doctors Supporting Medical Assistance in Dying (MAiD), a group of around 100 clinicians who are in favour of assisted dying legislation.

Chairman of the group Dr Andrew Lyne said: “Medical paternalism, where doctors assume what is in the patient’s best interest, is no longer acceptable. Patients’ choices should be respected and supported where reasonable, with decision-making shared between doctor and patient.”

Also representing the group, Kildare GP and IMT columnist Dr Brendan O’Shea added that, while the issue of resources is important, indications elsewhere have been that uptake of assisted dying has been higher among more affluent people.

“Dr Lyne observed that in systems where this service is available, among the earliest takers and significant users of the service are particularly affluent people,” he said. “To translate that to Ireland, that means people with private health insurance, where there are far lesser strictures on service provision. Affluent, educated people act on this and see this as a service relevant to them.

“That is an important point but probably should not be the most important point, which should be based on the existential need of a small proportion of people for whom this is an important choice at end of life. As doctors, we have all observed deaths we would not like for ourselves and that have worked out really wrong.”

While the committee heard from opposing views within the medical community, IHCA vice president Dr Gabrielle Colleran stressed the difficulties in finding a consensus on the issue. “The association has 3,500 consultants and there are varied views on this,” she told the meeting. “Probably similarly to the committee, people have strong views either way and many of us in the middle are struggling with the nuance of the debate.”

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