Many family doctors are conflicted over assisted dying, and most would prefer "not to get personally involved", an Oireachtas committee has heard.
The Joint Committee on Assisted Dying is examining how medical professionals could be safeguarded if assisted dying were legalised.
Deirdre Collins, Chairperson of the Irish College of General Practitioners (ICGP), said that, while some GPs "are vehemently opposed, and others strongly in support of assisted dying, the majority are conflicted".
Dr Diarmuid Quinlan, Medical Director of the ICGP, said that this inner conflict leads to "tension" between a doctor's "professional obligations" and their "personal moral beliefs" which are often "very strongly held".
A report commissioned by the ICGP found that most family doctors "would not like to get personally involved", and that there is "more passive acceptance than support or rejection", Dr Collins said.
The Red C report revealed that "most GPs recognise assisted dying is a societal issue".
Fewer than 100 of the ICGP's 2,000 members completed the survey, the committee heard, but Dr Collins said that wide consultations had taken place.
Those who did respond "clearly and unambiguously articulated 'there would be no compulsion' to participate in any aspect of assisted dying", she added.
They also emphasised that the doctor-patient relationship "could be adversely affected" were assisted dying introduced, she said.
"It's a hugely difficult space," Dr Collins told the committee. "It's hugely complex".
Dr Mary Neal, an academic lawyer at the University of Strathclyde, stated that the "best way of protecting professionals" would be to ensure that "only those professionals who actively want to participate in the process need do so".
She cautioned against "[forcing] morally-conflicted professionals to be 'indirectly' involved, or to refer patients to other providers".
"A wish to die is an expression of human suffering," Dr Harvey Chochinov, Professor of Psychiatry at the University of Manitoba, noted.
He warned that "abject, soul crushing, suffering" can "lead to therapeutic nihilism and the impulse to abandon".
Edward Matthews, Deputy General Secretary of the Irish Nurses and Midwives Organisation (INMO), said that the union "takes a neutral stance in relation to assisted dying and whether there should be a change in the law".
"The increasingly role of nurse practitioners has become a huge issue in this area," he said, but added that this is less of an issue in Ireland.
He also emphasised that it "is imperative to invest more in palliative care services".
'Coercion happening every day'
The committee was warned that "subtle" coercion is "happening everyday" for those considering assisted dying in New Zealand.
Dr Sinéad Donnelly, who is an Irish consultant and specialist in palliative medicine at Wellington Regional Hospital, told the committee that 1,800 doctors had signed an open letter cautioning against including them in the practice of of assisted dying, as to do so would cross a line which "would fundamentally weaken the doctor-patient relationship which is based on trust and respect".
Assisted dying in New Zealand mirrors the Canadian regime and "has been in effect exactly two years", she said, but cautioned that "it is far too early to derive lessons" as there is only "limited data".
But she said that the "practice of palliative care has deteriorated with less engagement on the tough subject of suffering".
Dr Donnelly also warned: "Coercion is subtle and happening everyday", citing the case of a man with cancer living alone, whose family refused to help him one week after promising to do all they could.
Dr Kritsin Good, the registrar for assisted dying with the New Zealand Ministry of Health, insisted that "strict eligibility criteria" with "specific eligibility exclusions" and "assessments for competence and coercion" offer "important protections for people at a highly vulnerable time in their lives".
David Seymour, an MP for Epsom, sponsored the End of Life Choice Act which, from November 2021, made assisted dying legal in New Zealand.
He provided the committee with data for the first complete reporting year, to March 2023.
He revealed that 807 people, around 2.5% of all who died, applied for assisted dying.
Fewer than half - 328 - had an assisted death, which is around 1% of all deaths in the country.
Of these, only 22 people chose to self-administer, while 306 chose to have a physician administer the substances which ended their lives.
A slightly larger number - 368 - were either found ineligible or withdrew their application.
While a quarter of all applicants - 202 people - had died while being assessed.
The remaining 111 people had yet to avail of the option having been approved.
He said that participation by physicians is "totally voluntary", and he urged the committee to ignore the "tragic" contributions and "misinformation" of opponents of his bill - including Dr Donnelly.
