The College of Psychiatrists of Ireland has warned the Oireachtas Joint Committee on Assisted Dying that the unequal distribution of palliative care services, a dearth of psychological and psychiatric supports available to people with challenging health journeys, and insufficient research in end-of-life care in Ireland cannot continue.

It said: “The answer to this is not to end our patients’ lives, but rather is to interrogate each and every incident of concern, to clarify relevant contributing factors, and to provide the appropriate evidence-based interventions ranging from improved pain control to family support.”

Speaking to the Committee, the College outlined four main points:

• The current status quo, where we know that an important minority of patients are not receiving the optimal level of specialist palliative care and psychosocial support to allow them to die with dignity, cannot continue
• As psychiatrists, we believe it is not possible to clearly differentiate between suicidal patients and patients who request assisted dying. There is potential for assisted dying to undermine the fundamental principles that suicide is preventable, and interventions that are proven effective in suicide prevention should take precedence across our health system
• We emphasise the impossibility of separating physical and mental disorders. Our longstanding splitting of illness into ‘real, medically and socially validated’ physical conditions such as cancer or diabetes, and ‘poor moral fibre, pull your socks up’ mental health disorders has persisted despite our advancing neuroscientific knowledge
• Autonomy and decisional capacity, and the cornerstone of any decision being 'voluntary and well considered' are highly complex for people who, for example, are autistic or have intellectual disability and can be difficult to assess.