Conscientious objection should be allowed for healthcare workers in any law to bring in assisted dying, HSE says

Any law allowing for assisted dying in Ireland should permit conscientious objection for healthcare workers (HCWs) that do not wish to be involved, says the Health Service Executive (HSE).

An Oireachtas committee set up to consider potential legislative or policy change in the area of assisted dying will hear from the HSE and representatives from the Department of Health on Tuesday.

It is currently an offence for someone to assist in taking the life of another person in Ireland though assisted dying is legal in some other countries.

Tuesday’s committee meeting is expected to be the last held in public before it reports to the Houses of the Oireachtas.

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Dr Siobhán Ní Bhriain, the HSE’s national clinical director for integrated care, and a consultant psychiatrist for older people, is due to deliver the HSE’s opening statement.

She will say that the issues raised in the statement “cannot be said to represent the entire body of the HSE” but rather they are a “representative sample” of matters it believes need consideration when it comes to assisted dying.

“As there is no legislation in place for assisted dying, we cannot give definitive commentary on exact requirements for implementation; however, we can provide the committee with some of the issues that we, as clinicians, consider need further thought,” Ms Ní Bhriain says.

She will raise the case of people “who may be vulnerable” saying some groups “are at particular risk of seeing themselves as a burden and are at risk of being subject to paternalism and coercion; these citizens may be particularly at risk of feeling undue pressure to consider assisted dying.”

Ms Ní Bhriain says the HSE delegation due to attend the committee talked to the HSE’s internal staff counselling service about the potential impact the introduction of assisted dying in Ireland could have on healthcare workers.

She says the counselling service’s experience of working with staff “involved in experiences that transgress their moral or ethical codes” is that it can negatively impact on their mental health and “can lead to feelings of self-blame, shame and a reduced ability to cope with other work-related stressors”.

Her statement said; “The psychological impact of being witness to, or making decisions relating to, assisted dying, or indeed, involvement in the painful and prolonged death of a patient, have the potential to significantly transgress an individual HCW’s core values and their psychological and emotional wellbeing.”

Ms Ní Bhriain said: “That said, clinicians should be able to discuss death, dying and end of life care in a sensitive and non-judgmental way.”

She says: “Conscientious objection should be enabled as part of any legislation.”

She also says there would need to be “robust and commensurate safeguarding measures” to support any person considering assisted dying.

“It is the conclusion of the senior clinical group in the HSE that there are significant supports, both legal and medical, in place in Ireland to enable people to die in a dignified way.”

She adds: “The importance of will and preference is now enshrined in law. People do have a right to refuse life-sustaining treatment and there is access nationally to palliative care services.

“The Draft Palliative Care Policy will further enhance and embed palliative care across the spectrum of healthcare provision in Ireland. Legal protections also form a strong part of other areas of clinical care, such as the Mental Health Act.”

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