Physician-assisted suicide and euthanasia (PAS-E) is not compatible with good medical care and its introduction in Ireland could place vulnerable patients at risk, the College of Psychiatrists of Ireland (CPI) has said.

PAS-E, which is also known as assisted dying, is due to be the focus of a special Oireachtas committee set up to examine the Dying with Dignity Bill (2020) in the New Year. Ahead of this, the CPI has published a position paper, which sets out some of the key issues related to this controversial topic.

According to the paper, PAS-E is contrary to the efforts of psychiatrists, other mental health staff and the public to prevent deaths by suicide.

It is also likely to place vulnerable people at risk. The paper noted that many requests for assisted dying are linked with issues such as fear of being a burden, depression and loneliness rather than from intractable pain. It called for an improvement in existing services to manage such issues.

Meanwhile, the paper also noted that while PAS-E is often introduced for patients with terminal illnesses, once in place, it is likely to be applied more broadly to other groups, which would lead to an increase in the numbers availing of it that is above expectations.

Dr Eric Kelleher is a consultant liaison psychiatrist and a contributing author on the paper. He said that psychiatrists are “acutely aware of the sensitivity of this subject” and they support the fact that dying with dignity is the goal of all end-of-life care. However, he believes that strengthening palliative care and social support networks make this possible.

“Not only is assisted dying or euthanasia not necessary for a dignified death, but techniques used to bring about death can themselves results in considerable and protracted suffering.

“With adequate resources, including psychiatric care, psychological care, palliative medicine, pain services and social supports, good end-of-life care is possible,” Dr Kelleher said.

According to consultant liaison psychiatrist and contributing author, Dr Siobhan McHale, experience has shown that once PAS-E is permitted in a jurisdiction, “more and more people die from assisted dying”.

“This is usually the result of progressively broadening criteria through legal challenges because if a right to assisted dying is conceded, there is no logical reason to restrict this to those with a terminal illness,” she added.

The position paper can be read in full here.