Holohan calls for ‘honest conversations’ about end-of-life between doctors and patients

Healthcare professionals need to have “honest and open” conversations with patients who have life-limiting or incurable conditions about what are reasonable goals for their treatment, according to former chief medical officer Dr Tony Holohan.

Where a cure is not realistic or the prognosis is limited, a clear explanation of choices available to the patients is a prerequisite, he said.

Dr Holohan was speaking on Tuesday at the publication of an Irish Hospice Foundation guide to putting your affairs in order before end-of-life. Last month, he was appointed to the board of the IHF.

Legislation to give legal standing to advanced healthcare directives — instructions from patients about their future care — will mark a significant step toward the widespread use of these directives, he pointed out.

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However, more needed to be done to “normalise” the completion of advanced healthcare directives by patients and their families, including training for healthcare professionals and patients in their use.

Dr Holohan urged families to have “kitchen-table” conversations about end-of-life care long before death is imminent, just as they make wills in advance.

“Starting a conversation about end-of-life care and dying isn’t always easy but it’s so important for us all to make our wishes known on both our healthcare and personal affairs. It means there’s no ambiguity for families and loved ones, our wishes are met and there’s great comfort in that for all involved.”

Dr Holohan’s wife, Emer Feely, died in Our Lady’s Hospice, Harold’s Cross in February 2021 after a long illness.

As a public health doctor, Emer was passionate about the need to improve services for people who were dying and their families, he said. She was also concerned about number of people who were dying in hospitals rather than more appropriate settings.

“As a result, we had many conversation about palliative and end-of-life care at that time in our lives. Little did either of us know just how much a part of our lives palliative services would become.”

His wife sought palliative care from the time of her first hospital admission in 2012. “We kept communication with each other, with our children and her medical teams at the centre of our priorities. As a result, a very difficult situation was eased through openness of communication and us having the capacity and confidence through our prof experience to navigate those conversations.”

Dr Holohan retired as chief medical officer at the start of July after 14 years in the position.

After announcing his intention to leave the role earlier this year, a position in Trinity College Dublin was to be created for him as professor of public health strategy and leadership.

The proposed appointment caused significant political controversy after it emerged his €187,000-a-year salary would be paid by the Department of Health on an open-ended secondment arrangement. Dr Holohan later deciding against proceeding with the academic position in Trinity.

In July, he was appointed to an adjunct professor position in University College Dublin (UCD).