Unfairness in death
Dying patients need a special type of care and comfort. These words encapsulate the philosophical thrust behind a forceful report from the Irish Hospice Foundation which highlights stark inequities in specialist palliative care services throughout the State. Where a person lives can decide whether they have a “good death”, whether there is a positive approach to the quality of their life at end of life, and whether suffering is relieved and families are supported through bereavement.
Unfairness in Irish health service provision may be endemic but it becomes particularly poignant when death approaches. As Access to Specialist Palliative Care Services and Place of Death in Ireland charts, about 2,500 patients are denied admission to hospice beds annually because of regional disparities in hospice care resources. This is despite a national policy that there should be one hospice bed for every 10,000 people. Based on the current population there should be 450 hospice beds. There are just 200, and 44 of these are not operational.
Three regions, the North East, the Midlands and South East as well as Wicklow, Mayo and Kerry have no hospice inpatient unit with only the Mid West and North West coming close to providing one bed per 10,000 people. However, the report is not just about in-patient beds: a pertinent theme is hospice home care, its value in keeping patients out of expensive acute hospitals and most important in allowing people to be cared for at home which is where the research shows most want to be at end of life.
Comprehensive in-patient units providing home and day care, respite, out-patient clinics and multi-disciplinary services allow patients to access care as their condition requires. According to international experience, such services can also reduce health expenditure. The report aptly concludes, no one should have to face death or bereavement without the care and support they need. Regardless of where people live, they should be enabled to face the end of life with dignity, comfort and choice.