The Ombudsman's reflections on end-of-life care will hopefully add momentum to the gathering debate on how we deal with death. In his report, A Good Death, A Reflection on Ombudsman Complaints about End of Life Care in Irish Hospitals, Peter Tyndall continues the interest of his predecessor, Emily O'Reilly, who had highlighted failures in the care of dying people. The Irish Hospice Foundation (IHF), and other campaigners, will not be surprised to hear yet again that poor communication is often at the core of complaints about the care of dying relatives, and indeed about how family members are treated when a loved one dies.
Misunderstandings about a spouse's cancer, the withholding of critical information, and a lack of understanding about "Do Not Resuscitate" decisions, can add to the grief of bereaved relatives. In these, and many other cases, there is often a gap, as the report says, between the message professionals intend to give and what relatives understand. At the report's launch, the IHF's chief executive, Sharon Foley, said the silence about dying had to be broken. There had to be a national palliative care, end-of- life and bereavement strategy to put the needs of the dying higher up the agenda. As the report says, "if something goes wrong with the care provided at end of life, nothing can be done to put matters right for the person most affected. The impact on the bereaved can also be traumatic and lasting."
How we deal with death is a measure of our society. Relatives being given the soiled clothes of a deceased loved one in a black plastic bag, lack of privacy during the final hours with a dying spouse, unexplained postmortem decisions, or remains being treated without respect diminish everyone. However, the current report and successful initiatives such as the Hospice Friendly Hospitals Programme, the Forum on End of Life, and the Think Ahead project should help promote a national discussion on what it means to have a “good death”.