Dying: breaking a taboo

Up to 12 per cent of total healthcare budget spent on care in last year of life


A survey by the Irish Hospice Foundation (IHF) highlights people’s concerns around end-of-life issues. It found that most people want to be pain-free, to be treated with dignity, and to die comfortably at home. Dying alone, the risk of poverty at the end of life and concern for family left behind were among specific concerns mentioned by the 2,600 people surveyed.

Speaking at a conference at which the survey was published, retired Supreme Court judge Catherine McGuinness said that as citizens and as a society we need to break the taboo that surrounds death. She called for effective systems to be put in place to enable people to be personally more responsible in planning for death.

Pointing out that “up to €1.3 billion is being spent on end-of-life care and we don’t know whether it is being spent wisely”, she said that in the next 10 years more than 300,000 people would die in Ireland and three million would be bereaved.

Prof Jenny Kitzinger of the University of Cardiff told the conference one in three people would lose the ability to make their own decisions at end-of-life. And, significantly, she noted there was concern surrounding treatments and tests administered to older patients who are dying when it will make no difference to their survival. Almost one-third receive inappropriate cardiopulmonary resuscitation while some 42 per cent are admitted to intensive care units. Research also confirms that one-third of older people are questionably treated with chemotherapy in their last six weeks of life. With up to 12 per cent of the total healthcare budget spent on care in the last year of life, the issue is clearly one of economic as well as ethical relevance.

Mrs Justice McGuinness urged people to fill in a Think Ahead document, which records care preferences in the event of emergency illness or death, when they cannot speak for themselves. The IHF plans to bring a Charter on Dying, Death and Bereavement to Government. As a progressive step forward, it should be acted on.