End-of-life rights merit as much debate as those of unborn

Nursing homes must focus not just on keeping us alive but keeping us happy

The residents are kept physically safe, they are fed and watered and generally  staff act kindly. With rare exceptions, nursing homes are not examples of places filled with joy; there is not much life to be found in them. Photograph:  Jonathan Brady/PA Wire

The residents are kept physically safe, they are fed and watered and generally staff act kindly. With rare exceptions, nursing homes are not examples of places filled with joy; there is not much life to be found in them. Photograph: Jonathan Brady/PA Wire

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In all probability at some time during 2018 Irish citizens will be asked to vote on whether or not to remove the Eighth Amendment to the Constitution. Right now advocates on both sides are preparing to debate the issue with a great deal of passion.

I find it interesting that we are so passionate about life at its beginning and so disinterested in life in its closing stages. I question how we care for those, the elderly, who are approaching the end of life.

The 19th-century American poet Ralph Waldo Emerson said “it’s not length of life but depth of life that is important”. I would add that quality of life is of vital importance. Quality of life is something sadly lacking from the lives of many older people, especially those in our nursing homes.

The residents are kept physically safe, they are fed and watered and generally the staff act kindly. With rare exceptions, nursing homes are not examples of places filled with joy; there is not much life to be found in them.

Medicine has made great progress during the past 100 or so years. People are healthier; average life expectancy has increased by several decades. Doctors do all they can to prolong the life of their patients.

However, the medical profession needs to recognise that there is a time to allow life to come to its natural end. To be truly alive, there needs to be more than just a heart that continues to beat.

Fear of death

I visit a relative who lives in a nursing home; she has been there for about eight years. When she was younger she and I used to have deep conversations about the meaning of life. She was always completely honest and she did not fear death. I know that she hated the thought that one day she would experience the life she now has.

Existing bed-ridden in a nursing home was her great fear. What she feared is now her reality. She is notorious for not taking enough liquids so throughout the day the staff monitor her intake of fluids and they nag her to take drinks she doesn’t want.

Perhaps her aversion to drinking water or even a cup of tea is that these drinks are thickened to the consistency of wallpaper paste. If she were to drink ordinary unthickened fluids, they would probably get into her lungs and cause infection. Would it be so terrible if that were to happen?

While staff encourage her to drink, they remind the other residents to stay sitting in the chair “in case you fall”. There is no time to coax her into conversation. She has lost her speech through lack of use, she has little sight and her hearing is impaired. And all the while the television blasts noise into the room.

Dancing and pets

I know this situation is not unique, it is repeated in most nursing homes. Recently I visited someone in temporary respite care. There were loud televisions in the bedroom and in the sitting room. Lights were left on all night and staff insisted that the client did not get out of the chair without assistance. As someone involved in caring for the elderly remarked, “clients enter the system mobile and continent and leave immobile and incontinent”.

I wonder how things would be if nursing homes and respite care facilities, banned television? How would it be if they put on some dance music and got the residents up to dance? What if they woke the residents up early and took them outside to hear the dawn chorus? What if they filled the homes with pets and if they arranged exchange visits with the local school? What if they gave the patients the pleasure of a drink of water or tea?

The homes would be less hygienic, there would be broken bones from falls there would be more pneumonia; residents would die a bit younger; but there would be life in the somewhat unhygienic mess and the chaos. Choose life!

It is not the length of life that is important, it is its depth and its quality that are important. Life is after all a terminal experience.

Rev Bridget Spain is minister at the Unitarian Church on Dublin’s St Stephen’s Green

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