Planning for the end

 

NEARLY 30,000 citizens die each year, leaving perhaps ten times that number bereaved. Yet we are often reluctant to discuss death as a policy issue, one that requires not just compassion but planning, protocols, and training. Irish funeral rites and customs, traditional hospitality, and neighbourly kindness can hide the considerable gaps in how we deal with those who are dying.

Ensuring dignity at end of life should be a core societal value. Our going out should be deemed as important as our coming in. Yet there has been a reluctance to debate death, even among health professionals whose focus on curing can deflect attention from the dying.

This reluctance is abating however. Largely through the Hospice Friendly Hospitals and Final Journeys initiatives many hospitals have hugely improved how they deal with death. The Forum on End of Life, which has been organising discussions on Do Not Attempt Resuscitation orders and organ retention, has enhanced debate on death issues as has the Think Ahead project, and the Oireachtas is finally dealing with advanced healthcare directives.

Campaigners for good end-of-life care will be encouraged too by comments at the Dublin international conference on emergency medicine. Dr Una Geary, of the emergency medicine programme, stressed the need for more end-of-life planning, how it would save considerable money and heartache. Prof Matthew Cooke, the British national clinical director for urgent and emergency care, said “we should not let people get to the end under the fluorescent lights of an intensive care unit”.

He was responding to an observation that many elderly people in emergency departments are being medicated and kept alive with no prospect of recovery, and at high cost. As an Irish Hospice Foundation audit has shown, up to 25 per cent of people could die at home rather than in hospital if there were sufficient supports. Most people want to die at home, but most meet their end in hospital. A good health service would respond to such patients wishes with imagination and planning.

And there is an economic argument for appropriate end-of-life care. Palliative and hospice care can save money, removed as it is from intensive, expensive and over-medicalised hospital procedures. Death is not just a health or indeed a religious issue. It involves sectors as diverse as family carers, funeral directors, chaplains and legal professionals as well as health workers and their educators. It is a societal matter needing planning and standards monitoring.

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