Dealing with death

THE REPORT of the Forum on End of Life has brought a sharp focus to how we treat death, dying and bereavement. The report is published today with draft proposals for making Ireland a better place in which to die. The Irish Hospice Foundation, which initiated the project, has recorded the opinions of – among others – illness groups, religions, older people, children’s interests, funeral firms, emergency services, doctors and nurses, architects, human and legal rights bodies, chaplains, statutory bodies, gays and lesbians, Travellers, educationalists and suicide support services.

One pivotal view is the need for a national end-of-life strategy to permeate every aspect of Irish life. As is clear from the submissions, death issues are not just the business of doctors and nurses. There needs to be regulation and high standards in the funeral business, in domiciliary care services, in bereavement and spiritual care, in mortuaries and in the treatment of remains after death.

Equitable distribution of palliative care services is also required. Single rooms should automatically be available to people who are dying in hospital. Indeed the new national council of the forum, which will work on the issues highlighted in the report and the draft action plan, could tackle the recurring issue of where and in what circumstances people die. With imaginative planning many more people could die at home rather than in overcrowded hospital wards. Some nursing homes too could desist from inappropriately sending elderly dying patients to emergency departments.

Behind all of these and other forum themes there is a human rights and legal underlay. As the draft action plan says, decisions made at end of life by patients, their families and health professionals need to be transparent. There need to be protocols, regulation and good practice. Issues such as advanced care planning, the communication of options to patients, and nationally agreed procedures and guidelines for “Do Not Resuscitate” orders should all come under the national council’s ambit.

Encouragingly, as the National Audit on End-of-Life Care in Hospitals indicates, Ireland is as good as other countries in hospital end-of-life care. The forum has highlighted the need for everyone to engage with issues pertaining to death. Its report and action plan have given a valuable framework. The national council and its chairwoman, Mrs Justice Catherine McGuinness, will hopefully encourage a continuing discourse on death. It should not be a taboo subject.