An Irishman's Dia

Tallaght and Beaumont hospitals have waiting lists of 809 and 659 long-term patients respectively

Tallaght and Beaumont hospitals have waiting lists of 809 and 659 long-term patients respectively. The crisis in the Mater Hospital means there is no recruitment or new training, and in the past week it has lost 70 beds. It's all terrible, and you'd better get used to it, because that's the way it's always going to be, writes Kevin Myers

Writing about the realities of unhealth actually isn't easy if you're a reasonably healthy person like me who has only ever been in hospital with flowers in my hand - apart from a few rugby injuries and once to say goodbye to a small, benign growth.

For anything I say that defends our health system will sound heartless, for I'm not ill.

Here follows a key word. Yet. But I will be. And just as certain as that certainty is that other certainty that state medical systems will ultimately fail their clients. For all over Europe, medical services are being overwhelmed by the expectations generated by our insane welfare state culture.

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It is not economically or organisationally possible to keep pace with these ludicrous expectations, even in a demographically balanced society. But demographically balanced societies don't exist anywhere in Europe. In Ireland, as elsewhere, the baby boomers are less than 10 years away from retirement: they are the débâcle unleashed downriver by that end-of-war sexual orgy.

It will not be possible to give all these people the hips they want just when they want them; the bypasses when they need them; the chemotherapy when it is absolutely vital. Society cannot organise itself primarily around the requirements of the old and the sick and yet still retain a functioning, viable economy. You can't have a racing car with its own sun-deck and sauna.

The German medical system is the finest in Europe. It has superb everything: wonderful people, magnificent technology, a humane and caring culture. But the German economy is losing 400 jobs an hour; that's 24 factories a day. (And that's now, even before the consequences of Iraq take hold. Who wants to be a Mercedes or BMW sales rep in the US in six months' time?) And regardless of economic factors, the Germans will soon make the discovery that we are now beginning to make and the British have already made: there is no limit to the appetite of a health service. The pit is bottomless. Worse, look what's hurtling downstream: the dam-burst of baby-boomers.

As one of that generation, in the past 10 years I've seen many parents of my generation go to their end. It has been perfectly barbarous. Patients with terminal cancer have been zapped with chemo, with the only possible outcome being a slightly deferred death and an infinitely more agonising life, when an earlier, managed death would have been infinitely preferable. The incontinent have endured infinite humiliations, made worse because their loved ones have had to clean up after them: not once, but repeatedly, not just for a day or a week, but over years.

No state can ameliorate the sense of despair and degradation old people feel in these circumstances. No state can ameliorate the guilt children or spouses of Alzheimer's victims feel that they can no longer endure the delirium, the chaos, the filth.

We have to accept that assisted voluntary death is a natural right - not merely because of the unbearable burden the old will one day be on their families and on a society which simply can't and won't cope, but also because of the insufferable burden the old will be on themselves.

Cue the morally righteous, shouting about thin end of the wedge. Cue the cries: what about those pressurised into early death? Reply: No system is perfect. But the present one is grotesque and cruel; and if you think it's bad now, hang around for 25 years or so. Then you'll really discover the meaning of horror, as scores of thousands of former baby-boomers become doubly incontinent, gibbering Alzheimer-boomers. Put them in homes, maybe? What homes? You won't be able to get the staff for such work very soon.

Premature, medically arranged death already happens. If you're "lucky" enough to have terminal cancer, you can be given "pain-killing" drugs whose real purpose is to kill you. That's how many people now assist the passing of loved ones who are in torment with terminal cancer: they administer large doses of Brompton Cocktail - with the tacit, but carefully unspoken approval of their GPs. Nobody complains, and nobody inquires.

Non-cancer victims - Alzheimer's sufferers, and those wretches with acute, observing minds marooned within worthless, disobedient bodies - have no such pretext or subterfuge for merciful death. They who need to die, but have no terminal condition to provide the pretext of hastening the inevitable, are allowed no lawful exit.

There is a dogma at work here: a cruel, vindictive and triumphant moralising over the gibbering and the helpless, who endure hell, and who know death is the only escape. But barbarously, that is the one option that they are denied.

It's possible to create the legal mechanisms - a living will, which authorises the implementation of death - and the technological ones - terminal drugs for the doomed in agony or the hopelessly dependent - to enable us to bring life to as painless a conclusion as possible. We have to unclog the system of the slowly dying, and to let those who need it to find death with method and dignity. But first, we have to remove the taboo on talking about it.