DYING IS more than a medical event. Innumerable ethical issues surround it and general end-of-life care. There is a reluctance sometimes to face many of these, even to realise that there might be questions of ethics involved. This is not to say that there is an unwillingness to be ethical. Ethics is a component of medical courses and the majority of healthcare professionals are conscious of the sacredness of death as an inevitable conclusion to life’s experience. But a weakness of focus has been apparent.
Hospital staff can have varying stances and protocols on “do-not-resuscitate” orders, on providing patients with information and on consent. Research shows the public is unfamiliar with many of the terms and issues involved. A recent Seanad debate on end-of-life care reflected the often uneven level of public discourse on such matters. There is some reluctance, too, to accept that Ireland is not immune to the controversies surrounding assisted suicide and euthanasia.
The Irish Hospice Foundation’s National Audit on End-of-Life Care reflected well on the quality of such care but it exposed many problems. Among these was the disinclination of medical staff to make decisions to stop invasive treatments of dying people. How often does technology’s availability lead to futile treatment, sometimes at immense discomfort to the patient? When is it appropriate to tell someone they are dying? How is a patient’s autonomy respected? Is it ethical to withhold nutrition and hydration?
These are among the topics tackled in an Ethical Framework for End-of-Life Carewhich was published yesterday in Cork for the Irish Hospice Foundation's Hospice Friendly Hospitals Programme. The framework – compiled in collaboration with University College Cork and the Royal College of Surgeons in Ireland – has had inputs from clinicians, sociologists, legal experts, theologians and ethicists. It draws on national and international research; is aimed at health professionals, patients, families and the general public; and is instructive in recognising the complexity of many situations.
The framework performs a valuable public service in highlighting issues such as managing pain, confidentiality, governance in clinical care, breaking bad news, healthcare decision-making and life-prolonging treatments. In that regard, it should encourage open public debate and enable healthcare professionals to be collaborative, informed and confident in addressing these matters, however complex and contentious.