AS WE plan for life, we should plan for death. Because although dying is part of life, it is often regarded as a peripheral event. And as such it has been treated as a poor relation within our health services and by the wider public as little more than a passing theme, generally ignored until the inevitable happens.
However, there are encouraging signs of change. Among them is the endorsement by the Health Information and Quality Authority of the work of the Hospice Friendly Hospitals Programme in relation to the development of standards for end-of-life care in hospitals. A new consultation document has set a benchmark for best practice in relation to end of life care provision, allowing families – and those who are dying – to know what they can reasonably expect from hospitals in terms of service provision, support and quality of care.
Most importantly, those who run hospitals and long-stay institutions – where 75 per cent of us die – will know and, hopefully, will be trained to adhere to the standards and to respond to the needs of those who are dying and to their families. The challenges are immense but surmountable. As the draft document states, there is no national end-of-life care strategy and no standardised measurement of whether there has been a “good death”. Among many other gaps, pressure on emergency departments is excessive and palliative care services are insufficient.
Advanced care directives or living wills, competency to make decisions, resuscitation, clinically assisted nutrition and hydration, organ donation and transplantation are all critical issues, as the consultation document states. They deserve proper public debate and, while the document has been shaped in the context of Irish law, professional ethical responsibilities and every person’s right to life under the European Convention on Human Rights, the debate cannot expect to be untouched by calls for the legalisation of assisted euthanasia. No doubt the palliative care movement will prepare a trenchant rebuttal.
With these issues in mind, the public is being encouraged to give its view on all aspects of end of life at a series of public meetings throughout the country. The Dublin event, at the Royal Irish Academy this evening, will concentrate on the financial costs of death: funerals, pensions, welfare support, and nursing homes among them. It is run by the Irish Hospice Foundation’s Forum on End of Life, which is garnering the views of citizens on dying and death. It deserves success.