Why all over-70s should have a chance to talk about end-of-life care with their GP

Prof Brendan O’ Shea

Kildare-based GP, assistant adjunct professor in public health and primary care at Trinity College Dublin and board member of the Irish Hospice Foundation

About 35,000 people die in the Republic of Ireland each year. As a GP, it appears to me that some people are very well prepared for what is usually a predictable event, others are somewhat prepared, and a substantial minority die full of uncertainty and in distress.

One factor that I believe would make a difference is if individuals who are dying have a good opportunity to discuss their end-of-life-care preferences. If this can happen, preferably before they become terminally ill, then it is more likely that their care preferences are clarified and acknowledged. When these issues are discussed openly, it also allows important issues between them and their family and friends to be resolved. But if they don’t have this opportunity, their care preferences and these unresolved issues can really add to the distress and pain associated with their dying.

As a society we have already given much thought to this. One of the requirements for clinicians from the Assisted Decision-Making (Capacity) Act 2015, which is just about to become law, is that GPs, medical consultants and nurses now have a duty of care to discuss with patients their end-of-life-care preferences, to document these and, as far as possible, to ensure they are acted on.

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Many doctors are getting better at having these discussions. But one small change that could make a difference would be to ensure that all individuals approaching the end of their life would have an opportunity to have this discussion, and preferably well before they become acutely unwell, while they are better able to engage in the discussion.

Following the Forum on End of Life (2010-2012), the Irish Hospice Foundation developed and supported the use of Think Ahead, which is, among other things, an end-of-life planning tool. Think Ahead has become a popular aid to facilitating end-of-life discussions, and the IHF issues about 2,000 copies each month.

My concern, however, is that these discussions are not yet happening consistently and, for most people, in a timely manner. The one small change that I would like to see is that everyone over 70 has an opportunity to have this discussion with their GP. A minority will opt not to have the discussion, but many more will usefully have the discussion. The discussion could be supported with Think Ahead, or indeed any other equivalent materials, of which there are many.

• As our health system begins to return to normal activity levels following the Covid-19 pandemic, we would like to hear about one change you would like to see. It can be something simple that annoys you, day in, day out, that is easily fixed, or it can be a small change in practice or attitude that would make life easier for everyone. Email health@irishtimes.com with your suggestion or fill in the form below