PRESIDENT MARY McAleese set the right tone when she officially launched the Forum on End of Life in Ireland last week. The target she said was to bring end-of-life and palliative care in Ireland to a level where each of us can die without dread. We cannot escape death, but we can ensure that in the words of Dylan Thomas, “death shall have no dominion”. Death does not have to be a triumphant enemy. It robs us of life but this does not mean it should deny us hope, dignity, peace, love, ease and comfort. As the President said on a previous occasion, we can ensure that everyone has a “caring, careful death”.
The task is immense. Dr Maurice Manning, the Irish Human Rights Commission president, who addressed the forum, put it well. We have to move from safe to difficult ground, from the profound to the practical, from prayers and poems to policy and planning. To do this there needs to be a framework. But before that it is vital to discover the views of organisations and individuals. This is why the Irish Hospice Foundation deserves plaudits for setting up the forum. It is a listening exercise, the start of a national conversation.
When this conversation formally ends, an agenda for action will be developed in 2010. This will aim to make Ireland the best place in which to die. Such an agenda will be all the stronger for being based on the experiences and expertise of individuals and groups who regularly encounter issues of death, dying and bereavement. We might then have some idea why there is so much reluctance to discuss death. We might learn why public policy which espouses a “life events” approach in addressing social need, fails to address adequately the experience which faces everyone – end of life.
Some views and concerns began to emerge at discussion groups following the forum opening. It was said that the beliefs of non-religious people can be ignored, that a patient’s personal autonomy might not be recognised, and that there can be scant awareness of different cultural needs. There was concern about poor discharge planning from hospitals, an emphasis on the need for single rooms, and worries about the ability of staff to communicate with dying people and their families. The failure of many people to write wills and to indicate their wishes in advance in regard to resuscitation were other concerns. The difficulties for same-sex partners when one of them is dying, and the need for education on end-of-life matters also arose. These and numerous other issues are now filtering into this unique national discourse, which is open to all.