END-OF-LIFE issues get little political attention. Nearly 30,000 people die annually in Ireland and perhaps ten times more are bereaved, yet politicians have been slow to articulate their policy positions on something that at some stage concerns everyone. Despite many gaps, Ireland has achieved high international rankings for hospice and palliative care but there is much more involved in end of life and the issues go beyond the medical.
That is why the National Council of the Forum on End of Life has urged the next government to prepare a national strategy on the subject. It wants wider recognition of the social, economic, emotional, philosophical, spiritual and environmental dimensions of dying and death. In particular, council chairwoman Mrs Justice Catherine McGuinness has highlighted the continuing unregulated nature of the funeral and cremation industry. The council advocates professional, regulated, inspected and fairly priced funeral provision and it wants mandatory training for embalmers and other funeral staff.
Despite the good work of the Irish Hospice Foundation in relation to end-of-life issues, it is clear that much of the thinking on the subject will only change with the development of a broad strategy. The same applies to how the State responds to people in older age. This has prompted the Older and Bolder organisation to call – again – for a positive ageing strategy.
Everyone deserves a good death and proper planning should help to bring that forward. One theme running through the recommendations from the End of Life forum is the scarcity of considered thinking on matters relating to death. In this regard, political engagement is critical to making Ireland a better place in which to die.
As the council says, this would involve education on end-of-life matters, care being available regardless of a person’s disease or location, enhanced facilities where people die and round-the-clock support for family carers, with respite arrangements.
Legislative changes would be welcome also with the reintroduction of the Coroners Bill, and the Mental Capacity Bill to include provision of end-of-life care preferences and “advance care directives”. The council also points to the failure to establish national guidelines on “do not resuscitate” orders.
These proposals, and the call for automatic medical cards for people with advanced incurable disease, deserve political attention.