LOGIC SUGGESTS that the deaths of many people should affect us more than the death of an individual. But reactions to death are not logical. We are stunned and terrified by the sudden, random, meaningless extinction of Paddy Ryan-Corr's young life by a bolt of lightning. We are heartbroken that the shadow of death has fallen over the luminous intelligence of Nuala O'Faolain, writes Fintan O'Toole.
But we shrug our shoulders at the most appalling revelation about our country this year - last week's report from the Irish Heart Foundation (IHF) showing that between 350 and 500 people die unnecessarily from the effects of stroke, merely because services are "so poorly organised that they are largely ineffective". In this area alone, Government mismanagement is killing up to 500 people, year in, year out.
Let's put that in context. Even the lowest figure of 350 is higher than the total number of road deaths last year. The higher figure is more than the total number of people killed in west Belfast over the course of the Northern Ireland conflict. It is higher than the total number of deaths in the very worst year of that conflict (467 died in 1972.) It is higher than all the deaths in that conflict between 1989 and 1994, inclusive.
Yet while road deaths have led to large-scale Government campaigns, and the Northern Ireland conflict was treated as an international crisis, the slow, quiet extinction of hundreds of citizens by sheer neglect gets a day's news coverage and a collective sigh.
About 10,000 people enter Irish hospitals every year after a stroke. If we called these people Paddy or Nuala, we might imagine them as more than statistics.
They are mothers and fathers, brothers and sisters - each one of them is near the centre of somebody's world.
And there is, in theory, very good news for these people. From the early 1990s onwards, medical practice learned how to deal with their crises. By getting patients quickly into specialist stroke units, giving them the right scans and the right clot-busting drugs, their chances of survival could be massively increased. With all of those things and proper rehabilitation, these survivors could go on to lead normal lives.
Governments in developed countries got this message. They embraced it partly because they had a duty to their citizens, and partly because investment in stroke services actually saves money. People who come out of stroke units without serious disabilities do not go on to become a long-term cost on the health and social services. Figures produced in the late 1990s showing that each unrehabilitated stroke patient cost the health services £64,000 more than a rehabilitated patient persuaded governments that proper stroke care is both decent and smart. As with much else, Irish public debate was a little slow to pick up on this new international standard of care. But it has nonetheless been understood by the government for a decade now. And in 2000, the council on stroke of the Irish Heart Foundation (IHF) made detailed recommendations to the government on bringing Ireland into line with international practice. None of them has been implemented.
Irish hospitals should have at least 365 dedicated stroke beds. They have precisely 12. While over 90 per cent of hospitals in the UK have a stroke unit, one of 37 Irish hospitals (3 per cent) does so.
Only one-third of hospitals in the IHF study could even identify a lead consultant with responsibility for stroke care. There's a grand total of five clinical nurse specialists and two clinical specialist therapists working in stroke care nationally. And the use of clot-busting drugs is "almost nonexistent" - 1 per cent of patients received them.
There's a term for this kind of wanton, life-wasting neglect. Without being unduly emotive - if we can't get emotive about 500 deaths a year, we're in trouble - that term is "corporate manslaughter".
If you think this is over the top, look at the Government's own Corporate Manslaughter Bill of 2007. The crime occurs "where an undertaking causes the death of a human person by gross negligence". To be guilty, the body must owe a duty of care to the person - which is the case with a state and its citizens. And it must breach that duty, thus causing "death by gross negligence".
Death by gross negligence is exactly what we're talking about here. The issue is not primarily about money, but about mismanagement. The IHF report uses language like "haphazardly organised" programmes, and a patient's chances being determined by "a haphazard combination of circumstances". Since this issue first surfaced, Brian Cowen, Micheál Martin and Mary Harney have all failed to respond to the knowledge that systems for which they were responsible were killing people. Since the 2000 IHF report, this negligence may have killed as many people as the entire Northern Ireland conflict. But in all that time, only one kind of stroke mattered in Irish politics.