A matter of life and death we as a nation must discuss

The 'Dying with Dignity' Bill presents a chance for a discussion on a matter of crucial importance to us all, says Kathriona Devereux
A matter of life and death we as a nation must discuss

CARE IN THE FINAL DAYS: Kathriona Devereux spent six months as an observer at Marymount for a TV programme on the hospice

LIKE most people, I’ve sadly lost close family members over the years and have experienced the front pew view of the Irish funeral, facing the comforting repetitive ritual of handshakes and “sorry for your troubles” condolences.

The steady procession is sometimes broken by the appearance of a surprising face — the person you didn’t necessarily expect to see at the funeral but whose presence conveys a deep acknowledgement of your loss and their respect or love for you or your loved one.

Those surprising kindly faces often dissolve any stoic demeanour, releasing a flow of tears, hugs and comforting pats on the back.

Sitting further back in the church as a mourner, I’ve listened to bitter-sweet eulogies and cried over friends gone too soon, or friends’ parents who were good people that raised kind humans. In Ireland, ‘showing up’ for a funeral is a demonstration of consolation and a huge part of the grieving process.

The pandemic has robbed the bereaved of so much comfort and consolation this past year. Now condolences are offered on webpages, or by hugging the perimeter of a church ground, or by clutching to the side of roads on the way to the graveyard. The community still turns up to console, but at a distance.

A few years ago, I had the privilege of making a documentary about Marymount Hospice when it was moving from it’s old building on Wellington Road to its state-of-the-art purpose-built facility in Curraheen.

We filmed with people in their final months as they went through the difficult process of dying and saw first hand the profound work palliative care teams do to make that process less difficult. We witnessed the medical, physical, emotional and spiritual support that is needed to help people who know they haven’t long to live and are trying to work out what’s important to do in the time that’s left.

What surprised me most was how the spirit of the hospice enables people with terminal diagnoses to live their lives meaningfully right up until their dying day, and the capacity of the human spirit to grow in the face of heartbreaking sadness.

The depth of care, understanding and empathy that hospice staff have mean patients and families are deeply comforted knowing that they are being minded and are in safe hands. Interestingly, some nurses had originally trained as midwives and had retrained later in life to become palliatives care nurses, considering palliative care to be a type of midwifery for the soul.

Spending six months in Marymount as an observer was an important life lesson that will stay with me till my own dying day. Which is why I have been following closely the progression of the ‘Dying with Dignity’ bill tabled by Solidarity-People Before Profit TD Gino Kenny and supported publicly by cancer campaigner Vicky Phelan. It proposes legislating for medically assisted suicide to allow people with terminal diagnoses to choose when and how they die.

In societies similar to ours, where Medical Assistance in Dying is legislated for, between 0.5% to 4% of all those dying choose and implement that option. There were 31,134 deaths registered in Ireland in 2019, so potentially between 155 to 1,245 people may request medically assisted dying should future legislation be implemented.

The Irish Hospice Foundation (IHF) believes the bill represents a “seismic shift in legislative terms which will impact on all areas of society” and particularly challenges the principle that palliative care ‘intends neither to hasten nor postpone death’.

The deadline for public submissions to the Committee on Justice was in January and the IHF believes there should be a comprehensive, in-depth debate on assisted dying in 2021.

In a letter to The Irish Times last year, the Irish Palliative Medicine Consultants’ Association said: “We are gravely concerned by any proposal to legislate for assisted suicide and euthanasia in Ireland.” They believe that dying with dignity already exists in Irish healthcare and have specific concerns about older adults, vulnerable patients and patients with mental health conditions

They said: “Many in our society don’t really know what dying is like, or how rare it is that severe pain cannot be controlled. Most people do not see that within the easing of physical, psychological or spiritual distress and addressing people’s fears, hopes, sadness and loss, the goal of palliative care remains to enhance the living of each life which often transforms the experiences of living, dying and bereavement for individual patients and their families.”

These are the words of doctors who lead the palliative care teams in Ireland’s hospices and hospitals and deal with the process of dying daily.

A meaningful and respectful debate is required and any future legislation will require significant scrutiny and interrogation and perhaps even a referendum. In the meantime, ensuring equitable access to hospice beds across the country continues to be a priority.

The Irish Cancer Society recently issued a call for more nurses to become part of their Night Nurses service which provides end of life care for cancer patients and their families in their own home. Demand for the service has increased dramatically as hospital restriction on visitors means more families are choosing to bring family members home to die.

“A nice way to go,” is a particularly Irish judgement of what could be called a “good death”. Enabling and protecting a “good death” will require a national conversation between us all.

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