WHEN IVAN Illich with his stern take on western medicine referred to the medicalisation of death, he touched a troubling sore. Medicine had in a sense lost its soul. It had become fixated with labelling diseases, with the implication that there was a cure for all ills.
Without that cure, medicine had failed and doctors had met the ultimate act of consumer resistance. No longer was death seen as a natural event, one that affects up to 30,000 people in Ireland every year. Society had lost the ability to accept dying and death as meaningful aspects of life and was entering the world of futile treatments and inappropriate resuscitations.
These and other issues will be highlighted at a conference in Dublin in October organised by the Forum on End of Life which is a project of the Irish Hospice Foundation. It will provide an opportunity to take stock of whether Ireland has improved its ability to deal with dying, death and bereavement. Has progress been made, for example, in ensuring that more people have the choice of dying at home rather than in hospitals or nursing homes? A national audit on end-of-life care in hospitals showed that about 25 per cent of them could if there were proper supports.
Participants may also scrutinise whether there have been sufficient advances in ending inequalities in the distribution of hospice care, and whether the Government will follow through with a five-year framework for palliative care. It will be hard for the Department of Health to gainsay persuasive evidence that increasing palliative care provision is not only better for patients and their families, it can be cost neutral or save money.
The funeral industry – where the forum’s national council has been seeking reform – also merits public discussion. In Dublin the average funeral costs €5,000, leading to suggestions of insufficient competitiveness between undertakers. Despite many good operators, an unregulated industry fails to inspire confidence. The forum has urged the Government to set up an office to regulate the sector, with frequent inspections of facilities and enforcement of mandatory training for funeral personnel. It is wrong that embalming, for example, can be carried out without training.
However, some advances in how Ireland deals with death have to be noted. The new children’s palliative care programme, the primary care-palliative care initiative, the Final Journeys project and the new ethical framework for end of life care, are all helping to ensure that more of us will have a good death.