Ireland needs end-of-life strategy

  • Deborah Condon

Ireland needs a national strategy to deal with the sensitive issues of death, dying and bereavement, according to a new draft action plan.

End-of-life care, advanced care planning and palliative care are just some of the topics raised in the report of the Forum on End of Life in Ireland, an initiative of the Irish Hospice Foundation.

The forum was launched last year and marked the first time that any country has asked its citizens to state their views on death and dying. It sought to identify what matters most to the public at the end of life from a wide range of perspectives, including social, economic, legislative, cultural and religious.

The Forum has now drawn up a draft action plan, which deals with many social, ethical, medical, administrative, policy and spiritual issues. It gives a clear guide as to what people in Ireland believe are the issues at the end of life and stresses that these issues are everybody's business.

The draft action plan proposes a campaign of openess and transparency in the way end-of-life desicions are made. It said that such a campaign could focus on:
-Advanced care planning based on patient participation.
-Good communications practice by staff to deal with often difficult conversations.
-The preparation and observation of nationally agreed procedures and guidelines in relation to ‘Do Not Resusciate' orders.

The plan calls for discussions to take place specifically on the issue of advanced care directives (ACDs). Sometimes known as a 'living will', an ACD is a statement about the type and extent of medical or surgical treatment you want in the future, on the assumption that you will not be able to make that decision at the relevant time.

The plan states that such discussions should look at what constitutes basic care, palliative care and life-sustaining treatment and also the process for putting in place a ‘Do Not Resuscitate' order.

In relation to palliative care, the action plan points to a number of recommendations made to the Forum, including the provision of adequate resources to community hospitals in order to provide more palliative accommodation and services closer to people's homes.

It said that palliative care should be provided to anyone who needs it in their home on the basis of need. Meanwhile those in community care should have access to consultant-led palliative care.

The draft action plan stresses the need to enhance end-of-life education and training. Another constant theme of the Forum was the contrast between people's preferred place of death (usually at home) and their actual place of death, (usually in a hospital or other institutional setting).

It noted that there are different reasons for this, ‘including the availability and affordability of community and palliative home care services'.

"Pending the introduction of the statutory entitlement to palliative care, it is recommended that the action plan include provision to campaign for a medical card for everyone with an advanced incurable illness and/or for a palliative home care package, or its monetary equivalent, for those being cared for at home," it said.

It is also suggested there should be a campaign to encourage people to make a will.

The public is invited to comment on the Forum report and draft action plan from Monday, May 17 until Friday, June 18. For more information, see




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