Dr. Paul D'Alton:

Dr. McQuillan has raised some important issues which arise in my clinical practice when working with LGBT patients towards the end of their lives. This connects with what Dr. McQuillan stated about people's experiences of religious institutions and religious education. At the end-of-life stage that notion of a very vengeful or judgmental God can become very active. Many patients are dying in hospitals or hospices that are run by Catholic organisations. This is going to become more of an issue in the future when women who spent much of their lives in Magdalen laundries and will come to die in facilities run by organisations that may have been involved in their earlier treatment.

On the cult or tyranny of the positive, this issue has major implications for people's psychological well-being. It also has huge implications with regard to the culture of death in this country. There is a pseudo-psychological belief that one's attitude will change the course of one's disease. That is simply not true. There is no conclusive evidence which indicates that one's mental state will change the course of one's disease. However, this belief has gripped people and, quite frequently, leads to their becoming isolated. Members of the same partnership or family often become terrified of opening up a conversation as a result of the belief that if someone observes that matters are not going so well, it will have an impact on the course of the disease. We need to be very careful about the language used. One sees evidence of this in newspapers all the time. If someone well known dies, it will be stated he or she lost his or her battle or gave up the fight. We need to be very careful about such language and also about the term "keeping positive". The language to which I refer creates a psychological experience, which is often one of isolation. To return to what I said, we know that in creating a culture where people die well we must ensure relationships are maintained. Relationships are what keep people well and all of the research indicates this to be the case. The cult of the positive interrupts this. We, therefore, need to be very cautious.