Ms Orla Keegan:

The point has been made that religion can work in two ways - that it offers solace to some people who have been bereaved, while others have a sense of being abandoned. It is not a one-on-one cause and effect scenario.

The other point is related to the model of bereavement support that is primarily provided in the community. Many of the voluntary bereavement support structures in the community have religious roots, which is appropriate provided people are aware of it. Some will opt to use a support and befriending service, rather than a counselling service that has a religious ethos. I can link this with the theme of nursing homes and the general work we are doing, through the Irish Hospice Foundation, in residential care settings in examining how end of life is approached in such settings. One of our programmes is entitled, What matters to me, and, again, it does not make assumptions. The person is approached with a view to finding out what is important to him or her in respect of religion, spirituality or other matters.

The issue of miscarriage is very important as it is a loss that can revisit people in later life. It is not only a matter of how that loss is managed through our communities and health systems. In terms of maternity hospitals, only the specialist hospitals take a formal, resourced approach to dealing with miscarriage and pregnancy loss. Much work needs to be done in this area. The maternity hospitals and units recently met as a network to share information on what they were doing well in this area and what additional support they required. Research carried out in a rural Irish hospital and recently published in the British Journal of Social Work shows just how excluded mothers who have experienced miscarriage and pregnancy loss feel. Hidden grievers, although primarily mothers, also include fathers. This issue is very much worthy of note.

On the issue of research, some longitudinal research studies are taking place in Ireland. Two studies, the Irish LongituDinal Study on Ageing, TILDA, and Growing Up in Ireland, provide an opportunity to trace the natural course of loss and bereavement. We could probably do more on this issue and in our approach to dying. Rather than recruiting people to participate in studies when they are in particular circumstances, it is preferable to include their views and experiences as they occur.