Jillian van Turnhout (Independent) | Oireachtas source

I thank the witnesses for their comprehensive presentations to us. I will not touch on every presentation but a general thread running through them was the relationship between the staff, the patient and the relatives - the triangle, so to speak. Mr. Nolan spoke about staff being confident, competent and comfortable but my thoughts were about the patient and words such as "consent", "choice" and "control". Listening to what many people said, I believe we remove much of the control from the patients. Dr. Madden said that the patient is the expert. I wonder if that should be the title of our report in terms of putting the patient first and foremost.

This morning we are focused on the care element at end of life. Everybody focuses on the end of life and forgets the care element that is so important but there is an issue about control and the interaction with relatives. I agree with Mr. Nolan on the staff training issue but relatives also face a cliff edge and in that respect they do not know the vocabulary or whether they are taking the right approach because they do not necessarily believe that somebody is advocating on behalf of the patient. They often do the wrong thing in trying to do the right thing for their relatives. Do the witnesses have views on how we can raise greater awareness among the public in that regard?

That brings me to a specific issue raised about which I am concerned, namely, the "do not attempt to resuscitate" issue. I did not realise that the legal basis was unclear. Dr. Madden spoke about the issue of consent, and Dr. King raised it also, but because it is not clear my experience is that the relatives have to unnecessarily repeat the request, which can sound callous at a very sensitive time for the patient and the family. That aspect hit home for me. There has been talk about advanced care directives, and the issue of the timing of when those advanced care directives should be discussed arose. That is something we must take on board.

Dr. King gave us compelling messages on the human tissue Bill.

I agree strongly with Professor Twomey on the issue of single rooms. Having that space is important on so many levels in terms of the patient's dignity.

On the medical card issue raised by Ms Kelly, we have had discussions here with the Minister for Health and representatives of the Health Service Executive about the six months aspect. Effectively, a patient almost has to apologise for living more than the anticipated six months. We have heard of cases where the patient does not want it written on their form that their condition is terminal. The family and others may know but we all know people approach these matters differently and to have the word "terminal" written down can be distressing. A number of issues intermingle in that regard.

I thank the witnesses and ask them to reflect on some of the issues I believe are important. Relationships matter greatly. In terms of the chaplain service, I would consider providing facilities and spaces. I am sorry but I had not realised that the HSE employs chaplains. We need to examine all those inter-relationships with a patient.

My final point is about a concern I have that an allocated staff member deals with the death discussion. If a patient were to ask that question, my understanding is that all staff should be present, certainly from listening to what several witnesses said, including Mr. Nolan, and not postponing that discussion. It should not be done bluntly but there is a way to do it. When we are considering our report we must ensure that it is not about having designated people. It is too easy, when considering reports, to say we will designate people to do this and that because from what I am hearing we should be providing a seamless service. That is more of a commentary, Chairman.