Professor Cillian Twomey:

Deputy McLellan asked whether the percentages of deaths can change. First and foremost, nobody wants to die. If we were to ask somebody where they want to die, they would first say that they do not want to die at all. By that I mean that we do not really think about dying. It is kind of a taboo subject and people have very different and personal understandings of it. That is again an educational deficit that needs to be addressed. When people are asked where they would best like to die when they die, they all say they would like to die at home. That is nice and appropriate, but we must caution that sometimes it is not appropriate that they die at home because their needs are such that they need to be looked after in a separate environment. Even though Mr. Nolan provided the figure that five people will die today in a hospice, several people will die today at home who are part of the specialist palliative care team and are being supported by the home care team at home. All three levels of palliative care I described need to co-exist and be organised for it to be done properly. There should be much fewer people dying in acute hospitals than is the case, but that will not happen unless we put the structure in place in the community or at home.

Advanced care planning might help a lot to inform progress in the area of residential care centres. The consultation does not take place when a person is near death or dying. It could take place today when a person is perfectly well, and the person is asked what kind of care they would like in the event of something happening to them. Professor Molloy devised Let Me Decide, which is a worldwide document that has been used along these lines. It is a tweaking of that booklet which is part of the pilot survey. The initial reaction from this pilot project is that relatives have not been shocked and horrified by the discussion and instead have welcomed it. Some might say they do not wish to talk about it at all, but many appreciated doing so.

A reference was made to Leas Cross. Without doubt Leas Cross scared the living daylights out of people in many places, because owners felt that if anyone died in their facility, there might be a Leas Cross type inquiry. HIQA standards for residential care specify there need to be end-of-life care discussions with all residents, so that one has a sense of what should be done in the circumstance.

Senator van Turnhout spoke about 80 year olds who are perfectly fit and well, and she is speaking to the converted in that respect. The majority are well. A figure was bandied about, which is correct, that 25% of those over the age of 85 get dementia, but that means 75% of people over the age of 85 do not get dementia, and many of the 25% who get dementia retain capacity. I might think Jack Lynch is still Taoiseach because I am from Cork, but that does not necessarily mean I lack intellectual capacity to decide-----