Professor Desmond O'Neill:

Yes, there have been huge advances and change. I was the eighth geriatrician in Ireland in 1993, there are now 120, who have care embedded. There has been a huge rolling out. There is a complete culture in our hospital that when death becomes clear, we arrange for a side room, we have very proactive chaplaincy services. There is a very ready recourse to as much as is required or needed. The vast majority of deaths have been with as much comfort as possible and with dignity. It would be folly to rule out something 100%. All the plays of Moliere are about the folly of humans trying to cast futures into concrete, whether it is Tartuffe building up religious credits or the miser building up financial credits. There will always be degrees of suffering. Death is a time of grief and people will come away from it with a range of emotions. Death in Ireland is among the best in the world that is possible. Palliative care is reaching further in all corners of care as well as in training of medical and nursing students. There can be an over-emphasis on doctors but there are many others involved in the healthcare system. When my own father was dying in hospital, the charm and care of the healthcare attendants was hugely important. During their courses, they are exposed to how we deal with death. The person who brings a patient his or her cup of tea and shares some kind words is important, and then there are nurses. There is a danger of over-focusing on one profession.

I think Dr. Regina McQuillan covered many of these bases very well. She pointed to many of the instrumental difficulties in implementing these and how people can have palliative sedation.