Feargal Quinn (Independent)

I am very happy to second it. I am delighted the Minister of State, Deputy Áine Brady, is present for the debate. However, like Senator Mullen, I am disappointed that there is an amendment, but I understand that is the way things are done in the House. Nonetheless, it is a shame.

I remember being a patient in the Mater Hospital for about five days more than 50 years ago. I thought I would never be able to pass a hospital again without thinking of all the people inside but soon afterwards never thought about it. The same applies to hospices. John, a friend of mine, died in St Francis's Hospice about 15 years ago. I was with him the day before he died and he was able to say to me, "You realise I am dying. I won't be here at the end of the week." He was very peaceful and looked after so well. It had an amazing impact on me because I had almost forgotten as I drove past what was happening there. This year my sister-in-law died. Some weeks before she died she went into Our Lady's Hospice in Harold's Cross where I visited her practically every day. She was looked after so well. What really impressed me was the care and attention given to her and the interest and sympathy shown. It brought the subject back to my mind. What also impressed me was the very large number of volunteers. It was voluntary work being done by people who went to the hospice to help in both big and little ways. It was very impressive and I realised I had been walking past without thinking. I had been in a few times, mainly to see people in the hospice for respite rather than end-of-life care, but had not realised the amount of voluntary work being done.

I am delighted Senator Mullen has introduced the motion. What he has done today is ensure a wider circulation for the very interesting information available on the enormous amount of work being done in many areas in end-of-life care in Ireland. It is most worthy of consideration and I hope this debate will ensure a wider circulation than might otherwise be the case.

We must bear in mind that in this country we are much better off than many other countries when it comes to end-of-life care. Ireland is one of only approximately 15% of countries in which palliative care services are integrated into the national health service. We must remember also the key role Irish Aid has played in supporting the development of hospice and palliative care services in poorer countries, especially in Africa. However, there is much more we could do to improve the lives of loved ones who are dying. According to the quality of death index recently issued by the Economist Intelligence Unit, the United Kingdom was the best place in which to die. Ireland ranks fourth in the overall ratings. However, in terms of a basic end-of-life health care environment, Ireland is ranked only 17th. This category includes social security health expenditure, nurse and doctor numbers, GDP, dependency ratios, life expectancy and hospital bed counts.

We must bear in mind the massive physical changes that have occurred in recent decades, particularly due to changed lifestyles and improved medical care. Death used to come quickly to most. In previous generations people were taken out by catastrophic infections, at childbirth, by pneumonia or heart attacks. How one should die was never such a problem when the period between diagnosis and death was short, leaving just enough time to say goodbye and for the last rites to be given. How to die was never such a problem when the period between diagnosis and death was short, leaving just enough time for goodbyes and the last rites. People still die suddenly in their sleep, in the shower, at their desks or on the road.

However, most of us who live in industrialised countries such as Ireland will die much more slowly of chronic progressive illnesses such as cancer, heart disease, lung cancer or from the multiple effects of ill health in advanced old age. Thus we have plenty of time to consider how we want to use that time. With almost half of all people dying in hospitals, we need to take the issue much more seriously. In the late 19th century 85% of people died at home. The hospice friendly hospitals programme survey found that while most people wished to die at home the vast majority still died in hospitals, as Senator Mullen said. In 20% of cases, however, the diagnosis of death in Irish hospitals occurs five to six days before death. Also, nearly 25% die alone in acute hospitals. It is much more referable to die at home for a number of reasons.

Pressure on emergency departments is excessive and palliative care services are insufficient. In Ireland approximately 56% of deaths occur in wards where five or six other people are present. This is partially due to the small number of single rooms available in our hospitals. One must also remember that the distance between beds is often extremely close and curtains do not provide adequate privacy. This makes it extremely harrowing for both the patient and his or her loved ones. In addition it means there is no privacy for other patients in the ward, a point very well made by Senator Mullen. It is commonsense that single rooms should automatically be available to people who are dying in hospital.

A new study carried out by researchers at Dana-Farber Cancer Institute, a teaching affiliate of Harvard Medical School, found that cancer patients who died in a hospital or intensive care unit had a much worse quality of life at end of life compared to patients who died at home with hospice services. Researchers also found that hospital patients' caregivers were at higher risk of developing psychiatric illnesses, including post post-traumatic stress disorder, during bereavement than are home-care caregivers.

In terms of hospital, "living wills", competency to make decisions, resuscitation, clinically assisted nutrition and hydration and transplantation are all critical issues which have been highlighted by the hospice friendly hospitals programme. I have been advocating presumed consent for organ donation, which is another aspect of end of life that deserves proper debate. I hope the Minister for Health and Children, Deputy Harney, is making progress on this issue. It is interesting to note that the Irish Hospice Foundation's survey of end-of-life care in hospitals found that one fifth of seriously ill patients could have died at home if sufficient supports were available. There are shifts to end-of-life care from the hospital to the home. In the UK, the Conservative Party has indicated it wants to introduce a major overhaul of funding for end-of-life care, with a new system to be based on the number of patients requiring it. Under the plan, more money could go to hospices and other providers, using savings made from reducing unnecessary stays in hospitals for people at the end of their lives. The changes involve the introduction of a tariff system such as those operating in other areas of health care, so funding is awarded on a "per patient" basis.

We too, should be looking at passing on the savings made from people not staying in hospitals at the end of their lives, to help them die at home. We could also encourage nursing homes to try and stop inappropriately sending elderly dying patients to emergency departments, if they were given the support to do so. We also have to better inform people about end-of-life care. According to a new national survey published in the Journal of Medical Ethics, many of us are uncomfortable and ill-informed about end-of-life issues. The lead researcher, Dr. Joan McCarthy, of University College Cork, found that there was a deep need for better public education about the processes and terminology of end-of-life care, as well as for new legislation to clear up the confusion around the role of professionals and families in making decisions for dying patients. For instance, a massive 71% had never heard of an advance directive, although more people knew of it by its more popular term, the "living will".

One of the most interesting aspects of that survey was that most people were more concerned about the quality of their dying than about death itself, and 81% said that if they were severely ill with no hope of recovery, the quality of life would be more important than how long it lasted. I support the call to develop and resource a comprehensive end-of-life care strategy to manage properly this critical aspect of being human which sadly is not being given the attention it deserves. As a society, we need to recognise that dying is a normal part of life, something as natural as birth and adolescence. With somewhat more imaginative planning many more people could die at home rather than in overcrowded hospital wards. No one should die alone, frightened and in pain. The challenge is to ensure every patient can die in comfort and dignity.

We avoided this issue for many years. It was something we did not talk about and we steered away from it. Perhaps the younger people are the more difficult it is to handle. The closer one gets to it perhaps makes it easier to understand. I had not understood this, however. Neither had I understood the willingness, as Senator Mullen mentioned, of giving drugs to relieve pain. It seems this is something we had not thought much about before. It is now well thought out. I have experienced in recent times the willingness to accept that if somebody is dying he or she should not die in pain. Steps are being taken in the right direction and I believe we have the intention to do the right thing. Let us ensure we do it.