Ciarán Cannon (Fine Gael)

In the past 50 years life expectancy in Ireland has climbed steadily from just under 70 years in 1960 to just under 80 years today. This is a phenomenal improvement in a relatively short time. Consider for a moment the improvements that will be made in the next 50 years. It is reasonable to expect that children being born now will routinely live into their hundreds. Such improvements in life expectancy allow us to push death away to a distant place where we can believe that it affects others and not ourselves. Whole industries are devoted to making us look and feel younger than we are. In our increasingly obsessive quest for the elixir of eternal youth, we are in danger of compartmentalising death, shutting it away in some dark cupboard and only opening the door when its inevitability is staring us plainly in the face. Approximately 20 years ago, a newspaper article on longevity had to remind us that the mortality rate in this country is 100%, that we all die eventually and that in a typical year, 28,000 people - our family, friends and neighbours - will die. Included in this figure are the 400 children who will die before their 18th birthday.

Death should form part of our everyday lives rather than it being isolated and hidden away. This motion is a welcome opportunity to debate the issue of death and how we care for our dying. I thank Senator Mullen and his colleagues on the Independent benches for choosing to use their Private Members' time for such a debate.

The Irish Hospice Foundation, IHF, has done us all a great service by carrying out extensive research into the needs of the dying and coming up with practical and sensible suggestions that, if acted upon, would allow our people to die in dignity and surrounded by those they love. Two clear lines of thought emerge from the research. First, it is more than clear that the majority of people would prefer to die in their homes. Second, it is also clear that we have much work to do to enhance the environment of hospitals so that we can allow our people to die with the dignity and level of care they deserve. The IHF survey of 2004 found that more than two thirds of people wanted to die in their homes. Only 10% expressed a wish to die in a hospital setting. The statistics tell us that more than 70% of us die away from home.

We need to work genuinely towards providing people with the choice to die in their homes, primarily because it is the right thing to do but also because the choice to die with dignity at home will create real savings for our health service. The average person consumes health services valued at €300,000 in his or her lifetime, approximately €70,000 of which occurs in the last year of life and €28,000 in the last month of life. People in the last year of life comprise only 15% of the population, but they account for almost 30% of all hospital expenditure. People using hospice services are mostly cared for and die at home, use fewer acute hospital services and live longer in greater comfort and dignity. They also consume at least 25% fewer medical resources than those who access hospital care. An interesting study in Barcelona concluded that the use of hospital resources by patients with incurable illnesses fell by 61% in that region once a comprehensive palliative care programme was put in place, length of hospital stays was reduced by 25% and the use of emergency rooms, always a crisis issue in Ireland, was reduced by 42%.

Evidence in Ireland reveals that cancer patients who use a developed local hospice service die at home, which is what most people want, while those patients in counties with limited or no hospice services tend to die in hospital. We all know of the excellent work being done by the hospice movement. For example, the Milford care centre in Limerick provides hospice services in the mid-west. In 2006, 31% of people with cancer in that region died in a hospital. The figure rises to 70% in areas not served by comprehensive hospice services.

We can only conclude from these statistics that it makes sense to extend a comprehensive hospice service to the whole of the country. Our people can die with the dignity they deserve in their own homes surrounded by the people who care for and love them. They would be in the place they want to be in their final days. As Senator Doherty alluded, doing this would not only be right and just but would also provide a significant saving for the health services.

For those who die in hospital, we need to provide a hospital environment that allows staff to deliver the dignified care they deserve. The IHF has produced an excellent set of guidelines on how best we can design the physical environment of hospitals to care for our dying. It is anticipated that these guidelines will be used primarily in the development of new hospitals, but they should also be used in refurbishments.

More than half of those who die in hospitals die in multi-bed wards. In the very last hours of their lives, they often must experience others dying in beds around them and listen to the anguished cries of bereaved relatives. I have personal experience of this occurring. It is not the environment in which any of us would choose to spend his or her last days and hours. If we genuinely believe in real equality, none of our people should be subjected to such a traumatic environment when at his or her most vulnerable.

I call on the Government to engage actively with the IHF in seeking to extend our palliative care services and supports to the whole of Ireland. It makes sense on every level to allow our people to die at home. The Government also needs to incorporate the foundation's design guidelines into any new hospital development. Let us give our dying the dignity they deserve.

I will conclude with an apt quote from the founder of the hospice movement in the UK, as cited by Senator Fitzgerald. The founder stated:

You matter because you are. You matter till the last day of your life. We will do all we can, not only to help you die peacefully, but to live until you die.