Rónán Mullen (Independent)

Let me quote the following lines from James Shirley's "Death the Leveller" to emphasise that death is something which comes to us all and that the experience of seeing loved ones die is one we will all share:

The glories of our blood and state

Are shadows, not substantial things;

There is no armour against Fate;

Death lays his icy hand on kings.

Sceptre and Crown

Must tumble down,

And in the dust be equal made

With the poor crooked scythe and spade.

There is a need to level at a high standard the quality of end of life care available in Ireland.

There is unity in the points of view being expressed on different sides tonight, although there is no unity of approach. I acknowledge the bona fides of the Government side and would have been willing to accept the Government's amendment with all that it contains, as credit should be given where it is due. However, what has been offered is an alternative rather than an addition to what is being proposed from the Independent benches. We are calling on the Government to develop measures to allow people to die at home rather than in hospital where that is their choice, with resources allocated in order that more can access comprehensive hospice services in the community. It should also ensure national guidelines are operational in all acute and community hospitals to address all key end of life care issues, etc.

The problem with old politics is that we must rub out what opposing factions propose and substitute our own version. There should be no problem in the Oireachtas with Members on all sides urging the Government to provide for the taking of action that we all recognise is required. In that context, I give credit where it is due. Other Senators have pointed out that there are good things happening. Notwithstanding what I said, it is the case that in many care settings efforts are made to assist, for example, to provide a single room for a person and so on. Much is done in many places, but this is about trying to ensure a high standard across the board. In that regard, we must admire the missionary spirit of the Irish Hospice Foundation, as the hospice movement is central to what is required in end of life care. What we see, particularly with the hospice friendly initiative, is a recognition that the spirit and practices that characterise hospice care must be replicated in other settings such as hospitals and in the home. A great tribute must be paid for the work being done to spread the vision and replicate the practices and spirit of the hospice movement and the work being done in conjunction with hospitals. In many places there is great receptivity to what is being proposed.

The Government is to be commended for supporting the hospice friendly programme and the Design and Dignity Fund. The making available of resources is such that improvements can be made in particular settings to end of life care facilities, which is to be welcomed. In the event that there is money to spare, unlikely as it might sound, it would be useful if we could look at the state of mortuaries, particularly at a time when there is emphasis on providing care for greater numbers in larger centres. It is clear that in some places such as Sligo mortuary facilities are very small and inadequate. Considering what people must experience when visiting mortuaries, it is important that there be a preferential option for end of life care. That explains my reluctance to pull back from the motion. The Seanad should state clearly what is required.

Dúirt mé níos luaithe go bhfuil sé tábhachtach a rá nach bhfuil sé toil gach éinne bás a fháil sa bhaile. Is í an méid atá á rá againn ná ba chóir go mbeadh sé indéanta bás a fháil sa bhaile, má tá sé sin á iarraidh ag daoine. Ba cheart dúinn a chinntiú go bhfuil cúram deireadh saoil ar fáil mar chroí-sheirbhís sna seirbhísí sláinte ar fud na tíre. Ní mar sin atá an chóras faoi láthair, áfach. Ba bhreá le go leor daoine bheith sa bhaile agus cúram deireadh saoil á fháil acu. Ní mar sin a bhíonn sé dóibh, áfach. Ní bhfaigheann ach idir 20% agus 30% de dhaoine cúram maolaitheach speisialtóra san ospidéal. Is féidir go bhfaigheann 25% de dhaoine bás leo fhéin. We have much to do to develop consistency across the board in the provision of end of life care facilities.

At this point I mention the excellent audit of end of life care services and the excellent standards achieved. One can consider about 18 recommendations made by the Irish Hospice Foundation and see the importance of providing for more planned admissions to hospitals. It should not be the case that 84% of those who die in hospital are admitted through the accident and emergency department when one considers how predictable cases are. That is one of the reasons cancer care services are so good relative to others: there is dialogue and planned admission, as well as single bed wards and programmes or procedures for end of life care in such cases.

"A lot done, more to do" is a discredited phrase but it summarises our position in the area of end-of-life care and on that basis I will press the motion. Even if I do not get Government support for it I hope the Government will study closely what was put forward in the motion from the Independent benches.