Seán Kyne (Fine Gael) | Oireachtas source

I welcome the Minister of State, Deputy Butler, to the Chamber and I thank the Cathaoirleach for selecting this important matter. It is an issue that has grown in prominence on account of Covid-19, and it was raised with me by the family of a woman who spent more than six weeks in intensive care in a Dublin hospital battling Covid-19 and its significant after-effects.

The woman in question underwent a cancer operation, which, thankfully, was successful, but she contracted pneumonia in hospital and spent almost eight weeks on that occasion in ICU. Following the excellent care from the team in the hospital, she was transferred from ICU and was on the road to recovery when, unfortunately, Covid-19 struck. Like so many people, she contacted the virus in hospital and had to be moved back to ICU and placed on a ventilator again. I understand that in most cases a ventilated person has to be kept heavily sedated, including in paralysis, due to the body's natural tendency to reject the ventilator. One can only imagine the worry and concern the family experienced as their loved one made it through ICU and into recovery only to be rushed back to ICU on account of this new and unknown virus.

On this second occasion, the patient was in a weakened state and gravely ill. It was at this time a nurse in the ICU mentioned to the family there was a do not resuscitate, DNR, order on their relative's file. This came as a complete shock to the already anxious and worried family. It led to several days of attempting to establish what the DNR order meant in practice at a time all hospital visiting had ceased and all communication with families was conducted over the phone. Very often, the staff member assigned to liaise with a family was a retired person who worked not from the hospital but from home. The family was told the nurse should not have mentioned the DNR order in the manner in which it was done. The family received an apology and an explanation regarding the reasons for a DNR order.

The family was told that over the previous 18 months, the HSE had wanted to be very clear on how far treatment was to be taken. The family was told that in the event of cardiac arrest, the DNR order would come into effect because cardiac arrest in ICU represents a failure in terms of the treatment. In the event of a cardiac arrest the quality of life of the patient would be negligible. This may all seem rational as I stand here now but at a time when a relative is seriously ill in ICU on account of a new illness and all hospital visiting had been suspended, it is a difficult concept to understand or accept.

Thankfully, in this case the woman overcame Covid-19 and has made a strong recovery in spite of the odds, which were stacked very much against her, and she is at home now with her family. However, the family's experience raises serious questions over the use and practice regarding DNR or do not attempt resuscitation, DNAR, orders. From my limited knowledge of the issue, I understand there is no strict definition of what a DNR order constitutes, although it generally it is taken to mean an order that no intervention be made when a person suffers cardiac arrest. There are no written guidelines for hospitals, although I stand to be corrected. There is no specific legislation in operation to guide this sensitive area.

The Assisted Decision-Making (Capacity) Act 2015 provides a legal framework for advanced healthcare directives but, to the best of my knowledge, the relevant section in Part 8 of the Act has not been commenced. In May, the Irish Hospice Foundation highlighted the need for the commencement of the legislation on account of Covid-19. I understand the national office for human rights and equality policy in the national quality improvement team of the HSE has oversight of guidance on DNAR orders and has been working to help prepare for the commencement of the legislation.

We need clarity in the use of DNR and DNAR orders in Irish hospitals and healthcare facilities. We need clarity on how patients' wishes are respected and we need clarity on the role of families and next of kin. We need an information campaign to raise awareness of DNR orders and the wider area of advanced healthcare directives. We need to spark a national conversation on these issues. It is never easy to discuss end-of-life matters because it forces us to confront our own mortality and the pain and loss caused by bereavement. The best time for such a conversation is before a pandemic. The second-best time is now. These issues are relevant at any time but particularly as we challenge and continue to grapple the unprecedented challenge of Covid-19.