Inevitably we will be confronted with death several times during our life: hopefully it will happen in a chronologically appropriate way by way of our grandparents’ generation first, then our parents and finally our contemporaries. The emotional fall-out from death can be very intense but eventually it dissipates somewhat and we learn to live without our loved ones.
The apparatus provided by institutional religion can be comforting during times of dying and death as people slip into a pattern where they know their roles and allow themselves be corralled into a well-rehearsed “drama”, where they do as they are told and do not ask questions. People who have not been to Mass for years slip into the tried and tested Roman Catholic funeral rites and find comfort into being slip-streamed along the journey of dying and death.
However, people have begun to think outside this box and become more pro-active in this process of dying and death. We see this in the tenfold increase in humanist funerals since 2007, while Irish funeral directors say that of the nearly 30,000 funerals held annually in Ireland, about ten per cent are humanist. Naturally a loose paradigm is evolving, but having said that, there is a lot of work to be done by the family of the deceased – that is unless that person has set out their wishes clearly beforehand.
Many people are reviewing the whole package. Working back from death is the process of dying. You may have read recently about the Death Café phenomenon, which is growing globally. This is where people gather to talk about death – that is the only agenda — and the objective is to normalise the notion of death so that it is seen as the organic part of life it is. There you can talk about how you want to die and whether or not you will submit yourself to treatments offered by doctors in the sometimes vain hope of a few extra years of sometimes dubious quality.
The recent death of my mother brought me face-to-face with some such issues as I watched my dying mother being kept alive in spite of the fact that we had been told she was going into palliative care and that she, with support from her children, had expressed the desire for no intervention.
She did not want to spend weeks dying without dignity. Her last few weeks left much to be desired and I am still haunted by the memory. It caused unnecessary agitation and much stress to all, especially my mother.
Is that good enough? Well it seems it is for the ordinary punter but not good enough for the doctors who impose those regulations. Often if they are diagnosed with a terminal disease, they choose to die as organically as possible with little or no interference.
An article entitled “How Doctors Die: It’s Not Like the Rest of Us, But It Should Be” by Dr Ken Murray is quite the eye-opener. Of course they want to live like the rest of us, but they know the limits of medicine and prefer to go gently into that space. It seems in America that as a group, they undergo far less treatment than the rest of Americans.
So when doctors ask people around the bed of a very ill loved one “Would you like us to do everything we can?” – caveat emptor! That might translate into what amounts to torture of the dying person that we would not impose on a dying dog. Some American doctors take their desire to avoid this very seriously by wearing a medallion on which is stamped NO CODE — this is the message to other doctors not to perform CPR on them.
To be fair to doctors, we must remember that they work within a system which ordains that they do everything in their ability to help people to live and they are not “euthanisers” – if they did take on that role we’d have something to say about it. However, it is important to keep two things in mind if you want to exercise self-autonomy right to the end: on a personal level, have a living will, and as a nation let’s begin a rational conversation about euthanasia.
It is not the only conversation we should have. We must start to ask why a consultant was about to discharge an elderly dying woman. When we did ask this question, his response was hurtful and robotic: a shortage of beds and if it’s a toss-up between an elderly dying woman and a 25-year-old who needs a bed, the younger person wins hands down.
Why should this be? What is wrong with us as a society that we will put a dying woman into an ambulance and bring her to a nursing home because of a shortage of beds? Isn’t it time for a change of culture in the Ireland of 2017? Or must it always be the consideration of value for money that trumps our concern and moral obligation of caring for our old and vulnerable?
The irony is that Ireland is at the top of the EU table regarding health expenditure. In 2014 health accounted for 19.9 per cent of government spending, five per cent above the EU average. What is happening to these monies?
If we think the situation is bad currently, it is worth reminding ourselves of a few facts concerning older people. According to the Central Statistics Office (2013), there are 540,000 people aged 65-plus living in Ireland, which is 12 per cent of the total population. This is projected to rise to 1.4 million, or 22 per cent of the total population, by 2041. Over that same period those aged 80-plus will rise from 130,000 to 458,000 — an increase of 250 per cent.
I would bet that many readers of this article fall into one of the above age brackets. Are you happy to allow our policy-makers and politicians to continue on their current journey?
And those of you who are younger, do you want to watch your parents die in agony, or at least gross discomfort, and in turn yourselves? Personally, I want better!
* Mary Alacoque Ryan was a second-level teacher for 30 years and is currently a correspondent with the Tuam Herald. The recent death of her mother and her own hospitalisation as a result of an accident, have reinforced her previous thoughts that there are too many unacceptable happenings in Ireland’s health care. It is not only that fiscal inequality follows people into hospitals but it is also that the system is not serving the people in ways where people have a say in their care during illness and their dying. Mary’s articles are about raising awareness of our rights and are urging people to become pro-active in those important areas.