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Column: Living wills could help end the taboo of death in Ireland

Living wills would remove doctors’ God-like ability to decide what happens to people who may be approaching the end of their life, writes Liam Twomey

A patient in a wheelchair at a hospice (File photo)
A patient in a wheelchair at a hospice (File photo)
Image: AP Photo/Natacha Pisarenko

ON FRIDAY I brought my Advanced Healthcare Decisions Bill before the Dáil. It deals with what are more commonly known as living wills. If enacted into law, it will take control of what happens to a person at the end of their life, out of the hands of medical professionals and give it back to the patient being cared for. It has nothing to do with euthanasia, and nothing to do assisted suicide.

There has been an increasing level of debate around end of life care in Ireland and the simple truth is that if we do not adequately deal with this issue, the subject will remain taboo. People will also continue to be denied the chance of communicating their final healthcare requests when they are in a position to do so.

Ireland currently lags behind many other countries when it comes to preferred end of life treatment. In my view, every person who would like a hand in determining the level of care they require when they are elderly or if they are incapacitated and are unable to make their views known, should be free to do so. This will ensure that is the case.

In the absence of a living will, and in the instance that a loved one is terminally ill or incapacitated, deciding on the level of care to be administered can be the cause of immense heartache and stress for family members. Living wills are a response to advances in medical care and to indefinite life-prolonging treatment, which may not appeal to all.

In the same way that a person can clearly set out what is to happen to his/her assets once they pass away or can state what happens to their organs by carrying a donor card, a living will allow for the bodily integrity and autonomy of the patient during the latter stages of life. It will also put an end to surrogate decision making by relatives who may be unsure of the best road to take. It is worth noting that, just as a legal will can be altered as a person grows and their priorities change, so too can a living will be changed to reflect changes in a person’s attitude to death.

‘Living wills would remove the physician’s God-like ability to decide what happens’

When it comes to determining what the best course of action is for a patient, views can differ wildly, not only among family members but also among medical professionals. As a junior doctor, I remember some consultants who were very quick to put a Do Not Resuscitate (DNR) sign over a patient’s bed, while others would go the full mile in prolonging the life of a terminally ill or elderly patient. Living wills would end all that by removing the physician’s God-like ability to decide what happens, giving the final say to the patient as to whether or not they would like their life to be spared to the nth degree.

For example, if an elderly family member with dementia or Alzheimer’s develops advanced or aggressive cancer, the indecision that comes with that can be overwhelming for families, despite the fact that the decision made may not improve the outcome for the patient or enhance their quality of life down the line. A living will would allow the person receiving treatment to clearly state that they would like to only be given pain control or fluid replacement, and that they would not be in favour of radiotherapy, chemotherapy or having radical surgery carried out, if that is their wish.

This issue has widespread support among Amnesty International, Age Action Ireland, The Society of Friends, The Humanist Association of Ireland and the Irish Council for Bioethics. Just last Wednesday, the Irish Hospice Foundation held a forum on End of Life Care in Dublin, the focus of which was Do Not Attempt Resuscitation (DNAR) orders which are currently part of a national consultation process being organised by the HSE. Last October, the Taoiseach launched the Foundation’s Think Ahead campaign which encourages people to ‘think, talk and tell’ loved ones about how they see their end of life care.

By addressing this issue seriously, we are allowing people to keep control over how they are treated at all stages of life. The Bill is being supported by the Government and I am looking forward to a vigorous debate about it in the Dáil. It’s time to put the power back into our own hands while at the same time removing the confusion and guilt for family members during what are unquestionably extremely upsetting times in their lives.

Liam Twomey is a Fine Gael TD for Wexford and a doctor.

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