Control of end of life

Discussion in 'Letting Off Steam' started by Logo, Jul 24, 2018.

  1. Logo

    Logo Frequent Poster

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    Last edited: Jul 24, 2018
    We attempt to control property rights, insurance, inheritance, wills and general tax affairs etc. However as a hospital visitor I've noticed that we seem to have very little control over our own end of life rights. Personally I've experienced a parent and relations ending up with strokes, Alzheimer's and cancer. None allowed for much quality of life. Once proud, capable individuals were left devoid of any dignity, in vulnerable situations and very often facing them alone. It would be classified as cruelty if an animal was treated in this way.
    Property rights, insurance, inheritance, wills and general tax affairs etc. will be relevant to many but end of life applies to all.
    Is it possible to make a living will in Ireland?
     
    Last edited: Jul 24, 2018
  2. Purple

    Purple Frequent Poster

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    You can make an Advanced Healthcare Directive.
    I do agree that we spend vast amounts of time and resources keeping people alive who have a very low quality of life,if any, and have no chance of ever getting better. In many cases we are in effect just make people die more slowly.
     
  3. dub_nerd

    dub_nerd Frequent Poster

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    We're all dying, without any chance of getting better. But we're not dead yet. Most people want to die more slowly.
     
  4. Sunny

    Sunny Frequent Poster

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    Do they? They question has never really been asked. There are correct concerns about assisted suicides but people should be allowed to a greater say in the right to die with dignity.

    Having said that, I have a family member who was down syndrome and when was in hospital, we noticed that a DNR order had been put on this file without any consultation with the family or staff members of the care home where he was residing. That was disturbing enough but apparently it was common practice. Think it has changed now.
     
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  5. Purple

    Purple Frequent Poster

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    I think you are being deliberately obtuse there.
    The thread was started in the context of people with terminal diseases.
    My Grandfather has a stroke when in his late 70's. The last few years of his life were a living hell for him, stripped of his mental and physical abilities and, more than anything, his dignity. He cried a lot. I remember him saying shortly before he died, as I wiped his excrement off his legs and backside, that he wished he's died when he had the stroke and his greatest hope for me was that nobody ever had to do that for me.

    I've had other relatives who were kept alive for weeks with no hope of them ever regaining any real quality of life, if they ever even regained consciousness at all.
     
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  6. cremeegg

    cremeegg Frequent Poster

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    This is not every stroke survivors experience. I think that there is a real danger that the fear of the situation you outline can push people into premature death.

    Relatives, medical staff, carers, even the people concerned themselves can become overly fixated on the negative and begin to see a life as no longer worthwhile.
     
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  7. Purple

    Purple Frequent Poster

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    I agree; I'm a stroke survivor myself.

    I don't.

    Let's find a middle ground then, where quality of life is also part of the discussion.
     
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  8. Logo

    Logo Frequent Poster

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    From what I've read an Advance Healthcare Directive (or a Living Will) deals with the type and extent of medical or surgical treatment you want in the future, assuming that you won't be able to make that decision yourself.
    According to Citizens information the Assisted Decision-Making Act was signed into law in 2015 but has not yet been commenced to bring it into effect.

    Also the next of kin are usually consulted but they have no legal right to make any such decisions.

    Strangely enough we don't have such wishy-washy rules governing our property rights, insurance, inheritance, wills and general tax affairs.
     
  9. cremeegg

    cremeegg Frequent Poster

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    I am sure its bad manners to quote oneself, but I would like to expand on this point as Purple disagrees. I have seen two cases recently where care staff and medical staff were completely reconciled to an elderly persons death, not emotionally but professionally.

    In one case the relatives insisted on treatment rather than care and the person made a full recovery from pneumonia. Although still frail and elderly with a poor quality of life compared to a healthy 60 year old, it is the life they have and I think it will be a pity when they lose it. In this case there was dissension among the relatives as to the approach that should be adopted, the care home staff were all on the side of letting the person go. The persons own wishes are impossible to discern.

    The other case I am familiar with involved palliative treatment only being prescribed for an elderly person with cancer. Largely it seems on the basis of age. When the patient questioned why she was not being actively treated, active treatment was provided. Six months ago she was given 6 months to live, now after a miserable period with chemotherapy she is just back from her holidays in Spain and hoping to go again in the Autumn when its cooler.

    It could be said that individual cases prove nothing but I think that there is a tendency to think, "they are old, they have a poor quality of life, let them go"
     
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  10. michaelm

    michaelm Frequent Poster

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    Quality of life should be, and is, a major part of the discussion. But there is a creeping culture of death. We'll all be a long time dead. Anyone with an interest in the subject could do worse than read With the End in Mind; I found it compelling and surprisingly easy going. Being Mortal is also a good read. No doubt we'll all agree on the desire for dignity in death, but perhaps disagree on what that looks like.
     
  11. Logo

    Logo Frequent Poster

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    Last edited: Jul 31, 2018
    I'm more concerned by professors within the medical hierarchy with ties to organisations that might be viewed as more Catholic than Christian and who continue to influence current Irish medical practice and procedure and are often consulted on current affairs programs today. Likewise for respected legal professors who were unsuccessful as anti-equality campaigners. Both were allowed to dictate social standards in the 1980s and '90s. I was part of that generation and have personal experience of friends who lost their lives as direct result of that agenda. Apologies for the rant but I reckon that as in life, these esteemed professors will continue to play a role in the decision of how my generation will die.
     
    Last edited: Jul 31, 2018
  12. Purple

    Purple Frequent Poster

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    We can't discriminate against people because they are Roman Catholic. We can insist that they operate within the ethical framework set down by the HSE or the State through legislation. I do have a problem with any religious group having an input into how those guidelines are set.
     
  13. Logo

    Logo Frequent Poster

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    Thanks Purple. I have amended my post so as not to discriminate.
     
  14. Purple

    Purple Frequent Poster

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    I agree with your revised post. Too often on RTE people are introduced as Doctor this or Professor or as a member of an institute without also informing viewers or listeners that they are also an active campaigner or have a strong agenda on one side of the argument or the other. That applies to both social and economic issues though if they are conservative or not a socialist RTE are more likely to note that in their introduction.
    For example the Hibernal Forum is noted as a conservative or right wing group but the Nevin Research Institute is not noted as the propaganda office of the Trade Unions.
     
  15. Brendan Burgess

    Brendan Burgess Founder

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    It's not consistent.

    After I heard this point made before, I listened out for it and Nevin was usually introduced as a think thank funded by the trade union movement. I suspect that we tend to notice the occasions when such a clarification is not made.

    Brendan
     
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  16. Betsy Og

    Betsy Og Frequent Poster

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    On somewhat the same territory, check out Enduring Power of Attorney - basically nominate someone who makes decisions on your behalf if clobbered by the proverbial bus, dont die but dont have capacity to make decisions. Slightly different to advance medical care order or whatever that phrase is (which is more - no CPR, no ventilator etc).

    For the terminally ill I think they should be given the right to choose their time of departure provided all the usual capacity issues (have capacity, not depressed or that is not the determinative factor - in pain might make you depressed, but underlying physical issues mean you are on the way out in the short term, no indications of duress etc.).

    For the non-terminally ill, its a trickier call. Suicide is a scourge and something I'm passionate (to steal an Inda Kenny phrase) about preventing, but hand on heart its usually young folk I have in my mind. If someone in their 80's dies by suicide well then its a pity etc. but if they left no-one after them then it doesn't seem as bad. I know that's probably poor form on my part, but haven't given it huge levels of thought as yet. A bit like the abortion debate, we're all for life, any life, no-one is too interested after that. So I think I'd rather focus on home help, combating loneliness, improved mental health and all the rest rather than opening the door for able bodied assisted suicide.

    For example Dignitas, do they have criteria they are bound by or choose to implement?