European Network of Health Care Chaplaincy
The Healthcare Chaplaincy Board
The legal regulations on end of life choices in Ireland:
Euthanasia and Physician Assisted Suicide are illegal in Ireland.
In recent years particularly, Irish society has become very concerned and articulate about appropriate end of life care being available for patients who are terminally ill. The current proactive response to heightened awareness around end of life issues and choices is being driven mainly by The Irish Hospice Foundation and by the wide availability and use of palliative medicine and care. The Irish Hospice Foundation is sponsoring a Forum on End of Life in Ireland throughout 2009. This is a yearlong conversation on what constitutes a Good Death. At the inaugural session of the Forum in March, representatives of various discipline in healthcare, and representatives of a diversity of faith traditions, belief systems and humanist groups engaged in dialogue around the physical, social, political, emotional and spiritual issues that impact on people who are negotiating the final stage of life. One of the follow-up sessions focused on the views and practices of different faith traditions and secular associations connected with end of life care.
It is widely recognised that the new public demand, in Ireland, for the ‘Right to a Good Death’ highlights a need for clear policy that would focus on the rights of persons who are dying, and the responsibilities of society generally, and the professions that provide care. It has been claimed that ‘End of Life’ needs to be part of the public health agenda, and that it is a matter of public ethics to raise relevant and important questions. An interim report to evoke national conversation on ‘End of Life’ will be published at the end of 2009. It is envisaged that this will result in the formation of a Coalition for End of Life in 2010, the goal of which will be to drive future policy on End of Life Care. The work of the Forum is generally considered to be broadly based, soundly principled and humane.
The view of the Roman Catholic Church on end of life choices:
Roman Catholicism is clearly opposed to any attempt to legalise any form of direct killing of a human person. This includes the practice of Voluntary and Involuntary Euthanasia or Physician Assisted Suicide for persons who are terminally ill or actively dying.
In the Church’s view, elderly and terminally ill patients, as well as being compromised by their medical condition can also be compromised by negative attitudes toward aging and terminal illness. It maintains that requests for Euthanasia and Physician Assisted Suicide reflect failure in the system around offering appropriate and effective End of Life Care. The Church stresses competence in End of Life Care, and considers humane and compassionate care at end of life as a human right. It believes there is need for religious leaders, clinicians and scientists to be engaging in ongoing dialogue around new insights and developments regarding End of Life Care. Descriptions of the suffering of elderly and terminally ill patients in places where euthanasia and assisted suicide are legal is seen as demonstrating a sad lack of appropriate medical, nursing and pastoral care of patients. It is also seen as lack of respect for the dignity of persons, and lack of professional competence.
Ireland has become a pluralist society and engagement around End of Life must be based on ideas and values. Regulation needs to be accompanied by virtuous thinking and action. Courage that is not tempered by prudence is recklessness, and this is especially evident in arguments concerning Euthanasia and Suicide. The Church is aware that confronting the erosion of language is a major challenge for those who care for people in the final stages of life. This is especially evident in the association of the words ‘dignity’ and ‘mercy’ with euthanasia and assisted suicide. Diligence and ingenuity are required of medical and nursing personnel that care for persons at the end of life.
The Church stresses the importance of developing ethical intelligence, alongside cognitive and emotional intelligence. Bioethics needs to be in ongoing dialogue with other areas of competence and knowledge. Such conversations would affirm and enhance efforts to promote professional competence, virtuous care, effective communication and reflective practice by those who care for terminally ill people. The Church emphasises that Advance Care Preferences should demonstrate strong moral force and should be made closer to the time of prognosis. These should be indicative and not legally binding. The Church highlights the need for Advanced Directives to be tightly controlled, and for awareness of the questions and issues that inevitably arise in making decisions around End of Life Care.
The main tensions in the chaplains’ general practice concerning quality of end of life?
There is need for heightened awareness of the importance of spiritual care in multidisciplinary teams, and early referral to chaplains so that patients can be accompanied throughout their journey with illness, and not just be called when a patient is dying.
Chaplains are often frustrated at not being included in discussion around End of Life Care for terminally ill patients.