Following
on my blogs on the Forum on End of Life in Ireland, and the launch of the
‘Think Ahead’ project at the most recent meeting of the Forum (see, in
particular, my blog of 17 October 2011) it is interesting to read the comments
of Professor Des O’Neill, who is a consultant in geriatric and stroke medicine,
on the subject:
[Irish Times Healthplus, 1.11.11‘[…] On thinkahead.ie, the latest initiative from the Forum on End of Life, it is disappointing to see how few people realise the danger of simplistic solutions to care giving for those who might have impaired intellectual capacity in later life, and also the danger of terming these plans largely based on not having treatment.‘For, contrary to popular opinion, the greatest danger at the end of life is not that you will be overtreated, but that you will be undertreated, in a system that has strains of ageism and prejudice against disability, in particular dementia. […]‘The availability of palliative care for terminal stroke and dementia, while increasing, is limited.‘As research develops into future care planning, there has been a marked cooling of enthusiasm for the concept of rigidly binding advance directives. Once faced with the realities of illness, people show huge changes over time in their preferences for the future. Indeed, the perceptiveness of age has been shown in the first Irish longitudinal study on ageing […], where older people wish to make any such plans only at advanced old age.‘Also the public and some healthcare professionals often underestimate both a patient’s quality of life and their ability to signal their needs and wishes, even with advanced dementia. […]I would like to request positive, proactive care, such as specifying that those looking after me would have specific training in gerontology and dementia care, so that my wishes can be interpreted in a sensitive fashion for as long as possible.‘Rather than binding my healthcare providers into an outdated view of a fast-changing medical landscape, I would like it to be phrased in terms of advanced care preferences with a strong moral force rather than a legally binding directive. […]‘In the case of the advance directives currently proposed by the Forum on End of Life, certainty might also foreclose early on your options for a full palette of care at the end of your life.’
