REMARKS BY PRESIDENT McALEESE AT THE INTERNATIONAL PALLIATIVE CARE CONFERENCE THURSDAY, 19 APRIL
REMARKS BY PRESIDENT McALEESE AT THE INTERNATIONAL PALLIATIVE CARE CONFERENCE THURSDAY, 19 APRIL 2007
Tá an-áthas orm bheith anseo libh inniu agus muid ag céiliúradh an ócáid mhór seo. Ba mhaith liom mo bhuíochas a chur in iúl daoibh as an gcuireadh agus as fáilte a bhí caoin, cneasta agus croíúil.
It is a very special pleasure to be part of this conference and to extend the traditional céad míle fáilte, a hundred thousand welcomes to all the participants but especially those who are visiting Limerick from abroad. My thanks to Dr Sinéad Donnelly for her invitation and to each of you for your warm welcome.
You gather to discuss a subject that most of us find stubbornly inhibiting. The process of dying has been the one common feature of human life for as long as there has been human life and yet for all its inevitability, we generally shun mention of it and so respond with dread and fear of the unknown when serious illness forces us to confront death’s and life’s realities. Why it should be so unknown and why so utterly normal a part of the human condition should provoke such terror says something about the extent to which we live our lives remote from its reality. We run away from it precisely because we know that, inside that reality, there is debilitation, disability, pain and distress and we have no idea how we will cope, or if we will cope. The elderly person who has led a good and full life may be philosophical and accepting enough about death itself and yet be frightened by the process of dying. The young mother facing terminal cancer may refuse to contemplate being taken from her children and become so consumed with finding cures that the process of dying goes undiscussed. The child facing death sees around him or her the grinding agony of devastated parents and siblings and while ignorant of the meaning of death, can tell that this thing called death drains the world around him of happiness.
Modern palliative care has thankfully moved from relatively uncharted territory to become not just a respected branch of medicine but a very important space in which dying can be comprehensively and frankly discussed, its complex elements reduced to practical issues that can be addressed and tackled. Palliative medicine offers no answer to terminal disease but it does offer an answer to suffering and in doing that it offers us a better quality of life and a better quality of death. It takes the darkness out of dying for patients and their families. Effective pain relief and pain management restores some sense of control and dignity through what Emily Dickinson describes as this “narrow time”. And that is just how it must feel to sufferers, to carers and to family and friends, a narrow time, constricting, restricting, ending. And yet with good palliative care it can be the most liberating and grace-filled of experiences for everyone involved. For within palliative care everything counts, everything matters, body, soul, mind, matter, emotions, friendships, family, comfort, discomfort, atmosphere. The experts in such care know that there are good ways to die and there are awful ways to die and they are determined to ensure that where possible the journey through serious illness to death will be as comfortable and as bearable as possible. It’s a tough journey for all concerned. For the practitioners who commit to this vocation, palliative care demands not just the highest level of medical skill but deep reserves of empathetic temperament and character, for while there may be good endings there are always tears and rarely truly happy endings. Yet your work makes a world of difference to the dying and those who love them. Your professional support is the crutch they lean on through very wobbly and uncertain times. Trust in you is all-important and because you become involved with people at the most vulnerable and probably utterly honest stage of their lives, you become drawn into their tense emotional circle, you join their emotional roller coaster. It’s a privileged place to be and a very sacred responsibility. We are so grateful that more and more people commit to it and are helping us to mainstream better attitudes to dying and greater access to quality palliative care.
We have also cause to be grateful to the many bereaved families whose experience of tough deaths forced the critical question why things could not be better. We are indebted to those whose determination gave rise to hospice movements and to a fresh focus on palliative medicine. They have become important funders of palliative care and research into such care. Their experience has become the resource base from which new insights have grown and improved services developed.
In the words of Dame Cicely Saunders "the losses of parting cannot be removed but their devastating effects can be ameliorated. For this we must give attention to the whole person, with all the insights the humanities can give us”. Increasingly palliative care is giving precisely that holistic attention and the huge public demand for it is vindicating the recognition of this work as a distinct medical discipline. We are proud of the fact that in 1995 Ireland became the second country in Europe to recognise palliative medicine as a distinct medical speciality. We are also very proud of the fact that the progress we have witnessed in recent years is due in no small measure to the welcome collaboration between the statutory and voluntary bodies involved in the provision of palliative care. The 2001 report of the National Advisory Committee on Palliative Care identified the core role of the voluntary sector in the development of hospice and palliative care in Ireland, and the importance of mechanisms to support a partnership between the voluntary and statutory sectors. This joining of forces is a modern take on the traditional Irish meitheal, the coming together of neighbours for a common task, and in this case, a vital one. I am delighted to see these developments taking place and I would like to take a moment to acknowledge the example set by our hosts. The partnership approach has long been a feature of palliative care here in the Mid-West, and this conference is itself evidence of that spirit of co‑operation; hosted jointly as it is by the Mid-West HSE and Milford Hospice. The benefits of this bond are readily apparent, with Milford Hospice now providing a state-of-the-art facility that is recognised both locally and nationally as a centre of excellence in the field of specialist palliative care. The quality of service delivered in Milford is a fine example of what can be achieved by the statutory and voluntary sectors working in harmony towards a common goal.
For sure we have a lot to learn about what palliative care is capable of and you have come here to both learn and teach. Each of you brings with you your own unique experience and insight. You will share that here and you will listen while others share their stories in turn. Hopefully the pieces of the jigsaw puzzle will begin to reveal themselves and you will leave here with heads full of creative ideas which will push this specialty across yet another line, into yet another new era. I thank you for being here and for investing in better lives, better deaths, for all of us and I wish you well in your deliberations over the next two days. Your search for ways of doing your job better is ultimately an essential investment in the human condition. It will bring benefits to all of us and allow us to hope that though we cannot defeat death we can at least defeat the dread of suffering. It allows us to hope, too, that we can begin to talk about these end things with greater confidence, greater insight and greater hope.
Thank you for your attention.
Go raibh míle maith agaibh.