It’s a common argument, most recently
put forward by Lord Farmer, that assisted dying isn’t necessary where there is excellent palliative care. Instead of giving dying people the right to choose the manner and timing of their deaths, the argument goes, there should be more investment in palliative care. This would, they argue, lead to no dying people needing or wanting to end their life at a time and manner of their choosing.
It’s flawed for several reasons. Palliative care is excellent in this country, and in a large number of cases it will be sufficient to give a person the death they want. But even the most ardent supporters of palliative care admit that there are limits to the suffering it can ease. Some dying people will want and need to end their lives no matter how good palliative care is. We can and should invest more in palliative care, and Baroness Finlay’s Bill deserves praise, but it’s unreasonable to believe it will be a panacea for all dying people.
Lord Farmer: Improving palliative care
Lord Farmer: Evidence for physician-assisted suicide 'is far from reassuring'
Secondly, it disregards the principle of the patients making choices about their treatment. In every other area of medicine, a patient’s voice is rightly taken into account. But where a dying patient wants to take control of their death, doctors are unable to respect their wishes. This cannot be right.
Lord Farmer’s question this afternoon will reflect on the findings in the PHSO’s “Dying Without Dignity” report. One of the main conclusions and key themes of the report is that patients must be engaged more in discussions about their end-of-life care. By withholding from terminally ill patients the choice of assisted dying, we restrict the discussions that empower dying people and lead to more honest, open conversations about death.
Finally, and perhaps most importantly, these arguments that palliative care is preferable to assisted dying are based on a false premise. The two are not mutually exclusive, and we can best serve dying people by providing them with both excellent palliative care and the choice of assisted dying.
In Oregon, USA, dying people have been legally allowed assistance to die for 18 years and in that time palliative care has improved. When the law was reviewed, after 10 years of practice, the Oregon Death with Dignity Act was found to have “improved end-of-life care among Oregon practitioners — including the increased use of hospice and palliative care”. 90% of those who have had an assisted death in Oregon have been enrolled in hospice care.
Much of the opposition to assisted dying is based on a fear that giving dying people choice would lead to unintended consequences. But the Oregon Hospice Association, which steadfastly opposed a change in the law before it became legal, now recognises that assisted dying does not pose a threat either to vulnerable people, or to the development of palliative care.
Lord Farmer and others would do well to listen to those who provide end-of-life care in Oregon, like the OHA:
“Oregonians need not choose between hospice and physician-aid in dying. Dying Oregonians can choose both from among the options on the end-of-life continuum of care.”
To see Lord Farmer's response to Dignity in Dying, see