Why on earth are we debating assisted suicide in the middle of a palliative care crisis?
4 min read
Supporters of legalising assisted suicide will say that doing so and improving palliative care are not mutually exclusive options. Evidence suggests that's not actually the case.
Palliative care is transformative. As the president of the Association for Palliative Medicine, Dr Sarah Cox, told the Committee considering Kim Leadbeater’s assisted suicide Bill: “We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live."
The Commission on Palliative and End-of-Life Care recently published its first report on the state of palliative care in the UK. It echoed Dr Cox’s confidence: “High-quality research undertaken over the past decade has shown that specialist palliative care works well, providing better quality of life, better outcomes including symptom control and emotional wellbeing, and reduced healthcare intervention.”
This includes effectiveness in tackling pain. As the report goes on: “Pain usually responds to analgesic medications”. While for the “relatively small number of patients” for whom this is less effective, alternative strategies, such as nerve block or palliative radiotherapy, can usually be performed as a single intervention… and can reduce pain scores by over 50 per cent”.
The facts are clear: no patient is beyond the help of palliative care. The problem is that we have not taken sufficient steps to ensure everyone who needs it receives it.
It is a tragedy that, for all the advancements in technological capability in end-of-life care, many continue to miss out on its benefits. Data suggests that although 75-90 per cent of dying patients would benefit from specialist palliative care, only around half receive it.
While those who support Leadbeater’s Bill may be motivated by good intentions, to suggest that the solution for those we have failed is assisted suicide is defeatist and wrong-headed. To put it bluntly, we are suggesting to the terminally ill that they should consider taking their own lives because of our failure to invest in palliative care.
Furthermore, the reality is that given structural inequality in provision, the pressure to opt for assisted suicide will be felt most acutely by the most vulnerable, the poor, the isolated, those with conditions like dementia, and BAME communities.
Instead of distracting ourselves with months of contentious talk on assisted suicide, we must devote our time to getting to grips with palliative care.
The Commission highlights examples of good practice and palliative care that have given real choice and autonomy to the terminally ill. We need to ensure these are replicated and rolled out across the country, using our powers under the Health and Social Care Act 2022 to set minimum standards. This must include providing 24/7 access to specialist palliative care services. And we need to ensure a fairer, long-term funding model for hospice care, above the welcome £100m capital grant awarded last year.
This is harder graft, but only then will patients have the true choice they deserve.
Of course, supporters of assisted suicide will say that legalising assisted suicide and improving palliative care are not mutually exclusive options. Unfortunately, evidence from overseas does not back up this claim.
Data from countries in Western Europe show that between 2012 and 2019, countries without assisted dying laws increased palliative care provision by 25 per cent, compared to just 7.9 per cent in countries with ‘assisted dying’. Worryingly, palliative care funding actually decreased in New South Wales following a change in the law. While in Canada, C$6bn was promised for palliative care and home care over ten years when ‘Medical Assistance in Dying’ was legalised. However, after five years, only C$184mn could be shown to have been given.
To vote for assisted suicide now, in the hope that palliative care might improve in the future, is therefore a risky gamble.
Finally, we should be concerned about the threat that assisted suicide poses to hospices already in crisis. MPs’ rejection of an amendment to allow hospices and care homes to conscientiously opt out of providing assisted suicide may force some to close. As St Gemma’s Hospice has warned: “If compliance with assisted dying provision becomes a condition for NHS funding, institutions like St. Gemma’s may have no alternative but to cease operations entirely…”. Is this what we want?
Mary Glindon is the Labour MP for Newcastle upon Tyne East and Wallsend.
