Improve palliative care or introduce assisted dying? It's a false choice – let's do both
Supporters of the assisted dying bill demonstrate in Parliament Square, April 2026 (Alamy)
5 min read
Few issues in politics demand more humility than assisted dying.
It asks us to confront death, suffering and the limits of medicine. It forces us to wrestle with competing values that are all deeply held: the sanctity of life, personal autonomy, protection of the vulnerable and compassion for those enduring unbearable suffering.
For me, this debate has never been abstract. I lost my Nana and my Grandad, my heroes. I saw the very best of palliative care: the extraordinary skill, kindness and humanity that dedicated professionals can bring to someone's final days. I will always be grateful for that care. But I also saw its limits.
Even the finest medicine cannot relieve every form of suffering, restore every lost dignity or answer every fear that can accompany the end of life. That experience did not weaken my faith in palliative care. It strengthened my conviction that compassion sometimes requires us to offer one final choice.
I support legalising assisted dying. I do so not because I value life any less but because I value dignity, compassion and the belief that, in the final chapter of life, people deserve both exceptional care and the freedom to make deeply personal decisions.
Too often, this debate is framed as a choice between improving palliative care and introducing assisted dying. It is a false choice. Choice without care is no choice at all, but care without choice is not always enough. A progressive society should be ambitious enough to provide both.
That begins with fixing social care. For decades, governments have ducked the challenge. Families carry impossible burdens. Carers remain undervalued. Local authorities struggle under impossible pressures. Too many older and disabled people lose independence long before they lose life.
Alongside that, we should build the best end-of-life care in the world. No family should face a postcode lottery in access to specialist palliative care. No hospice should have to spend as much energy fundraising as caring. Every person approaching the end of life deserves expert support, effective pain relief and the chance to spend precious time with the people they love.
For many, excellent palliative care transforms the final chapter of life. But we should also have the courage to acknowledge an uncomfortable truth: even the very best palliative care has limits. Not every symptom can be relieved. Not every kind of suffering is physical. Some people experience an irreversible loss of autonomy, dignity or function that medicine cannot restore. Others continue to suffer despite receiving world-class care.
Recognising those limits is not a criticism of palliative care. It is an acknowledgement of reality. That is precisely why improving palliative care and legalising assisted dying are complementary, not contradictory.
Palliative care asks how we help people live as well as possible until they die. Assisted dying asks what should happen when, despite receiving that care, a mentally competent, terminally ill adult reaches a settled decision that they no longer wish to endure suffering they find intolerable. These are different questions. Compassion demands that we answer both.
Indeed, assisted dying should never be seen as an alternative to good care. It should exist only alongside excellent palliative care and a properly functioning social care system. If someone seeks an assisted death because they cannot access pain relief, because their family has been abandoned by social care or because they feel like a burden after years of state failure, that is not genuine autonomy. It is society letting them down.
Some argue that assisted dying represents a failure of compassion. I profoundly disagree. Cruelty is forcing someone, against their settled wishes, to endure suffering they find unbearable when every safeguard has been met, every alternative explored and every opportunity for high-quality care has been offered. Compassion is trusting terminally ill adults to make deeply personal decisions about their own lives, while protecting the vulnerable through the strongest legal safeguards.
As progressives, we should be capable of holding more than one principle at once. We should fight for a social care system worthy of the name. We should build the finest palliative care service in the world. And we should give terminally ill people, in carefully defined circumstances, the choice of a peaceful and dignified death.
When I think about this debate, I think about my Nana and my Grandad. I think about the love that surrounded them, the remarkable professionals who cared for them and the comfort that great palliative care brought our family. I also remember that even the best care cannot answer every circumstance or relieve every kind of suffering.
The test of a civilised nation is not whether it chooses between care and choice. It is whether it has the courage to provide both. That is why I support assisted dying. And that is why I will continue fighting with equal determination for better social care, world-class palliative care and the right of terminally ill people to avoid unnecessary cruelty at the end of life.
Because no one should have to choose between dignity and compassion – and nor should Parliament.
Michael Payne is Labour MP for Gedling
