The impact of “assisted dying” on Palliative Care Provision

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In the recent report by House of Commons Health and Social Care Committee “Assisted Dying/ Assisted Suicide Second Report of Session 2023–24”. They speak about the impact on Palliative Care and wrongly state that if there is a change in the law palliative care services would not be affected.

This muddled thinking, seems solely down to one piece of evidence which highlighted evidence from New South Wales, Australia, where alongside a change in their law, the state Government promised a massive injection of money. In part this commitment was made to ease the mind of the doctors who raised doubts about the impact of end-of-life services. Had the money been delivered, it might have well led to improvements, but the politicians welched on the deal. As reported just last month, budgets have been cut by $250 million dollars on what was promised, leaving many palliative services facing budget cuts of around 30 per cent.

There are other problems with the assertion on palliative care. Using the same data set as the Health and Social Care Committee, you clearly see a glaring problem. In 2015 New Zealand was 3rd in the table on Quality of Death Index and in 2021 they had dropped to 12th. Likewise, Canada were 11th and now they are 22nd. Both jurisdictions having changed the law to allow one form or other of Physician Assisted Dying.

The UK currently sits at the top of the table on the Quality of Death Index. This will not be the case if the law is changed, and palliative care services will truly suffer as night follows day. The evidence is clear for all to see.

They go on to say, “The UK has long been a world leader in palliative and end of life care, but access to and provision of palliative and end of life care is patchy” and one of the few recommendations they make is:

“The Government must ensure universal coverage of palliative and end of life services, including hospice care at home. It is important that everyone is able to choose what type of support they need at the end of their life, and that their advanced care plan is honoured where possible”.

Where I live a home death is not possible or safe as we have no local palliative care services that can support such a wish. This happens to be in the same constituency as Liam McArthur MSP who now wants to introduce a Bill into Holyrood that would allow “assisted dying” to use his term. It is in fact Physician Assisted Suicide he is asking for. He is now using the report to support his claim that palliative care services will not be affected – not the case.

There are other questions that Mr McArthur’s proposals have yet to answer, not least how any safeguards will be protected and be enforced.

This is a legitimate question, as in all the jurisdictions that have changed the law, over time the rules are relaxed either via legislative change, judicial activism or simply by campaigners pushing the boundaries.

Take for example, the US state of California, a number of MSPs, have recently been on a fact finding mission paid for by a campaign group that supports assisted suicide.

A new bill in California, is seeking to alter the eligibility criteria from terminally ill (6 month prognosis) to a “reasonably foreseeable”, which could be years. Other changes seek to include those suffering from dementia, non-Californians even change how the death row drugs are delivered.

California is far from an isolated example on this front. Canada has massively expanded its law that was introduced in 2016. What was supposed to be a law to end suffering or those with terminal diseases has quickly been expanded to include those with mental health problems, disabilities and is even promoted to people seeking social care – that right a group of disabled veterans, including a former paralympian, who were requesting support and adaptations to their properties, were denied these, but in a chilling turn of events were offered an “assisted death”.

And then we look at Belgium and the Netherlands. Again a system designed to alleviate suffering has been expanded to include disabilities such as blindness, psychiatric conditions such as anorexia, conditions such as dementia and has been extended to include both adults and children who are not mentally competent, including babies born with such conditions as spina bifida.

No, the current law, as imperfect as it might be the safest law is the one we currently have and why MSPs should focus not on changing the current law but ensuring that palliative care is extended to all and regardless of where they live.

Francis Edwards, BSc (Hons) RGN, RSCN

Francis Edwards, RGN, RSCN, BSc (Hons) (Senior palliative care nurse retired). He lives on Orkney.