Palliative care, no matter how good, isn’t always enough to allay the indignity and loss of control that people with terminal illness experience, says Baroness Young
Last week the Commission on Assisted Dying published its recommendations, highlighting that the current legal status of assisted dying is incoherent and inadequate. The current informal rules are at the discretion of the director of public prosecution, assistance to suicide is left in the hands of amateurs or paid strangers in a foreign country, and caring and compassionate friends and relatives are thrust into the role of suspects.
Several professional witnesses told us the current rules stifle open discussion about choices at the end of life between patients and their health professional.
We suggest that the law could be changed, if Parliament permits, to allow those with a terminal illness and less than 12 months to live the option of a more dignified death at a time they felt right. Health professionals are rightly cautious in their approach to this issue, as they are likely to be most affected by any change, and we recognise that it is into their expert hands that our framework would place the important responsibility for supporting patients through the process of requesting an assisted death.
“During the course of our research we found no evidence to suggest that changing the law on assisted dying would have a negative impact on end-of-life care”
Our system of strict safeguards would protect both patients and professionals. To be eligible, the person who requests assisted suicide would need to be diagnosed as having a terminal illness and have mental capacity (which could preclude those with clinical depression). Two independent doctors must also be able to agree that the person’s decision has not been subject to any external pressure, where possible gathering insights from nurses or social workers who know the patient and their personal circumstances. Also, to ensure that the safeguards are correctly adhered to in each case, we recommend that a national monitoring commission should be established to oversee the system. Professionals who wished to opt out on moral or religious grounds could do so as is the case with abortion law.
We have made these recommendations in the knowledge that, while there is clearly much room for improvement, palliative care in this country is among the best in the world. During the course of our research we found no evidence to suggest that changing the law on assisted dying would have a negative impact on end-of-life care. In fact, we found quite the opposite. We found that in countries where assisted dying is legal, for example in Belgium and the Netherlands, legal change has been accompanied by greater investment and improvements in the quality of palliative care. On top of this, we heard evidence from individuals for whom palliation, no matter how good, wasn’t enough to allay the indignity and loss of control of their situation.
We think there is a strong case for redress of this issue, which denies hundreds of people dignity in their death, and we hope the medical profession will support us on this. A duty of care should not exclude the terminally ill. Our safeguards would place nurses and doctors on the frontline in any new system and the responsibility would be great, but 80% of the public support assisted dying being an option for those with terminal illness and we believe, like them, that this is a problem too big to ignore any longer.