Improving palliative care

Britain has a proud history of good end of life care. The modern hospice movement started here and rapid developments in the clinical specialism of palliative medicine have been seen in the last few decades. A 2010 survey by The Economist ranked Britain first amongst 40 OECD and non-OECD nations in terms of quality of care for the dying.

However, a recent report by the Parliamentary and Health Services Ombudsman found that some people at the end of their lives experience unnecessary pain and suffering and that end of life care services need to improve. The 136 people cited in the report were let down by a system that was simply not effective or responsive enough to provide patients with the pain relief they needed at the end of their lives. They were failed by a system that knows what to do but is not doing it.

The Ombudsman’s report concluded that: “There is potential to improve the experience of care in the last year and months of life for approximately 355,000 people” every year.

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Perhaps hearing about such poor experiences leads some to think that physician-assisted suicide would be the solution to poor end of life care.

But doctors – particularly those who spend most time with dying people – can see the dangers associated with physician-assisted suicide only too clearly:

• the vulnerable who will feel they are a burden and that they should ‘see themselves off’;

• those with undiagnosed depression who may make what they feel is a rational decision to end their lives without realising how much the state of their mental health has affected their judgement;

• and, tragically, undisclosed motives, often financial, of kin holding more sway than anyone would feel comfortable with.

Six in seven GPs would not take any part in assisting suicide and 96 per cent of palliative care doctors are not prepared to participate in physician-assisted suicide.

At the moment, national suicide prevention strategies ensure doctors play a compassionate role in our societal response to people who feel suicidal, but it is against the law to encourage or assist someone to commit suicide. It should remain that way.

Efforts should focus instead on ensuring those who are dying are able to get support around the clock and do not suffer as a result of poor services, and carers know how to confidently manage medication and when to call for help. All clinicians must receive the necessary education and training to provide care and support of the highest standards with knowledge of pain and symptom control with opiates and other medicines a core skill.

For these reasons, while I oppose Lord Falconer’s Assisted Dying bill, I support the Palliative Care Bill tabled in the House of Lords by Baroness Finlay of Llandaff.

Everyone deserves compassionate care at the end of life. Access to the best palliative medicine for dying people and a comprehensive support system for them and their loved ones would mean this is not just possible for a few – it should be expected for all.