Senior Doctors Urge Government to Prioritize Palliative Care Amidst Assisted Dying Bill Advancement

Senior medical professionals assert that addressing the deficiencies within the palliative care system should be an urgent governmental focus, particularly as a legislative proposal concerning assisted dying has advanced to the subsequent parliamentary phase. The Association for Palliative Medicine (APM) has articulated concerns that financial resources required for medical practitioners and judicial oversight of assisted dying might be redirected from existing care provisions for terminally ill individuals. Dr Sarah Cox stated, “The UK is often held up as having the best palliative care in the world – but that is not the case any longer. We are not getting the funding we need.” On Friday, Members of Parliament cast votes in favor of amending the law in England and Wales to permit assisted dying. This represents merely the initial legislative obstacle for the bill, with further months of discussion and balloting anticipated. There remains a possibility that the proposed legislation may not succeed and could ultimately fail to be enacted. In an interview with the BBC, Dr Sarah Cox, who serves as president of the APM and opposes assisted dying, remarked: “Health Secretary Wes Streeting said part of the reason he could not vote for assisted dying was because palliative care was not good enough. “So I would say to him, now is the time to fix that.” Liberal Democrat MP Layla Moran, who supported the bill in her vote, expressed her conviction that terminally ill adults “should be able have that choice”. Nevertheless, she reiterated demands for enhancements to palliative care, stating on the BBC’s Today programme: “I don’t think we need any further votes in the house to be clear that Parliament’s will is that government wants them to sort out palliative care – that’s both the funding but also possibly reforms and they should be getting on with that now.” Dianne Abbott of the Labour party informed the BBC that “people really need is access to hospice care”. She cast her vote against the legislation and conveyed to Today: “I am very worried that vulnerable people will get swept up in the assisted dying route when actually what they really need is access to hospice care and proper end of life care.” She voiced apprehensions that numerous individuals considering assisted dying might choose this path due to anxieties about becoming a burden or depleting family financial resources through healthcare expenses. Ms Abbott stated, “I think they should have a genuine choice and not see supported suicide as the only option”. She further indicated her belief that the bill lacked adequate safeguards, remarking: “In my experience, once you’ve voted for legislation in principle at second reading, you can tweak it at committee stage, but it comes back substantially the same.” Toby Porter, chief executive of Hospice UK, an organization maintaining a neutral stance on the proposed legal alteration, expressed his reassurance upon observing Members of Parliament from both factions of the debate recognize the necessity for improved palliative and end-of-life care across the UK. Addressing the BBC’s Today programme a day following the significant vote, Mr Porter conveyed that for numerous palliative care consultants, “the absolute, fundamental definition of palliative care is that it neither hastens nor postpones death”. He further stated that the bill represented “a enormous and fundamental change in the UK” from the principles that this “wonderful group of doctors believes in and has practiced up until now”, yet acknowledged that “society has spoken through the MPs” and the pertinent issues had been “extensively debated”. Earlier this week, the Office for Health Economics declared that augmented funding for palliative care was essential, given the system’s current difficulties in addressing the requirements of an increasingly elderly populace. A minimum of three-quarters of individuals require palliative care during their final stages of life, equating to approximately 450,000 people annually throughout the UK. For instance, in cases of incurable illness, palliative care endeavors to maximize comfort by alleviating pain and other distressing symptoms. However, a recent publication from the end-of-life charity Marie Curie referenced data indicating that approximately 100,000 individuals lack such care, and half of families express dissatisfaction with the care provided to their deceased loved ones. Accounts exist of individuals enduring pain and receiving insufficient assistance. Audits reveal that four out of 10 hospitals do not offer specialist palliative care services on a seven-day-a-week basis. Hospices, which deliver care to approximately 300,000 individuals annually, are facing financial difficulties. Roughly one-third of their funding originates from the NHS, compelling the sector to generate the remaining funds independently. A parliamentary report has characterized this funding framework as “not fit for purpose”. Several Members of Parliament who endorsed the assisted dying bill asserted that its implementation would contribute to the enhancement of palliative care. They cited a report from the Health and Care Committee, which indicated a correlation with improvements in certain nations. However, Dr Cox challenged this assertion, describing the situation as a “very mixed picture”. She further stated: “We know money is the NHS is finite – and our concern is that palliative care will lose out. The NHS will need doctors to assess patients, and judges to agree. That is all going to cost money, and palliative care is already struggling.” She indicated a requirement for enhanced coordination among hospitals, community NHS teams, care homes, and hospices, noting that training for non-palliative care specialists also presents a challenge. Sam Royston, director of policy at Marie Curie, concurred that measures were necessary for palliative care, stating: “We have taken a neutral position on assisted dying, but we do not take a neutral position on the need for improvement on palliative care. “The needs of people at the end of life are being neglected. There are no realistic plans currently in any UK nation to improve palliative care.” He commented that the MPs’ endorsement of assisted dying did not automatically imply corresponding enhancements in palliative care, adding: “We had asked for a clause within the bill for a strategy around palliative care. If it does pass we will ask for this to be given greater attention.” Conversely, Professor Sam Ahmedzai, a retired palliative care physician and former NHS advisor on end-of-life care, noted his observations in countries where both systems operated effectively in conjunction, and in certain locations where assisted dying had been implemented, palliative care had seen improvements. He proposed that increased focus and education could be directed towards the primary providers of palliative care, frequently general practitioners, district nurses, and hospital doctors across various departments. Baroness Ilora Finlay, a prominent authority in palliative care, indicated that momentum was gathering for demands for an independent commission to scrutinize hospice and end-of-life care. Any such commission would operate independently of the bill progressing through parliament. The crossbench peer, who is against the proposed legislation, mentioned that influential political figures from various parties have participated in discussions regarding the formation of such a commission, among them former prime ministers Theresa May and Gordon Brown. She further stated: “We need a commission to look at the services people need,” adding, “It’s just not sustainable that hospices only receive one third of their funding from the NHS, with the rest being made up from cake sales, fun-runs and the like.”