‘End-of-life care and choice are not in opposition to each other’

As GPs and as parliamentarians, we know firsthand that too many people struggle to access the health, care and support they need in this country. This is inarguable, and we welcome wholeheartedly the Prime Minister’s commitment to tackling our straining services. It has for too long been placed in the ‘too difficult’ box, with individuals and families bearing the brunt of Parliament’s inaction.

The same too can be said of the ban on assisted dying: a 60-year-old law entirely unfit for the modern realities of how we live and die. Medical breakthroughs have brought cures and longer lives, but they also mean we die for longer, with more complex and sometimes uncontrollable symptoms. Even with the best care, terminally ill people can suffer as they die, some resorting to taking their own lives at home or abroad with no upfront safeguards to ensure it is their choice alone.

Both care and choice at the end of life are therefore in dire need of reform. The public agrees we need better services alongside an assisted dying law. So do MPs, who voted twice for the Terminally Ill Adults (End of Life) Bill in the last parliamentary session before it was obstructed by a handful of unelected Lords. International experience proves we can and must do both.

We have had the privilege of speaking directly to doctors in the US and Australia at the coalface of their assisted dying laws, legislation similar to the Bill proposed in Westminster and the laws recently passed in Jersey and the Isle of Man. Not only are clinicians now able to provide safe, compassionate choice to those in extremis, but they have seen care improve across the board, with increased palliative care funding and better communication between patients and doctors about end-of-life wishes, which creates more opportunities for care needs to be met. Data from other jurisdictions shows the vast majority of people accessing assisted dying do so while receiving palliative care. Poor or insufficient care is not a motivator; this choice is a last resort option for dying people whose suffering cannot be relieved by other means.

READ MORE: Labour MP to reintroduce assisted dying bill to Parliament

We have already begun to see the benefits of the assisted dying debate here, with a light shone on end-of-life care like never before and £125 million additional Government funding for hospices secured. Former Care Minister Stephen Kinnock said the Bill had been a catalyst for this work, and hospice leaders admit this investment may not have materialised otherwise.

 Let’s also remember the people we are talking about under this Bill. Only adults in their final six months of life with full mental capacity, as confirmed by two independent doctors, would be eligible. This cohort would already be receiving end-of-life care, and would also be eligible for fast-track NHS Continuing Healthcare funding, which provides free, urgent social care within 48 hours for individuals with a rapidly deteriorating condition that may be entering a terminal phase. A social worker, psychiatrist and senior lawyer would also have to review every assisted dying application to ensure the person was making their own decision in full awareness of the options open to them, free from pressure. If the Bill receives final approval, it has a four-year implementation period, time in which plans for end of life care improvement will continue.

 We are reassured by the Prime Minister’s appetite not to duck the tough questions, to tackle the issues that affect people’s daily lives and to work on a cross-party basis to address them. Assisted dying is a shining example of this from the last parliamentary session: the Bill received more debate and scrutiny than most Government legislation, benefitted from extensive cross-party collaboration, and constituents praised MPs for finally acting upon their longstanding calls for a safer, kinder law.

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MPs did so after careful deliberation, voting according to their own personal conscience rather than party policy. Many will have heard from constituents like Nathaniel Dye, the Labour activist, music teacher and cancer campaigner who devoted his limited time to telling parliamentarians and journalists about the reality of facing the end of his life without proper choice. He died aged 40 from terminal bowel cancer in January, having seen the Bill passed in the Commons and then stalled in the Lords. It fell not because it was defeated, but because Peers were prevented from coming to any votes by a minority of Lords who preferred procedural game-playing over a fair debate. 

 Under Lauren Edwards MP, the Bill has rightly returned and on 11 September, MPs will debate it once again. They have the opportunity to continue the democratic process, return it to the Lords as soon as possible so they can do their important work while upholding the will of our elected chamber and respecting the overwhelming public support for change. There is no binary choice between pursuing much-needed reforms to health and care services, and introducing true choice at the end of life. To support everyone to live and die on their own terms, we can and must do both.

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