Instead of Funding a State Suicide Service

Dr Cajetan Skowronski writes:

Last week, I closely observed the three days of oral evidence sessions for Kim Leadbeater’s assisted suicide Bill. As a geriatric medicine and palliative care doctor who has worked with a large number of patients nearing the end of their lives, there was plenty to engage my interest but I listened with particular care to the evidence provided by my palliative care colleagues.

We did not need last week’s evidence sessions to know that the majority of those who work in the palliative care sector oppose Leadbeater’s Bill. Neither were the Committee hearings required to ascertain that the Bill would risk undermining palliative care within the UK, as evidenced by the experience of other countries that have introduced such laws. All this was perfectly clear before the vote at Second Reading when, regrettably, MPs still decided to proceed with the flawed Bill.

While high-profile names such as Sir Chris Whitty and Lord Sumption dominated headlines with their testimony to the Committee, for me, the most powerful intervention in the opening sessions came from Glyn Berry, Co-Chair of the Association of Palliative Care Social Workers. She outlined the inequitable provision of palliative care services and that, in some of the countries where assisted suicide laws have been introduced, there are people who feel they have no option other than to opt for a premature death because of inadequate palliative care. The reasons why someone might feel forced into assisted suicide, however, go beyond lack of access to palliative care. Berry also highlighted the role that failure to access secure housing or financial instability could play in some people going down the assisted suicide route.

Berry also made the important point that, while many clinicians may understand the clinical needs of their patients, they may not be equipped to form a holistic view of that patient’s position within society, the nature of their relationships with loved ones or their vulnerability to coercion. This is especially concerning given the role of the two doctors in the assisted suicide sign-off process. Berry requested that representatives from the palliative care sector be present alongside the two clinicians when a decision is made to sign off on requests.

The Chief Executive of the Royal College of Nursing, Professor Nicola Ranger, echoed Berry’s concerns. When asked by Danny Kruger MP whether it was possible that someone’s request for assisted suicide might arise out of a lack of adequate palliative care, she warned, “I think it could be possible”. 

Palliative care doctor Rachel Clarke also reinforced the view that the current state of palliative care in the country would inevitably lead to some opting for assisted suicide because they feel they do not have any choice.

The President of the Association for Palliative Medicine, Dr Sarah Cox, reminded members of the Committee that approximately 80 per cent of the Association’s members opposed assisted suicide with only 5 per cent being in favour. She also stated palliative care has improved three times more in countries where assisted suicide has not been implemented. Not only that, but she cited evidence that assisted suicide laws have impeded the development of palliative care services in some jurisdictions. 

MPs and observers also had the opportunity to enjoy Alex Greenwich, the MP for Sydney, Australia, being educated by Danny Kruger concerning the state of palliative care services in his own state. Despite Greenwich’s claim that palliative care services in New South Wales (NSW) had benefitted from the introduction of euthanasia, the facts tell a very different story. 

While in 2022 NSW committed to spend an extra $743 million on palliative care over five years when assisted suicide/euthanasia was legalised, in 2023 this decision was reviewed and the palliative care budget slashed by $249 million in a single year, resulting in cuts to palliative care staff and services. At the same time, NSW diverted $97.4 million in new funding over four years to roll out its assisted suicide/euthanasia programme.

Sadly, when it comes to the implications for palliative care, it seems some proponents of Kim Leadbeater’s Bill just don’t want to know. I found the way Kit Malthouse MP, one of the Bill’s sponsors, appeared to be scrolling through his phone as palliative care doctors gave evidence last week very dispiriting.

One of the most troubling aspects for me is that the recently announced Palliative and End of Life Care Commission is unlikely to report before the decisive vote on whether to approve Kim Leadbeater’s Bill. I am not entirely sure what the justification is for rushing through this flawed Bill before MPs have been given an opportunity to assess and consider the current state of palliative care and the likely impact of Leadbeater’s Bill on it. Despite all evidence to the contrary, I continue to hope this is not a cynical attempt to railroad the Bill through Parliament before MPs have all relevant facts at their fingertips.

Many wonderful people work in palliative care and there is excellence throughout much of the sector, although provision remains patchy. It is thought that about 100,000 of the 550,000 Britons who die every year lack the care they need. Instead of funding a state suicide service, surely our efforts should be focused on improving the palliative care sector instead?