Withering believes that it is time for a proper debate on end-of-life care and finds himself on the side of doctors who wrote to The Guardian.

It was Benjamin Franklin who wrote that there were only two certainties in life – death and taxes. When it comes to death and dying, most people want to have a good death, and to die at home, but a recent report on palliative care by the London School of Economics has found that, for many, the likelihood of having a good death is remote, which may re-open the debate on voluntary euthanasia.

Every year, about 570,000 people die in the UK, and the number is growing as our population ages: end-of-life care is important.

The report has identified significant shortfalls in the delivery and quality of care for many people: tellingly, over 100,000 people who would benefit from palliative care are not offered it. Last year, a national audit of hospitals in England found that only one in five hospitals offered specialist palliative care seven days a week despite national recommendations; in addition, people cared for in hospital were less likely to feel that they had been treated with dignity.

Though people prefer end-of-life care to be provided in their home, pain control is poorer, with only 19 per cent of people reporting that pain was relieved “completely, all of the time” at home, compared to twice as many in hospitals and three times as many in hospices.

More than just cancer and pain relief

 

However, palliative care is not all about cancer and pain relief. People with other conditions, such as motor neurone disease or dementia, are likely to need palliative care at the end of their lives. However, NHS services focus much more on cancer, to the exclusion of people with other diagnoses: not only do they receive less specialist care, they also receive less generalist palliative care.

Two or three years ago, a family friend died of cancer. He was only in his 50s. He was able to die at home, among his family, and the MacMillan nurses who came every day were devoted and caring. But he was certainly not pain-free all of the time. Would he have wanted the option of voluntary euthanasia? I did ask him about it. “Maybe,” was his answer – but only if things got really bad. How bad did things have to get? He didn’t know.

The question of palliative care is central to the debate about voluntary euthanasia, or, as I prefer to call it, voluntary assisted dying at the end of life. The opponents of voluntary assisted dying have pointed to the availability of palliative care as one of the fundamental reasons why assisted dying is unnecessary.

The LSE report shows how hollow such objections are. It’s time our wretched politicians summoned up the courage to debate this issue properly. Did anyone notice that we have just had a general election – did you ever wonder where your local candidates stood on this issue?

Pen name of a practising independent community pharmacist

Withering’s views are not necessarily those of ICP