Palliative Care Must Improve Before Assisted Suicide Becomes an Option, Expert Says

People take part in a demonstration to oppose the Terminally Ill Adults Bill at Old Palace Yard in Westminster, London, on Nov. 29, 2024. Yui Mok/PA Wire

Palliative care must “massively improve” before assisted suicide could even be considered an option, the president of the Association of Palliative Medicine (APM) told MPs.

Sarah Cox gave evidence at the Terminally Ill Adults (End of Life) Bill committee on Tuesday, where she described the current state of palliate care as “inadequate,” suggesting that a lack of access to end-of-life care could push the terminally ill to opt for assisted suicide.

Cox, who has 30 years of experience in end-of-life care, told MPs, “We need to massively improve palliative care in order that this bill is actually offering patients a real choice.”

The palliative care consultant explained that effective palliative care “can change somebody’s point of view, from having a terminal illness and wanting to die, to having a terminal illness and wanting to live.”

According to Cox, 25 percent of people who die in the UK do not have the palliative care they need, estimating that figure to be around 100,000 people a year.

“I think the position that we would ask you to consider is this: ‘Is this the right time to be bringing in a law to give people a choice for assisted dying when they don’t have a choice to have good palliative care?’” Cox put to the committee.

“I accept that there will be people—even with a very good palliative care system—who would still choose assisted dying. We do not currently have the very good palliative care system that we need. That’s the thing that concerns me,” she added.

Coercion Concerns

Cox was one of several specialists called to give oral evidence for the committee stage of the assisted suicide bill after it was passed in the House of Commons at second reading on Nov. 29, 2024, with a majority of 55.

The private members’ bill, put forward by Labour MP Kim Leadbeater, would allow terminally ill adults who have been given a life expectancy of less than six months to end their lives with the assistance of the state.

Those in favour of legalising medically-assisted suicide say it gives people with terminal conditions a dignified death and spares families from watching loved ones suffer.

When Leadbeater introduced her bill in November, she had said, “Parliament should now be able to consider a change in the law that would offer reassurance and relief—and most importantly, dignity and choice—to people in the last months of their lives.”

However, those against the measures have warned that the elderly, vulnerable, and disabled who are terminally ill could feel obligated or coerced to end their lives, and campaigners have called for better care for those facing death.

James Sanderson, CEO at the palliative and bereavement support charity Sue Ryder, also said that there are “clearly gaps” in the provision of end-of-life care.

Cox said that 80 percent of APM members are opposed to the legalisation of assisted suicide, with just 5 percent in favour.

She said that the reasons behind such strong opposition—besides poor palliative care availability—include concerns about the impact assisted suicide would have on palliative care resources, as well as how safeguards would be enacted, including against coercion.

Dr. Rachel Clarke also shared her concerns over the ability of medics to spot victims of coercive behaviour, saying that in her clinical experience, the majority of doctors are “not necessarily trained in spotting coercion explicitly.”

Leadbeater has said that her bill, which covers England and Wales, would have “layers and layers of safeguards and protections which I believe will probably make it the most robust piece of legislation in the world.”

This includes making it a criminal offence coerce a person to agree to assisted suicide.

People Now Frightened of Death

The APM president also told MPs that it is unclear how this would be funded. She said given the limited resources, assisted suicide services could end up competing with palliative care for public money.

Questioned whether improvements in palliative care could not be made at the same time as offering assisted suicide, Cox reiterated her earlier point that current availability is “inadequate,” and there would have to be a certain level of service before the country could be at a position to offer assisted suicide.

“We need to make sure that the 75 percent to 90 percent of people who are dying—that need palliative care—are getting it.” Cox said.

She continued that hospitals would need to have seven-day-a-week services, as 40 percent of hospitals have no daily end-of-life cover. Also, only one in three communities have overnight telephone advice services for patients and families.

“There are some very concrete things that we could change to demonstrate that we are delivering a good service. But currently, we’re not,” she said.

Kim Leadbeater (C) is joined by campaigner and cancer sufferer Sophie Blake (L) and Rebecca Wilcox daughter of Esther Rantzen Rebecca Wilcox (R) after hearing the result of the vote in parliament for her Terminally Ill Adults Bill in Westminster, London, England, on Nov. 29, 2024. Stefan Rousseau/PA Wire

At the end of the evidence session, the palliative care specialist made an observation on the impact that this bill was having on the public’s view of dying.

Cox said, “The stories that have been told have suggested to many of the public that death is inevitably ugly and horrific and dramatic, and actually that’s made many people fearful.”

She said she had been receiving emails from people saying that they were now afraid of dying.

“They may then choose assisted dying before they need to, because they have had a fear instilled in them that death is inevitably horrible and dramatic,” she said.