THE BLOG

Failings in Care Should Not Pave the Way for a Physician Assisted Dying Bill

22/05/2015 15:51 BST | Updated 22/05/2016 10:59 BST

The 'Dying without Dignity' report published last week by the Parliamentary and Health Service Ombudsman highlights many shocking examples of inadequate end of life care.

We all fear dying; for most people fear of pain ranks far higher than fears about dignity, place of care or being involved in decisions about their care. The 136 people cited in 'Dying without Dignity' report were let down by a system that knows what to do but just is not doing it - even making sure that pain relief was given when needed did not happen.

With the UK ranked highest in the world for palliative care, this should not be happening. The modern hospice movement started here - so what is happening? After all, with good palliative medicine, and broader end of life support for dying people and those important to them, a good death is not just possible - it should be routine.

The PHSO's Chair, Dame Julie Mellor believes that there is potential to improve the experience of all those who die an expected death - some 355,000 a year. As a professor of palliative medicine, I agree wholeheartedly. As Cicely Saunders highlighted, the tragedy of a bad death lives on in the memory of those left behind.

At present, specialist palliative care services in England remain patchy. Wales has ensured that specialist palliative care services are available seven days a week. England must follow.

People spend their last hours, days and weeks in different places; only 6% die in a hospice. But wherever patients are dying, they should have responsive care that listens to them and deals with severe distress as an emergency.

Doctors and nurses must be freed up from administrative tasks to give them the time - and develop confidence - to talk clearly and practically about death with patients and relatives. Knowledge of pain and symptom control with opiates and other medicines must be a core skill.

Whilst end of life care provision is excellent in many areas of the country, the report reveals that in some places patients and their families are still not getting the support they need - and shows what a devastating impact poor care can have.

This week is Dying Matters Week. The public and private conversations should be happening. Yet according to ComRes, almost two thirds of the adult population haven't made a will, even when they have children under 18 living with them; their death would leave their children's futures in precarious limbo. And even fewer have registered as organ donors or taken out any form of life insurance.

The Health Select Committee called in March, as many third sector organisations have done, for free social care at the end of life - so that people can stay at home surrounded by everything that is familiar but that those close to them, already anticipating their loss, do not have to bear the burden of their personal care alone. It is likely that such social care support for dying people would relieve the pressure on hospitals and reduce costs - as well as providing a better death for people.

When people are at home, those important to them, whether family or friends, are usually the mainstay of their care. They have to decide when to call for help, whether to give an extra dose of medicine or whether to dial 999. Yet our systems don't recognise the responsibility they carry - and they need to know where help is accessible 24/7.

The current discussions about assisted suicide and euthanasia are a dangerous distraction from what needs to be done. The excellent care that many receive can and must become the universal norm.

There is no excuse for turning a blind eye to distress; those providing care, whether care assistant, family, nurse or doctor need to know they are supported in doing what the patient needs, not shackled by risk averse attitudes that paralyse common sense and hinder care provision.