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Promoting Assisted Dying Is Not a Compassionate Response to Suffering

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Today, David Burrowes MP will be leading a debate on care for the dying in Westminster Hall.

Those who have known somebody with a terminal illness will know the distress and concern that can be present towards the end of life, and the real vulnerability that exists amongst families in these circumstances. There is a growing belief that advances in medicine are allowing people to live much longer, but not enjoy any quality of living in those final years of life.

The question to be debated in Westminster Hall on Tuesday is, how should we, as legislators, respond? Clearly it must be with compassion and concern for those who are in a very vulnerable state.

It has been suggested by some that the answer lies in amending the law to allow assisted dying. Those who believe that this should happen invariably cite the need to promote an individual's right to choose, or that given the state of pain and distress that many are presumed to be in, that a premature death at a time of their choosing would be in their best interests.

I want to examine these arguments and explore how the application of palliative care can both alleviate suffering and refocus the important questions that are often under-emphasised in this debate.

Free to choose?

Promoting freedom of choice sounds attractive, but we should question whether assisted dying really does promote genuine choice. Assisted dying is suggested as the means to avoid uncertain future pain and distress, but too often fear of future pain can lead people to make decisions from a position of uncertainty and anxiety. A patient can be fully informed about their treatment options in theory, yet not be in a position practically to evaluate what quality long-term symptom relief could achieve for the alleviation of distress and the securing of an acceptable quality of life.

I cannot see how promoting individual autonomy works effectively when that decision is made in the wake of fear, anxiety and a partial understanding of what the future could bring. This is hardly 'informed consent'.

A healthy 85-year-old in the early stages of Alzheimer's could sign consent for assisted dying at a hypothetical point in the future. Yet that individual may live longer than they anticipated, and in periods of lucidity that patient's decision may not reflect their settled will. It is questionable how robust procedures for respecting and communicating a change in wishes could be codified in law.

Whose well-being?

Arguing for assisted dying on the basis of the perceived well-being of the patient ignores the very real possibility that the patient's well-being would not reliably be at the heart of a decision to end life.

Whose well-being will be promoted? Pressure could be applied - implicitly or explicitly - to elderly patients to end their life by their well-meaning relatives; or doctors could find themselves under pressure to support a decision against their best judgement of the patient's interests. Moreover, the patient themselves could feel under an obligation to their relatives to relieve them of further expense and inconvenience.

Even with basic safeguards, it is very difficult to assess whether somebody had mixed motives for seeking to end their life. The decision to end life prematurely is one with no legal recourse or possibility to undo. The potential for a decision to be made on factors other than the patient's well-being convinces me that legislative change to allow assisted dying cannot be the right response.

Responding with concern and compassion: palliative care

In the face of potential distress and suffering at the end of life, palliative care and the excellent examples of the hospice movement offer us a way forward. Too frequently the assisted dying debate underplays the increasingly comprehensive contribution that palliative care makes for those in the final stages of life.

Britain is the only country in the world where palliative care is a recognised medical specialism, and the quality of palliative care in Britain was ranked as the best in the world by the Economist Intelligence Unit in 2010. Doctors often report that patients express gratitude that they did not seek to end their life having received unexpectedly good palliative care.

Palliative care is a response that recognises the value of life, and reflects compassion and concern for the individual's well-being. Rather than moving towards assisted dying - fraught with its risks, uncertainties, and legal problems - the government should support and promote the extension of excellent palliative care. This will go a considerable way to meeting the physical, social, psychological and spiritual needs of patients at the end of their life.

As a society, we should not be led to believe that a compassionate response to suffering at the end of life lies in promoting assisted dying. It is in caring comprehensively for the person at the end of life that the value of life is affirmed, the value of the individual is upheld, and compassion is truly expressed.

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