End-of-life care in England and Wales cannot cope with demand, say doctors opposed to assisted dying

End-of-life care in England and Wales cannot cope with rising demand and will require billions in new investment, warn palliative care doctors opposed to new assisted dying laws.

It is predicted that a further 130,000 people in England and Wales will need palliative care by 2048. The Department of Health and Social Care estimates that the NHS already spends around £6 billion a year on palliative care.

The Association for Palliative Medicine, one of the world’s largest representative organizations of healthcare professionals practicing end-of-life care, has position statement in the debate over new assisted dying laws, stating that it is opposed to legislation due to several concerns including “the lack of adequately funded specialist palliative care services”.

It also warns of safeguarding issues and “concerns about trust and the impact on doctor-patient relationships”. The association recognizes that “while a substantial majority of members opposed (assisted dying), some of our members have a different view.”

Sarah Foot, a palliative care doctor and member of the Association for Palliative Medicine, which opposes new laws to allow assisted dying, said an overhaul of palliative care is needed. “We shouldn’t need charities to fund it,” she said. “We need to invest in the workforce and invest in palliative beds so people can die comfortably.”

Rachel Clarke, a specialist in palliative care in hospitals, said she had decided not to make her general position on assisted dying known because of her relationship with patients, but was “categorically” of the view that the law should not be changed at this time should be allowed because so many patients have ‘completely failed’ at the end of life.

She said: “My concern is that if we change the law without adequate resources for palliative care, there will be people who choose to end their lives because they are not getting the care they need.

“I sometimes see patients (near the end of their lives) who come to the hospital in unspeakable pain and want their lives to end. It’s not because their pain can’t be prevented, but because they don’t get the care they need. Labor and Conservative governments have failed to provide adequate palliative care for patients.”

Clarke said significantly more investment needs to be made to ‘fix’ palliative care ahead of any legislative debate on assisted dying.

A report published by Marie Curie, Britain’s largest charity, has predicted that the number of people who would benefit from palliative care in England and Wales will increase to over 646,000 by 2048, an increase of more than 25% compared to 2023.

Palliative care is provided in hospitals, hospices and in the community. Hospice UK warned in July that one in five hospices were cutting services during the worst funding crisis in two decades.

In evidence to the Commons health and social care committee last year, then Health Secretary Helen Whately said there was variation in access to care. She said that in addition to the £6 billion the NHS spends annually on palliative care, the hospice budget was around £1.6 billion a year.

A bill was introduced in parliament on Wednesday aimed at giving terminally ill people with only months to live the right to end their lives, subject to the agreement of a judge and two doctors. Molly Meacher, who introduced an assisted dying bill in the House of Lords in 2021, has said she wants any new legislation to be accompanied by greater investment in palliative care.

The debate over the bill has divided both major political parties and exposed divisions within the Church of England, with the Archbishop of Canterbury, Justin Welby, opposing it and his second predecessor, George Carey, speaking in favor of the bill .

Former Supreme Court President Brenda Hale said this weekend that it is “not very Christian” to let someone continue to suffer if they want help ending their life.

In a conversation with the former Archbishop of Canterbury, Rowan Williams Expectation magazine Lady Hale said: “It is not very Christian to force someone to continue to suffer intolerably when he does not want to.”

The bill on the end of life for terminally ill adults is expected to be voted on on November 29. If the bill is passed in the House of Commons, it will move to the committee stage where MPs can table amendments, before facing further scrutiny and votes in both the House of Commons and the House of Lords.

A government spokesperson said: “This government wants a society where everyone receives high-quality, compassionate care, from diagnosis to the end of life. We are committed to moving more healthcare out of hospitals and into the community, to ensure patients and their families have access to the personalized care they need, in the most appropriate environment.”