Palliative care and pain management are the key words in the debate about assisted dying | Letter

As specialists in pain medicine who have worked with specialists in palliative medicine, we believe that the debate on assisted suicide (How are ministers likely to vote on assisted dying?, November 18) has the significant gap between what is currently provided and what needs to be provided. in end-of-life care. In Oregon, poorly controlled pain is a major symptom one in three patients who request medical assistance to die, and a factor in determining the requests of 59% of Canadian patients.

The Health and Care Act 2022 requires the provision of palliative care in England by specialists. Not enough orders have been given yet.

Specialists in palliative medicine cannot work in isolation from other doctors. The curriculum of their four-year program devotes time to specialists in the separate field of pain medicine – understanding when these doctors should be involved in complex problems.

However, this involvement is complicated to arrange due to the full-time contractual obligations of the NHS. The additional capacity to support multispecialty work is limited. Because much palliative medicine is based in charitable hospices outside the NHS, access is an issue as hospices rarely employ pain medicine specialists. Our experience with informal collaboration has shown that very good results can be achieved, transforming the last few weeks of many patients’ lives. Formal contractual cooperation between hospitals and hospices is required.

If pain medicine is properly made available within specialist palliative care settings, the argument of an ill-conceived legal change in assisted dying could be redirected back to the actual needs of improving end-of-life care.
Dr. Barry Miller Consultant, Bolton and former Dean of the Faculty of Pain Medicine of the Royal College of Anesthetists; Dr. Arif Ghazi ConsultantLondon; Dr Patrick McGowan ConsultantLondon; Dr. Andrew Severn Retired consultantMorecambe Bay