Gill Pharaoh's recent death at a Swiss assisted suicide facility has brought the assisted dying debate back into the news. But one of the dangers of the assisted dying debate is that it detracts from the discussion about how to improve the experience of the living.
There was a time when many people were afraid to go into hospital - because hospitals were seen as places where you went to die. Today their reputation has done a complete turnaround, but a similar problem has dogged hospices since their appearance fifty or so years ago. Until very recently, admittance into a hospice meant one thing in the collective consciousness: your number was up.
Thanks to the huge advances that have been made in palliative care over the last twenty or thirty years, that image is gradually disappearing. Many admissions to hospice today are temporary events and the patients concerned are discharged home, after their symptoms have been stabilised, to continue with their lives. Such admissions can truly transform their quality of life.
It's a welcome advance and Britain, as the founder of the modern hospice movement, can be justly proud of what it has achieved in this field of medicine. Yet this week we have seen something that risks setting the clock back. A piece in The Guardian by an anonymous author, who claims to be the CEO of a hospice, suggests that hospices should not be averse to participating in 'assisted dying' - i.e. giving terminally ill patients lethal drugs with which to take their own lives - if such practices were to be legalised.
This notion runs completely counter to the culture of hospice and palliative care, which is to support seriously ill people with comfort and dignity until they die. This culture does not and should not include collaborating in suicide. The impact of that on how hospices are perceived would be entirely negative. On a practical level, where are the doctors and nurses going to be found within hospices who would be prepared to engage in such practices? Palliative care practitioners, who form the backbone of hospice care, are near-unanimous in their rejection of assisted suicide.
We are told by the campaigners for legalisation that assisted suicide and hospice care work together harmoniously in Oregon and that nine out of ten people who take lethal drugs under Oregon's assisted suicide law are “enrolled in hospice care”. But hospice care in Oregon isn't the same thing as hospice care in Britain. In Oregon, hospice care means for the most part basic nursing care. If you go into a hospice, it's for comfort care only - and you sign away your rights to clinical treatment. As a House of Lords select committee was told on a visit to Oregon, “It pretty much is a one-way ticket opting out [of life, if you opt] into hospice.”
In Britain the concept is different and more advanced. Palliative care has been a recognised clinical speciality here, like paediatrics or oncology, for nearly thirty years. We have a nationwide network of in-patient hospices as well as hospice at home, and they are staffed in the main by specialists, working in parallel with disease-specific specialists such as oncologists or neurologists.
Hospices in Britain have become places of hope as well as of dying. They can be oases of calm where seriously ill people can receive expert support to resolve their problems and in many cases receive a new lease of life. It is no wonder that most of those who work in them, and many of those who support them in others ways, have serious reservations about notions that they should involve themselves in deliberately assisting the suicide of their patients.
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