The Urgency of Change in End-of-Life Care
Time is indeed running out to rectify the injustices woven into England and Wales's proposed assisted dying legislation. The House of Lords is currently conducting crucial committee sessions that will dissect the bill on December 5 and 12. Meanwhile, sweeping changes loom in Scotland, where the assisted dying bill has just passed its second stage, raising further concerns about the hastiness and implications of such measures.
Recent findings from the National Audit Office and Hospice UK starkly illuminate the financial crisis engulfing end-of-life care services. This reality underscores a fundamental truth: we should not be rushing to legislate assisted dying when our palliative care infrastructure remains in dire straits.
No one disputes the compassion driving the bill's supporters. However, our primary focus should be to ensure that quality end-of-life care is universally accessible before contemplating any measures that facilitate assisted death.
It is, therefore, imperative that we cast a critical eye on the funding—or lack thereof—available to hospices, which has dwindled alarmingly over the years. Out of a total of 2,000 beds across England, 380 are rendered unusable, stripping away thousands of potential care days. Reports tell us that as many as 310,000 individuals relied on hospices last year, yet many are now left waiting.
The Disparity in Access
Statistics are sobering: the Commission on Palliative and End-of-Life Care reveals that between 450,000 and 540,000 of the 600,000 annual deaths in the UK would have benefited from palliative care but didn't receive it. This gap underlines the urgent need for comprehensive changes to our end-of-life care system.
As it stands, 56% of patients express a preference to die at home, yet 43% succumb to their ailments in hospital settings. This disconnect illuminates systemic failures within the health care infrastructure; how can we talk about assisted dying when basic palliative options are insufficiently supported?
Systematic Failures and Their Consequences
Although the government has made promises to improve access to palliative care at home and reduce unnecessary emergency room visits, the reality is still grim. Currently, only 51% of individuals needing specialist palliative care receive it at some point during their final days. Recently announced funding increases—£100 million for adult hospices and £80 million for children's care—are being eaten away by surging staffing costs. More than half of UK hospices ended their last financial year operating at a deficit.
The crux of the issue is that it is invariably the most disadvantaged communities that bear the brunt of this inequity. Consider that over one in four individuals whose lives are cut short between the ages of 20 and 65 are living in poverty.
A Call to Legislation
As the House of Lords wades through this contentious bill, it must bring to bear the wisdom and insight necessary to debate an issue that directly impacts lives. The current assistance die legislation privileges the legal right to assisted death without guaranteeing commensurate rights to quality palliative care. This imbalance needs to be rectified.
I firmly advocate for a position wherein the assisted dying law cannot be implemented until the government fulfills the recommendations laid out in the recently submitted end-of-life care report. We must prioritize lives before death.
Should We Fear a Two-Tier System?
Moreover, we must be wary of creating a fragmented system in England and Scotland. The proposed Westminster bill specifies a six-month life expectancy as part of the eligibility criteria for assisted dying, whereas the Scottish version lacks this stipulation, presenting the risk of a two-tier system that could worsen inequalities.
To navigate this precarious path, both parliaments need to engage in meaningful dialogue and consultation before moving forward.
Public Sentiment
Recent.poll data reveals a compelling public consensus: 65% of respondents agree that our priority should be addressing the systemic issues within palliative, social, and end-of-life care before we even think about introducing assisted dying.
This sentiment encapsulates a critical truth: assisted living matters just as much as assisted dying, if not more. Until we ensure that every individual facing the final moments of their life is afforded adequate and compassionate palliative care, we must hesitate to expand end-of-life legislation into uncharted territory.
- Gordon Brown was UK prime minister from 2007 to 2010
Source reference: https://www.theguardian.com/commentisfree/2025/dec/02/assisted-dying-palliative-care-underfunded-politicians
