Assisted Suicide bill to be debated in parliament

[Nearly Sane]

Wes Streeting saying that Assisted dying would affect other services. Note those isn't an argument against it per se but is about what we want the health service to do.


https://www.bbc.co.uk/news/articles/cew2jj94zwyo

[SteveH]

Wes Streeting saying that Assisted dying would affect other services. Note those isn't an argument against it per se but is about what we want the health service to do.


https://www.bbc.co.uk/news/articles/cew2jj94zwyo

I'd've thought it'd save money, if anything, since the patient would require a few weeks or months less care - which is an observation, but emphatically not a pro-AD argument.

[Nearly Sane]

I'd've thought it'd save money, if anything, since the patient would require a few weeks or months less care - which is an observation, but emphatically not a pro-AD argument.

I think it's more capacity, than cost.  If the assessment were done properly, including the judicial support, then it's time rich for a lot of specific people. L who might them not be supporting other services.

[jeremyp]

I think it's more capacity, than cost.  If the assessment were done properly, including the judicial support, then it's time rich for a lot of specific people. L who might them not be supporting other services.

Yes but we are constantly being told that palliative care in the NHS is "broken". The main reason for that is that there aren't enough people or facilities supporting it. There's already a capacity shortage. Assisted dying will just slightly spread the load a bit more.

[Nearly Sane]

Yes but we are constantly being told that palliative care in the NHS is "broken". The main reason for that is that there aren't enough people or facilities supporting it. There's already a capacity shortage. Assisted dying will just slightly spread the load a bit more.

I don't think the point is about palliative care but about the doctors time being taken up with what if those sponsoring the bill are correct will be a time demanding process.

Your post reads like assisted gmdying should be seen as addressing the issues with palliative care which I would suggest  sounds very like getting rid of people to save money.

And it's not just palliative care that Streeting described as broken it's the entire service.

[ProfessorDavey]

Interesting views from my neighbour which rather counters the comments about NHS challenges being the key issue.

Her brother was diagnosed with particularly aggressive cancer and recently died, with her at his bedside throughout the final days and weeks. Her experience of his last few weeks prior to death has made her a passionate supporter of changing the law to allow assisted suicide.

Her brother was in Chicago and due to his work had access to the very finest private palliative care possible.

Even with the very best palliative care there will be people who would still want the option to choose assisted dying, even if that is in the last few days or weeks (rather than months), because palliative care necessarily trades off pain relief with the ability for autonomy and self-determination as patients need greater and greater levels of pain relief. I know everyone's experiences may be different, but my experience is that palliative care works well in the earlier stages towards death, but not at the latest stages where the person (in this case my father, but similarly my neighbour's brother) can no longer interact yet was clearly regularly in a state of significant distress which simply could not be alleviated, nor was there opportunity for comforting.

[Nearly Sane]

Interesting views from my neighbour which rather counters the comments about NHS challenges being the key issue.

Her brother was diagnosed with particularly aggressive cancer and recently died, with her at his bedside throughout the final days and weeks. Her experience of his last few weeks prior to death has made her a passionate supporter of changing the law to allow assisted suicide.

Her brother was in Chicago and due to his work had access to the very finest private palliative care possible.

Even with the very best palliative care there will be people who would still want the option to choose assisted dying, even if that is in the last few days or weeks (rather than months), because palliative care necessarily trades off pain relief with the ability for autonomy and self-determination as patients need greater and greater levels of pain relief. I know everyone's experiences may be different, but my experience is that palliative care works well in the earlier stages towards death, but not at the latest stages where the person (in this case my father, but similarly my neighbour's brother) can no longer interact yet was clearly regularly in a state of significant distress which simply could not be alleviated, nor was there opportunity for comforting.

I'm not sure anyone has described 'NHS chalkenges' as the key issue. And I'm not sure anyone has taken the position that were the best palliative care to be available that no one would want assisted dying.

[jeremyp]

I don't think the point is about palliative care but about the doctors time being taken up with what if those sponsoring the bill are correct will be a time demanding process.

They are both NHS resources.

Your post reads like assisted gmdying should be seen as addressing the issues with palliative care which I would suggest  sounds very like getting rid of people to save money.

Well you are the one suggesting we should torture people to save money - at least that is one way to read your complaint about resourcing.

[Nearly Sane]

They are both NHS resources.Well you are the one suggesting we should torture people to save money - at least that is one way to read your complaint about resourcing.

Yes, they are both resources but the impact of demand on time is different from the demand on money.


And it's not my complaint about resources, but rather Streeting warning it might have an impact, and I specifically said when I posted it that it is not an argument against assisted dying.

[ProfessorDavey]

I'm not sure anyone has described 'NHS chalkenges' as the key issue. And I'm not sure anyone has taken the position that were the best palliative care to be available that no one would want assisted dying.

Actually I think that has been a key line of argument from some who are opposed to assisted dying - effectively that people are only requesting assisted dying due to the inadequacies of palliative care provision. And that were the highest quality palliative care provision to be available universally that assisted dying would be unnecessary. I don't think that argument holds water at all as there are plenty of people who have seen the best that palliative care can offer in practice with their loved ones (including me) and still consider that the option of assisted dying should be available. And I think those people making those arguments misunderstand the reasons why people want the option of assisted dying - in many cases this is first and foremost about self-determination.

[Nearly Sane]

Actually I think that has been a key line of argument from some who are opposed to assisted dying - effectively that people are only requesting assisted dying due to the inadequacies of palliative care provision. And that were the highest quality palliative care provision to be available universally that assisted dying would be unnecessary. I don't think that argument holds water at all as there are plenty of people who have seen the best that palliative care can offer in practice with their loved ones (including me) and still consider that the option of assisted dying should be available. And I think those people making those arguments misunderstand the reasons why people want the option of assisted dying - in many cases this is first and foremost about self-determination.

I think the argument that's been put is that some who might choose palliative care might feel coerced into assisted dying if they feel the palliative care is of such low quality that they had no choice. I haven't seen anyone on here make the argument you've suggested.

[Gordon]

My take on this, as someone for whom this issue isn't just of academic interest, is that dealing the distress of my family at the point my health irreversibly declines would be the main factor: I wouldn't want my death to become a dragged-out drama for my loved ones where we all already know how it ends (be that sooner or later).

I've recently had a bit of a 'dip', which turned out to be less scary than I thought it was, so I'd also say that it would only be as I approached the very end, assuming I was still able to, that I could even countenance this option. At that point, for me, it would be about people and not about policies or services.

[ProfessorDavey]

I think the argument that's been put is that some who might choose palliative care might feel coerced into assisted dying if they feel the palliative care is of such low quality that they had no choice.

But the current situation is the reverse of that, but in spades. Effectively people have no choice other than to accept palliative care (alone) as there simply is no other lawful option - not just a low quality alternative option but no option.

So how many people feel 'coerced' into accepting palliative care right through to the end of life (something they don't want) because there is no other option available to them.

[ProfessorDavey]

I think the argument that's been put is that some who might choose palliative care might feel coerced into assisted dying if they feel the palliative care is of such low quality that they had no choice.

But that comment suggests it to be an either/or choice. Experience from Oregon suggests it isn't like that at all - rather than people who finally opt for assisted dying will also use palliative care through an earlier stage of their end of life journey. The data I've seen suggests that nigh on 90% of people who ultimately used assisted dying were enrolled into palliative hospice care prior to taking the prescription medication that ended their lives.

And I think this is really important - we need to get away from the either/or and understand that active disease treatment/management, palliative care and assisted dying will all work in conjunction with each other. Some people, of course, won't use all of the options, but I would imagine the most common scenario will be someone who works through all three (if Oregon is a guide). And that it will be the individual who will decide at which point it is right for them to move from one stage to another, based on their own understanding of their quality of life and ability to take their own decisions about how their life will end.

[ProfessorDavey]

My take on this, as someone for whom this issue isn't just of academic interest, is that dealing the distress of my family at the point my health irreversibly declines would be the main factor: I wouldn't want my death to become a dragged-out drama for my loved ones where we all already know how it ends (be that sooner or later).

I've recently had a bit of a 'dip', which turned out to be less scary than I thought it was, so I'd also say that it would only be as I approached the very end, assuming I was still able to, that I could even countenance this option. At that point, for me, it would be about people and not about policies or services.

Gordon - I know how difficult it is for you to discuss your own situation but I am very glad that you do. How you describe your own position seems very likely to be common were assisted dying to be legalised. An individual may move from active disease treatment to palliative care when the active treatment was no longer effective or was intolerably burdensome to the individual both in terms of side effects but also quality of life in those final months.

But there may be a point where the same would be said of palliative care - that it no longer works (and retaining the ability for self determination, ability to still interact with loved ones and a level of dignity are likely as important as pain management in this respect), so that continued palliative care becomes intolerably burdensome. Currently that person has no other option than to continue with palliative care, which may desperately not what they want, and will typically lose any possibility for self determination days or perhaps weeks before they die.

The Oregon experience also suggests that patients are often prescribed the medication long before they use it, which is often in the very final end of life stages, perhaps just a few days before likely death. And also, of course, many people are prescribed the medication but don't actually take it, presumably because their palliative care never attained the point where it was intolerably burdensome.

[Nearly Sane]

But the current situation is the reverse of that, but in spades. Effectively people have no choice other than to accept palliative care (alone) as there simply is no other lawful option - not just a low quality alternative option but no option.

So how many people feel 'coerced' into accepting palliative care right through to the end of life (something they don't want) because there is no other option available to them.

Yes, but that's where the argument lies, and it's a personal estimate of where you are that reflects that. Again no one on the thread that I've seen is arguing any differently to that.

[Nearly Sane]

But that comment suggests it to be an either/or choice. Experience from Oregon suggests it isn't like that at all - rather than people who finally opt for assisted dying will also use palliative care through an earlier stage of their end of life journey. The data I've seen suggests that nigh on 90% of people who ultimately used assisted dying were enrolled into palliative hospice care prior to taking the prescription medication that ended their lives.

And I think this is really important - we need to get away from the either/or and understand that active disease treatment/management, palliative care and assisted dying will all work in conjunction with each other. Some people, of course, won't use all of the options, but I would imagine the most common scenario will be someone who works through all three (if Oregon is a guide). And that it will be the individual who will decide at which point it is right for them to move from one stage to another, based on their own understanding of their quality of life and ability to take their own decisions about how their life will end.

It wasn't meant to suggest that it's an either or.

[ProfessorDavey]

Yes, but that's where the argument lies, and it's a personal estimate of where you are that reflects that. Again no one on the thread that I've seen is arguing any differently to that.

Then it is a very odd argument - effectively that people may feel coerced into choosing one of two options because one of those options may not be of as high quality as we'd wish, and that must be avoided at all costs by preventing assisted dying being legalised.

Yet currently people are currently are definitely being coerced into choosing one of two options because the other options is unlawful and therefore unavailable, and that's OK.

I think people should have the choice and I think we need to avoid a situation where someone feels that they have to choose an option they do not want.

[Gordon]

I think, in all this talk of safeguards and services, that the emotion get missed: maybe you have to be in a position where AS is a relevant option to really understand what this option 'feels' like.

I've been through the horror of being told, in October 2020, that I had terminal cancer when I had no idea I was ill, to quickly becoming seriously unwell and dealing with months of catheterisation and then surgery. Then it was all fine until earlier this year, when blood tests went awry and pain started, and even if things are still manageable the proverbial writing is starting to become clearer on the proverbial wall.

So, if this option becomes available in Scotland, I want to be able to decide, along with my loved ones and the wonderful people at The Beatson West of Scotland Cancer Centre who really do look after me so well, what is best for ME and US!!!!

[Nearly Sane]

Streeting getting some pushback on being so open.

https://www.bbc.co.uk/news/articles/cpqdy9ndrndo

Problematic given Starmer's promise to get this discussed for his friend.

[ProfessorDavey]

I think, in all this talk of safeguards and services, that the emotion get missed: maybe you have to be in a position where AS is a relevant option to really understand what this option 'feels' like.

I've been through the horror of being told, in October 2020, that I had terminal cancer when I had no idea I was ill, to quickly becoming seriously unwell and dealing with months of catheterisation and then surgery. Then it was all fine until earlier this year, when blood tests went awry and pain started, and even if things are still manageable the proverbial writing is starting to become clearer on the proverbial wall.

So, if this option becomes available in Scotland, I want to be able to decide, along with my loved ones and the wonderful people at The Beatson West of Scotland Cancer Centre who really do look after me so well, what is best for ME and US!!!!

Gordon - what an amazing post. This should be sent to every MP who has to vote on the matter as it get absolutely to heart of the matter - this is about people and their ability to determine what happens to them at the most difficult times imaginable.

[Nearly Sane]

Then it is a very odd argument - effectively that people may feel coerced into choosing one of two options because one of those options may not be of as high quality as we'd wish, and that must be avoided at all costs by preventing assisted dying being legalised.

Yet currently people are currently are definitely being coerced into choosing one of two options because the other options is unlawful and therefore unavailable, and that's OK.

I think people should have the choice and I think we need to avoid a situation where someone feels that they have to choose an option they do not want.

You're trying to boil down what is a debate on values into something simple here. It could be phrased that  people aren't being 'coerced' into not dying, they are not being provided with treatment to kill them, and the framing that people choose on such questions are indicative of their positions rather than being objective fact.

Earlier Gordon posted this article which covers the 'odd argument'

https://www.theguardian.com/commentisfree/2024/oct/12/terminal-illness-assisted-dying-debate-mps

[Nearly Sane]

Gordon - what an amazing post. This should be sent to every MP who has to vote on the matter as it get absolutely to heart of the matter - this is about people and their ability to determine what happens to them at the most difficult times imaginable.

It is, indeed, an amazing post, and Gordon is an amazing person on this, and generally. I'm sure though that all MPs will also have amazing communications from people in similar situations arguing for, against, and everything in between. There is not a simple answer, as Gordon agrees.

[jeremyp]

Yes, they are both resources but the impact of demand on time is different from the demand on money.

No it isn't. Salaries are an enormous expense for the NHS (about 45% of the budget). Time is money in any service organisation. You need more doctors? You pay more salaries.

[Nearly Sane]

No it isn't. Salaries are an enormous expense for the NHS (about 45% of the budget). Time is money in any service organisation. You need more doctors? You pay more salaries.

And in the short term the demand on doctors may be such that the supply to other areas is not what it was. At least that is my reading of Streeting's comments, and is what is being looked into.