Good palliative care and assisted dying can go hand in hand | Letters

Jane Turner is right that end-of‑life care needs fixing (MPs, you told us clearly that end-of-life care in the UK is broken. So now we need you to fix it, 28 September), and I argue that it needs fixing on two fronts at once. My husband, John, died in March aged 43 after nearly six years of bowel cancer treatment. He endured more than 70 rounds of chemotherapy, determined to watch our children grow up. He spent his last three months in a hospice, receiving the best palliative care on offer. Even so, he suffered terribly.

Some pain cannot be controlled quickly, and some suffering cannot be treated at all. One evening he screamed in agony while stranded in a bath, unable to move, for nearly an hour before relief took effect. As the cancer swelled his torso, he slowly suffocated – and no drug could prevent it. He was fully aware throughout, and told me repeatedly that he could not go on. In his last hours, I wore earplugs to bear the sound of his gasping.

Most hospices are charities that receive very little state funding – that must change. Better palliative care will spare many people needless suffering. But it cannot spare everyone, and no amount of funding would have given John what he wanted: the chance to face the inevitable on his own terms.

Improving palliative care and legalising assisted dying are not rivals. Doing both would also free hospice beds for those who want them; John occupied one for three months.

John was always going to die from his cancer, but the trauma of his final months, for him and for our children, was preventable. MPs should not choose between fixing care and offering choice. They must do both.
Liz Wilson
Coventry

Jane Turner is absolutely right that we need to invest in palliative and end-of life care. She is also correct that the greatest unmet needs are seen in NHS hospitals, and that it is here where investment is most urgent. That all sounds very expensive, but if we look at the headline financial figures, we see that actually it might cost very little in terms of new money. The Nuffield Trust tells us that the UK spends £6.6bn on emergency hospital care in the last year of life. This contrasts with only £1.1bn to run all 204 UK hospices, including the 24 NHS hospices.

I was a consultant physician at one of these units for 20 years, and I am told that it now costs around £5m annually to provide a comprehensive specialist palliative care service to a population of 250,000, delivered across all settings, including hospital wards. This implies a total cost of around £1.4bn to provide this NHS service across the UK population of 70 million people. The NHS has complete access to the patient activity and financial figures of these 24 units, so these figures can easily be confirmed.

One of the strengths of specialist palliative care services is that they always try to help patients and their families to plan for the future: when you get more poorly, where would you want to be cared for? If this planning enabled us to avert only 10% of emergency admissions in the last year of life, the money saved would more than fill the funding gap. If emergency admissions fell by more than 10%, it would, overall, save the nation money.
Stephen Kirkham
Lytchett Minster, Dorset

Jane Turner is absolutely right that palliative and end-of-life care must be properly funded and available to everyone who needs it. Those of us who campaigned for assisted dying have never argued otherwise. Better palliative care and greater choice at the end of life should not be competing ambitions.

But there is an important question that cannot be lost now the parliamentary vote is over: what happens to the people whose suffering even excellent palliative care cannot adequately relieve?

I am living with incurable secondary breast cancer. I love my life and want to be here for my daughter for as long as possible. But I also know from painful personal experience that I am allergic to opioid painkillers. After the birth of my daughter, when I needed multiple operations, my pain could not be properly controlled. It was frightening. So when I am told that better palliative care will remove the need for assisted dying, I have a very simple question: what if it cannot?

Jane is right that even with the best quality care, some deaths can still be difficult. Those people matter too. Since the fall of the terminally ill adults (end of life) bill, terminally ill people have not suddenly become less frightened about what lies ahead. Our diagnoses have not changed, and neither have the limits of medicine.

So yes: fix palliative care. End the postcode lottery. Make sure nobody reaches the end of their life without the support, expertise and compassion they deserve. But we should be able to hold two thoughts at once. Excellent palliative care can transform many deaths. It cannot guarantee that every dying person’s suffering can be relieved.

The question for those who opposed assisted dying therefore remains: what is the answer for those people?
Sophie Blake
Hove, East Sussex