Assisted Suicide Funding Must Be Matched With Improved Palliative Care: BMA

The recommendations came after MPs passed the Terminally Ill Adults (End of Life) Bill on Friday, with the bill now progressing through the House of Lords.

A general view of staff on a NHS hospital ward at Ealing Hospital in London, England, on Jan. 18, 2023. Jeff Moore/PA Wire

The British Medical Association (BMA) has urged parliament to ensure that any funding for a new assisted suicide service is matched with more money for palliative care, mental health, and social care services.

The BMA, a trade union and professional association for doctors, passed a motion during its annual representatives meeting in Liverpool on Monday stating that assisted suicide should “never be seen as a cheaper alternative to high-quality, state-funded public services”.

Palliative care, in particular, was described by doctors as being “wrongfully under-resourced,” with patients often facing a postcode lottery when trying to access end-of-life care.

Palliative medicine registrar Dr. Sarah Foot, who supported the motion, said, “Hospices and palliative care does not have enough funding. We cannot live in a society were we fully fund assisted dying, but we don’t fully fund hospice and palliative care.”

The BMA adopted a neutral on assisted suicide in 2021 but has engaged with the legislative process to ensure that doctors are represented in key issues.

Dr Andrew Green, chairman of the BMA’s medical ethics committee, said the association has been clear that any future assisted suicide provision should be offered through a separate service that doctors must opt in to, and not be part of any doctor’s regular work.

“This service must come with additional funding, alongside further investment in palliative care, which we know has for too long been under-resourced, leading to huge variations in availability across the country,” Green said.

The recommendations came after MPs passed the Terminally Ill Adults (End of Life) Bill on Friday. The bill had its first reading in the House of Lords on Monday.

Discussing All Options With Patients

The motion at the BMA also proposed a number of changes to the bill, including that a terminally ill person should have a face-to-face meeting with a specialist end-of-life doctor to ensure they are fully aware of the options available to them, and to give doctors more opportunities to spot signs of coercion.

During the Commons committee and report stages, MPs had tried and failed to pass amendments that would have prohibited doctors from raising assisted suicide with a terminally ill person unless the person raised it first.

The BMA said on Monday that while it strongly opposed banning doctors from raising the subject first with patients, there must be a wider discussion with patients of all options available, including palliative care.

Palliative medicine registrar Dr. Sarah Foot, who supported the motion, said: “Choice is only a choice if it is an informed choice […] this is about making sure that patients know their options, that have had access to palliative care. What is uncomfortable is patients choosing to die when they haven’t had access to palliative care and don’t know what’s available to them.”

No Budget

The legislation would allow terminally ill adults in England and Wales with less than six months to live the right to apply for what is called a “medically assisted” death, subject to assessment by two doctors and a panel made up of a senior legal figure, a social worker, and a psychiatrist.

It passed by a narrow margin of 23 in the House of Commons on Friday, with some senior MPs voting against it.

Among them was Health Secretary Wes Streeting, whose department would be in charge of implementing the service if the bill becomes law.

Following the vote, Streeting said there is no budget allocated to a potential assisted suicide service and that “setting up this service will also take time and money that is in short supply.”

One of Streeting’s long-held concerns was that end-of-life care in the UK is not good enough to give the terminally ill a “real choice.”

Palliative Care ‘Inadequate’

Some palliative care specialists have raised concerns over the disparity between adequate palliative care and an assisted suicide service.

In January, the president of the Association of Palliative Medicine, Sarah Cox, told MPs that the current state of palliative care was inadequate, suggesting that a lack of access to end-of-life care could push the terminally ill to opt for assisted suicide.

According to Cox, 25 percent of people who die in the UK do not have the palliative care they need, estimating that figure to be around 100,000 people a year.

The sponsor of the Private Member’s Bill, Labour MP Kim Leadbeater, has argued that it should not be seen as a choice between assisted suicide and palliative care.

On June 13, Leadbeater told MPs, “Palliative and end of life care and assisted dying can and do work side by side to give terminally ill patients the care and choice they deserve in their final days.”

The bill must proceed to the House of Lords for further scrutiny before it can gain Royal Assent and become law.

PA Media contributed to this report.