Assisted Dying Bill – Understanding the Impact
The assisted dying bill has hit the news recently with the recent passing of the Terminally Ill Adults (End of Life) Bill in the UK marks a significant shift in the country’s approach to end-of-life care. This landmark legislation, while still subject to amendments and further scrutiny in the House of Lords, has ignited widespread debate about its potential impact on various aspects of healthcare, sparking questions about the reality of assisted dying in practice. Assisted dying is currently legalised in countries worldwide including Switzerland, Canada, Netherlands, 10 USA states, and Spain. Looking at the experiences in other countries, we can identify the impact the Bill may have here in the UK.
Assisted Dying Bill – What is the Terminally Ill Adults (End of Life) Bill?
The Terminally Ill Adults (End of Life) Bill, introduced by Labour MP Kim Leadbeater, proposes allowing terminally ill adults in England and Wales the right to assisted dying. Assisted dying refers to the practice where a terminally ill individual with a prognosis of six months or less is provided with life-ending medication by a physician, which they then self-administer. This is distinct from euthanasia, where a doctor directly administers the medication.
To be eligible, individuals must:
- Have a prognosis of six months or less.
- Be over 18
- Have Mental Capacity
The process involves strict safeguards, including two witnessed declarations, assessments by two independent doctors, and a High Court judge’s ruling. A 14-day reflection period is mandatory, and the individual must self-administer the life-ending medication. Any coercion or pressure is strictly prohibited and carries a severe penalty of 14-years’ prison sentence.
Assisted Dying Bill – The Impacts
End-of-life Care
Currently, three-quarters of people require palliative care at the end of their lives – that is around 450,000 people a year across the UK. The Economist’s “Quality of Death Index” declared the UK a global leader in palliative care, ranking highest in quality of death worldwide. However, even as an acknowledged pioneer in palliative care, there remains complex issues in end-of-life care across the UK including underfunding, lack of access, and an ageing population.
Legalising assisted dying could impact palliative care through:
- Increased Focus – The presence of assisted dying may prompt a greater emphasis on palliative care services. Palliative care focuses on improving the quality of life for patients with serious illnesses by managing symptoms, providing emotional support, and coordinating care. As assisted dying becomes an option, there may be a renewed focus on ensuring that patients have access to comprehensive palliative care to explore all available options.
- Reduced Funding – At the moment, only a third of hospice funding comes from the NHS, with private funding or fundraising making up the difference in funding. With the introduction of the Bill, there are concerns that further funding could divert into funding assistive dying including doctors and judges to assess patients – leaving palliative care to continue struggling with underfunding.
- Increased Funding – However, End-of-Life Care Research Group at Vrije Universiteit Brussels found across Belgium, Netherlands, and Luxembourg that the regulation of assisted dying expanded palliative care services. In Belgium, the Government investment in palliative and end-of-life care doubled between 2002, when assisted dying was legalised, and 2011 – reflecting the need for high quality palliative care alongside assisted dying legislation. Likewise, the House of Commons Committee Report “Assisted Dying/Assisted Suicide Report” explains the importance of assisted dying working in tandem with palliative care to support people during their final days, highlighting the need for additional funding in the sector to better support existing palliative services including hospices, care homes, and nursing homes.
- Access – Currently, a recent report by charity Marie Curie found around 100,000 in the UK go without access to palliative services, with half of families unhappy about the care their loved ones receive when they die. Access to palliative care will be essential during the legalisation of assisted dying, ensuring everyone has access to high quality end-of-life support. Additional services will have to be created to meet demands, providing more accessibility for people nation-wide.
- Advance Care Planning – Recently, there has been considerable focus on Advance Care Planning in palliative services, working with individuals to understand their wishes, beliefs, values, and preferences about their care, including medical treatment. These discussions would be essential practice in the future of palliative care to ensure individuals receive the support they desire.
The NHS
Implementing assistive dying will involve major shifts within the NHS. This includes:
- Resource Allocation – Implementing and regulating assisted dying will require additional resources from the NHS. This includes funding for assessments, advice and procedure administration. Careful planning and resource allocation will be crucial to ensure the smooth integration of assisted dying into existing healthcare services.
- Training and Guidelines – Healthcare professionals will need comprehensive training and clear guidelines to navigate the ethical and practical complexities of assisted dying. This includes ensuring adherence to safeguards, managing conscientious objection, and providing compassionate care to patients and their families.
- Increased Workload – Healthcare professionals will face increased workload due to the assessment and administration process, potentially affecting waiting times for other services.
Grief Counselling & Bereavement
Grief and bereavement are complex emotions for people to deal with after losing loved ones. The introduction of assisted dying will bring new forms of grief to the forefront of the UK. Ataloss, a dedicated bereavement charity, identified the omission of bereavement from the Assisted Dying Bill in the UK, championing support for those left behind after assisted death.
Legalising assisted dying could impact grief counselling and bereavement through:
- NHS Support – More accessible support services will be needed for individuals impacted by loss due to assisted dying.
- Charities and VSCEs – Working with charities like Ataloss offers cutting edge support for individuals in the aftermath of loss with their development of their new grief support programme The Bereavement Journey, focusing on community connections and de-stigmatising grief.
- Utilising Technology – Meanwhile, technological advances like Grief AI programmes offer new forms of support in dealing with loss. Although not a replacement for professional therapy, Grief AI can be used to help individuals process emotions, track grief patterns, and offer coping mechanisms between counselling sessions. For more information on Grief AI see our previous post Grief AI: A New Frontier in End-of-Life and Bereavement Care.
Thinking Ahead
Assisted dying is a complex issue with potential implications for various aspects of end-of-life care. While it can empower individuals with a choice in their final moments, it also requires careful consideration of its broader impacts. Ensuring access to comprehensive palliative care, mental health services, and robust ethical guidelines are crucial in navigating the evolving landscape of end-of-life care. See more information on assisted dying here.
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