End-of-life Care Needs A Fundamental Review, Not Just More Funding | Letters

Your editorial (29 October) highlights nan urgent request for amended backing for end-of-life care. As a expert and world who has worked successful this area for 40 years, I would for illustration to raise 3 underlying issues.

First, it implies that hospices are nan only exemplary for delivering bully end-of-life care. It is arguable that successful Britain we person overrelied connected nan charitable sector. We now person NHS-funded infirmary palliative attraction teams who tin supply fantabulous attraction erstwhile patients are coming to nan extremity of life but still needing master treatments – which very often hospices cannot aliases will not offer.

In my evidence past week to nan House of Lords prime committee connected nan terminally sick adults bill, I pointed retired that patients connected mean are referred to end-of-life services specified arsenic hospices only successful nan past weeks of life. And astir 80% of these person crab – different conditions causing decease pinch adjacent amounts of suffering are hardly catered for.

Second, accrued backing for end-of-life attraction is apt to support nan aforesaid imbalanced model, pinch its geographical and socioeconomic inequalities. It is easier to talk of much money than of fundamentally reviewing work models.

Third, your editorial restates nan fallacy of assisted dying being a competitor for backing against nan hospice sector. There is ample grounds that successful jurisdictions pinch legalised assisted dying, palliative attraction and assisted dying tin beryllium broadside by side. Indeed, introducing assisted dying has often led to an summation successful palliative attraction backing and referrals.

The truth is that end-of-life attraction has grounded to germinate successful nan 60 years since nan opening of nan first modern hospice and successful nan 40 years since we person had master palliative medicine. It could return for ever for hospice-based end-of-life attraction to execute nan backing it wants. And for ever is thing that dying group do not have.
Prof Sam H Ahmedzai
Emeritus professor of palliative medicine, University of Sheffield

Your editorial is perfectly correct to impulse greater committedness to palliative attraction services; my ain specialty present successful nan Australian authorities of Victoria for 20 years. However, it misses a captious point: assisted dying is simply a complement to specified care, not a competitor. (Subsequent letters (2 November) from leaders successful nan assemblage neglect to mention assisted dying astatine all; somewhat astonishing fixed nan high-profile statement nan UK is presently engaged in.)

In Victoria, wherever voluntary assisted dying (VAD) has been disposable since 2019, I person supported much than 70 patients done nan process. Every 1 of them received master palliative care. Most wanted simply to cognize that, if their suffering became intolerable, they had different lawful option. They did not cull palliative care; they weighted it deeply. But for a mini number, it could not wholly meet their needs successful nan last days.

Experience present has shown that introducing VAD has strengthened, not weakened, our attraction culture. About 80–85% of group who usage VAD are already successful receipt of palliative care, and governments person responded pinch much than A$1bn (£500m) successful caller palliative-care finance since 2017. My specialty, historically sceptical of assisted dying, has knowledgeable a important displacement successful favour, astatine past recognising what our patients had agelong been telling us: palliative attraction and prime spell manus successful hand.
Dr Greg Mewett
Palliative attraction physician, Ballarat Central, Victoria, Australia