Health: End of Life

Baroness Hollins Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Hollins (CB)]

My Lords, as the immediate past president of the BMA and chair of the BMA Board of Science, I remind your Lordships’ House that the BMA opposes all forms of assisted dying and believes that ongoing improvements in palliative care allow patients to die with dignity. The BMA respects the concept of individual autonomy and encourages patient choice about clinically appropriate treatments, but it believes there are limits to what people should be allowed to choose when their choice impacts on other people.

The Department of Health end-of-life care strategy says that more people are making choices about their care and treatment, but that too few health professionals yet know how to talk about death and dying. Can the Minister say what is being done about this? There is clearly still plenty of room for improvement.

Despite that, we can be rightly proud of our pioneering work to create and develop the specialty of palliative care. We are ahead of the curve, leading the global race. Dame Cecily Saunders, the founder of palliative medicine, left us an extraordinary legacy. As suggested by my noble friend Lord Alton, I agree that her legacy could be undone by the introduction of assisted suicide as a choice. Without strong advocacy, constraints on NHS funding could lead to more cuts being made to end-of-life care. Assisted suicide, instead of being an option, would be the cheaper alternative. We would be offered either/or—rather as in Oregon, where patients have to sign out of active treatment to access hospice support and where palliative care is not a clinical specialty. Since our healthcare system is more similar to that of the Netherlands than that of the USA, we should be studying practice there, with one in 34 deaths now being through euthanasia.

It could be argued that it would make economic sense both for families and for the nation. However, this is a policy change that would replace our traditional commitment and compassion to each other—“in sickness and in health”—with a greater value being placed on high-achieving, fit and healthy members of our communities. Instead, we could invest more in our pioneering palliative care services and sell them abroad. We could train overseas doctors and nurses. We could accelerate our search for a cure for dementia and other long-term conditions. Now that we have legally recognised parity between physical and mental health, we could become the most psychologically aware nation in the world, and bring our new learning about their interrelatedness to our understanding of death and dying, rather than continuing to deny it. Let us use our emotional intelligence here.

In response to the question of the noble Lord, Lord Joffe, it is usually unfinished business with family and friends that causes someone’s unbearable suffering, both mental and physical. People who have expressed a wish to die are now being publicly encouraged to commit to such a view to support the campaign by Dignity in Dying—which of course formerly had “euthanasia” in its title.

Certainty is difficult to commit to until you have the experience. Deciding is a process that unfolds and human beings have an extraordinary capacity to adapt. Help the Hospices told the Select Committee that informed choice means experience of palliative care, not just information about it. Let us show the world that our palliative care services put us ahead, not behind, those—only seven—jurisdictions which have chosen a cheap and unwise solution to the problem of death and dying and dependency.

The focus in the debate today has been more on a timetable for dying rather than coming to terms with leaving this life and what that will mean for the dying person and those left behind. Healthy adults are emotionally interdependent upon one another, and if we had time I would draw on psychoanalytic literature. Suffice it to say, the real issues at the end of life are the care and compassion that comes from being in a relationship with other people, including receiving more than giving, including becoming more dependent. I am talking about the love that endures rather than any physical inconvenience.

Emotional angst about unfinished business is better worked through than avoided through the mistakenly perceived control that comes with suicide. Dealing with unfinished business allows someone to let go of life and let go of suffering. Dealing with unfinished business is also better for those left behind, who will then live more peaceably when their loved one has gone.