Assisted dying: BMA says patients should meet end-of-life care doctor first
Terminally ill people who want help to die should have face-to-face reviews with a specialist end-of-life doctor in an effort to detect coercion, medics have said.
A motion passed by delegates at the British Medical Association's annual representative meeting (ARM) in Liverpool on Monday proposed a number of changes to the Terminally Ill Adults (End of Life) Bill.
The proposed legislation for assisted dying cleared the Commons with a majority of 23 votes on Friday and will move to the House of Lords for further debate.
As it stands, the Bill would allow terminally ill adults in England and Wales, with fewer than six months to live, to apply for an assisted death, subject to approval by two doctors and a panel featuring a social worker, a senior legal figure and a psychiatrist.
British Medical Association (BMA) members have now called for patients to also have an in-person review with an independent palliative care doctor at the very start of the process.
Speaking at the union's meeting, Dr Samuel Parker said: 'To ensure patient care needs have been met, and to help detect coercion, any patient requesting assisted dying should be encouraged to attend face-to-face reviews by an independent specialist palliative care doctor before the assisted dying pathway begins.
'This can also ensure the patient has received the best quality outcomes prior to commencement of assisted dying.'
Dr Sarah Foot added: '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.
'Our united voice will help influence this Bill in the House of Lords later this year, be proud and proactive and stand up for some of our most vulnerable patients.
'Those who are dying are physically and emotionally dependent on us in society to help safeguard them. They need to be safe and supported.'
Dr Parker warned palliative care in the UK is under-resourced, 'with few specialists, a postcode lottery and a shortage of funding'.
He said patients deserve rapid access to high-quality care, adding that 'safety and patient welfare are essential'.
Dr Foot 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.'
Last week, the Health Secretary – who was one of the most senior opponents of the legislation – warned legalising assisted dying would take 'time and money' away from other parts of the NHS.
Writing on his Facebook page, Wes Streeting said he could not ignore the concerns 'about the risks that come with this Bill' raised by the Royal College of Psychiatrists, the Royal College of Physicians, the Association for Palliative Medicine and charities representing under-privileged groups.
The motion at the BMA ARM also affirmed the right of doctors to decline involvement in the service. An opt-out for all healthcare professionals is already built into the Bill.
Speaking of the potential impact of assisted dying on the mental wellbeing of healthcare professionals, Dr Parker called on the BMA to ensure there are 'no subtle pressures' on doctors to participate, and 'no risk of professional sanction or discrimination'.
Dr Andrew Green, chairman of the BMA's medical ethics committee, said: 'While the BMA is neutral on the issue of assisted dying – that is whether the law should change or not – we have been engaging with legislation to ensure doctors are represented on a number of key issues.
'This motion reaffirms, and strengthens, a number of the BMA's existing positions, including the right for doctors to decline to participate for any reason should the law change, and the need for any assisted dying service to be funded through new money and not at the expense of other parts of health and social care.
'We have been clear that any future assisted dying provision should be offered via a separate service that doctors must opt in to, and not part of any doctor's existing 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.
'In discussions around Kim Leadbeater's Bill in England and Wales, which has now passed its final stages in the Commons, we have strongly opposed moves to ban doctors from raising the subject of assisted dying with patients, but have been clear that this must be part of a discussion around all options available.
'This motion expands on this, ensuring that patients who may be considering assisted dying are able to access information about all possible treatment and routes available to them.'
Meanwhile, research has suggested almost half (47%) of UK adults surveyed are worried they or their loved ones will have a painful or undignified death.
The survey, carried out by Focaldata for King's College London (KCL), found 44% feel worried about the quality of palliative and end-of-life care in the UK, although 46% said they feel confident services will be available when they or loved ones need them.
Meanwhile, the polling found 61% of the 2,106 adults asked in March were supportive of the assisted dying Bill.
KCL is launching The Impact Centre for Palliative and End-of-Life Care in autumn, a privately-run centre aiming to improve palliative care in the UK, and establish a framework for better care which it said could be applied around the world.
The centre, funded by the Kirby Laing Foundation, will be the first of its kind in the UK and will work to 'create long term, systemic change in the delivery of care for dying people'.
Centre lead Professor Katherine Sleeman, said: 'Although a wealth of evidence has now been generated on ways to improve experiences and outcomes for people approaching the end of life, too often this evidence is not used to improve care, meaning dying people suffer and those close to them are left to pick up the pieces.
'By closing the gap between evidence and practice, the Impact Centre for Palliative and End-of-Life Care will make a profound and lasting difference for people with life-limiting illnesses and their loved ones, now and in the future.'
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