Dealing with false perceptions of death and dying.

Dr Charles Skinner provides an overview of the practice of palliative care in the UK in the context of the end-of-life debate

recent advances in medical science and clinical practice have “transformed the dying process”

Dr Charles Skinner, a London palliative medicine consultant, explains in his paper (“Palliative Care: What Is It? And What Has It Got To Do With ‘Assisted Dying’?”) how palliative care has developed in Britain and where it stands in relation to the ‘assisted dying’ debate.

Britain is a world leader in this branch of medicine, he tells us, citing a 2010 report by The Economist Intelligence Unit, which placed Britain at the top of the international league table, ahead of other developed countries, including the United States, Germany and The Netherlands. “Palliative care is not a panacea for serious illness: no branch of medicine is that “, he writes.

But recent advances in medical science and clinical practice have “transformed the dying process”. Though a very small number of determined and strong-minded people might not be harmed by the legalisation of ‘assisted dying’, “for every such patient there are many others more afraid than resolute, more fearful of the future than wanting to die, more in need of help than of options, who could all too easily find themselves embarked on a course about which they were less than wholehearted but to which they could see no alternative”.

Dr Skinner concludes that “compassion for an individual may prompt sympathy for a one-off assisted death, but compassion for our wider society should make us wary about the unintended harms of legalisation”.

It is frequently suggested by campaigners for legal change that, in the few jurisdictions where ‘assisted dying’ has been legalised, palliative care has flourished in consequence.

But this is to miss the point. As Dr Skinner observes, palliative care in Britain is not the same thing as palliative care in many other countries. In Britain it has been a recognised clinical speciality for over 20 years, with specialist teams in hospitals and a nationwide network of hospices, whereas elsewhere “palliative care is typically provided by generalist practitioners who have developed a personal interest in the field”.

Moreover, as a parliamentary select committee was told in 2004 by researchers in the US State of Oregon, the enactment of that State’s “Death with Dignity Act” in 1994 reflected “a definite dissatisfaction with some aspects of end of life care”.