Hospice crisis fuels euthanasia fear as MPs deliberate

As the Parliamentary debate for assisted dying approaches, fears are growing that the hospice funding crisis could make patients more likely to opt to die.

Parliament is gearing up to debate proposals to give terminally ill people in England and Wales the right to choose to end their life later this year. At the same time, hospices, who receive only a third of their funding through the NHS, have been calling for more government support as they face job cuts, bed cuts and even closure.

While some are able to continue through generous donations from their community – in June church members in East Hampshire church raised nearly £20,000 for Phyllis Tuckwell Hospice – not all can. In October, Zoe’s Place, a hospice for babies in Liverpool, shut its doors after 29 years due to ‘insufficient funds’ for a new lease on their building or for relocation (Liverpool Echo).

We spoke to Lucy Honeysett, former hospice nurse and Lead Coordinator of charity Christians in Care, about what this crisis may mean for patients considering assisted dying.

en: You’ve spent 16 years in the care sector. In that time, how have you seen lack of funding impact hospices?

LH: There has been a definite shift in the ways hospices have to work these days – hospices need to be wise about the way they use their limited resources. When I was still working in palliative care, we would journey with patients and their families from diagnosis through to death, offering bereavement support afterwards. Now, we tend to provide episodes of input, so if someone is more stable then we withdraw and are reintroduced if things change.

We’ve also got a significantly ageing population and so the demand on the provision of end-of-life care is increasing, with a desperate need for more funding.

en: How do you think these pressures affect the debate around assisted dying?

LH: I will never support the introduction of assisted suicide or ever feel there’s a right time to debate this, but now feels especially like the wrong time to be considering it – when we know that the health and social care sector is under such great strain and that hospices are struggling to keep their essential services going. People won’t be given a reasonable choice between good access to end-of-life care versus assistance to kill themselves.

Patients may be offered a long waiting list for treatment, or a far shorter list for medical assistance in dying. So, it’s all the wrong way round. Our Government needs to invest in the struggling health and social care sector so that people are given proper care and support through their illnesses.

en: How would good hospice care help a person considering assisted dying?

LH: The founder of the hospice movement Dame Cicely Saunders strongly opposed euthanasia, partly because she was a committed Christian, and also because she argued that good symptom control was possible, and people can be supported to die well and live until they die. She was very clear that a person isn’t just a physical condition. We are all multi-dimensional; we are spiritual, psychological, social, relational and physical beings.

What is beautiful and unique about the contribution from hospices is that real acknowledgement of the whole person. So, if somebody is frightened, their pain will be increased. If somebody is anxious about leaving their children because they’re dying, they will need more people alongside them to listen, plan and support.

In this country we’re very privileged to have hospices, and people can have good control of physical symptoms that were previously unbearable – but of course people still have worries and fears, and where possible they need to be soothed and listened to.

en: What can we learn from other places across the world that have legalised assisted dying?

Most countries have incrementally extended assisted suicide to go beyond people with terminal illness: to people with mental health problems, autism, homeless, the physically disabled, children.

We have to learn from that, even if we as a country believe assisted dying is only for terminally ill people. We also know it is very hard to be clear about the six-month prognosis; we know people can live much longer than that. And it’s hard to be sure they have mental capacity – that’s the other criteria. People who are contemplating ending their life early are likely to be feeling frightened, anxious and low, so how are we sure that they’re able to make a careful decision, and not be coerced or feel pressure as a burden?

The reason people give for wanting to kill themselves in these countries is often not about physical suffering but because they don’t want to be a burden and that’s not a good enough reason. We have to do much more to be sure that people have the care available – we first need to fix the problem.

en: If legalised, might assisted dying have an impact on Christians in hospices?

Doctors and nurses will have the right to refuse to participate in the process if they conscientiously object to assisted dying. But we’ve heard of hospices in Canada who refuse to offer assisted suicide and have had all of their government funding pulled.

Also, we often think about doctors and nurses – but what about the person who does the paperwork, provides care or the transport? They may be believers and desperate for that work. They may be compromised because they won’t have the same rights to stand against this.