Neil Shastri-Hurst: ‘When palliative care fails, we must help those suffering to have a good death’

I recognise that the debate around assisted dying is difficult. Where there are strongly held views on both sides. Each and every one of us will reach our own settled view on this subject, and it is not one where there is a right or wrong answer: it is therefore entirely appropriate that any vote is a matter of conscience.

As one would expect, I have taken time to reflect and marshal my thoughts on this issue. Having done so, I have concluded I intend to vote in support of the Terminally Ill Adults (End of Life) Bill when it is brought before parliament for a second reading on 29th November 2024.

Prior to coming into parliament, I worked as a medical practitioner for more than a decade. In that time, I had significant experience in terminal care. Being present at the end of someone’s life is a huge privilege. I use that phrase carefully and deliberately; for death is an incredibly personal moment.

As a clinician, it is always our aim to enable a patient to have a good death. What constitutes a good death for one person over another will vary. However, it strikes me as uncontroversial that as a society we would hope that the end of life can be made as comfortable and peaceful as possible. Palliative care and improving the current offering is an important part of achieving that objective. However, sadly palliative care will not be able to achieve this in each and every case. Therefore, I do not see this debate as a binary choice between improving palliative care or assisted dying. Rather, they should be considered as a range of choices available to patients at the terminal phase of their lives.

I am mindful that, for too many years, medical practitioners have been caught between the law, as it stands, and our compassion for patients. Terminally ill patients who look towards their doctor to retrench their pain and suffering. This results in clinicians being left in the difficult position of administering large amounts of opiates, in order to relieve pain, but cognisant that by doing so death may be accelerated.

The proposed bill is about giving people dignity in the last days of their life. Opinion Research found that three-quarters of respondents (75%) said that they would support making it lawful for dying adults to access assisted dying in the UK.

As a Member of Parliament, I constantly reflect upon the views of my constituents when organising my thoughts. In cases such as assisting dying this is even more acutely the case. This proposed legislation is the predominant issue raised in correspondence with me by my constituents. There is a range of strongly held views; clearly my decision will not be agreed with by all. However, I hope that my measured approach will be respected.

This parliament has a once in a generation opportunity to bring the laws around assisted dying up to date, ensuring they are fit for purpose. I appreciate that many feel uncomfortable about the subject and I understand their concerns. However, I also have a responsibility to reflect the current mood in the population and, more importantly, be brave enough to change the law in this difficult area for the benefit of patients.

I support the intended simple criteria for assisted dying outlined in this bill, which is for a patient to see two doctors who have a full set of their medical records. These doctors must confirm that the patient has full capacity, is suffering with a terminal illness with less than 6 months to live and is making this decision of their own free will. It appears entirely logical to me that such safeguards should be put in place prior to the act of dying, as opposed to retrospectively analysed once a death has occurred.

In countries which have adopted similar legislation around the world, many patients who sign up for assisted dying do not in the end request that their lives are curtailed. The reassurance that they have this option is enough to relieve much of the anxiety and stress as death approaches. I view assisted dying not as an alternative to good palliative care, but, instead, an extra component of a holistic palliative care plan.

With the above in mind, I support the proposed legislation. As a barrister, as well as a clinician, I know it is a difficult area of law, but I have reached my decision based upon evidence and grounded in compassion. In my view, it introduces a series of practical, robust measures to ensure the protection of the vulnerable whilst, at the same time, not sentencing another generation of patients to face the unenviable choice of travelling to Dignitas — or simply taking their own lives in an unsupported and secretive manner.

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