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Increased legalisation of medical assistance in dying: relationship to palliative care
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  • Published on:
    Assisted dying compatibility with palliative care is an illusion
    • Claud Regnard, Consultant in Palliative Care Medicine St. Oswald's Hospice, Newcastle upon Tyne, NE3 1EE
    • Other Contributors:
      • Carol Davis, Consultant in Palliative Medicine
      • Matthew Doré, Consultant in Palliative Medicine
      • Rob George, Professor of Palliative Care, Consultant in Palliativ Care
      • Leonie Herx, Palliative Physician Consultant, Associate Professor and Head of Palliative Medicine
      • Amy Proffitt, Chair of the Association for Palliative Medicine, Consultant in Palliative Medicine
      • Juliet Spiller, Consultant in Palliative Medicine
      • Dominic Whitehouse, Consultant in Palliative Medicine
      • Gillian Wright, Researcher in Medical Ethics

    Cohen and Chambaere imply that palliative care (PC) and ‘assisted dying’ (AD) will develop a loving relationship, albeit with compulsory marriage guidance.(1)

    Claiming existing ‘integrated and synergistic’ links contradicts the fact that growth in PC services has stalled in Belgium and the Netherlands since 2012.(2) This assumes expert PC teams are accessible. In the UK, an estimated 118,000 people in 2017 could not access expert PC,(3) and only 15% of Canadians have access to publicly funded PC.(4) Even when PC is involved, the median duration of specialist PC involvement is 19 days,(5) barely enough time to resolve physical symptoms, let alone a wish to die.(6) Claiming PC or hospice involvement in AD patients is meaningless without knowing the expertise and length of involvement.

    Suggesting that because some PC teams are involved in AD the rest must follow, ignores the depth of disquiet. Even 15 years after Oregon’s AD legislation, two thirds of hospices were refusing to participate.(7) The authors point to a paper which surveyed staff from two Canadian hospices.(8) This exposed profound concerns amongst staff about participation in AD but ignored the insidious impact of government mandates forcing hospice involvement, while glossing over reports of clinical complications and concerns about patients’ capacity and the steadfastness of their decision. There is no mention that Canadian AD legislation has removed many safeguards such as the 10-day reflectio...

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    Conflict of Interest:
    None declared.