I write this sitting in an NHS corridor in Oxford waiting for radiotherapy. I'm about to lie in a very expensive machine while radioactive rays are beamed at my breast. First though, two or three good natured people will manhandle me into exactly the right position. Tiny tattoos have been placed on my skin to enable them to do this. They will talk in a language of co-ordinates over my naked top half. Afterwards the area will be sore – similar to sunburn. I suspect from my experience of daily treatment over the past fortnight that I'll feel a little downhearted. I have no idea if this temporary gloom is a frequent side effect, or even if it is related at all; as with the much more severe feelings during chemo, immunotherapy and an operation the mental effects of treatment are barely discussed. The juxtaposition between the mental costs and its all too physical toll is what gives me pause – and what makes me question how we care for those far more ill than I am. Our hospital has a remarkable psychiatric team, but I worry that the patients who need them most may not get them in time.
This Thursday, a handful of MPs will be chosen by ballot to introduce a private members bill. Assisted dying campaigners want one of them to reintroduce an identical bill to the one which we have been discussing in parliament recently. I think both sides of the debate accept it is flawed, as do all of the Royal Colleges who have refused to attest that it is safe. The Royal College of Psychiatrists and the Royal College of Physicians are categorical: “vulnerable patients particularly those with remediable mental health or other unmet needs, are not adequately protected by the current bill”. I think about how I’ve felt during treatment and it deeply concerns me that the bill makes no provision at all for doctors – or indeed society – to care about the psychological impacts on patients. It flips on its head our entire approach to looking after people in their darkest moments.
Both as a lawyer and now as a patient, I'm sure we need a different approach. Making law is hard. We need clearly expressed policy intent, rigorous expert evidence and serious thought about consequences, including stress tests of the effects on different groups in our communities. It struck me repeatedly during the long debates in the House of Lords that what most of us were trying to do – finding a way to alleviate suffering at the end of life – was simply not what this inadequate piece of legislation covered. We have to understand that introducing assisted dying into an NHS where palliative care is not available to all is not a neutral act. Both my own parents received kind palliative care at the end of their lives, but this was something we had to ask for. I'm seriously concerned that the best service is not available to all. Over 100,000 people die each year without access to specialised end of life care from which they would benefit. Two thirds of the public worry that this care will not be there for us when we need it most. This, in my view, is where all our current energy and resources should be focused first – if there is to be choice. Campaigners argue that there’s nothing in the bill to stop progress on palliative care, but that’s to dismiss the realities. The government's palliative care framework was due months ago; it is now unlikely to come forward until 2027. It is as Lord Stevens, former chief executive of the NHS identified, “remarkably cheap” to introduce assisted dying, while the costs of doing something with palliative care are “far greater”. We must be concerned that this bill will not provide choice. It will instead push people, particularly the vulnerable and those less well-off, towards a single fatal option.
To achieve the best deaths, we have to talk about the subject more openly. We must speak clearly about depression as a side effect of many treatments, and as a natural part of living with pain and uncertainty. We must accept there are some cruel diseases for which palliative care does not currently provide much relief and work together on how we can help those who suffer from those to have better deaths. We must make sure doctors know we value this care and there are clear rules in place to protect them when they provide it.
A new bill in the same terms will not resolve any of this. It will inherit all the same unresolved tensions – and do so without the pre-legislative scrutiny, the impact assessments, or the government’s backing that legislation of this magnitude demands. If parliament is serious about this issue, it should not be done without a mandate. Something of this consequence needs the appropriate policy development work to take place before legislation is published, not after. Anything less, in a bill of this consequence, is not good enough. The dying deserve better.
Victoria Prentis was Attorney General from 25 October 2022 to 5 July 2024.
