As an organisation that believes that the law should change to allow the choice of assisted dying, within upfront safeguards, you might think that we would welcome stories about healthcare professionals systematically hastening death. If true it would make the job of legalising and regulating (an existing practice) that much easier. Except on the evidence available it isn’t true. Furthermore, our concern is that unsubstantiated fears about the LCP may lead to an increase in unnecessary suffering at the end of life.
What we do know is this, sporadically some doctors do deliberately hasten the death of a patient, but this is not a systematic practice nor is it linked in any way to the LCP.
Under the LCP medical treatment, including artificial hydration and nutrition, may be withdrawn, in order to make the process of dying better, not to hasten death. Oral hydration and nutrition, as basic care, should always be provided. A patient in hospital should only be put on the LCP when they are within hours, or at most days, of death. It should be explained to the patient (if possible) and of course their family/those close to them what is happening.
The LCP was designed to minimise suffering at the end of life, and to bring best practice from hospices to hospitals. It does not aim to hasten death but to improve the dying process for patients – there are good medical reasons why you don’t want to artificially hydrate a dying person. It should be noted that the LCP is supported by all the major stakeholders involved in end-of-life care.
However, we do accept that there are sometimes issues with consent and communication around decisions to place patients on the LCP. It is very important that wherever possible doctors discuss the use of the LCP and treatment decisions more broadly with patients and those close to them. And whilst there are clear examples of people not being properly communicated with about the LCP, research shows that this is not the typical scenario. The 2012 National Care of the Dying Audit assessed the LCP and found that, on the whole, people are being communicated with about medical end-of-life decisions.
The situation is this: at present a relatively small (but nevertheless important) number of patients are helped to die illicitly or take matters into their own hands. As a result of this, and in an effort to provide a holistic patient centered approach to end of life decision making, we think the law should change to enable assisted dying for terminally ill people within upfront safeguards. We don’t want to change the law because people are being systematically helped to die, because put simply they are not.