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The terminally ill fear the process of dying more than death itself.

“The name Dignity in Dying indicates that palliative care should be more widely available to ensure a peaceful dignified death for all terminally ill patients. I suspect that most people who know of the organisation are more aware of the issues related to assisted dying than they are of the consequences and causes of the limitations of palliative care services in general.

“During the 40 plus years that I worked as a doctor in an NHS hospital I saw terminally ill and dying patients for whom palliative care provided an improved quality of life and a pain free, peaceful and dignified death. But I also saw others whose care was very poor. Why wasn’t it available for everyone who needed it?

“Palliative care in the UK is second to none and excellent strategies for improved provision have been published in both England and in Scotland. As a result, more patients and their family/carers are “taken on board” by a palliative care team from the time their condition is diagnosed until they die: They have physical, psychological and social support and access to financial support is identified; they have a peaceful and dignified death and are increasingly enabled to die in their own homes. But this still only applies to a minority of patients. Palliative care has historically been provided exclusively for cancer patients and remains so to a large extent – and significant numbers of these also miss out.

“Patients lacking this support are often ill informed about their diagnosis and treatment, lack social support and, when close to death, have inadequate help to die peacefully: the situation is improving but only slowly.

“There are several reasons for this disparity; patchy implementation at the local level of published guidelines, a shortage of qualified palliative care staff, inadequate training courses to enable non-palliative care doctors and nurses to acquire basic palliative care skills and the non-involvement of many senior doctors in the care of the dying. To some doctors, dying indicates a medical failure which is resisted by continuing “active” treatment as opposed to providing palliative end of life care. This is a well documented ongoing problem.

“Poor doctor/patient communication is another common contributing factor: Most patients wish to know the details of their condition, their outlook and their treatment options and may become anxious or depressed if this doesn’t happen. But many doctors avoid doing so, ostensibly because it would cause “upset.” The fact is, many lack the necessary communication skills, and/or are disinclined to address “painful” end-of-life issues with their patients. This is recognised by the British Medical Association and the General Medical Council in publications which recommend that all doctors should acquire the necessary communication skills to do this: It hasn’t yet happened, although such skills are now taught in medical school.

“Good palliative care allays the fears and anxieties of most of those for whom it is available but it is widely recognised that even at its best, for a small number it fails to provide the autonomy and peace of mind they need in order to die peacefully in the place and at a time of their choosing.

“As I see it, palliative care can provide for the many what assisted dying could offer for a few: They are equally important but the means of achieving them are quite different. In terms of a strategy, one size does not fit all.

“Twenty five years ago a now retired palliative care consultant wrote; ‘The terminally ill fear the unknown more than the known, professional disinterest more than professional ineptitude, the process of dying more than death itself.’ Dignity in Dying addresses these concerns.”