UK's End-of-Life Care Inadequate for Assisted Dying, Says Health Secretary

Wes Streeting, the UK's Health and Social Care Secretary, has expressed reservations about the country's readiness for assisted dying legislation. Speaking at the FT Weekend Festival in London on September 7, 2024, Streeting highlighted concerns about the current state of end-of-life care in the United Kingdom.

The Health Secretary emphasized the importance of ensuring that individuals are not pressured into choosing assisted dying due to inadequate support in end-of-life care. He stated, "Candidly, when I think about this question of being a burden, I do not think that palliative care, end-of-life care in this country is in a condition yet where we are giving people the freedom to choose, without being coerced by the lack of support available."

Streeting's comments come in the context of ongoing debates about assisted dying in the UK. In July 2024, former Labour justice secretary Lord Falconer introduced a Bill in the House of Lords that would allow terminally ill adults with six months or less to live to receive medical assistance in ending their lives. Additionally, Labour MP Jake Richards recently mentioned the possibility of bringing forward a Private Members' Bill in the Commons.

The issue has gained prominence following Dame Esther Rantzen's revelation earlier this year that she had joined Dignitas, an assisted dying clinic in Switzerland, due to her stage 4 lung cancer diagnosis. It's worth noting that while assisted dying is legal in Switzerland, the UK's Suicide Act 1961 still makes it illegal to assist in someone's suicide, with a maximum penalty of 14 years imprisonment.

A recent report funded by the cancer charity Marie Curie has highlighted "patchy and inconsistent" care for people at the end of their lives in the NHS. The study, conducted in part by Cambridge and King's College London universities, found that one in three people dying in England and Wales experienced severe or overwhelming pain in their final week of life. These findings underscore the challenges in the current palliative care system.

Streeting acknowledged the complexity of the issue, stating, "I struggle with this, unusually – I've got strong views on most things. Underneath that philosophical ethical question are a whole series of practical ones about which I am deeply uncomfortable."

The debate on assisted dying in the UK is part of a global conversation. Since the Netherlands became the first country to legalize euthanasia in 2002, several other nations have followed suit. Canada legalized medical assistance in dying (MAID) in 2016, and New Zealand approved assisted dying in 2020 after a referendum. However, the World Medical Association continues to oppose euthanasia and physician-assisted suicide.

In the UK, the landscape is slowly shifting. The British Medical Association dropped its opposition to assisted dying in 2021, potentially paving the way for future legislative changes. However, as Streeting's comments indicate, significant improvements in end-of-life care and robust safeguards against coercion will be necessary before any potential legalization of assisted dying in the UK.

"How do you make sure that people aren't coerced into exercising their right to die, if it were available? I don't just mean direct coercion and inducement. The burden of guilt – what one might feel about being a burden on their families, even if their families didn't even remotely feel like they were a burden. I wouldn't want someone to take their own life thinking they were a burden on others. How do you put the right protections and safeguards?"

As the debate continues, it's clear that the UK faces complex ethical and practical considerations in addressing end-of-life care and the potential legalization of assisted dying. The coming months and years will likely see further discussions and potential legislative efforts to address these challenging issues.