Professor Jugdeep Dhesi is a consultant geriatrician at Guy’s and St Thomas’ NHS Foundation Trust and Professor of Geriatric Medicine at Kings College London. She is the current President of the BGS. Jugdeep is also the Deputy Director for the Centre for Perioperative Care and has recently joined the Palliative and End of Life Care Commission as Commissioner.
The debate around the legalisation of Assisted Dying has attracted a huge amount of public and media attention over the last few months. In case you missed it, the BGS published a blog in December to get you up to speed with everything you need to know about where we are now and what happens next for Assisted Dying.
The BGS position is currently opposed to the legalisation of Assisted Dying, and we have submitted written evidence to the Terminally Ill Adults (End of Life) Bill. Although the BGS’s organisational position is one of opposition to the Bill, there will be a wide range of views and opinions across our diverse membership. This has been reflected in three commentaries recently published in Age and Ageing.
The first, by Dr Andrew Stanners and others involved in developing our position statement, outlines the reasoning behind the BGS position on Assisted Dying. It discusses concerns about the development of effective safeguards to protect older people from harm, the right to conscientious objection for healthcare professionals opposed to the legalisation of assisted dying, and BGS priorities for end of life care which should be implemented before a change in the law is considered.
An alternative perspective is given by Professor Rowan Harwood in We should not fear assisted dying. This commentary highlights the importance of autonomy for older people wishing to have an assisted death, safeguards which have been implemented in other countries, and the importance of healthcare professionals respecting a diversity of patient views.
In a third commentary, Dr Sarah Hopkins, Dr Annabel Price, and Dr Simon Etkind highlight the importance of considering frailty in the assisted dying debate. The commentary discusses the ambiguities of the eligibility criteria in the Terminally Ill Adults (End of Life) Bill, the unclear distinction of frailty as a disability or terminal illness, considerations of relational autonomy, and the lack of safeguards that address internalised feelings of being a burden.
All three commentaries offer different perspectives on the complicated issue of assisted dying, and I encourage members to read the thoughtful arguments. There are ethical issues to consider on both sides of this debate, and there will be a plethora of views across our membership.
One thing we are all aligned on is the need to improve end of life care for older people. A welcome consequence of the assisted dying debate is that it has raised awareness of the under-resourced state of palliative and end of life care in the UK, resulting in the formation of the Palliative and End of Life Care Commission. I am pleased to have been invited to join the commission as a commissioner, and I will work hard to ensure that older people’s interests are represented.
While the assisted dying debate has raised awareness of the importance of end of life care, it has also inadvertently distorted public understanding of how the majority of people die. Most people die in older age at the end of their natural lifespan. Each year, around 670,000 people die in the UK, nearly two-thirds of whom are aged over 75 and most have multiple long-term conditions and/or frailty, rather than a single condition. The majority of people who die do not have contact with specialist palliative care services. They are cared for instead by the generalist health and social care workforce and by those specialising in older people’s care in the community, care homes and in hospitals. Focusing on the needs of the many is vital, and better provision of end of life care could enable more people to die well in a place of their choosing.
The forthcoming NHS ten-year plan is an important opportunity to ensure that older people have access to high quality care throughout their lifespan. The BGS will continue to push for high-quality, personalised care for older people right until the end of their lives.
