A matter of life and death

LORD JOFFE's Physician Assisted Suicide bill was blocked in the House of Lords on 12 May but he has pledged to reintroduce it at a later date. Claire Job, a Palliative Care Specialist Nurse and a member of the Socialist Party relates her concerns about the bill.

The bill enables a competent adult who is suffering unbearably as a result of terminal illness to receive medical assistance to die at his or her own considered and persistent request. The doctor can provide the patient with the means to end their life (in other countries this is a large dose of barbiturates) or, if the patient is physically unable to do so, to end the patient's life.

So what are the main issues that socialists may need to consider when deciding to support or not support this bill?

Firstly, take a step back and look at the mess the NHS is in at this moment in time. Throughout Britain at present, many workers are fighting to save NHS services, jobs and hospitals. Nationally the NHS is being run into the ground and dismantled through neglect.

Providers of palliative care (aimed at improving quality of life for patients and families facing problems associated with life-threatening illness, such as pain) rely on charitable funding to hold up services that are chronically under-funded by the state. These services are viewed at times of financial constraint as non-essential services that can be left without proper funding for staff and resources.

Many palliative care services barely have the funding to support cancer patients and those with other life-threatening illnesses. Many, such as Motor Neurone Disease and Multiple Sclerosis, are excluded from palliative care - this is often a post code lottery.

We live in a society where there is a marked gradient in the incidence of most health conditions in the poorer sections of society and this is due to income, the environment in which people live and a lack of education on health promoting activities/behaviours. People living in the most deprived areas are not only more at risk of diseases such as cancer but the community health care available to support them is usually under-resourced and stretched.

Access to health care is not equal. Cancer Research UK estimates that Britain could have over 100,000 extra cases of cancer in 2024 because of its ageing population - this will intensify pressure on our cancer services that are already cash-strapped.

The government has no intention of addressing the causes of ill health in our society - deprivation, improving air quality, providing decent housing, non-hazardous employment, affordable nutritious foods, recreational facilities and investing in health promotion programmes. Cynically I could argue that the government is more than aware of this predicted increase disease burden on the NHS that will require investment in health and social care in order to support patients. Physician assisted suicide however will not cost a penny and go some way to easing the burden.

Lord Joffe's Bill states that a specialist palliative care professional, be it a doctor or nurse, must attend the patient to discuss the option of palliative care. Therefore the bill is stating that palliative care is the first step in trying to alleviate patient suffering. However, until palliative care is resourced properly we can't assume that it has failed - many of us are ignorant of what modern palliative care can achieve. One of the main functions of good palliative care is that it returns power and control to the individual, enabling them to make choices about the last days of their life such as whether they are cared for at home or in hospital or a hospice.

I am not in principle opposed to physician assisted suicide, however I am concerned that we protect the most vulnerable from subtle pressures in society - pressure of feeling a drain on resources and the pressure of being a burden on family. The motives of such a bill cannot be trusted in a capitalist society that is driven by profit not care. We should demand equal and properly funded access to palliative care for all before pursuing suicide or euthanasia.