Hard cases make bad law.

It is a well-established maxim, one which British Parliamentarians continue to accept when they weigh the evidence of how assisted suicide plays out abroad, and of how the needs of dying people here can be met, against calls based on highly emotive and well publicised personal stories. The latter are what drive the polling assisted suicide campaigners are so fond of - but what makes people so receptive to their claims?

Doctors.net reported recently:

'Public ignorance about dying increases fears about the pain and indignity associated with the event, senior medical academics say today. Large numbers of people get information from fictional events while the most common source of knowledge about dying is from family and friends, according to a survey conducted for the Academy of Medical Sciences. Some 20% say they have gained their knowledge from documentaries while just 22% have gained it from medical professionals.

'This leads to a lack of understanding that death can be "gentle, peaceful and pain-free", according to Professor Dame Lesley Fallowfield, professor of psycho-oncology at Sussex University. The survey found that 60% of people said they knew "just a little" about what happens at the end of life.'

What is there to know? According to the Economist Intelligence Unit:

'A pioneer in palliative care, the United Kingdom maintains cutting-edge services and is the world's best location to receive terminal care and pain-alleviating treatment.'

Polling commissioned by Hospice UK in 2017 found that

• Only 57% of UK adults 'are aware that services provided by hospices are generally free for those receiving them'
• 31% 'think hospice care is available only in a hospice building'
• Less than half (45%) 'are aware that hospice care is available in community settings such as at home and in care homes'
• 20% 'think hospice care is only for people in their last days of life, suggesting they are unaware that people with terminal and life-limiting conditions can use hospice care at any stage of their illness, not just at the very end of their life'

Yet despite being home to both incredible provision and innovation, palliative care in the UK is under great strain.

David Clark, Professor of Medical Sociology at the University of Glasgow and a vice president of Hospice UK, wrote in February:

'For the first time ever, one of Britain's 200 independent hospices has closed its doors. St Clare's in Jarrow near Newcastle had been serving its community in the north east of England for 30 years, raising most of its annual costs of £2.2m from local charitable giving. But after a trying period of medical under-staffing, concerns from independent regulator the Care Quality Commission and mounting financial problems, it has had no choice but to shut down.'

'Worryingly, the closure may be a sign of much bigger problems in the sector. Senior sources familiar with hospice finances tell me that up to 50 more hospices may be in difficulties.'

'So what has gone wrong? In an era where charitable giving has been hit by austerity, hospices simply cannot afford to do all the things they once could - especially when demand is growing. The reality is that they are currently propping up the NHS to the tune of £1 billion in care each year, much of which should be provided by the state. It's time for radical action. That means closing expensive hospice in-patient facilities in a planned way - and investing resources elsewhere.'

Note that this is not primarily a question of what healthcare professionals are capable of doing in terms of alleviating symptoms and supporting patients, but rather a question of properly planning and resourcing care. Research released subsequently by Hospice UK has found that:

• 37% of hospices questioned had cancelled or delayed expansion plans due to increasing cost pressures
• 20% had taken steps to reduce some services
• 73% have had statutory income cut or frozen over the past two years
• 90% had insufficient resources to meet future population needs

We also know that there are disparities in access to hospice and palliative care depending on factors like diagnosis and where in the country patients live.

And of course while hospices care for a great many people, both as inpatients and in their own homes, they are only part of the picture. More than 45% of deaths in England in the year to February occurred in hospitals, and it has long been highlighted that the failure to ensure out of hours access to palliative care has a deleterious effect on both patients and the health service. Simon Jones, Director of Policy and Public Affairs at Marie Curie, said in January:

'We know that the lack of care and support available out of hours is a huge issue across the UK. This is a segment of the health service that has been often overlooked and has not connected well enough with the emergency services, which operate 24/7. The reality is people don't stop needing care after 6.30pm - they can't switch their condition on and off depending on what time their GP, pharmacist or district nurse is available. More focus needs to be placed on what care and support is available out of hours, so people can access the right care they need at home to avoid unnecessary hospital admissions and reduce the pressure on an already over-worked emergency service.'

Assisted suicide advocates have become increasingly skilled at placing unrepresentative hard cases before the public, building an image of an impotent palliative care profession able to provide little more than tea and sympathy, necessitating state-sponsored death as a remedy.

This is not a true reflection of what can be achieved in the UK, but through poor knowledge and understanding, through contact with those parts of the system which are working less effectively and through simple fear, assisted suicide has come to seem palatable to many. The proper response to that fear is to resource fully and effectively, to keep innovating, and above all never to leave anyone behind, feeling a burden; the response of advocates is to make causing patients' deaths a new form of "care". Time and again, we have seen this response leading to assisted suicide becoming recognised as the cheapest form of "care". It would be a grave disservice to both patients and healthcare professionals to reach a stage where instead of facilitating meaning and dignity until natural death, increasing numbers of patients in this country were caught in a system where more expensive treatments were cut off and suicidal ideation was endorsed.

We do much, but we can do better, and we must do better - certainly better than assisting patients' suicides.

© Image copyright of Niccolò Ubalducci and licensed for reuse under Creative Commons Licence