Assisted dying: 'I'm a cancer specialist - these plans do not take into account added pressure for oncology units'

This is obviously a fiercely strong ethical and emotive topic but what seems to have been missed by protagonists and campaigners on both sides, is the massive disruption this would cause to our already overstretched oncology services.

It is proposed to allow adults who are terminally ill, subject to safeguards and protections, to request and be provided with assistance to end their own life. This would be the second step in a long and complex process before it would eventually become UK law. If the bill passes, individual could legally be prescribed drugs, such high dose barbiturates, which would end their own life, provided they:

• have a life expectancy of less than six months
• have mental capacity and have a clear and settled intention to end their life.
• have reached their decision voluntarily.
• there is a high court judge ruling supporting the action.

As pointed out by Dame Esther Rantzen, taking a tablet which puts you asleep in 10 minutes, surrounded by friends and family, could be a favourable option for some people, as opposed to 6 months of distress.

In my experience, however, as a consultant oncologist for 25 years, although many families would discuss this, a tiny number would actually take it up. Most people want to live as long as possible and with good palliative care, keeping people free of pain, nausea and psychologically supported. Even when dying, the quality of life for many individuals can be acceptable especially if they can spend more time with their loved ones.

I can only recall two cases who stated that they would use Dignitas “when the time came”. Also, studies have demonstrated that discussions around assisted dying are also very stressful for families leaving them with guilt, and worse bereavement.

Assisted dying is already available across Europe. In addition to Dignitas in Switzerland it’s legal in Austria, Spain, The Netherlands, Belgium and Luxembourg. Although interest is increasing, with more people registering, only 40 to 50 people a year take up this service in each country. Data from Spain does shows that that more people do opt for assisted dying if it more freely available in their own country, rather that travel to another.

However, this still remains a fraction of the 2 million people who die of cancer each year in the UK and Europe. Although palliative care is expensive, the savings from a handful of patients using assisted suicide instead of palliative care for 6 months is minute. What’s more, there is still considerable cost for assisted dying with the second opinions, the cost of the legal drugs themselves, not to mention the legal fees from the high court judges proposal in the UK.

Speaking to oncology and nursing colleagues, who will be on the coal face of this proposal if it is made law, what concerns them is the massive impact it will have on the length of the oncology consultations. Even though it is unlikely that most patients would opt for assisted dying, most would want to discuss it. Clearly the only way to do this properly, in order to support their decision is to set up separate, robust and carefully conducted meetings with patients and their relatives supported by safeguarding staff and procedures.

Often family members would be flying in from across the world wanting to discuss, again, all the previous medical treatments, alternative clinical trials, alternative medicines over the last few years. Understandably and quite correctly, these would be lengthy and extra consultations requiring a lots more of a precious commodity which oncology services are most short of - time.

My consultant and nursing colleagues all agree it’s obvious that extra consultations would be requested by a large number of dying patients, but that the vast majority would be unlikely ever to actually take up assisted dying. The reality is there remains a drastic shortage of oncology staff so, unless the UK government decides spend billions on doubling the oncology staff budget, this process would cut into the time that consultants are able to spend with curable patients.

What’s more, even after these extra consultations, even if someone does decide on assisted dying, the logistical practicalities are unlikely to make it actually happen. Patients often have rapidly progressing disease and distressed families would have to make an application to a judge in the high court.

Over and above the cost, the lack of capacity of the courts to handle extra assisted dying cases, bearing in mind the short time frames of the individuals suffering from a terminal diagnosis, it is unlikely patients would get the legal clearance and other logistical hurdles set up in time.

Obviously assisted dying would help some people but considering these significant practical hurdles for the country, the money would be better spent investing good quality palliative care services which would help make the last few months of a dying person’s life as bearable as possible.