Palliative care and assisted dying research

info@dignityindying.org.uk - 020 7479 7730

“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I wish to be treated as a responsible adult and believe that people should be legally able to register their wish for an assistance with suicide, if needed. I support Dignity in Dying primarily to help change the law on assisted suicide.”Sir Michael Holroyd CBE, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“I believe that the exercise of free will concerning the end of life, and the timing of the end of life, is an essential human freedom. I believe that while religious dogma may dictate or limit the choice of believers it should not be imposed on others.”Rabbi Dr Charles Middleburgh, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“Having seen my father die, it became very clear to me that we as society need to grasp the nettle and deal with this contentious issue in a way that is humane and acceptable to the majority of right thinking people.”Matthew Wright, Dignity in Dying Patron
“I believe that decisions about the timing and manner of death belong to the individual as a human right. I believe it is wrong to withhold medical methods of terminating life painlessly and swiftly when an individual has a rational and clear-minded sustained wish to end his or her life.”Professor A C Grayling, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“It is because we believe in the dignity and value of life that we hope for a good death. This is what Dignity in Dying hopes to permit and I passionately support its aims. To linger on against my will on a half-life is no life at all.”A.N Wilson, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“I see it as almost inevitable, that society will become more understanding, and more sophisticated, about assisted dying. As with suicide, it is right to strive to find better options, but when the alternatives have run out it must surely be wrong for society to insist that people suffer.”Nick Ross, Dignity in Dying Patron
“Being incapable of helping a loved one to die when they are at the end of their life, suffering and asking for help is undignified and wrong, and I know this having witnessed it myself at close hand.”Zoe Wanamaker, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I see it as almost inevitable, that society will become more understanding, and more sophisticated, about assisted dying. As with suicide, it is right to strive to find better options, but when the alternatives have run out it must surely be wrong for society to insist that people suffer.”Nick Ross, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“I support Dignity in Dying because I care about suffering and want the law changed so that those who presently suffer terrible deaths will in future have the option to end their suffering through ending their lives at a time and in the manner of their choice.”Lord Joffe, Dignity in Dying Patron
“I support Dignity in Dying because I care about suffering and want the law changed so that those who presently suffer terrible deaths will in future have the option to end their suffering through ending their lives at a time and in the manner of their choice.”Lord Joffe, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I see it as almost inevitable, that society will become more understanding, and more sophisticated, about assisted dying. As with suicide, it is right to strive to find better options, but when the alternatives have run out it must surely be wrong for society to insist that people suffer.”Nick Ross, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“My father, who was suffering from cancer and no longer wished to live, died as he chose: in peace and dignity, with my mother beside him. I passionately hope that, if I too were terminally ill, and was finding life unbearable, I could be allowed to die at a time of my choosing.”Rosemary Brown OBE, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I believe that decisions about the timing and manner of death belong to the individual as a human right. I believe it is wrong to withhold medical methods of terminating life painlessly and swiftly when an individual has a rational and clear-minded sustained wish to end his or her life.”Professor A C Grayling, Dignity in Dying Patron
“I see it as almost inevitable, that society will become more understanding, and more sophisticated, about assisted dying. As with suicide, it is right to strive to find better options, but when the alternatives have run out it must surely be wrong for society to insist that people suffer.”Nick Ross, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“I believe that decisions about the timing and manner of death belong to the individual as a human right. I believe it is wrong to withhold medical methods of terminating life painlessly and swiftly when an individual has a rational and clear-minded sustained wish to end his or her life.”Professor A C Grayling, Dignity in Dying Patron
“I believe that decisions about the timing and manner of death belong to the individual as a human right. I believe it is wrong to withhold medical methods of terminating life painlessly and swiftly when an individual has a rational and clear-minded sustained wish to end his or her life.”Professor A C Grayling, Dignity in Dying Patron
“I see it as almost inevitable, that society will become more understanding, and more sophisticated, about assisted dying. As with suicide, it is right to strive to find better options, but when the alternatives have run out it must surely be wrong for society to insist that people suffer.”Nick Ross, Dignity in Dying Patron
“I believe that decisions about the timing and manner of death belong to the individual as a human right. I believe it is wrong to withhold medical methods of terminating life painlessly and swiftly when an individual has a rational and clear-minded sustained wish to end his or her life.”Professor A C Grayling, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“As a doctor for over 35 years, I became increasingly aware of the failure of even the best care to deal with the suffering of some patients. The present clinical, ethical, and legal fudge - and a law which is discredited in practice - is dangerous for patients and also for professionals.”Professor Raymond Tallis, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“We live in a free society with all the choices that go with it. We choose when to marry, have children, what treatment we should have, where to live, who to consult for advice, in fact how we should live our lives. This should include the opportunity to choose the time we die.”Simon Weston OBE, Dignity in Dying Patron
“As a child there existed in my mind a nagging fear about this thing called death. As I have become older, I want to give an assurance to the people I love that the circumstances of their death will be 'good', to be celebrated, and their final hours will be reflective of life well lived.”Jo Brand, Dignity in Dying Patron
“I endorse the work of Dignity in Dying because I believe passionately that any individual should have the right to choose, as far as it is possible, the time and the conditions of their death. I think it's time we learned to be as good at dying as we are at living.”Sir Terry Pratchett, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron
“We have no control over how we arrive in the world, but at the end of a life we should have legal control over how we leave it.”Sir Patrick Stewart, Dignity in Dying Patron

Palliative care
and assisted dying

Evidence demonstrates that in places where assisted dying is legal practice, palliative care (or end-of-life care) is delivered to a high standard. Legal assisted dying practice compliments palliative care, encourages wider discussions around end-of-life care and increases investment in end-of-life-care and uptake of training by health care professionals.

Oregon

Inadequate palliative care is not a significant motivation for requesting assisted dying (1). In 2009 over 90% of people who had an assisted death were enrolled in hospice care (2), which is considered best practice for palliative care (3).
The rate of use of assisted dying legislation has been described as 'very low' by researchers, who suggest that the reason for this may be the high quality of care provided by Oregon's hospices (4).
Ganzini et al found that physicians have improved their palliative care knowledge so they can offer appropriate treatments and carefully explore options with patients (5).

Netherlands

A European-wide study ranked the Netherlands as the 4th most effective in terms of the development of palliative care (6). The Netherlands was ranked 7th in a study on quality of death across the world (7).
The number of specialist palliative care facilities and beds for terminally ill patients rose between 2003-2005 (8).
Research also indicates that the doctor/patient relationship is strong, with good communication around voluntary EOL practice (9, 10).
A European-wide study found that patients in the Netherlands had the highest regard and trust for their doctor, with 97% of patients feeling confident in their GP (11).

Belgium

Van den Block et al found that the practice of assisted dying is compatible and synergistic with palliative care delivery (12). Assisted dying is viewed as an optional part of a package of end-of-life care rather than as stand-alone practice.
Palliative care is excellent in Belgium. Belgium ranked 5th in a study on quality of death across the world (7).

References
(1) Lindsay R (2009) Oregon's experience: evaluating the record The American Journal of Bioethics 9(3): 19-27
(2) 2009 Summary of Oregon's Death with Dignity Act (2010)
(3) Ganzini L, Beer Tm Brouns M et al (2006) Interest in physician-assisted suicide among Oregon cancer patients Journal of Clinical Ethics 17: 27-38
(4) Ganzini L et al (2002) Experiences of Oregon nurses and social workers who requested assistance with suicide New England Journal of Medicine 347(8): 582-8
(5) Ganzini L, Nelson H, Schmidt Tm Kraemer D et al (2000) Physicians' experience with the Oregon Death with Dignity Act New England Journall of Medicine 342: 557-563
(6) Centeno C et al (2007) Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC task force Palliative Medicine 21: 463-471
(7) Lien Foundation The Quality of death: Ranking end-of-life care across the world. A report from the Economist Intelligence Unit (2010)
(8) Korte-Verhoef R (2004) Developments in palliative care services in the Netherlands European Journal of Palliative Care 11(1): 34-37
(9) J-J Georges, Onwuteaka-Philipsen BD, Muller MT, van der Wal G, van der Heide A and van der Maas PJ (2008) Dealing with requests for euthanasia: a qualitative study investigating the experiences of general practitioners Journal of Medical Ethics 34: 15-155
(10) Norwooda F, Kimsma G, Battin M (2009) Vulnerability and the 'slippery slope' at the end-of-life: a qualitative study of euthanasia, general practice and home death in The Netherlands Family Practice October 14: 1-9
(11) Kmietovicz Z (2002) R.E.S.P.E.C.T. - why doctors are still getting enough of it BMJ 324 (7328): 11-14
(12) Van den Block, Deschepper R, Bilsen et al (2009) Euthanasia and other end-of-life decisions and care provided in the final three months of life: nationwide retrospective study in Belgium BMJ 339:;b2772doi10.1136/bmj.b2772