Palliative care and legal assistance to die – the evidence does not lie.

The report found that palliative care is well developed in these countries, or at least no less well developed when compared to care delivered in the UK, Germany, France and Spain.

The idea that legislation of euthanasia and/or assisted suicide might obstruct or halt palliative care development thus seems unwarranted and is only expressed in commentaries rather than demonstrated by empirical evidence…There is scant evidence of the supposed underdevelopment of palliative care

The report acknowledges that whilst palliative care is organised differently from country to country, it is still delivered to an equivalent standard in those countries which have legalised assistance to die practices.  Healthcare in the Netherlands is characterised by its emphasis on primary care and that palliative care should be delivered, as much as possible, in the patient’s home. As a result GPs have training in palliative care (in fact, a survey of six European countries found that the GPs Netherlands received the most palliative training) and are also supported by specialised palliative care experts. Similarly in Belgium palliative care is not a distinct speciality, rather healthcare workers are trained in palliative care and are supported by specialists where necessary.

A global study published in 2010 ranked the Netherlands as seventh in terms of quality of death and Belgium as ninth.

The report concludes that “The idea that legalisation of (voluntary) euthanasia and/or assisted suicide might obstruct or halt palliative care development thus seems unwarranted and is only expressed in commentaries rather than demonstrated by empirical evidence”.

Although not discussed in the report, the introduction of assistance to die legislation has actually had a positive impact on palliative care. In 2002 in Belgium, at the same time as the legalisation of voluntary euthanasia, a palliative care law was passed which guaranteed the right to palliative care and led to an increase in end-of-life care funding and reorganisation of care.

In both the Netherlands and Belgium healthcare professionals and patients can have frank and open discussions about end-of-life choices.  In the Netherlands there are about ten times more requests than actual cases of voluntary euthanasia, demonstrating that the majority of people want to be able to discuss their end-of-life concerns and options without actually wanting assistance to die. Currently in the UK these types of discussions put healthcare professionals at professional risk as highlighted in recent RCN guidance.

The EAPC report, which is entirely evidence-based, should be read and reflected on by those on both sides of the assisted dying debate in the UK.