OPPONENTS of assisted dying often argue that a better alternative is good palliative care. But few people, on either side of the debate, take the trouble to scrutinise the adequacy of the state of end-of-life care in Britain today.

Every year, 600,000 people die in the UK. Of these, 480,000 need palliative care. Yet only half of them currently receive it, according to the director of Cicely Saunders International, Professor Irene Higginson. The growing numbers of older people and the increasing prevalence of chronic illness mean that the need will continue to rise.

Illnesses are changing in ways that mean that the predictable trajectory of decline towards death has altered significantly. Older people have more complex medical conditions, more individuals suffer simultaneously from multiple diseases, and dementia is growing.

Covid has exacerbated this trend. During 2020, demand for palliative care surged, reaching levels previously predicted to be reached only in 2040. The wide-ranging impact of the pandemic on NHS services — delays to surgery and consultations, an increase in long-term conditions, and changes to the ways in which health and social care are delivered — mean that the situation will get only worse. Current estimates suggest that approximately 75 per cent of people approaching the end of life may soon need palliative care.

Already, as last week’s leader comment acknowledged (11 October), patients do not have enough choice or control over decisions taken about their care. Too many people with life-limiting illnesses — as well as those approaching death — spend long periods of time in hospital unnecessarily, without the option of an alternative care setting.

Professor Higginson was speaking last week at the centenary celebration of the Sir Halley Stewart Trust, which has funded hundreds of pioneering medical, religious, and social projects since it was founded in 1924 to work for the prevention of human suffering. One of its most innovative acts, in 1958, was to fund Dr Cicely Saunders as she began to explore her conviction that pain was emotional, social, and spiritual, as well as physical. It sparked the birth of the modern hospice, which put care for the person before treatment of the disease.

The evidence that Saunders gathered on symptom-management in a more holistic approach to end-of-life care is now being applied in a new way. The latest research shows that, if the Saunders techniques are applied earlier, they can extend life as well as improve its quality.

Yet the Government provides hospices with only one third of their funding, leaving them to scrabble to find the rest from charitable giving. And, of every £100 spent on health research, a meagre 23p goes into palliative care — despite the new evidence that it has much to offer a crisis-ridden NHS, in which 20 to 30 per cent of an individual’s lifetime health-care costs are incurred in the last year of life.

Arguments about assisted dying are complex, perhaps even intractable, because they proceed from divergent definitions of what we mean by human dignity, and how best, as individuals and as a society, we honour and enhance it. We can return to this at a later date. But those who argue that palliative care is the alternative to voluntary euthanasia would do well to lobby for serious improvements in this most neglected area of health care.

The Church Times and Modern Church will be hosting a webinar on assisted dying on Thursday 28 November. Find out more here.