Dear Editor,
Dr Salisbury rightly states that even if the assisted dying bill becomes law, it is still a long time before terminally ill patients potentially have choice over the timing and setting of their death. So, what can we all do now in our clinical practice?
Approximately 1% of the population are in the last year of life (accounting for many GP consultations) and almost a third of hospital inpatients are in the last year of life. Therefore, all clinicians need to be experts in identifying patients in the last year of life and initiating compassionate and skilful discussions about their care. Many already do.
Dr Salisbury also observes that the parliamentary debate and vote to change the law on assisted dying has meant that more people are now talking about death. As there will be less stigma for patients to raise assisted dying with us now, we must be prepared to have non-judgmental, open conversations. We must become more adept at future care discussions with patients, and now is the time to ensure we have those skills before any potential change in law. We must not fear these discussions but actively engage; ensuring that we become more comfortable with these.
We must learn to explore mentions of assisted dying with curiosity, listening and kindness. It takes bravery for people to bring this to their clinicians and thus expose their vulnerability: we should be grateful for their openness. It is crucial to understand why people are raising this issue and truly understand what they mean: what is going on for them; what are their fears, priorities and what matters to them; what’s their individual subjective suffering, distress or burden; what’s their understanding of assisted dying, and what do they really want? Assisted dying is not glamorous, does not always go to plan and is not what most people would even want to have to consider.
This should not be an isolated conversation but naturally lead to a discussion around advance care planning. As we also need to ascertain what treatments terminally ill patients do and don’t want, which includes clarifying wishes for resuscitation status and priorities of care. Dr Salisbury says that palliative care clinicians are already skilled in navigating these important conversations, as are others. It is however incumbent on all of us to become comfortable and skilled at having these conversations.
Let’s start getting this right for our patients now!
NB: Although I use the word patient, as this is about interactions with clinicians, it is really about the person, the human being, the unique individual, who likely, would not be wanting to be in a position to need to have these conversations.
Let’s get assisted dying conversions right for patients now!