There is no meaningful choice about how to die if good end-of-life care isn’t available in the first place.
Palliative care in the UK is not reliably available to all; many people never get access to high-quality pain relief or emotional support at the end of life, and this gap falls hardest on Black, Asian and other ethnic minority communities, who face lower referral rates and greater mistrust of end-of-life services.
Introducing assisted dying without first fixing this creates an unfair choice between a bad death and an assisted one that a person might not otherwise have chosen. Investment in palliative care must come first.
You cannot do both
The promise made for this Bill is that assisted dying will sit alongside excellent end-of-life care, and that nobody will choose it for want of the alternative. That promise cannot be kept on the current trajectory.
Building an assisted dying service is not free. It needs funding, clinical time, training, oversight, inspection and administration — and it needs them from the same health budget, the same workforce and the same ministerial attention that palliative care has been waiting years for. Every one of those things spent standing up a new service is not spent on the one that already exists and is already stretched.
Given how long good end-of-life care has taken to reach everyone who needs it, it is hard to see how both pathways can be properly funded at the same time. Under budget pressure, it is the newer, cheaper service that tends to win out, not because anyone intends it, but because that is how stretched systems behave.
That is the risk this Bill poses for Parliament to weigh: not “assisted dying as well as palliative care”, but assisted dying arriving before palliative care ever reaches the people who need it.
Trust in the NHS
For some patients, particularly older people or those managing complex or chronic conditions, a doctor raising the topic could be seen as steering them towards an assisted death to save the NHS money. Even with good intentions, this risks eroding trust at exactly the point when patients are most vulnerable and need to feel fully supported.
“We should be helping people to live, in a comfortable way on their own terms, before we make it easier to die.”
— Florence Eshalomi MP · Big Issue