Guest Post: Quality Heath Report

By Hayley Wardle, Director of Patient and Quality Care, Ashgate Hospicecare

The level of support provided for the dying varies massively from area to area across the UK. In many areas of the country palliative care is not considered as a core service by clinical commissioning groups (CCGs), and although there are national initiatives in place now to monitor how services are developed and reviewed, they are not consistently utilised by all. The types of services provided across the country also vary widely.

At Ashgate Hospicecare we are very proud to provide specialist palliative and end of life care alongside a wide range of both in-patient and community-based care and support services for people with life limiting illnesses and their families across the whole of north Derbyshire. Core to this however is the awareness of what we do, as well of course, the financial support to make it happen. We believe passionately that everyone who needs the specialist care that we offer should be able to access it, but sadly at the moment due to stretched resources, this is an ambition and not a reality.

Earlier this year we commissioned Quality Health, the UK’s largest provider of patient and employee surveys and related consultancy to the NHS in England, to carry out a report on our behalf regarding our services.

The findings from the survey of 6,000 local households indicated a general lack of knowledge about the availability and range of hospice services, as well as limited understanding as to how to access hospice care in north Derbyshire. While over 90% of respondents had heard of Ashgate Hospicecare, the survey reported that only one third of those questioned, associated the hospice with the provision of day care and or care in people’s homes.

Not least given the current political and economic backdrop, we need to shine a light on the full extent of hospice services and how access to information about referrals, the services we provide and hospice care itself, needs to be improved.

The recent survey results have only made us too aware that hundreds across the region and indeed the UK are missing the expert, compassionate support they need to gain hospice care, whether this is in their own homes (including care homes) or within the hospice itself. It’s made us more determined, now more than ever, that we need to work together to raise awareness and indeed the funding for this to happen.

We are very proud that our hospice services are free at the point of access but it costs an average of £5,000 to care for each patient and their family. Later this year we will be launching our ‘Hospice at Home’ campaign to further raise awareness of our services and to help us raise the extra funds that we will need to provide the extra care to meet the needs of those we currently and sadly can’t reach across our community .

For further information and / or to pledge your support please visit www.ashgatehospicecare.org.uk

 

Why I’m leaving a gift in my Will……..

Last year we received an amazing gift from the late Harry Fisher. Harry left the Hospice a gift in his Will which amounted to just under £900,000. An extraordinary act of kindness and generosity, which came, in part, as a result of the Hospice caring for Harry’s wife and daughter during their terminal illnesses some years ago.

Harry’s legacy to the Hospice was financial but the true value has been realised in how we have used the gift; restoring and refurbishing our old building, which was so badly in need of repair and tender loving care. From meeting with Harry’s friends and the Executors of his Will, we know that Harry would have been really pleased with how his gift has been used, and proud of the positive impact it will have on so many people for so many years to come.

The fact that bereaved people can now come for counselling away from clinical areas, that children and young people have a dedicated safe space for art therapy, that 30% more space has been created for staff and volunteers to go about their work, caring and learning, and that approximately £40,000 per year will be saved on new efficient lighting and heating systems, releasing more cash for care, is an amazing reflection of the lasting impact of legacy giving.

Of course Harry’s legacy was exceptional in value. No less important are all of the other gifts left to Ashgate Hospicecare; the average being around £18,000. Such generosity from those who have thought about the Hospice when making their Will, is every bit as important to talk about, and just as much need and appreciated.  Each year, gifts in Wills help to ensure that the Hospice can go on helping patients and their families whose lives are affected by life limiting illness. In fact one in eight of our patients are cared for by using gifts in Wills. Without those gifts, it is likely that 275 fewer patients would be cared by the Hospice each year.

Sometimes people shy away from talking about leaving a legacy. For me personally, I want to talk about it. I know that giving feels good, and I know that the time when I could afford to give a little more would be after my death. As I am about to embark on re-writing my Will, I am happy to say that I intend to include a gift to Ashgate Hospicecare in my Will. Leaving a legacy is an important mark of commitment to a cause; being able to give something when I no longer need it as much as others therefore makes perfect sense to me. I also know that I want the Hospice to be a strong sustainable force for good in the community long into the future and I hope by talking openly about legacy giving I can encourage others to feel more comfortable in talking about it.

Anybody can make a gift to Ashgate Hospicecare and every gift, irrespective of value, will help to secure care for patients and their families long into the future.

One of supporters shares her story on why she is leaving a gift in her Will:

Alison has chosen to support Ashgate Hospicecare by leaving a gift in her Will after her husband, Mark, died in the Hospice in September 2014. She says, “The Hospice kind of tracked our journey and came into and out of our lives as and when we needed it. We were absolutely overwhelmed at the kindness of everyone, just the smallest of things that the staff and volunteers did all built up and meant so much to us both. Ashgate Hospicecare is a community resource and I know that the gift I am leaving in my Will really will make a huge difference to those people facing a similar situation to ours.”

Ashgate Hospicecare can only provide its specialist care for the local people who need the Hospice thanks to the donations and fundraising that sustains our work, and gifts in Wills are a fundamental part of this. It just shows how significant these very special gifts actually are and without them, the Hospice would simply be unable to continue to help the people who need the care they deserve.

When the time is right for you to consider making or changing your Will, please remember that a gift pledged to Ashgate Hospicecare will help provide for our future and your legacy will live on.

Guest Post: Ashgate Hospicecare believes that ‘Every Person Matters’

By Esther Preston, Director of Fundraising and Marketing, Ashgate Hospicecare

As a fundraiser I have a big responsibility to increase our income to meet the growing need for hospice care in our local community. People are living longer with more complex symptoms. Competition for donations in a saturated charity marketplace is becoming fierce. These things, coupled with the latest Charity Aid Foundation report showing that giving in the UK has dropped from £10.1 billion in 2014 to £9.6 billion in 2015, mean that fundraising for hospice care is becoming more and more challenging.

Being a local organisation delivering very visible services and the fact that one in three people are touched by hospice care (https://www.hospiceuk.org/support-us/corporate-partnerships) does work in our favour.  However, we don’t have the large marketing budgets of national charities and often, when asking the public what their perception of hospice care is, the answer is ‘a sad place where people go to die’.  Whilst yes, a place for people to die is part of what we do, hospice care is so much more than that. There are many happy emotions amidst the sadness.

One challenge that Ashgate Hospicecare faces with its fundraising communications is explaining the breadth and depth of our services in a way that supporters can understand the difference they make.  We’ve talked about the number of patients we care for and how many home visits we make.  We’ve talked about what their donation could buy, for example £54 could pay for a patient to attend our day hospice. This all helps people to understand what their money was spent on, but crucially not connect emotionally to the difference they made.

However, the greater challenge with communications is ensuring prospective patients see a referral to Ashgate Hospicecare as something positive.  There is nothing sadder than hearing about a person who could have benefited from our services but was put off accepting a referral as they were worried about what that would mean for them.  Lack of communication around death and dying can have an adverse affect on the perception of hospice care.  Dr Katherine Sleemans’ excellent TED talk about how sometimes health care professionals say their patient isn’t ready to be referred for palliative care, even though the evidence is this means feeling better and potentially living longer (https://www.youtube.com/watch?v=2VsYhw9z-1Q), is worth watching.

Not a sad place to go and die

This time last year, we knew we did great work, we knew we changed people’s lives, we knew we needed to connect donors to the difference they make, but we were falling short. We couldn’t change the perception of the hospice being ‘a sad place to go and die’.

To solve this problem we worked with fundraising specialists Rob Woods on his Major Gifts Mastery Program (http://brightspotfundraising.co.uk/) as well as Alan Clayton and Lucy Gower on a 3-day residential masterclass at The Inch Lodge in Scotland (http://revolutionise.com/).  They all helped us understand the power of storytelling to connect with people emotionally, communicate our messages, and make them stick.

The power of real stories told from the heart

After working with Rob, Alan and Lucy, I started to look more closely at how we could use real stories to help patients, supporters and the wider community really understand what we do.

We had always tried to include a patient story in press releases and mailings to show how our services helped people. They always focused on the factual details of the care we delivered.  For some patients, this was pain relief and for others it was more practical solutions, like equipment, to enable them to stay at home with some independence. What was missing was making an emotional connection for the reader or listener and helping them understand how the hospice made a difference to real people.

We wanted to help local people who had no experience of hospice care to understand:

  • What impact Ashgate Hospicecare makes to individuals and whole families
  • That a hospice is a warm and friendly place and not a ‘sad place to die’
  • How we also help people to stay in their own homes
  • That a hospice is not a place to be feared – by sharing experiences of other people who have overcome their fears
  • And from a fundraising point of view, we wanted people to understand that every donation helped us care for the next person who needs hospice care, creating a link between how much we raise and how many people we can care for.

We asked people who had experienced hospice care first hand to talk on camera about the difference Ashgate Hospicecare had made to them and their loved ones. We didn’t want a script. We simply encouraged people to tell their story in their own words. As people told their story, they opened up about what the problems were before the hospice was involved. For example, Matt talked about how low his Dad got when he couldn’t get out of his chair without assistance. When Ashgate Hospicecare brought him a motorised chair, he could get in and out without assistance and Matt saw him quickly return to his old bubbly self.  In many cases, the things that meant the most were the simple things that reflected normality, such as Rob, who shared his experiences of being able to move a bed into the garden and sit in the sun with his mum.

We heard so many stories, for example, when Alison shared with hospice staff that she wanted to spend a night with her husband, which she had been unable to do for months because of his pain, the staff worked out how they could make this happen and Alison and Mark were able to sleep next to each other.  Alison said “that night, we shared a bed for the first time in months and that was a lovely memory and a lovely feeling”.

The powerful lesson for me was the ‘can do’ attitude of the staff who didn’t give up at the first hurdle. They kept going until they found a solution, because if it mattered to Alison and Mark, it mattered to them.

The stories were a really emotional experience for everyone involved.

‘Every Person Matters’

The videos are very raw and real.  You can see them here. http://www.ashgatehospicecare.org.uk/patient-stories/

How we are making sure our whole community hears these powerful stories

Having the stories is the start; now we are working hard to get them to everyone that needs to hear them. We’ve integrated the videos into our website www.ashgatehospicecare.org.uk and other communications.

We’ve used photos of the storytellers in each video to form a series of adverts, collection box wraps and leaflets.  As well as engaging and inspiring our existing supporters, we wanted to reach out to new supporters. We’ve started an outdoor advertising campaign that we hope everyone in the community will see which includes adverts on petrol pumps, buses and telephone boxes.

Already we are starting to get anecdotal feedback about the difference that this storytelling approach is making. Tracie works in one of our charity shops. She has been recognised as one of the storytellers in the adverts. Yesterday, she told me one of her friends had seen the advert on a petrol pump and then watched her video on our website, which inspired her to set up a Direct Debit to donate to Ashgate Hospicecare regularly.  She said this wouldn’t have happened if she hadn’t watched Tracie’s video. She was really pleased to have the opportunity to make a difference.

What next for Every Person Matters

We know that helping our teams understand this new approach, which is more emotional and different to what we have done in the past, is important. Word of mouth is a powerful method of communication, so I have started a series of focus groups with staff and volunteers to connect everyone to the problem that we, as a charity, are here to solve.  I show the story videos and encourage people to use these real examples as inspiration to explain in their own words what Ashgate Hospicecare does.  It is important to help them understand the reasons for this new approach; that real stories connect people emotionally, communicate messages, and make them stick. To understand the power of stories, they must experience the powerful connection themselves by telling their own powerful stories.

Later this year, we will be holding story-telling training sessions for staff, volunteers and supporters who want to become communication ambassadors and help spread our new messages.  Our aim is to develop a strong network of local advocates for the hospice to reach all local people face to face.

We will also run a series of focus groups with members of the public to discuss what their perception of hospice care is and how easy they feel it is to access.  The information from these focus groups will then be used to form a questionnaire to gain quantitative data to support the need for service developments and therefore growth in fundraising income in order to fund the new developments.

What I’ve learned

One of the things that has really stood out for me is the need to reconnect staff and volunteers to why they do what they do.  Establishing a common purpose is a big part of bringing everyone together. There is also great value and connection in hearing each other talk about what the hospice means to them.

The other learning point for me as someone who is impatient for change has been having the patience to repeat the same messages because it takes time to shift mindsets and bring people with you.  I’ve also learned that sometimes I am not the best person to make the case because I am too close to the cause, which is one of the reasons why working with external experts like Rob, Alan and Lucy has such an impact on organisations.

Most importantly, I have learned to be uncompromising about the things that matter.  It is our responsibility to be there for every person who needs us. Every person matters.  Every patient I talk to inspires me to keep going to make sure that Ashgate Hospicecare is no longer perceived as ‘a sad place where people go to die’ but a way of caring that is as unique and as inspirational as the patients we care for.

Thank you to ehospice who first published this blog post on 16th June 2016. Click here to view

Dying Matters Awareness Week

I recently read the most moving book of my life so far. When Breath Becomes Air…a remarkable account a man’s journey to his premature death, published posthumously. Poignant, painful and articulate; the story details Paul Kalanithi’s personal experience of what it is to come to terms with one’s own mortality. Apart from the fact this is a beautiful piece of writing, a story about love, ambition and courage; it is also a story about death and dying and it hits hard.

Even more poignant perhaps is the fact that Paul Kalanithi was a medical doctor, a brain surgeon – he understood what was happening to his body in a way that others would not. What is clear however is that his medical background made him no better prepared for the emotional experiences that he would face, or that his wife would face in approaching his death and in her losing the man she loved.

Perhaps due to my own personal experiences in life, I have always been drawn to reading about other people’s experiences of death and dying, always been happy to talk about death and dying, and applaud those who talk openly about their own mortality and experiences of illness, such as Kate Granger, who I recommend people follow on Twitter. I do recognise however that this ‘openness’ does not feel comfortable to everyone.

Is talking about death and dying easy? No, not always. For some, it is extremely hard and can’t be done without help, support and guidance. Is it easier to talk about the physical process of dying, rather than about feelings and emotions? Maybe…. If so, I make no judgement about why that might be, but I do know that talking about death, dying and grief can be good and can be helpful. Talking can ease pain and worry, and support the process of grief that death and dying brings to us all.

A hospice is a place to talk about death and dying, about grief, and about people’s personal journeys towards the end of their lives. Hospices can help people to live their lives to the end by facilitating difficult and painful conversations with patients, and by encouraging and supporting patients and families to have open, clear conversations about what is happening to them.

So…..my three prompts for Dying Matters Awareness Week are:

  1. Read Paul Kalanithi’s When Breath Becomes Air
  2. Follow Kate Granger on Twitter (@GrangerKate)
  3. Support your local hospice

Derbyshire charities win ‘Innovation in fundraising’ award 2015

I am so proud to be able to write about the fact that Ashgate Hospicecare has recently been recognised by Hospice UK, and has won a very important award.

Announced at the Hospice UK annual conference last week, the award was in the ‘Innovation in Income Generation’ category and was won jointly with Blythe House Hospice and Helen’s Trust; two other Derbyshire-based charities which support people with life-limiting illnesses.

Sometimes it is important to do things alone, and to stand out individually but my sense is that we can usually achieve greater things if we come together with others. The #ChallengeDerbyshire partnership illustrates how working together can yield great results, and although doing that in fundraising isn’t easy, this partnership has been a real success.

The three charities were praised for working on the joint fundraising project, which gives local people the opportunity to undertake a fundraising challenge, whilst raising money for all three organisations with similar causes. To date, the joint venture has raised over £30,000 which will be split equally between the charities. The partnership has been such a success because all three charities had experienced supporters who expressed that they found it hard to choose one charity over another. This particularly applied to some local businesses who wanted to spread their support, and it actually meant we were all losing out at times. The obvious solution was for all three organisations to come together to set up a specific joint fundraising venture. As such, #ChallengeDerbyshire was launched.

I do wonder if the word collaboration is sometimes over used, and I wonder how often people stop and think whether something really is collaborative, and what that means. I like the word, and I also like to work collaboratively because I believe that the ideas and thoughts of many people always produce greater results. I also like to drive innovation and take risk, when it’s in the interest of improving or developing people and services; that is very much a part of the culture that I have tried to create here at Ashgate.  But….as I heard someone at the Hospice UK conference say this week; “you can’t form partnerships, or collaborate effectively without taking risks!”

Too true, and we have all taken a risk in embarking on this innovative project. However, the great news is that it is paying off in more ways than we expected, as is often the case when you do take a risk!

Gaining recognition of the things that we do at Ashgate is always a great joy and winning an award for a collaborative piece of work is really exciting. It fills me with great confidence that we can continue to build strong, meaningful partnerships with others, which will ultimately better serve our population’s needs. We know income is getting harder to find and so working in this way is a positive step towards embracing collaboration and breaking down previously held misconceptions about competitiveness in fundraising. Those misconceptions may have prevented us from working together in the past, but not now….we’re doing it!

Well done team, I’m very proud of you all!

Photo: L-R, Dr Ros Taylor MBE, George Plumptre (NGS), Janet Dunphy, Heidi Hawkins, Esther Preston, Lord Howard of Lympne

L-R, Dr Ros Taylor MBE, George Plumptre (NGS), Janet Dunphy, Heidi Hawkins, Esther Preston, Lord Howard of Lympne.JPG

New lease of life planned for old building

Challenges and aspirations

The hospice sits on a large, green, rural space. People are often surprised by the size of the estate, and by the magnitude of the buildings. Visitors to the hospice come to a modern entrance and a spacious reception but in order to get to other parts of the building, they are taken down a long, winding corridor; which is actually the hospice’s In-patient unit itself.

This can’t be right….! It doesn’t feel right bringing guests and visitors through the ward routinely; passing frail vulnerable people and grieving relatives. Sometimes people are eating, sleeping, or being moved to a bathroom for personal care. Doctors and nurses are working, trying to concentrate or have difficult conversations. It isn’t right to expose our patients and their families in this way to visitors who come to the hospice on general business, and who have no reason to be on the Inpatient unit.

Of course, we do our very best to manage this uncomfortable situation by bringing people into the hospice building via different routes where possible. Other routes in are poor, tired looking and underwhelming – not the image we want to portray; or one that we feel encourages people to come back and support us.

In reality of course, people are usually overwhelmed when they come to the hospice – it’s the people they meet, passionate, warm and open. The gardens are outstanding and there is an air of calm, peace and tranquillity. Sometimes it is a good thing to show people the In-patient unit, to arrange time for patients to speak to important guests and dignitaries. Some of our patients relish the chance to do that, wanting to tell their personal story – talking positively about their hospice experience.

However, that fact does not resolve the challenges that we face in improving the site; in improving privacy and dignity, in developing the buildings and in creating better use of our wonderful space overall.

There is a vision emerging for the hospice estate, a vision to improve, to modernise and to develop. I thought I would write about that vision and current plans, in the hope of generating interest in what is likely to become a significant and long term project.

What we have now

The hospice is made up of three main building sections. The old part of the hospice, some of which is Grade II listed, and date back to the 1600s; the original extension, built before the hospice opened in 1988; and the most recent building which was completed and opened in 2005.

Over the years all activity in and around the hospice has continued to grow, numbers of staff and volunteers have grown, space has become increasing challenging to manage. This fact, coupled with the need to start to look longer term towards the needs of the whole estate, led us to thinking about potential developments.

Early thinking led us to a much needed buildings survey and we were somewhat alarmed to discover significant structural weakness and parts not fit for full use within the old building. For safety reasons, we immediately reduced the number of people using some of the upstairs rooms in the building and we then began to talk to various funders to see whether we might find financial support to help us start this work.

The survey concluded that without intervention, the building would become uninhabitable within two years. Sadly, we weren’t successful in our applications to funders, due to the fact that the building is still currently classed as being ‘in use’. Knowing we were likely to have to spend around £500,000 on structural repairs alone, we were also mindful of the opportunity that is presented in refurbishing the building; ultimately bringing the building back to life and full use.

Where are we now?

Last year we received an amazing legacy. The late Harry Fisher left the hospice a gift in his Will totalling almost £1 million. Meeting with executors of Harry’s estate, we discussed use of the legacy, and it was confirmed that Harry would very much approved of his donation being used to help us with our building plans.

After much discussion, it was decided that we would engage architects and plan the structural repairs needed, as well as the much needed refurbishment of the old building. Using the money this way, means we can do the essential work as well as starting to address some of the wider challenges that we face in improving the total site.

What we hope to achieve in this phase of work is ambitious but we are confident that we can make the money stretch and will end up with a wonderful, safe and well used old building which will see a restored entrance, new counselling rooms, an education room, an upgraded kitchen and dining facilities to name a few of the improvements. The new hospice branding will be reflected in the finished look and feel, and will be combined with a tasteful and sensitive restoration of the listed areas.

We’ve have worked hard to engage staff and volunteers along the way, and thinking ahead, we have also engaged our chosen architects to help us visualise how we could link the new and old parts of the hospice together, whilst continuing to reduce the general footfall on the In-patient unit. We are already seeing ideas which would achieve this and would further enhance the total site. There is such potential to enhance patient experience further, to make better use of space, to better position the fundraising element of the hospice, and to retain the wonderful welcome and warmth of our receptionists.

There’s a lot of work to be done, and any work done beyond this first phase in the old building needs careful assessment and the finances to support it. What’s most important is to ensure that whatever we do, it is for the benefit of our community, our patients and their families long into the future.

Look out for updates as we move along with plans and when we are ready, more photos will be shared.

building

Guest Post: Why I should not be allowed to help my patients commit suicide

Dr David Brooks:

It’s Monday morning. I am sitting by the side of a bed holding the hand of a dying woman. As a doctor, there is nothing else left for me to do for her. She is sleeping comfortably. One of her loved ones around the bed says “Couldn’t you just give her something doctor – put her out of her misery?” And yet it is not her misery that I see but his. I understand. I have been there myself at my father’s bedside, listening to every last breath, half of me wishing it was his last and the other half hoping there was one more to come. We had thought she wouldn’t survive the weekend so his bedside vigil has taken its toll on his emotional resources. And I can’t give her anything. It is against the law.

The House of Commons are about to review proposed legislation which would permit physicians to assist patients to commit suicide. But even if this were passed, it would not apply to her. It is for mentally competent patients who have expressed a fixed wish to commit suicide. If polls are to be believed, there is increasing support in society for such legislation. And yet repeated polls of doctors show not only opposition to a change in the law but particular opposition to the involvement of doctors in such a role. In fact the more time a doctor spends working with dying patients, the more they are likely to oppose a change. A survey published earlier this year showed that less than 4% of doctors who specialise in caring for dying people would be willing to be involved in assisting suicide were this legislation to be passed. Why is this?

When the Suicide Act 1961 was passed which decriminalised attempts at suicide, a section was included which was intended to protect vulnerable people from malicious or manipulative assistance with suicide. Under the Suicide Act, a person who encourages or assists the suicide of another person commits a criminal offence.  On 25th February 2010 the then Director of Public Prosecutions, Keir Starmer QC, published a Policy for Prosecutors which clarified the circumstances in which prosecutions under this section of the act were more or less likely. Doctors’ leaders at the time successfully argued for the inclusion of health care professionals in the group of individuals particularly liable to prosecution, mainly due to the nature of their relationship with patients which makes the patient particularly vulnerable to influence. Yet in this Bill it is envisaged that the doctor will be the decision maker and the implementer. The proposed Bill does require doctors to run the decision past the High Court, but this fails to recognise the fundamental problem. It keeps assisted suicide as part of medical care and leaves the Court with, essentially, a rubber-stamping role.

The current Bill proposes Physician Assisted Suicide only for those thought to be terminally ill. Any doctor will tell you of the perils of prognosticating. Most of you will know someone who has been told they have weeks to live but has gone on to live for months or years and vice versa. In my 28 years of caring for terminally ill patients, I have cared for many people who enjoyed a much longer prognosis than their doctors had predicted – in some cases years when the doctor had predicted days or weeks. This is not because the doctors who predicted were bad doctors but because people are individuals and their response to illness is different.

Even if we could separate this population, should we? If we do think it’s right to help people commit suicide, should we only be offering that help to people who doctors think may die?

The law preventing people from assisting suicide is to protect the vulnerable from encouragement or coercion to do something that they might regret were they to live to tell the tale. My many years of caring for terminally ill people have taught me how challenging this time can be for people. When they are told they probably only have months to live, most of them set off on an emotional roller coaster. That isn’t to say that everything is doom and gloom as there are often many high points, but there are also times of despair. If anything, these people need more protection under the law than others.

Hospices have a hard enough time persuading people that they are not just places where you go to die (in fact, the evidence is the contrary that early referral to palliative care may extend life expectancy). When I sit beside a patient, I want them to know I am there to care for them and support them. That they can tell me when they feel so bad they just want to end it all without me suggesting I help them. Knowing that I will explore what is making them feel so bad and do everything within my power to help them through it.

When you support a dying person, you support a family and even an extended family too. You inevitably develop relationships with the extended family. If the person does want to commit suicide, it is unlikely that all of the members of the extended family are of the same mind. A doctor who was asked to decide whether the person should receive help to commit suicide would be pulled in many directions and would become distracted from his or her main role of caring. That doctor may be the family doctor which might affect their relationship with those who are their patients for years to come after they have made such a decision.

If society does want to legalise assisted suicide then it should be left to the family court to investigate and make an independent decision about complex cases of treatment withdrawal and that the administration is left to an independent party. The court would have the power to call upon evidence such as any recent changes to the Will, life insurance policies and their beneficiaries that doctors, asked to assess for coercion or duress, would have no access to. This way the care and support for the dying person and their extended family from the health care professionals can continue without prejudice alongside the judicial process.

An opinion survey of doctors who specialise in caring for dying people published in January 2015 showed that while, if the law were changed, most would be willing to provide factual evidence to the court to inform decision making, almost all were not willing to be the decision maker or support the suicide process. 73% felt that the passage of such a law would have an adverse effect on the delivery of hospice and palliative care.

Personally, I do not believe it is possible to change the law to allow the few who do have clear and settled intention to end their own life without risking harm to the many, many more who do not. Those few who do wish to end their own life (following a decision which has been reached voluntarily, on an informed basis and without coercion or duress) strike a huge comparison to those who don’t want to but are still vulnerable and may incorrectly feel others would be better off without them. But if parliament does decide it wants to change the law then I, like most doctors, believe that it would reduce the risk of unintended harm if this process was kept totally separate from clinical practice.

I urge our lawmakers to think long and hard before imposing this change on a medical profession, most of whom think this would put vulnerable people at risk of harm.

Dr David Brooks, Consultant in Palliative Medicine at Ashgate Hospicecare since 1992.  Previous to his role at Ashgate, David was a GP trainee, GP and SHO Pall Med at Hayward House, Registrar at TPCC and later at Lecturer at Sheffield University, then became consultant at Chesterfield Royal Hospital.  His qualifications include Mb ChB DRCOG MRCGP and FRCP.  He is of the lead the integration of Palliative Care services in North Derbyshire and the modernisation of clinical practice within the hospice.