Hospice staff are experts in death, but they are divided over assisted dying

The debate, sparked by Kim Leadbeater MP’s private members’ bill, has huge consequences for the hospice sector, ITV News UK Editor Paul Brand reports

At Royal Trinity Hospice, they deal with death on a daily basis.

But when I visited this week, I was surprised by how much life there is to the place too.

Not necessarily vibrant, energetic life. But a calm, contemplative atmosphere, where life can be savoured and reflected upon.

Reflection is indeed a big part of the work of a hospice – helping people to come to terms with their terminal illness, or the grief their family is about to experience.

Now, they are reflecting on a new dynamic. Whether life should be shortened via assisted dying.

The debate sparked by Kim Leadbeater MP’s private members’ bill has huge consequences for the hospice sector.

In other countries where assisted dying has been legalised already, hospices have gone from prolonging life and easing suffering, to in some cases shortening life and ending pain altogether.

And yet despite the huge implications, the UK hospice sector is taking a neutral stance on the matter.

At Royal Trinity, you can understand why.

I’ve come to hear how staff and patients here feel about assisted dying and it is immediately clear that they are deeply – though very respectfully – divided over the matter.

One of the first people I meet is 77-year-old Terry Davie. He arrived at the hospice two nights ago and has terminal cancer. He knows he will not leave.

It is a difficult conversation to have with him, but Terry tells me he would like more control over how long he’s likely to stay for.

“I don’t want to be suffering in a situation where the obvious is known," he says.

“If there’s an opportunity to nip it in the bud, then I’d do it.”

“You would like the option of an assisted death?” I ask.

“Yes. No ifs, ands or buts," he replies emphatically.

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It is a view his wife Mary Anne shares, even though she’s been willing him to live for as long as possible.

“We had our wedding anniversary a few days ago on October 26. I was keeping my fingers crossed that he would pass that date and yes, we have been married for 46 years.”

“It’s up to him. Because he’s in a lot of pain. As long as he’s kept comfortable right up to the end, that’s all I wish for him," she tells me.

Terry and Mary Anne are being looked after by a team of doctors and nurses, as well as counsellors and spiritual mentors who guide them through their anxieties and grief.

These staff are experts in death, yet they each have a different view on how best to manage the end of life.

“We want to think that everyone is going to go peacefully in their sleep and thankfully many people do," senior counsellor Claire Moor tells me.

But she feels that even a brilliant hospice can’t always provide a good death.

“If you’ve got a terminal illness and your body is being taken over by your disease, there’s no guarantee of that.

"And for some people the thought of going towards that is understandably very frightening for them. And they also don’t want their loved ones to witness it.

"So they want the choice to die with dignity. And dignity is the key word when thinking about assisted dying.”

Claire tells me that assisted dying has come up many times in the conversations she’s had with patients, perhaps because they feel her counselling sessions are a safe environment in which to raise it.

She cannot help to explore the option of course, because under the current law to do so might be illegal.

Yet in the same hospice, dealing with the same patients, I meet Dr Samantha Lund. She says assisted dying is rarely raised with her in her medical role.

And like the majority of palliative care doctors in the UK, she would oppose it because of the risk it might pose to vulnerable patients.

“For me, this was brought massively into focus recently when my mum died," she tells me.

“Whenever my mum was asked what worried her, she would say about the impact of her illness on her family. And I worry if assisted dying had been legalised she would have felt a pressure to consider it.”

That is not the only worry for some in the hospice sector.

In other countries that have legalised assisted dying, hospices have been obliged to facilitate assisted deaths, in some cases losing their funding if they don’t.

A report by the Health Select Committee in Parliament this year did not find evidence that palliative care has suffered in countries that have introduced assisted dying.

But the sector here faces a funding crisis, and some worry that assisted dying will overtake any focus on improving hospice care as a first priority.

Hospice UK, which represents hundreds of hospices across the country, is remaining neutral, while asking not to be forgotten in the debate.

Charlie King from Hospice UK told me: "Hospice staff, volunteers and of course patients have crucial experience and expertise to bring to this debate.

"It is so important that they are listened to by politicians as the country considers the legislation on assisted dying.

"As Hospice UK we are neutral on a change in the law. But we can all agree it is intolerable that anyone might feel they need to choose an assisted death for fear of not getting the care they need at end of life.

"Yet currently, the hospice sector is under severe financial pressure. We'd urge all MPs to back the need for reform of how we fund palliative and end of life care in the UK."

The assisted dying bill will be debated and voted on by MPs on November 29.

If it passes, it will be the biggest social change in Britain in generations.

It will fundamentally alter our relationship with death, even for those in the hospice sector who are already well acquainted with it.

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