As pain medicine specialists who have worked with palliative medicine specialists, we believe the debate on assisted suicide (How are cabinet ministers likely to vote on assisted dying?, 18 November) must recognise the significant gap between what is currently provided and what should be provided in end-of-life care. In Oregon, poorly controlled pain is an important symptom in one in three patients who request medical assistance to die, and a factor in determining the requests of 59% of Canadian patients.
The Health and Care Act of 2022 mandates the provision of palliative care in England by specialists. It is as yet inadequately commissioned.
Palliative medicine specialists cannot work in isolation from other doctors. The curriculum for their four-year training schedules time spent with specialists in the separate discipline of pain medicine – understanding when to involve these doctors for complex problems.
This involvement, however, is complicated to arrange because of full-time NHS contractual obligations. Additional capacity to support multi-specialty working is limited. With much palliative medicine based in charitable hospices outside the NHS, access is a problem, as hospices rarely employ pain medicine specialists. Our experience with informal collaboration has shown that very good results can be achieved, transforming the last few weeks of life for many patients. Formal contractual collaboration between hospitals and hospices is required.
The proper resourcing of pain medicine within specialist palliative care settings would focus the argument from a poorly considered change in the law on assisted dying back to the actual needs of improving care at the end of life.
Dr Barry Miller Consultant, Bolton, and former dean of the Faculty of Pain Medicine at the Royal College of Anaesthetists; Dr Arif Ghazi Consultant, London; Dr Patrick McGowan Consultant, London; Dr Andrew Severn Retired consultant, Morecambe Bay
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