“How long have I got?” is the question doctors will be asked at some point by their terminally ill and dying patients. This is going to become a much more loaded question if we legalise assisted suicide.
One of the so-called “safeguards” in Kim Leadbeater’s assisted suicide bill currently before Parliament is that only people expected to live for six months or less may be eligible for assisted suicide. However, this safeguard is not as safe as it seems.
Not good at predicting death
Despite their knowledge and experience, doctors are not good at predicting when a patient will die. A 2023 study found that only 32% of doctors were accurate in making a life expectancy prognosis. This means that, if Kim Leadbeater’s bill succeeds, decisions to choose assisted suicide could be based on inaccurate information.
“Although clinicians can recognise when patients with advanced cancer have become terminally ill and will no longer benefit from life-prolonging treatment, they still cannot be sure whether the remaining time is to be measured in days, weeks or months”, states Professor Paddy Stone from the Marie Curie Palliative Care Research Department at University College London.
Professor Stone was commenting on a 2021 study, which found that algorithms can be as accurate as doctors in predicting how long terminally ill people with advanced cancer have left to live.
The “surprise question”
The “surprise question” is used by doctors to identify people who might die within a year. Using their clinical judgment, doctors ask the question: “Would I be surprised if this patient died within the next 12 months?” However, a 2017 study published in the Canadian Medical Association Journal concluded that this tool “performs poorly to modestly when used to predict death at 6 to 18 months, with poorer performance among patients with noncancer illness”.
Professor Stone has also researched the surprise question. The data he collected in his 2017 study was used by The Telegraph newspaper to report that doctors were “likely to be correct” when they said that they would not be surprised if their patient lived longer than a year. However, where doctors predicted that the patient would die within a year, the doctors were “wrong 54% of the time”. So, over half the patients expected to die lived on.
NHS inaccuracy
The Telegraph conducted its own research into how long people live after they have been given less than a year to live. In an article published this month, The Telegraph reported on information it obtained from the Department of Work and Pensions (DWP) about “Special Rules” payments, which allow an adult or child nearing the end of life to get easier access to and higher payments for certain benefits. “Nearing the end of life” is defined as “likely to have less than 12 months to live”.
After three years, the DWP contacted those patients who are still alive. The Telegraph reports that data consistently showed that one in five claimants were still alive after that time. This, says The Telegraph, is the “first government data to confirm the inaccuracy of NHS life expectancy estimates”.
The uncertainty about how long a patient has left must surely discount “six months to live” as a safeguard in Leadbeater’s Terminally Ill (Adults) End of Life Bill.
Quickly set aside
In a paper commissioned by SPUC on assisted suicide and euthanasia in Australia, Dr Gregory Pike writes: “One might argue that accuracy about the time left to live doesn’t really matter that much if someone really wants to die, and that would be precisely the point – the terminality requirement is argued as a safeguard to bolster the appearance of rigour, and yet it can quickly be set aside in the face of suffering deemed intolerable.
“This is supported not only by calls within Australia for it to be waived, but by the overseas evidence showing it has in fact been waived.”
“Six months to live” is not a safeguard at all. If the Terminally Ill (Adults) End of Life Bill is passed, it will be a death sentence. Lives will be cut short. Precious moments with family will be lost. And once the patient is dead no one will ever know what the future might have held for them.
