Ethical questions – our position
Providing compassionate care on the journey towards the end of life generates a number of challenges for the professionals caring for a patient and their family. Many of the issues that cause ethical dilemmas are emotive and can lead to misunderstandings and inaccurate perceptions of hospice and end of life care.
Here at Trinity, we are open and honest in everything we do, and have clear position statements on a number of common ethical dilemmas. We hope these go some way to explain the challenges we may face, and our considered response to them.
Our statements take into account:
- Professional guidance from the General Medical Council and Nursing and Midwifery Council
- Professional statements from the Association of Palliative Medicine for Great Britain and Ireland
- Statements from the Royal College of Physicians and the Royal College of General Practice
- The current law in England
- Opinions expressed by staff working in Trinity and the consensus of professionals working in specialist palliative care
- Our assessment of the impact of the statement on patient care across the family of Trinity services
Our Position Statement on Assisted Dying
Both euthanasia and assisted suicide are illegal under English law.
Trinity Hospice and palliative care abides by this law providing specialist palliative care which affirms life and death as a natural part of that life.
To value people’s lives is fundamental to every aspect of palliative care and is at the heart of the care we provide to all our patients and families. We believe that all have the right to be well cared for up until the time of death.
The whole ethos of hospice and palliative care, as defined by the World Health Organization, is that it “intends neither to hasten nor postpone death”. Assisted dying is not a part of palliative care practice.
For our staff and volunteers, the issue is not about whether to live or die, but is about respect for individual dignity and the right to be well cared for up until the time of death.
Often requests to hasten death are expressions of fear and distress and may reflect a need for assurance that pain and suffering will be relieved and that end of life decisions made by patients will be respected.
We use an ethical framework to guide us in all care and decision making with our patients and families respecting the following principles; the need to maximise good and minimise harm, the individual’s right to self-determination and the importance of fairness and honesty.
As part of our compassionate, individualised, holistic and supportive care we encourage our patients, their families and carers to talk about end of life decisions with each other and with our staff and to make an Advance Care Plan. As part of these discussions we can discuss natural death and explore the alternatives to assisted dying if this is raised.
As an organisation we feel that if any part of Trinity Hospice and Palliative care services were to provide assisted dying, this would fundamentally undermine the trust between patients and staff and negatively affect the care we provide for patients and their families. We share concern that a change in the law may result in vulnerable patients feeling obliged to consider assisted dying for fear of becoming a burden on others, so a right to die may become a duty to die.
We acknowledge and respect the wide range of views and perspectives in society about the ethical issue of assisted dying and this statement makes no value judgement about assisted dying or the people who are supportive of it or who request it. If eligible patients hold views that are different from our own about this or other ethical issues this would not prevent them from accessing our services and support. It would not change the way we care for them.
We believe that all patients and those important to them should be made aware of options for hospice and palliative care, and should be offered an assessment of their individual needs to address symptoms or any spiritual or psychosocial distress and to make sure that appropriate palliative care is being provided.
