Talking about death and dying can be uncomfortable.
But, the reality is that all lives end.
Options and choices regarding end-of-life care have recently received scrutiny in the media, popular culture, academia and in the UK parliament, as well as devolved governments.
Views are often polarised and debates elicit a range of responses.
The issues are complex and nuanced and need to be explored in some depth in order to examine and understand them properly.
For all these reasons, the BMA launched a major project in November 2014 to examine both the public and medical professionals' attitudes on aspects of end-of-life care and physician-assisted dying.
We wanted to explore:
- how the reality, and perceptions, of end of life care compare to models of good practice;
- the challenges of providing good care at the end of life; and
- the possible impact on the doctor-patient relationship if physician-assisted dying were to be legalised.
We believe the outcomes and recommendations from this project will help inform our own decisions and deliberations and also contribute to the broader public debate, now and into the future.
It is important to be clear that the project was not intended to alter current BMA policy on end-of-life care or physician-assisted dying, but to help facilitate a full and informed debate on the issue.
Volume 3: Reflections and recommendations
The third and final volume, which marks the culmination of this major project is now available. The report contains the BMA’s reflections and recommendations on all that has emerged from the research contained in volumes 1 and 2.
While recognising the many excellent examples of end-of-life care provision, our research highlights the variability in the quality of care between and within geographical areas and between different medical conditions.
It also outlines the main challenges to providing good end-of-life care and the ways we can address them.
Download volume 3: Reflections and recommendations
Our reflections and recommendations are grouped into the eight categories that the public identified as being important for end-of-life care:
|Being treated as a person
||Planning and coordination
||Financial and legal
We have also identified three overarching themes that emerged from this work:
- the need to ensure the provision of consistently high-quality end-of-life care
- The need for ongoing education, training and support for doctors
- The central role of families and those close to the patient
This report sets the agenda for our future work and policy development in these areas and we hope that it will serve as a basis for discussion and action, among both members and stakeholders.
Volume 2: Public dialogue research
The BMA works to support doctors, our members, with the practical and ethical challenges they face every day in their clinical practice. Supporting patients at the end of their lives is one such challenge.
In order to effectively support doctors in providing the best possible care to patients, we wanted to understand their views better. We recognised, however, that understanding what the best end-of-life care looks like could not be done without listening to patients as well. To assist with this we commissioned social research agency, TNS BMRB, to help us run a series of dialogue events.
Throughout 2015 a total of 21 events were held across the UKwith a wide range of opinions and experiences heard from doctors and members of the public.
Our findings from these events is available in volume 2 of the publication, and added to the vast amount of evidence which already exists.
This publication is there to prompt greater understanding and discussion on end-of-life issues amongst doctors; and to add our voice to those already calling for improvements in end-of-life care services.
Download Volume 2: Public dialogue research
2015 events: at a glance
(click to enlarge)
Volume 1: Setting the scene
All patients deserve a good death. High-quality end-of-life care is critical to this.
The UK has led the way in the development of comprehensive and holistic care at the end of life, and we are recognised internationally for the standard and quality our healthcare system can provide.
We know, however, that some problems persist, and there is significant scope for improvements to be made.
Volume 1 of this report sets the scene against which the qualitative research commissioned by the BMA has been conducted, outlining the context in which public, parliamentary, and professional debate has been conducted, and bringing together both peer-reviewed research and surveys of opinion.
It is a literature review, not a systematic review; it does not seek to state the BMA's views or make value-judgements on the included materials.
Download Volume 1: Setting the scene
News and media
BMA calls for UK Governments to prioritise end-of-life care, as new research finds the current provision does not match expectations
Read the press release
End-of-life essentials: a question of ethics
Read the latest BMA news
Imagine having cancer and being told nothing
Read the latest live and learn blog
End of life care and physician-assisted dying are two distinct issues.
End of life care
Refers to the total care of a person with an advanced incurable illness and does not just equate with dying. The end of life care phase may last for days, weeks, months or even longer. It is defined as care that helps those with advanced, progressive, incurable illness to live as well as possible until they die. It includes the prevention and relief of suffering through the assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.
An overarching term to describe physician involvement in measures intentionally designed to terminate a person's life. This might include knowingly and intentionally providing a person with the knowledge and/or means required to end his or her life, including counselling about lethal doses of drugs and prescribing such lethal doses or supplying the drugs. Administration of the drug may be by the individual him or herself (physician-assisted suicide) or by the physician or another person (euthanasia.)