Time for Choice References

Below are the references for our Time for Choice report

Freedom of Information request

In April 2023, Dignity in Dying sent a Freedom of Information request to all NHS trusts and health boards in England, Wales and Scotland, excluding some specialist trusts (e.g. trusts dealing specifically with mental illness or pediatric care).

England and Wales

  • 155 NHS trusts and health boards were emailed (some were discounted e.g. trusts dealing specifically with mental illness or pediatric care, some responded on behalf of multiple trusts and some trusts ceased to exist).
  • 37 responded saying that the FOI request would take too long to fulfil, or that they did not hold this data.
  • 67 had no record of any suicide or suicide attempts amongst patients receiving specialist palliative care in hospital in the last five years.
  • 13 had a record of at least one suicide or suicide attempt amongst patients receiving specialist palliative care in hospital in the last five years.

Scotland

  • 14 NHS health boards were emailed (some were discounted e.g. trusts dealing specifically with mental illness or pediatric care, some responded on behalf of multiple trusts and some trusts ceased to exist).
  • 2 responded saying that the FOI request would take too long to fulfil, or that they did not hold this data.
  • 7 had no record of any suicide or suicide attempts amongst patients receiving specialist palliative care in hospital in the last five years.
  • 3 had a record of at least one suicide or suicide attempt amongst patients receiving specialist palliative care in hospital in the last five years.

Cost of an assisted death overseas

The cost of travelling to Switzerland for an assisted death is based on the average cost of flights, transport in Switzerland, accommodation, food and drink and fees of organisations that provide assisted dying. A direct comparison has been made with an equivalent calculation by Dignity in Dying in November 2017 in The True Cost: How the UK outsources death to Dignitas PDF).

Polling

All polling figures, unless otherwise stated are from Opinium Research. Total sample size was 10,897 adults. Field work was carried out between 9th – 22nd February 2024. The survey was carried out online. Figures are weighted to be politically and nationally representative.

Other references

p. 2-3

Infographic – all evidence in the infographic is cited in the references below

p. 4-7

p. 8-11

  • ‘In a study commissioned to inform the assisted dying debate, the Office of National Statistics found that people with severe and potentially terminal health conditions, including low survival cancers, are around twice as likely to die by suicide than a matched control group.”
  • ‘Based on research and localized studies of coroners records, Dignity in Dying estimates that up to 650 dying people end their own lives every year…’ Last Resort: The hidden truth about how dying people take their own lives in the UK, Dignity in Dying, 2021 (PDF)
  • ‘Before legalisation, parliamentary inquiries into end-of-life choice in Australia received evidence that 10-15% of recorded suicides were by terminally ill people, similar to current estimates in the UK.’ Coroners Court of Victoria, 2016, Parliament of Victoria, Legal and Social Issues Committee, Inquiry into end of life choices. Final Report, 2016, Queensland Parliamentary Committee Report No 34 (2020)
  • ‘In Victoria, coroners reported the most frequent methods used by this cohort were poisoning, hanging, firearms and suffocation.’ Parliament of Victoria Inquiry into End of Life Choice Transcript, Witnesses: Ms Caitlin English, Mr John Olle and Dr Jeremy Dwyer, Standing Committee on Legal and Social Issues, 7 October 2015
  • ‘People who have an assisted death in Australia and the US tend to be over 65, have cancer, be highly educated and were receiving palliative care.’ Voluntary Assisted Dying report of operations (July 2022 to June 2023), Voluntary Assisted Dying Review Board, Safer Care Victoria
  • “I have used assisted dying to introduce patients to palliative care and improve their symptom control, and I have had several cases where traumatic suicides have been averted because of the availability of this process.” Dr Cam McLaren https://insightplus.mja.com.au/2022/20/what-you-need-tonavigate-voluntary-assisted-dying/
  • “The Committee is of the view that the existing end of life legal framework is untenable […] The evidence is clear that assisted dying can be provided in a way that guards against abuse and protects the vulnerable in our community in a way that unlawful and unregulated assisted dying does not.” Parliament of Victoria, Legal and Social Issues, Committee, Inquiry into end of life choices. Final Report, 2016

p. 12-17

  • Laraine Blackson’s story – courtesy of Go Gentle Australia https://www.gogentleaustralia.org.au/my_way_you_must_give_people_the_choice_of_dying_with_dignity
  • ‘The Office of Health Economics estimates that even if every dying person who needed it had access to the level of care currently provided in hospices, 6,394 people a year would still have no relief of their pain in the final three months of their life. This equates to 17 people a day.’ https://www.ohe.org/publications/unrelieved-pain-palliative-care-england/
  • ‘Research shows these symptoms can have a devastating impact on dying people.’ https://www.dignityindying.org.uk/wp-content/uploads/DiD_Inescapable_Truth_WEB.pdf
  • ‘Research shows dying people and healthcare professionals think palliative sedation can blur the lines between end-of life care and assisted dying’ Engstrom et al., Palliative sedation at the end of life – a systematic literature review, European Journal of Nursing Oncology, February 2007.
  • ‘There is no formal monitoring of how often palliative sedation is used, but in one study 17% of doctors said it was used in the last death they attended.’ Anquinet et al., The practice of continuous deep sedation until death in Flanders (Belgium), the Netherlands, and the U.U.: a comparative study, Hournal of Pain Symptom Management, May 2012
  • ‘A 2009 study of UK doctors found 7.4% reported they had made decisions with to some degree, the intention to hasten a person’s death.’  Seale, Hastening death in end-of-life care: A survey of doctors, Social Science & Medicine, July 1997
  • ‘Assisted dying legislation adds clarity to the law and this has encouraged honest and open conversations between dying people and their doctors.’ Wang Shi-Yi et al, 2015, Geographic Variation of Hospice Use: Patterns of the End of Life, Journal of Palliative Medicine. September 18(9): 771-780
  • ‘Prior to law change in Australia, the government-funded Palliative Care Outcome Collaboration published data from over 100 palliative care services which showed that 4.9% of patients experienced severe physical pain in the last few days of life.’ Patient outcomes in Palliative Care: National report January – June 2018, Palliative Care Outcomes. Collaboration, September 2018
  • ‘A 2018 report commissioned by Palliative Care Australia which examined assisted dying around the world and found “no evidence to suggest that palliative care sectors were adversely impacted by the introduction of legislation. If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced.”’ Aspex Consulting on behalf of Palliative Care Australia (2018) Experience internationally of the legalisation of assisted dying on the palliative care sector
  • ‘Since law change across Australia there has been a huge boost in funding for palliative care, totalling the equivalent of over half a billion pounds.’ https://mforum.com.au/palliative-care-a-human-right-vad-voluntary-assisted-dying/ & https://statements.qld.gov.au/statements/93249
  • “Data from Australian States shows over 80% of people who access assisted dying received palliative care. In Oregon, 9 out of 10 people who have had an assisted death since 1997 were enrolled in hospice care.” Voluntary Assisted Dying Board Western Australia Annual Report (2022-2023), Voluntary Assisted Dying Board Western Australia Annual Report 2021-22, Oregon Death with Dignity Act 2023 Data Summary
  • “For example, we know that in Oregon the average time to unconsciousness when someone self-administers the life-ending medication is around 5 minutes and the average time to death is around 30 minutes.” Oregon Death with Dignity Act 2023 Data Summary
  • ‘Oregon is in the top 25% of hospice access in the USA. Research has found law change has “resulted in or at least reflects more open conversation and careful evaluation of end-of-life options, more appropriate palliative care training of physicians, and more efforts to reduce barriers to access to hospice care.”’ Wang Shi-Yi et al, 2015, Geographic Variation of Hospice Use: Patterns of the End of Life, Journal of Palliative Medicine. September 18(9): 771-780, National Palliative Care Research Centre, America’s Care of Serious Illnesses (2019)
  • “End-of-life care in Australia is now safer and fairer than ever before. We have brought behind-closed-doors practices into the open and given dying people meaningful, transparent choices. Crucially, none of the fears that were put forward as reasons not to change the law have been realised. The status quo was broken. Assisted dying works.” Australia: A blueprint for choice at the end of life, Dignity in Dying, 2022

p. 18-22