To be or not to be, is that THE question?

When Shakespeare introduced Hamlet to us, little did he know that years after his demise, Hamlet’s moral question and intriguing curiosity with life and death would befall Great Britain. Great Britain is in the throes of a moral and medico-legal conundrum now. For the uninitiated, our parliament overwhelmingly voted in favour of the Assisted Dying Bill just the other day.

The Bill, which is not yet law (and may not become—ergo to be or not to be), proposes that any adult with a terminal illness and less than 6 months to live should be allowed to die. Specifically, we, the medical community, should help them die. Hamlet, in Shakespeare’s play ‘Hamlet’ calls death ‘…an undiscovered country that might arouse curiosity, but is a dreadful one where no traveller returns…’ This is the state we are in Shakespeare’s country. We are collectively more curious about death than life. It is true when they say that literature is a mirror of the society. In my opinion, literature is a mirror that shows us not only what we are, but what we are not.

The rest, is silence -Hamlet

Were he to come back to life, Shakespeare would wax lyrical about the priorities of this country’s leadership. He would rhyme how the National Health Service (NHS) is a gift which we are skinning alive and when the flesh is exposed, we divert our attention to non-issues. Assisted Dying and whether it should be legalized or not is not an urgent conversation in the context of our healthcare infrastructure. We can pretend it is and indeed get worked up debating for and against it but take friend, this is not an urgent conversation.

The current life expectancy in the UK at birth is 79 years for males and 83 years for females. This shows that we have done everything we could do to keep people alive for longer. Diseases that used to diminish life expectancy, including advanced cancers are being managed better. It means that we have found a way to live despite the medical surprises that come in the journey of life. Ironically, instead of planning for better social protection because people are living longer even when they are unwell, government after government has mismanaged the budget of the country and now, they want to throw the baby and the bath water. Welcome to Britain where we take three steps forward and five steps backwards.

The NHS is suffering under decades of defunding and a social care sector running on fumes and good vibes. Terminally ill patients can live for years after the initial diagnosis. Just because a doctor says six months does not mean six months. We should improve palliative care enough to help these patients live their best lives for whatever duration of time God will grant them. This is the conversation we should be having.

Some of the needs of a palliative care patient revolve around their personal care. The social care sector is responsible for organizing packages of care and it is true that they are overwhelmed by high demand and a pitiful budget. That does not mean greasing the slippery slope of Assisted Dying to make us look away from the problem. It is no different than hiding our heads in the sand. Funding social care sector and improving palliative care services ensures that patients can be taken care of in their homes or in hospices or wherever else they choose without the rigmarole of hospital admissions and its associated impact on their wellbeing. As human beings, we not only have a right to live well, but to die well. This has nothing to do with death on demand.

Besides funding, care integration is another approach to improve palliative care services in the UK. The current setup of care in the NHS and primary care is in isolated silos where one model does not effectively communicate with the other. Breaking down these silos would be helpful to ensure that oncologists, geriatricians, general practitioners and every other specialty involved in end of life care are interlinked. This enables frequent multidisplinary meetings to formulate patient-centred care in line with what really matters to the patient.

Another unutilized approach is the use of telemedicine to cater for the patients in the comfort of their homes. The Covid-19 pandemic taught us that virtual wards can and should work in line with established guidelines.  We can extend the same services to end of life care services.

Finally, and perhaps most importantly, the United Kingdom needs to pay her healthcare workers well. Compared to other economies like Australia and the United States, it is an open secret that the United Kingdom shortchanges her healthcare workers. From nurses, doctors to community health workers, nobody feels motivated to apply for or even stay in a job whose wages barely give them a chance to get ahead in life. This is the elephant that every government, past and present avoids facing head on. When you pay them well, they will feel motivated to stay and attend to palliative care needs of the country.

Healthcare workers are human beings and inasmuch as they love their jobs, the Maslow Hierarchy of needs dictate that as long as their basic needs are not being met, self-actualization is a pipe dream. Loving one’s job and caring for the difference you bring is part of self-actualization. Maslow says that that can wait as you leave the job you love to go to a place where you will be paid enough to address your basic needs.

The Assisted Dying Bill as it currently is, leaves enough loopholes for the most vulnerable in our society to be coerced into. That means that underserved minorities, people in abusive relationships, prisoners, among other categories of people may be the most affected by the outcomes of such a bill. The United Kingdom has not yet addressed health inequalities and passing this Bill next year would open the floodgates of even more health inequalities. With this in mind, methinks to be or not to be, is not THE question. What do you think?