The Royal College of Physicians (RCP) has published a new statement in response to the Government’s recent impact assessment of the Terminally Ill Adults (End of Life) Bill currently going through parliament which seeks to legalise assisted dying.
The RCP welcomes the impact assessment of the Terminally Ill Adults Bill (TIA Bill) published by the Department of Health and Social Care (DHSC) and Ministry of Justice (MoJ) recently. The RCP recognises that the document focused on the costs and cost savings of assisted dying however we believe this limited the assessment as it did not address or explore the many non-financial impacts.
Shortcomings of current Government costings:
- We believe that the impact assessment underestimates the medical costs significantly. It uses salary point midway between that of a first-year doctor and a consultant to calculate costs for the coordinating and independent doctor. The RCP is clear that doctors directly active in assisted dying discussions, decisions and delivery must be senior responsible clinicians i.e. consultants or GPs.
- The impact assessment did not explore the impact on usual NHS services of diverting services to assisted dying in terms of costs and impact on patient care. In particular, the impact assessment does not explore the impact of the TIA bill on palliative care services workforce and funding.
- The impact assessment acknowledges that there is inequity and unavailability in access to palliative care but does not recognise that if these inequities were addressed there would be significant cost savings to the NHS.
Impact on inequalities:
- Minoritised groups report lack of trust in health care services that result in reluctance to access NHS care. The impact assessment did not explore the potential negative impact of the TIA bill on this.
- The IA did not adequately explore the impact on older people, especially (but not exclusively) those living with frailty, from coercion. The report notes that this pressure may not always be via other individuals, but older people (or those living with disability) may feel pressured to end their lived prematurely, especially when there is a recognition of impending or existing costs of social care.
This position statement was developed through the RCP short-term clinical reference group on assisted dying, set up as a sub-group of Council.