DOROTHY was a terminally ill amputee who attended the Day Centre at Trinity Hospice in Blackpool every Tuesday. Despite her controlled pain she was full of fun and always lit up the room. She was quite an artist and I’ll never forget the pen and ink drawing she gave me of a teddy bear with piercing black eyes that conveyed something of her inner conflicted self. Yet Dorothy was living proof that hospice care was about “living with” rather than “dying from.” Far from being places full of death, hospices tend to be full of life!

The concept of hospice care can be traced back to the mid-1800s. In 1843, Jeanne Garnier established a facility in Lyon, France, to care for the dying, marking one of the earliest forms of organised end-of-life care.

This initiative laid the groundwork for future hospices, with several more establishments opening in France and New York by the turn of the 20th century. The modern-day hospice movement came into being in 1967 when Dame Cicely Saunders founded St Christopher’s House in London.    

Hospice care covers all stages of life from the point of diagnosis with a terminal illness right through to the end and embraces neurological, heart, kidney or lung conditions, cancer, HIV, and dementia.  

It is holistic as it places a high value on dignity, respect and the wishes of the person who is ill. It aims to look after their medical, emotional, social, practical, psychological, and spiritual needs, and the needs of the person’s family and carers. It can be provided at home, in a care home, as an in-patient, or in a day therapy unit. Hospice teams might include doctors, nurses, healthcare assistants, social workers, therapists, counsellors, trained volunteers, and chaplains.

As one of those chaplains I came to respect and admire both the patients and staff I had the privilege of serving and working alongside, who gave me far more than I felt I ever gave them. I visited everyone on the residential wing, in the day centre and in the children’s hospice, spent time with the staff and helped to induct new nurses as they embarked on a demanding and specialised type of care.

The atmosphere was so positive and life-affirming that everyone who entered the place felt as though a great big pair of arms had been wrapped round them. Catering particularly for people’s spiritual needs in the broadest possible sense, as opposed to the more restrictive expectations of a particular religious affiliation, I found that chaplaincy was ultimately about caring for the whole person with whom I shared a common humanity.

With the recent passing of the third reading of the Assisted Dying Bill by a slim majority of 23 in the House of Commons the case for improving access to hospice care with increased funding and provision is more imperative than ever. No longer is it acceptable for such care to be subject to a postcode lottery so that those at the end of life requiring specialised attention are often denied the treatment they so desperately need.

As the Bishop of London, Sarah Mullally, a former Chief Nursing Officer for England, puts it: “If enacted, this legislation...would mean that we became a society where the state fully funds a service for terminally ill people to end their own lives but shockingly only funds around one third of palliative care. We must oppose a law that puts the vulnerable at risk and instead work to improve funding and access to desperately needed palliative care services.”

And now the Bill has to go through all the stages in the House of Lords that it went through in the Commons, and then MPs will get a final say when they have looked at any changes suggested by the peers. This is the point where the Bill will officially become law unless it runs out of parliamentary time or peers opposed to it find a way of blocking it.

Any change in the law must take into account its real-world impact on the vulnerable in society such as the disabled and the elderly. Disabled organisations have been vocal in expressing concerns about the attendant risks and the evidence concerning the impact on the vulnerable in other countries where assisted dying is legal is far from reassuring.

When it comes to the criteria for the lethal jab or infusion the Association for Palliative Medicine stresses that “prognostication for the last six months of life is notoriously difficult and highly subjective.” Also almost all amendments proposing stronger safeguards have been rejected especially the requirement that a High Court judge signs off any application. Even hospices will not be exempt from providing the means to ending one’s life.

Liberal ideas about individual rights and personal autonomy when divorced from social and material realities mask the fact that this is ultimately a class issue. As this paper’s editorial argued last October, “there is a powerful case that assisted suicide is impossible to safely legalise in a capitalist society which judges a human being’s worth by how much profit can be extracted from them.” The proposed cuts to disability benefits only reinforce this argument with the spurious aim of helping the disabled into work while withdrawing the very support that makes this possible.

Which brings us back to the need for universal hospice and end of life care for there is no freedom to choose if the alternative is not available or affordable. As Cardinal Vincent Nichols stated after the latest passing of the Bill, “The provision of a choice to die cannot exclude the provision of properly resourced care for those who choose to live until a natural death.”

According to the government’s impact assessment assisted dying would direct funds away from the NHS and other public services as it is estimated that each death would cost the taxpayer around £15,000 and the cost to the NHS would be £425m in the first 10 years. Despite exacerbating existing fears surrounding fears of coercion among the vulnerable this is peanuts compared with finding billions for war at the expense of welfare and international aid. It also avoids the issue of properly funded healthcare by reversing austerity, ending the privatisation of the NHS, taxing the rich and redistributing the wealth created by the working class.

In a letter signed by Christian, Jewish, Muslim and Sikh leaders and published in the Observer last November they wrote, “Over decades, we have witnessed how compassionate care, along with the natural processes of dying, allow those at the end of their life to experience important moments. We have seen relationships repair and families reconcile. We have seen lives end in love. Much can be lost by cutting these processes short.”

Surely we must listen as a movement to these concerns, together with those of the Royal College of Psychiatrists, the Royal College of Physicians, the Association of Palliative Medicine, organisations representing the disabled, and charities serving the underprivileged.

We must demand that improved universal palliative and end of life care moves further up the political agenda, and provides a genuine alternative to ending one’s life that is as pain-free as possible.

In conclusion Dr Albert Schweitzer sums up perfectly the original purpose of Trinity Hospice where I spent 11 years accompanying those on their final journey when he wrote, “Here, at whatever hour you come, you will find light and help and human kindness.” Dorothy would certainly have agreed.