Times letters: Assisted dying and improving end-of-life care

Sir, Alice Thomson emphasises some of the complex and deeply personal issues around assisted dying against a background of an ageing population, worries around loneliness, being a burden, chronic illness, the cost of care and other matters that may put pressure on individuals (“Why I changed my mind over assisted dying”, May 1). Despite an increasing number of people seeking assisted dying once it has been established, these individuals remain a tiny proportion of those who die each year.

Thomson points out that more than 50 per cent of people with an end-of-life condition die in hospital even though only 3 per cent of people state that to be their preferred place of death. Good end-of-life care should be provided by the hospice service, with an emphasis on quality of life. However, a recent all-party parliamentary group report on end-of-life care found that the integrated care boards that supply health funding locally were “not fit for purpose”, which was echoed in a parliamentary debate last week.

We need excellent — and properly funded — end-of-life care across the country for 24-hour care by all hospices, not just some. Skilled palliative care is the chosen path for most of us but we must get assisted dying right for the few who choose it.
Professor Stephen Spiro
Vice-chair of trustees, St Luke’s Hospice, Kenton, Harrow

Sir, Alice Thomson is to be applauded for her courage in changing her mind, given the ever-widening selection criteria in the Netherlands and Canada. Clinical experience indicates that many patients also change their minds, after an initial request of “Please help me to die”, if they are given the opportunity and the time to discuss their fears of dying. Patients who have assisted suicide no longer have the chance for a change of mind.
Dr David Jeffrey
Former palliative care doctor; senior lecturer, Three Counties Medical School, Worcester University

Sir, I am a retired NHS surgeon and a Swiss citizen. I have always believed in assisted suicide the Swiss way. The Swiss law on assisted suicide was passed in 1942 and enacted the next year: the country “got it right” from the start and the law has not changed since. The only change has been that individual cantons can (and have) chosen to impose on hospitals the duty to allow it to take place in hospital. In the canton of Vaud (where I grew up and trained) this is done by Dignitas or Exit, not the team caring for the patient. The process has been working well there for nigh on 80 years now.
Michael Dusmet
Ret’d thoracic surgeon, Richmond upon Thames, Surrey

Sir, Alice Thomson emphasises the downsides of assisted dying in societies that have it: expansion from terminal illness to someone with depression, the possible inclusion of children, and much else. But it need not be like this. Proper rules, carefully supervised, can control assisted suicide. There will be controversies and even mistakes. But we should not let the perfect get in the way of the good.
Paul Larsmon
Burbage, Wilts

Sir, The crux of Alice Thomson’s article is in her last sentence: “I don’t want to hasten anyone else’s death.” But what if the person concerned wants to hasten their own death? It is morally wrong and patronising to deny that person their wish.
Rachel Wildblood
London SE21

Penal reform plan

Sir, The systemic crisis in the Prison and Probation Service is undeniable (Katy Balls, comment, May 2). The government needs to take immediate action. We propose the following five actions. First, the replacement of a failed senior leadership team at the top of the service. Repeated inspection reports show that management culture, as much as funding cuts, have destroyed safety and purpose. Second, a review of the prison estate. Instead of multibillion-pound building programmes, we should give priority to preparation for a crime-free life after custody, diverting funds to approved premises, women’s centres and open prisons. Third, an independent review of prison officer safety, recruitment, training and retention to keep good staff and recreate vocation; broken staff cannot fix broken people. Fourth, an immediate drive, led by the National Crime Agency, to smash the grip of serious organised crime in prisons. Fifth, a new drugs strategy led by experts with knowledge, skills and experience of treatment regimes to promote recovery. Only when we tackle the endemic availability of illicit drugs in prison will rehabilitation change from fantasy to reality.

With more than 50 years’ experience between us, we believe these measures would create a bridgehead to restore order, safety and purpose to a system awash with violence and wasted potential.
Ian Acheson, visiting professor Staffordshire University; John Podmore, honorary professor Durham University; Emeritus Professor David Wilson

Homicide disparity

Sir, It will be five years this week since the death of 17-year-old Ellie Gould, brutally murdered in her own home by an ex-boyfriend, for which he received a 12½-year sentence. How much longer must the mothers of murdered women wait for a response from the government to the domestic homicide sentencing review (“Mothers fight leniency for murderers”, Feb 23)? An 18-year-old youth kills another in the street with a single knife wound. His sentencing starting point is 25 years. A husband throttles then suffocates his wife, stabs her 70 times and dismembers her body and disposes of it in several places, refusing to say where it is. His sentencing starting point is 15 years.

This ten-year disparity in sentencing cannot be allowed to continue. Women are disproportionately affected by this injustice and the perpetrators are released back into society far too soon, posing greater risk to the public. Too many women are killed in their own homes by partners or ex-partners and this is treated as a lesser crime. The Wade review makes a plain case for a change in the law and for coercive control and “overkill” to be considered within the sentencing framework. The government says tackling violence against women and girls is a priority and has promised these mothers a swift response, but will this important legislation get lost in the run-up to an election? The lord chancellor must respond and fulfil his promise to change the law.
The Marchioness of Lansdowne
Chippenham, Wilts

Claiming asylum

Sir, The Illegal Migration Act 2023 has created “Schrödinger’s asylum-seekers”: until and unless they can be removed to a “safe” country (which, in the case of Rwanda, is deemed to be so by the Safety of Rwanda Act, notwithstanding the November 2023 Supreme Court judgment), the UK will neither recognise them as refugees based on the 1951 Refugee Convention pursuant to status determination, nor deny them such status. While they remain, in effect, in legal limbo, Channel-crossers will face severe legal consequences in terms of liberty, access to services, employment and their long-term status. Hence, unless the act is repealed, the real asylum backlog will grow far larger, even if those denied access to asylum are artificially excluded from it. Labour’s plan to (re)enable irregular arrivals to be eligible for asylum if they meet the requisite criteria is to be welcomed (“Labour will allow thousands of boat migrants to claim asylum in UK”, May 2).
Dr Reuven Ziegler
Associate professor in international refugee law; Oxford

Freedom of speech

Sir, Further to your report “Payout for social worker suspended over gender beliefs” (news, Apr 29), given that Social Work England and Westminster city council still give prominent exposure to Stonewall on their websites, how likely is it that they will give the balanced training to all staff on freedom of speech, as directed by the judge? Any such thing was explicitly banned by Stonewall in its memorable diktat of “No Debate”.
Kate Harris
Co-founder, LGB Alliance

Island theatre axed

Sir, In deciding to dispense with Brownsea Open Air Theatre (“High drama as trust shuts island theatre”, Apr 30), the National Trust seems in danger of shooting itself in the foot. In 1964 it took a courageous gamble by inviting the Bournemouth Little Theatre Club to stage The Tempest on the island without knowing whether it would attract an audience, let alone a large one. The fact that we had to put on an extra performance, such was the demand, spoke for itself and BOAT was born. Since then Shakespeare on Brownsea has become a much-loved tradition, its success never wavering, and the National Trust has been a beneficiary of its creative excellence. The reasons offered in your report for this baffling decision are lame and unconvincing. We hear a lot about the shameful downgrading of the arts in this country and it is alarming that the National Trust should apparently be following this depressing trend.
Margaret Bircher
Founder BOAT cast member; Hereford

Anxiety strategy

Sir, Robert Crampton is right that, with anxiety, the last thing one should do is get stuck at home rather than go out to work (“What I’ve learnt about mental health from a lifetime of treatment”, Apr 30). While it was not always easy, and my job was often stressful, I found going into work during periods of anxiety and personal difficulty immensely helpful. Having a familiar routine, social interaction and focusing on work tasks acted as a good distraction from my worries, so much so during the most difficult of times that the perceived “easiness” of work in comparison to everything else going on in my life helped to lessen my anxiety. It did not cure me of my anxiety but did equip me with better coping mechanisms.
Fran Stuart
Carlisle, Cumbria

Hymn’s Irish origin

Sir, You say (Apr 30) that All Things Bright and Beautiful was written in Wales as a tribute to the landscape and wildlife of Monmouthshire. I have always thought it a description of Co Tyrone and its hills and the River Mourne; Mrs Alexander lived in this area for some time and appreciated its beauty, and was inspired by the ripe fruits in her Irish garden.
Canon Brian Stevenson
West Peckham, Kent

Sir, How very sad that the Rev Annabelle Elletson disdains I Vow to Thee My Country (letter, May 2). I cannot believe she regards the second half, which is about Heaven, as inappropriate. As for the first half, I have not been called on to make the final sacrifice but I admire those who have. And I still offer my country, and its people, the service of my love.
Thorda Abbott-Watt
London W8

Sure as eggs

Sir, My wife and I went to a local restaurant with Michelin star pretensions. The salad starter arrived with a very sad-looking poached egg on top (letters, Apr 29, May 1-2). My wife pointed it out to the maître d’ and was invited into the kitchen to explain how to do a good one. She did. Thanks and drinks were suitably dispensed.
Rob Hubbard
Leigh on Sea, Essex

Lower than rats

Sir, Rodents that undertake their own experiments (May 1; letter, May 2) and refuse to participate in those of the scientists thereby validate the proposition, put to me by a disgruntled litigant, that scientists should use lawyers rather than rodents in their laboratories “because there are some things that rats just won’t do”.
Lord Wolfson of Tredegar, KC
Justice minister 2020-22

Well-read shins

Sir, As a young football player when boots had hard toecaps I used Reader’s Digest as shin pads for protection (news, Apr 30; letter, May 2).
Brian Donohue
Wilmslow, Cheshire