MPs today took a vital step towards making assisted dying a reality in England.
The House of Commons voted in favor of the Terminally Ill Adults (End of Life) Bill which, if passed into law, will give patients with less than six months to live the right to request euthanasia at a medical equipment.
While passed, the bill still needs to go through several amendments and further votes in both the Commons and Lords, and even if this goes smoothly, it could be years before it actually comes into practice.
Debate over the controversial bill continues, including specific concerns about the accuracy with which doctors assess how much time terminally ill people have left to live.
Experts have told MailOnline that estimating survival is not an exact science. In fact, some have compared the reliability of a forecast to that of weather forecasts.
Generally speaking, the closer a patient is to death, the more accurate doctors’ predictions are.
This is because certain biological signals, such as a patient’s blood pressure, appetite and alertness, as well as high doses of medications such as painkillers, can give doctors a decent idea of whether they have days or even a few hours left. .
Debate over the controversial bill continues and specific concerns have been raised about how exactly and precisely doctors assess how much time terminally ill people have left to live. stock image
But when longer periods are involved, the situation can become more complicated and therefore uncertain.
Estimates vary by study. Some suggest that doctors are generally right about 50 percent of the time, others suggest it’s only a third of the time.
Professor Karol Sikora, a retired oncologist and former director of the World Health Organization’s cancer programme, told this website that the estimates doctors give when patients ask how much time they have left are based on population averages of other patients. .
These calculations take into account the specific disease a patient has, their age, and the severity of the condition.
This means that an older person with multiple tumors will likely die sooner than a younger person, even at the same stage of cancer.
An important factor to remember is that these estimates are based on averages, meaning that exceptions apply at both ends of the scale: some will die sooner than estimated and others will defy the odds and persist much longer.
Professor Sikora added that the reliability of these estimates can naturally vary depending on how common or rare the condition is.
“Of course you can be wrong,” said Professor Sikora.
MPs have voted 330 to 275 in favor of assisted dying, although we won’t know if the bill becomes law until at least next year.
“It’s a totally inexact science.”
Other experts agree. Professor Paddy Stone, former head of the Marie Curie palliative care research department at University College London, said there was no estimation method reliable enough to act as a safeguard against assisted dying.
‘My research shows that there is no reliable way to identify patients who have less than six or twelve months to live… at least, no method that is reliable enough to act as some kind of ‘safeguard’ ‘ of the proposed assisted dying legislation. ,’ he said to the Financial times.
Professor Irene Higginson, a palliative care expert at King’s College London, added: “All the studies from this country and beyond show that estimating the remaining six months to live is extremely difficult and not very accurate.”
“The science is not very developed and I’m not sure it can be, because individuals vary so much.”
Experts cite studies such as one from 2023 on almost 100,000 patients that show that doctors were right almost three out of four times when estimating whether the patient would die within a fortnight.
They were even more precise, getting it right four out of five times, when it came to whether a patient would live more than a year.
But the period in between, whether a patient had “weeks” or “months” left, was much more complicated, with doctors only getting it right about a third of the time.
In total, 236 Labor MPs supported the bill alongside 23 Conservatives, 61 Liberal Democrats and three UK Reform MPs.
Another estimate, calculated by The telegraphfound that on 7,000 occasions doctors were correct in predicting whether a patient would survive six months, a little less than half of the time.
The uncertainty in the estimates raises concerns that patients who would otherwise live longer could die sooner if they opt for assisted dying.
Commenting on the data, Professor Katherine Sleeman, a palliative care expert at King’s, said: “Estimating how much time someone has left to live is notoriously difficult.”
He added: “If a person’s estimated prognosis will be key to determining whether they are eligible for assisted dying, MPs should carefully consider how this estimate will be made, by whom and what the likely error rate will be.”
Professor Sikora added that another, less scientific, factor he had observed throughout his career was that some patients defy the odds with a specific goal in mind.
“They want to live for some specific reason, for example, because their daughter is getting married,” he said.
He recalled one patient in such circumstances who had a survival estimate of just a few weeks.
“His daughter was getting married in two months and he just wanted to go to the wedding,” she said.
“He arrived at the wedding and died the following Sunday. Which was fantastic for him as it was against all odds.”