Senior professors of palliative care and oncology are raising concerns about the ‘impossibility’ of accurately predicting the length of time a patient will survive as MPs contemplate the scope of the proposed assisted suicide Bill.
Last week, Labour MP Kim Leadbeater tabled her Terminally Ill Adults (End of Life) Bill and, while the details of the Bill have not yet been released, the Bill is expected to apply to people with fewer than six or twelve months left to live.
However, senior medics have shared concerns about the difficulties of accurately predicting the prognosis of an illness.
Medics share concerns at predicting timescales for terminally ill patients
Professor Katherine Sleeman, a specialist in palliative care, told The Telegraph “It is not possible to accurately determine someone’s prognosis as a number of months, say six months or 12 months”.
“As a doctor, patients do ask me, ‘How long have I got left?’ and I would never say, ‘Six months or fewer.’ I might say, ‘Your prognosis is probably measured in months, or “long months”.’ That’s as precise as I would be”.
“When someone has only a few days, or certainly only a few hours left to live, it can be easier to understand with a higher degree of certainty that they’re likely to die within that time-frame. But when we’re getting into the territory of months, it is very, very difficult”.
Professor Sleeman also drew attention to the “arbitrary” nature of the idea of a six or twelve-month prognosis. “There is nothing special about six months when it comes to terminal illness, or 12 months, for that matter”, she said. “Why are we not talking about four months or eight months? This is an arbitrary line in the sand. It’s not a firm foundation”.
Professor Chris Parker, Consultant Clinical Oncologist at The Royal Marsden, warned that some patients who would have lived for longer will instead choose assisted suicide, saying “I have little doubt that some patients would choose assisted suicide if it was legal, because they were told they had less than six months to live, but in truth, if they had not had assisted suicide, would have lived for years and enjoyed a good quality of life, because I’ve seen patients like that”.
Baroness Finlay of Llandaff, a former professor of palliative medicine said “Predicting life expectancy is impossible… I have known people who live well and actively for years after they were thought to have no more than a few weeks to live”.
“Estimating how long someone has left to live is notoriously difficult”
The senior medics’ concerns are confirmed by research indicating that over half of patients expected to die within six months to a year outlive those expectations.
Based on over 25,000 clinicians’ responses, the results showed that on 6,495 occasions when a doctor thought a patient would likely die at any point in the following 12 months, they were incorrect in more than 54% of cases.
Responding to the numbers, Professor Katherine Sleeman said “These findings are in line with my clinical experience, that estimating how long someone has left to live is notoriously difficult”.
“If a person’s estimated prognosis will be key to determining whether they are eligible for assisted dying, MPs need to carefully consider how this estimate will be made, by whom, and what the likely error rate will be”.
Research from the Marie Curie Palliative Care Research Department at University College London in 2016 found that the accuracy of prognoses for terminal illness can range from 78% to a mere 23%.
Spokesperson for Right To Life UK, Catherine Robinson, said “As these professors and research confirm, prognosis is very difficult to predict accurately and is therefore a poor safeguard to prevent people who are not ‘terminally ill’ from accessing assisted suicide”.
“Problems with accurate prognoses are yet another major issue with Leadbeater’s assisted suicide Bill and yet another reason why it must be scrapped entirely”.
