Law, ethics and end-of-life care: the policy and practice interface in England

Palliative care aims neither to hasten nor postpone death but instead offers support to people with advancing, incurable somatic illness (WHO, 2002). At the same time, individual nurses hold a wide range of views on euthanasia and end-of-life care, whilst the care-giving in clinical practice occurs in a social context in accordance with local and national policy (Quaghebeur et al 2009). Policy and practice must conform to the law, which defines liability in the end-of-life phase. However, as this paper highlights, the law has primarily focused on the criminalisation of euthanasia and less on the complex issues involved in the ‘good death’ concept. As a result, contemporary policy that helps to shape and direct end-of-life care faces a tension between end-of-life liability and the way in which palliative care is developing (LACDP, 2014).

The authors of this paper are not suggesting as a response to this tension that euthanasia should be legalised nor equating it with a 'good death'. The central argument from the authors of this paper is different: that for end-of-life care to develop and progress, practice has to interface with law and policy to a greater extent. A better interface will facilitate policy and law to be shaped by the complexity and demands of practice decision-making, so allowing a better understanding of what the end-of-life process entails. This is not to suggest that all end-of-life issues should be driven singularly by palliative care practice, but that a better future for the end-of-life entails the linking of law, policy and practice. Palliative care nurses have an obvious interest in the processes aimed at improving the interface between law, ethics and public policy. The approach of this paper is significant at the current time when palliative care policy is being actively debated (LACDP, 2014; NCPC, 2014, NICE 2015) with issues of communication between end-of-life care staff and patients as central (PHSO 2015; RCP, 2016).