Editorial legalised AD only 5 years ago, and yet has seen a 36% increase in assisted deaths in the last year alone, such that 2.5% of all deaths are now assisted (Statistic Canada, 2020).

Nyatanga does not mention that every area where AD has been legalised have steadily removed and relaxed safeguards over time, with the view that these intitial safeguards are a discriminatory barrier to care (Rooney et al, 2018; Calati et al, 2021; Nath et al, 2021). If UK legalisation is restricted to assisted suicide, euthanasia is merely a single court-case away. Published international experience shows that the AD criteria of capacitous adults and terminal prognoses will also quickly disappear under the challenge of discrimination (Calati et al, 2021; Dehkhoda et al, 2021). As an example, one UK organisation is already campaigning to remove the 6-month prognosis limit (McCabe, 2021). Safeguards in AD legislatures are flimsy at best, but the UK’s record on safeguards is not one to be proud of, with persisting scandals in the care of vulnerable individuals (Confidential Inquiry into the Premature Deaths of People with Learning Disabilities, 2013; Stephens et al, 2015). The UK continues to struggle to implement key safeguarding legislation, the Mental Capacity Act, despite 15 years of intense effort (Wilson et al, 2017). It is delusional to assume that AD safeguards will result in better compliance.

The failure of the editorial to inform its readers is concerning enough, but to ignore published data on palliative care is remarkable for a publication dedicated to the specialty. AD is cheap, with Canada estimating they will have saved the equivalent of nearly £88 million in 2020 (Bernier et al, 2020). The skilled compassion of palliative care is not cheap and everyone, including the IJPN, needs to fight hard for the many thousands of people around the world who currently cannot access that expert, person-centred care. IJPN Claud Regnard, Honorary Consultant in Palliative Care Medicine, St Oswald’s Hospice, Newcastle upon Tyne Maggie Bisset, Nurse Consultant in Palliative Care, London Sergio Damaso, Clinical Nurse Specialist and Visiting Lecturer in Palliative Care Carol Davis, Consultant in Palliative Medicine and Clinical Lead for End-of-Life care, University Hospital Southampton Francis Edwards, Retired Senior Paediatric Palliative Care Nurse, Orkney Marie Fallon, Professor of Palliative Medicine, University of Edinburgh Rob George, Professor of Palliative Care, Kings College London; Consultant in Palliative Care, Guys and St Thomas’s Foundation Trust; Independent Clinical and Medicolegal Expert Jennie Pollock, Associate Head of Public Policy at the Christian Medical Fellowship Amy Proffitt, Consultant in Palliative Medicine; Chair of the Association for Palliative Medicine, London Vicky Robinson, Retired Consultant Nurse, Palliative and End-of-Life Care Juliet Spiller, Consultant in Palliative Medicine, Marie Curie Hospice, Edinburgh Angela Thavaraj, Palliative Care Clinical Nurse Specialist, University Hospital Lewisham, London Alison Twycross, Senior Lecturer in Children and Young People’s Nursing, The Open University; Editor-inChief, Evidence Based Nursing Robert Twycross, Emeritus Clinical Reader in Palliative Medicine, Oxford University Gillian Wright, Researcher in Medical Ethics; Chair, Our Duty of Care Arias-Casais N, López-Fidalgo J, Garralda E et al. Trends analysis of specialised palliative care services in 51 countries of the WHO European region in the last 14 years. Palliat Med. 2020; 34(8):1044–56. https://doi.org/10.1177/0269216320931341 Bernier G, Malanik-Busby, Ahmed AM. Cost estimate for bill C-7 ‘Medical Assistance in Dying’. 2020.

http://www.pbo-dpb.gc.ca/en/blog/news/RP-2021-025-M--cost-estimate-bill-c-7-medical-assistance-indying--estimation-couts-projet-loi-c-7-aide-medicale-mourir (accessed 10 February 2022) British Medical Association. Physician-assisted dying survey. 2022. https://www.bma.org.uk/advice-and-

support/ethics/end-of-life/physician-assisted-dying-survey (accessed 7 February 2022) Campbell CS, Cox JC. Hospice-assisted death? A study of Oregon Hospices on death with dignity. Am J

Hosp Palliat Med. 2012; 29(3):227–35. https://doi.org/10.1177/1049909111418637 Calati R, Olié E, Dassa D et al. Euthanasia and assisted suicide in psychiatric patients: a systematic review of the literature. J Psych Res. 2021; 135:153-173. 10.1016/j.jpsychires.2020.12.006 Confidential Inquiry into the Premature Deaths of People with Learning Disabilities. University of Bristol.

2013. http://www.bristol.ac.uk/cipold/reports/ (accessed 7 February 2022) Cost estimate for bill C-7 “Medical Assistance in Dying”. 2020. http://www.pbo-dpb.gc.ca/en/blog/news/

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International Journal of Palliative Nursing 2022, Vol 28, No 2

Consultant Editor Brian Nyatanga Editor Laura Glenny Group Classified Manager Daniel Doherty Circulation Director Sally Boettcher Associate Publisher, Medical Education Tracy Cowan Production Manager Larry Oakes Publishing Director Andrew Iafrati Managing Director Anthony Kerr Chief Executive Officer Ben Allen Editorial enquiries: ijpn@markallengroup.com Sales enquiries: andrew.iafrati@markallengroup.com Editorial Board AUSTRALIA Donna Drew Clinical Nurse Consultant in Paediatric Oncology and Palliative Care, Sydney Children’s Hospital Jason Mills University of the Sunshine Coast, Queensland Jane Phillips Professor of Palliative Nursing and Director of the Centre for Cardiovascular and Chronic Care, University of Technology, Sydney BELARUS Anna Garchakova Director, Belarusian Children’s Hospice BELGIUM Tine De Vlieger General Coordinator for Palliative Care, University of Antwerp IRELAND Julie Ling CEO of the European Association for Palliative Care, Our Lady’s Hospice, Dublin ITALY Valentina Biagioli Research Fellow in Nursing and Allied Health Professional Development, Continuing Education and Research, Bambino Gesù Children’s Hospital, Rome, and Lecturer, Campus BioMedico University, Rome NORTHERN IRELAND Sonja McIlfatrick Professor of Nursing, University of Ulster SWITZERLAND Philip Larkin Kristian Gerhard Jebsen Chair of Nursing Palliative Care, Professer, Centre hospitalier universitaire vaudois, University of Lausanne

UGANDA Julia Downing Honorary Professor in Palliative Care, Makerere University, Kampala UNITED KINGDOM Bridget Johnston Professor and Florence Nightingale Foundation Chair of Clinical Nursing Practice Research, University of Glasgow and NHS Greater Glasgow and Clyde Daniel Kelly RCN Chair of Nursing Research, Cardiff University Diane Laverty Nurse Consultant in Palliative Care, St Joseph’s Hospice, London Carole Mula Macmillan Nurse Consultant in Palliative Care and Professional Lead Nurse for Division of Clinical Support Services, Christie NHS Foundation Trust, Manchester Brian Nyatanga Senior Lecturer, University of Worcester Julie Skilbeck Senior Lecturer, Sheffield Hallam University Dion Smyth Lecturer-Practitioner in Cancer and Palliative Care, Birmingham City University Anna-Marie Stevens Nurse Consultant in Symptom Control and Palliative Care, Royal Marsden NHS Foundation Trust, London UNITED STATES Jennifer Baird Harvard-Wide Pediatric Health Services Research Fellow, Division of Medicine Critical Care, Boston Children’s Hospital Patricia Berry Professor and Director of Hartford Center of Gerontological Nursing Excellence, Oregon Health and Science University

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