Assisted Dying in the UK: A Psychologist’s Perspective on Choice, Suffering & Compassion

Dr Marianne Trent (: 00:00

When my dad was dying, the suffering was at times unbearable. And whilst he may never have chosen assisted dying, I sometimes wonder whether we should have been able to have the option to explore it. In this episode, I'm exploring the assisted dying debate through both a personal and a professional lens, what it means for patients, families, and for psychologists, especially as the UK government begins to reconsider the law from moral injury in the workplace to hospice care funding and the role of psychology in end of life care. This is a conversation we need to be having, even if it's uncomfortable. I hope you find it useful and thought provoking.

(: 00:45

Hi, welcome along to the Aspiring Psychologist Podcast. I am Dr. Marianne, a qualified clinical psychologist, but I'm also the daughter of a father who is no longer with us. He died in December, 2017, and since that time I've really begin to think and talk more publicly about grief because it's an area that is not that comfortable for many people. And having lost someone to a palliative care diagnosis, I have listened and watched the story of the assisted dying debate with eager attention. Actually, today's topic is ethically loaded, deeply complex and incredibly human. If you are not in the right head space to be watching or listening to this right now, or if you have younger ears around you who you don't feel yet are ready necessarily to be thinking about these sorts of issues, please do make that choice to look after yourself or come back to it at a later stage.

(: 01:48

This conversation was reignited on the 20th of June, 2025 when the assisted dying debate was being discussed in parliament and voted for and on the same day it was discussed live on the Jeremy Vine, BBC Radio two Show. Now, you might well have heard me talk about Jeremy Vine before. I tend to listen to his show Every lunchtime. I'll sit down and I'll eat my lunch and I will listen to the radio show. I'll often contribute as well. I've spoken to Jeremy a number of times and if Jeremy or his team are watching this, I'd love to be your go-to psychologist because I really relate with the way that you communicate with us, with me. And yeah, I think I've got something to offer, but that is a complete aside. I listened to what Jeremy and his guests were saying, and I also love that Jeremy spoke about his own experiences losing his father.

(: 02:49

And I'm going to be reading aloud a small segment of what he said a little later too. And I think one of the things that really struck me about, and when Jeremy talks about grief on other occasions as well, is that you can actually hear his emotional connection to that in his voice. And you might well hear that in my voice today at points as well. And actually I think that's to be saluted. I think being a human, especially when you're conveying difficult information, people are really forgiving of that. And it's really nice. You don't want to be robotic. And I think sometimes people might say to me when they're looking for kind of career advice, they might be saying, oh, I feel like I'm too emotional. I worry I'd be upset, or I worry, I would cry with someone. And actually I think that's okay if you have listened to the wonderful episode by Dr.

(: 03:39

Suzanne Brown on I-S-T-D-P, one of my favourite episodes. If you haven't, I would recommend doing that. She talks about the experience of being able to be affected and impacted upon by a person so long as it's kind of their stuff that you are reacting to, not necessarily your own in a therapy situation. That's okay. Some people's stories are so sad and so horrific that we ought to be moved by those. And what does it say about us as kind of burnt out clinicians if we are not? So Jeremy, I salute you and if anyone working with someone around grief, trauma, death and dying is finding themselves be moved by the emotion of their client, I'd say that's absolutely fine. So my lovely dad died in December, 2017. He was diagnosed with cancer, esophageal cancer when I was pregnant with my youngest son. And my youngest son has just literally turned nine years old last week, and he was diagnosed as palliatively unwell.

(: 04:46

I think it was just after Christmas. So my little boy, I think was six months old and he died on the 20th of December. So my youngest son was 18 months. So that was actually a very difficult time in my life. And watching someone you care about fade, he's a challenge, is a struggle. And for me, this issue is obviously if someone has an end of life diagnosis, they are not going to survive and they know there's going to be a downward trajectory. That's the issue we are discussing here. I think the issue of mental health diagnosis and suffering is a whole other one. And we're not touching that today. We are literally thinking about the kind of the limits and the outlines of the current bill as it's proposed that it would actually only be available for someone who was already diagnosed as palliatively. Not going to last too much longer.

(: 05:49

But we're looking at that control. We're looking at the ability to have a good death as they say, and to be able to give yourself time to have a mindful goodbye with the people around you. And I don't know if my dad would've wanted that, I don't know. But had it been legal for us to even discuss that, it might well have been something that we would've gone for or that we would've supported him to explore. And that's because the level of suffering, the level of trauma potentially that we were subjected to, but he was subjected to in those moments as well and loss of dignity. This was a man who really loved being out on his motorbikes and spending time with his family and spending time with his friends. And I think especially with it being esophageal cancer, you lose so much of what it is to be human when you're not able to sit and have a drink or a cup of tea or even he loved a slice of cake, he loved kind of pasties and he loved my cooking.

(: 06:52

And when you're not able to do those things, it really does impact on your quality of life in very difficult ways. I think the assisted dying debate, if it is approved, gives families a chance to gather, to be present. I know a number of people who haven't been able to be present when their loved one died, when they would've wanted to have been present, especially if it's been a very protracted bedside vigil. Often it seems that people nip out to get a shower or go and find a meal after having been there for many, many, many hours, sometimes days, and they miss it. And that can be a very difficult experience to kind of make peace with at the time and afterwards too. So in my experience, my dad was in hospital for a number of weeks and it was incredibly challenging. We were awaiting a hospice bed, but that was not forthcoming.

(: 07:50

It led to daily phone calls trying to find a hospice bed, and one did eventually come up. He was transferred quite late in the evening on the 18th of December. We spent the 19th of December with him and he died on the 20th of December. Like very quickly after he got there, I think he just thought, right, this is my space, this is the time. It's difficult. And actually this is also raising bigger conversations about the funding of hospices in the UK as well. I learned from speaking to hospice staff recently, actually only around a third or even as little as a quarter of hospices in the UK are funded by the NHS and the rest must be will donations or charitable fundraising giving. And so if you are looking to do any fundraising or you are looking to make a donation to a charity, you could absolutely consider your local hospice who spending time.

(: 08:48

There is such a wonderful place with people who are so compassionate and pro people really and pro being human dignity and respect is to the hilt. And this led me to think about actually the kind of people that might be filling a service basically for assisted dying. So of course we know that many people would choose to work in an assisted dying service, and that would include probably physical health, but that also would include mental health staff as well. And many people, like I said, would be choosing to be there. But I guess this is also kind of opening up moral debates about what about staff who actually just happen to live nearby a service like this and so maybe are choosing to apply for an NHS role, but this is the only one with vacancies currently, or that they maybe going there on placement.

(: 09:49

Perhaps they are a trainee clinical psychologist, for example, and they might be being placed in a service that actually brings up lots of difficult moral questions. So these are, I'm absolutely pro-choice, but these are considerations that we must begin to have and to explore and even thinking about workforce planning, how do we make this come together in a way that creates a service and honours the people using it, but also honours and respects the needs and the wishes and the right to work in an environment that helps you to thrive personally and professionally for the staff in the service. Let me now read aloud to you from the episode on the 20th of June on the Jeremy Vine BBC Radio two Show. I hope it's okay for me to have used this. I haven't used the actual taping because I know that isn't allowed, but I hope it's okay for me to use this small segment, which really resonated with me.

(: 10:49

My heart goes out to anybody who is in this situation currently. I lost my dad in 2018 and he had Parkinson's, and I wish I could erase from my mind the last year and a half because I've got so many memories of him suffering, which I've really, really painful now. He would never have gone down this route, but maybe you think it should have at least been available. And then his guest, Claire spoke to say, yeah, I think when my dad was diagnosed and we were going through treatment, we were very much like a lot of people we're going to beat this, but it came quite suddenly that he was terminal death was inevitable. If the option of assisted dying was available, I think it would've been just something we could have discussed as a family. And then Jeremy goes on to say, one of the arguments I hear is that we now have such brilliant pain control that you will not feel it.

(: 11:37

And then I hear people say that their relative has died screaming. And then Claire goes on to say, absolutely. I mean, sorry if my voice is wavering here, but the day my father passed away, he was meant to be coming home. We had everything set at home for him to pass around his family. And I walked into the hospice who I must say were angels, and he was riding in pain. I could hear him as I entered the doorway and they said, you need to get your mom, your sister, and your husband up here now because he hasn't got long to live. And I think for me, that really hits the urgency, doesn't it? That this is something that is deeply painful both physically and emotionally, and for the idea of Jeremy wanting to almost erase that from his mind and the trauma that people are left with from having that, I mean, saying goodbye to someone you love is never going to be easy, but it's how much trauma and distress and suffering is laid on top of the inevitable sadness.

(: 12:35

The work I do with people, we often think about actually, how much of the trauma do you need to hold onto? Hopefully none. How much of the grief will you choose to hold onto? And some people say, I can manage the grief, I just don't want the trauma. And so it's actually important to think about separating those two things, trauma and grief, and actually they are different things, but when you are in the midst of it, you can just think that's grief. But actually it's the bits that you find yourself tripping up or tripping over that feel exquisitely painful. That might be trauma rather than grief. And if we were able to stop families having to experience that extra exquisite traumatic distress period point of this, I think that's absolutely worth us considering. And of course, thinking about psychology and trying where possible. To keep my finger a little bit on the psychology pulse, I'm aware that this is an issue that clinical psychologists are already involved in.

(: 13:36

So for example, the Association for Clinical Psychologists, the A CP have had parliamentary involvement with this to date. They recently shared updates with their members, of which I am one Anna Al, and I hope I've said that right. I apologise if I haven't. Anna and Sadie Thomas Unsworth, and they were representing the A CP UK at the A PPG Commission on Palliative and End of Life Care. The commission's report included details of the need for psychological support from the outset of terminal care. The A CP also wrote to senior health leaders to advocate for clinical psychology leadership across NHS reforms, not just for mental health, but within physical hair and integrated systems too. They also importantly responded to the National Cancer Plan via the P-S-Y-C-A-P group, which urges the government to ensure that level four psychological services remain a key component of core holistic cancer care.

(: 14:38

This is of course encouraging and it's really good to see conversations like this being had and people out there doing this work, but I would love to know what you think. How is this cropping up you in your work? Perhaps it's leading to people that you are working with mulling over the choices that they might be making in future or that those they might have made differently had this legislation been around earlier in their life or in the life of somebody they've lost. I sort of feel like I'm still adjusting to potentially being a thought leader. And it was only in discussions with somebody in my Ready to rise programme that I actually was reflecting on this today and saying, suddenly we can find that we've created a space for ourselves where we're having to actually think about what our own thoughts, feelings, opinions are, and to be curating that space, curating this debate, and encouraging people to share their ideas really.

(: 15:43

And I think as we progress in our own careers or as we support others to progress their careers, being able to do that, to become a thought leader and to have opinions about things that you can weigh up, pros and cons and be able to hold complex emotional debates really is so very important. I hope you found this episode useful, thought provoking, inspiring. I would love your thoughts. Please do comment if watching on YouTube, please do rate and review if listening as an MP three, let's support each other in the comments. Let's build a really supportive community where we can be curious, where we can be nonjudgmental, and where we can be compassionate and be human fast. If you are grieving or if you're getting your head around grief, please do consider checking out the grief collective stories of life loss and learning to heal.

(: 16:45

There's details in the description or the show notes. It's a really nice way of trying to grapple with and understand what grief is from a variety of different perspectives, from people who have grieved for a variety of reasons, and it gets lovely reviews. If you've read it already, please do drop me a review on Goodreads or Amazon. This is kind of a companion episode to my previous episode where I was talking with Tia, a trainee clinical psychologist about death anxiety. If you think that might be useful for you or for someone that you are working with, please do check that episode out as well.

Jingle Guy (: 17:21

If you're looking to become a psychologist, then let this your podcast psychologist.