The latest crisis concerning UK end-of-life care arose in June 2018 with the publication of the Jones inquiry into opioid-related excess mortality at Gosport War Memorial Hospital in the 1990s.1 Hundreds of premature deaths resulted from misuse of diamorphine and syringe drivers, which often followed the clinical instruction ‘please make comfortable’. It is hard to overstate this scandal, one of many in the NHS. The report highlights patient safety failures at multiple levels, concerns about institutional culture, insufficient challenging and investigation of poor practice, and poor support of whistleblowers. Pocock et al’s editorial considers whether this was the result of a rogue clinician or systemic failures, while assessing the effect on palliative care provision.2 What merits further discussion is the complexity surrounding opioid prescribing in palliative and end-of-life care, with its repercussions on both public and political discourse in the UK and further afield.
COMPLEXITY IN THE UK PALLIATIVE CARE DEBATE
Person-centred compassionate palliative care was pioneered in the UK in the 1960s by Dame Cicely Saunders, encapsulated by her quotation: ‘You matter because you are you, and you matter to the end of your life’.3 However, the recent emotionally-charged debate around the now withdrawn Liverpool Care Pathway for the Dying was a painful challenge to this approach, with numerous examples of uncaring and impersonal practice.4 The Gosport scandal provokes further challenge to this rhetoric, now with a focus on the use of strong opioids and syringe drivers. While opioids are well-recognised as highly effective in the management …