Giving people control over how and when they die would reduce unavoidable suffering, says the chief of one of the largest hospices in England

“We are failing our patients by not engaging openly and honestly with the issue of assisted dying,” says Mark Jarman-Howe, chief executive of St Helena, the largest hospice in the east of England. “We have to end the climate of fear that surrounds discussion of this in the hospice and palliative care sectors, or more than 6,000 people a year will continue to die in avoidable suffering.”

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Four years ago Jarman-Howe wrote an anonymous article in the Guardian, unable, he felt, to openly support the bill then going through parliament, which, had it passed, would have legalised assisted dying. Since then he has “come out”, and last week he sent his fellow UK hospice chief executives – of whom there are more than 200 – an open letter and a copy of the latest report from campaigning organisation, Dignity in Dying, where he is now a board member.

Jarman-Howe, 46, is hoping to encourage some open conversations atthis week’s Hospice UK annual conference, and to give some of the colleagues that he knows silently agree with him “the confidence to speak out”.

The Dignity in Dying report sets out in difficult-to-read detail how those who are least lucky at the end of life die. “Vomiting their own faeces” perhaps gives a sufficient, horrifying, flavour. And these are not people suffering due to lack of palliative care (though that can also be an issue). “Like all fields of medicine,” says Jarman-Howe, “even the very best palliative care has its limits. That isn’t failure – it’s reality.”

Ultimately, he believes, the hospice movement and palliative care doctors need to accept, even encourage, and certainly plan for, a change in the law that makes assisted dying legal in limited circumstances and under careful regulation. “We are not talking about assisted suicide,” he insists. “We are talking about giving control over their own death to people who are already dying … who have a diagnosis of terminal illness with a prognosis of six months or less to live – and full mental capacity.”

There are strongly held views, and I can understand that it’s uncomfortable

Assisted dying for such people is already legal in nine US states (10 from 1 January), all of Canada and, as of earlier this year, the Australian state of Victoria. Western Australia is currently considering an assisted dying bill and it is likely to be legalised in New Zealand next year. A YouGov poll published on Wednesday finds that nearly three-quarters of people with advanced or terminal illness would support a change in the law on assisted dying, 64% would welcome this as an option alongside good-quality palliative care and more than a third have or would consider going abroad for an assisted death. The latest poll of the British public (the largest to date) earlier this year suggests 84% of people would also support a change in the law, and the Royal College of Physicians has formally adopted a neutral position on the issue.

The official position of Hospice UK is one of “no collective view”, but it points out that the ethos of hospice and palliative care (as defined by the World Health Organization), is that it “intends neither to hasten nor postpone death” – clearly incompatible with assisted dying. The organisation does add that it encourages discussion and debate on the subject. However, Jarman-Howe says that in practice this is not happening.

“There are strongly held views, and I can understand that it’s uncomfortable,” he says. “The hospice movement had a Christian foundation and, while most hospices are now secular, some still have links to Catholic organisations with traditional values. There is also a view that assisted dying detracts from the argument for greater funding for palliative care, but the evidence suggests otherwise.”

It is certainly the case that palliative and hospice care desperately need to be properly funded. Most hospices get only about one-third of their costs from the government and have to raise the other two-thirds themselves. That’s about £5m a year for St Helena. “It doesn’t seem right that something as important as end-of-life care is left to chance and goodwill,” says Jarman-Howe. “There should be a legal entitlement to hospice and palliative care and the option of assisted dying.”

Where assisted dying has been legalised, including in Oregon , the funding and focus on palliative care has improved. “I don’t think this is despite, I think it is because. Assisted dying means policymakers and funders must ensure there is a full range of safe options – that no one is pushed towards assisted dying by lack of care,” he believes. What is more, he adds, where palliative care and hospice sectors opposed the law change – for instance, in Oregon and Canada – they have since come to support it.

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Jarman-Howe has seen death and its public management (or mismanagement) from multiple angles. Starting his career in the prison service, he moved into the NHS including in palliative care before joining the hospice sector. “The more I talked to dying people and their families, the more convinced I became that we need assisted dying,” he says. “I can’t understand why I am still such an isolated voice on this. A legal, transparent, regulated form of assisted dying would be safer than now.”

Yet, he believes that the law will finally change in the UK within 10 years, perhaps even five. “So end-of-life professionals need to start discussing – and start planning,” says Jarman-Howe.

Curriculum vitae

Age: 46.

Family: Married, two teenage children.

Lives: Essex.

Education: The Ashcombe school, Surrey; University of Exeter (BA Hons politics); Henley Business School (MBA).

Career: 2013-present: chief executive, St Helena Hospice; 2011-13: divisional director of operations, Colchester hospital university NHS foundation trust; 2010-11: programme director, Cambridge university hospitals NHS foundation trust; 2006-2010: head of operations for emergency care, Cambridge University hospitals NHS foundation trust; 2005-06: associate director, South Cambridgeshire and Cambridge City primary care trust; 2003-05: head of national prison officer training, HM Prison Service; 2001-03: deputy governor (and acting governor), HM young offender institution, Dover; 1999-01: head of residence and prisoner activities, HMP High Down, Surrey; 1998-99: lifer governor, HMP Whitemoor, Cambridgeshire; 1995-98: accelerated promotion scheme, HM Prison Service.

Public life: Chair, North East Essex Health and Wellbeing Alliance; vice-chair, Compassion in Dying; non-executive director, Dignity in Dying.

Interests: Politics, running, modern literature.