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Written by Paul
Dr Paul Manktelow is a vet who’s worked for almost 20 years on the front line in some of the UK’s busiest veterinary hospitals. As Chief Vet in the Charity Sector, he leads a team of vets and nurses that treat thousands of pets every year. Paul also appears regularly in the media as a TV and radio presenter, writer, public speaker and podcast producer.
The debate around assisted dying is often framed in terms of terminal illness and prognosis—who qualifies, how long they have left to live, and whether they should have the legal right to choose when their life ends. But as a veterinary professional, my experience in end-of-life care has shown me that quality of life is just as, if not more, important than life expectancy.
In veterinary medicine, we don’t simply base euthanasia decisions on how long an animal has left to live—we assess their pain, suffering, mobility, and overall well-being. So, why isn’t quality of life more central to the human assisted dying debate?
Assisted Dying and the Focus on Terminal Illness
The Assisted Dying Bill currently under discussion in the UK Parliament proposes that only terminally ill adults with six to twelve months to live would be eligible for assisted dying. This model focuses entirely on prognosis, rather than a broader evaluation of suffering.
However, this approach raises important ethical questions:
- What about individuals with chronic, debilitating conditions that cause extreme suffering but are not terminal?
- Should a fixed prognosis timeframe be the determining factor in eligibility?
- Is life expectancy truly the best measure of whether assisted dying should be an option?
Veterinary medicine takes a different approach—one that prioritises an individual’s welfare over rigid timeframes.
How Veterinary Medicine Assesses End-of-Life Care
As vets, we assess end-of-life decisions based on a combination of medical, physical, and emotional factors. The key considerations include:
- Pain and suffering – Is the animal in constant pain that cannot be relieved?
- Mobility and function – Can they move comfortably and maintain a reasonable standard of daily living?
- Emotional distress – Are they anxious, confused, or no longer enjoying the activities they once did?
- Owner’s ability to provide care – In some cases, practical constraints such as financial limitations or the owner’s physical ability to care for their pet also play a role.
If a pet is experiencing significant suffering with no realistic chance of improvement, euthanasia is often considered the most humane option. Importantly, prognosis alone is not the main factor—we look at suffering in the present, not just a projected timeline.
Could the Assisted Dying Debate Benefit from a Quality of Life Framework?
While human medicine and veterinary medicine operate in different ethical and legal landscapes, the question remains: Should quality of life be given more weight in assisted dying laws?
If the goal of assisted dying is to prevent unnecessary suffering, a rigid prognosis-based model may be too limiting. For example:
- A person with advanced motor neurone disease (MND) may have more than 12 months to live but suffer from extreme physical distress and loss of autonomy.
- Someone with chronic, intractable pain may not meet the prognosis criteria but experience severe, unrelenting suffering that significantly impacts their daily life.
A broader framework that considers suffering and quality of life, rather than just time left to live, may offer a more compassionate and patient-centred approach to assisted dying.
Final Thoughts
As a vet, I have seen how prioritising quality of life over prognosis leads to compassionate end-of-life decisions for animals. While human assisted dying laws must be carefully safeguarded, the current debate could benefit from a more nuanced conversation about what constitutes unbearable suffering and who should have the right to choose a dignified end.
What are your thoughts? Should quality of life play a greater role in the assisted dying debate? Let’s continue the discussion.
🎧 Want to explore this topic in more depth? Watch my podcast episode: Should Vets Have a Voice in the Assisted Dying Debate? where I discuss these ethical challenges and share my experiences in veterinary end-of-life care.
