The intriguing way doctors calculate how long patients have to live – and why they’re often wrong… as MPs vote FOR euthanasia

MPs today took a decisive step towards making assisted dying a reality in England.

The House of Commons has voted for the Terminally Ill Adults (End of Life) Bill which, if passed, would give patients with less than six months to live the right to request euthanasia from a medical team.

Even though the bill has passed, it still needs to go through various amendments and more votes in both the House of Commons and the House of Lords, and even if everything goes smoothly, it could be years before it actually comes into force.

Debate over the controversial bill continues, including specific concerns about how accurately doctors estimate the life expectancy of terminally ill patients.

Experts told MailOnline that estimating survival is not an exact science. In fact, some compare the reliability of forecasts to the reliability of weather forecasts.

Generally speaking, the closer a patient is to death, the more accurate medical predictions become.

This is because certain biological signals, such as a patient’s blood pressure, appetite and alertness, as well as large doses of drugs such as painkillers, can give doctors a good idea of ​​whether they have days or even hours left.

But when longer periods are involved, the situation can become more complex and therefore uncertain.

Estimates vary by study. Some believe that doctors generally get it right 50 percent of the time; others believe it is only about a third of the time.

Professor Karol Sikora, a retired oncologist and former director of the World Health Organization’s cancer program, told this site that the estimates doctors give when patients ask how long they have left are based on population averages of other patients.

These calculations take into account the patient’s specific disease, age, and severity of the condition.

This means that an older person with multiple tumors is more likely to die earlier than a younger person, even at the same stage of cancer.

One important factor to remember is that these estimates are based on averages, meaning that exceptions apply at both ends of the scale: some will die earlier than expected, while others will defy the odds and persist much longer.

Professor Sikora added that the reliability of these estimates could naturally vary depending on how common or rare the disease is.

“Of course you could be wrong,” said Professor Sikora.

“It’s a completely inexact science.”

Other experts agree with this. Professor Paddy Stone, former head of Marie Curie’s palliative care research unit at University College London, said there was no assessment method robust enough to protect end-of-life care.

“My research shows that there is no reliable way to identify patients who have less than six or twelve months to live… at least there is no method that is reliable enough to act as any kind of “defense” for the proposed assisted living legislation. death. ” he told the Financial Times.

Professor Irene Higginson, a palliative care expert at King’s College London, added: “All the research done in this and other countries shows that estimating the six months remaining to live is extremely difficult and not very accurate.”

“The science is not that well developed and I’m not sure it’s possible because people are so different.”

Experts point to studies like a 2023 study of nearly 100,000 patients that showed doctors were right nearly three out of four times when estimating whether a patient would die within two weeks.

They were even more accurate – four times out of five – when it came to whether the patient would live more than a year.

But the middle period, when the patient had “weeks” or “months” left, was much more difficult, with doctors getting it right only a third of the time.

Another estimate, calculated by The Telegraph, found that in 7,000 cases, doctors were only right in predicting whether a patient would live six months in half the cases.

The uncertainty in the estimates raises concerns that patients who might otherwise live longer may die sooner if they choose euthanasia.

Commenting on the data, Professor Catherine Sleeman, a palliative care expert at King’s, said it was “extremely difficult to estimate how long a person has left to live.”

She added: “If a person’s perceived prognosis is going to be key to determining whether they are eligible for assisted dying, MPs need to carefully consider how that assessment will be made, by whom and what the likely error rate will be.”

Professor Sikora added that another, less scientific factor he had observed throughout his career was that some patients defy the odds with a specific goal in mind.

“They want to live for a specific reason, like their daughter getting married,” he said.

He recalled one patient in such circumstances whose life expectancy was only a few weeks.

“His daughter was getting married in two months and he just wanted to go to the wedding,” he said.

“He made it to the wedding and died the following Sunday.” It was fantastic for him because it was against all odds.”