Right to die
off the street

For Sin Bad, a homeless man living with a serious lung condition, the fact he is going to die is not what scares him most.

“The type of death I’m going to have worries me far more than the idea of death itself,” he said. “I watched an ex-partner’s mother die from the same condition I have – chronic obstructive pulmonary disease – and it wasn’t pretty.

“Then there’s the fact that it could happen when I’m on the streets. It’s terrifying, quite honestly.”

A Big Issue North vendor currently based in York, Sin Bad, 48, has spent the past seven months living in a tent – despite the fact he relies on a wheelchair to get around. As well as COPD, he suffers from epilepsy, a prolapsed disc and the muscle-wasting disease fibromyalgia.

He is exactly the kind of person that staff at York’s St Leonard’s Hospice had in mind when they came up with a project aimed at widening access to end of life support in the city.

Barriers to care

The UK’s end of life strategy includes the concept of advanced care planning – where people write down their wishes for the end of their life.

The guidelines state everyone has the right to palliative care but the reality is different. Even people in stable housing may struggle to get a hospice place if they have an illness other than cancer, so those on the margins of society are almost completely excluded.

In just two London boroughs there are around 20 clinical nurse specialists who carry out outreach work with homeless residents, helping them access medical appointments – something that does not exist in York. A number of hostels in the capital also have medical beds, with access to doctors, nurses and psychologists. Homeless people die in surroundings in which they feel comfortable.

To mark its 30-year anniversary, St Leonard’s ran sessions at a homeless shelter, Arclight. Twenty staff were trained in how to hold delicate conversations with people who are unwell – finding out how they would like to die.

One worker went on to speak at a hostel resident’s funeral, after holding meaningful conversations with him.

Alison Skelton, clinical nurse educator at St Leonard’s hospice, said: “We talk a lot about sudden death among the homeless population but quite often people are living with serious conditions that will not get better.

“Everyone is entitled to palliative care but we know those who are homeless face a lot of barriers in accessing healthcare. This training is about recognising that someone might have end-stage liver disease, for example – while they are not dying in front of your eyes, they are not going to get better – and finding out what matters.

“Someone’s wishes could be that they want their dog to be with them, or their partner. They may prefer to die in bed or not want to die alone on the street.”

A small but bold step

At St Leonard’s, the NHS covers 29 per cent of its running costs – with the remainder coming from public donations. Dr Kate Flemming, a lecturer in palliative care at York University and former trustee at the hospice, said: “Homeless people say death and dying are part of their everyday life – they see people vanish off the streets. We want to help people open conversations and facilitate them in accessing services.

“There is a traditional thinking about what hospices should be. When you think their funding comes from people doing coffee mornings and marathons, funding projects like this is a really bold step for the trustees.

“At this point it’s very much about taking small, incremental steps, but when we can prove we are making a difference we can go to the commissioners and ask if they can help.

For homeless people such as Sin Bad these improvements cannot come quickly enough.

He said: “I’d like to think the council might consider putting me into a house or a care home or something like that, since I’m unwell and don’t have any family to look after me. But they say they can’t help.

“I really wish we had the right to die in this country because I would sign up tomorrow. Everyone should have that right, not just me.”

Photo: Big Issue North vendor Sin Bad on his pitch in York where a hospice is engaging the homeless population in end of life care planning and conversation