I’ve seen this happen twice since the start of this year – terminal patients left in pain that is completely unnecessary. Pain that could be treated. Pain that should be treated, and yet, it isn’t. And the worst part? It goes under the radar. Quietly. Repeatedly.
This isn’t some rare failure. Across England, tens of thousands of people at the end of life are in pain that is not properly relieved. Estimates suggest over 125,000 people in palliative care are living with unrelieved pain, with thousands receiving no relief at all in their final months. More recent reporting suggests around 20 terminally ill people in the UK die in unrelieved pain every single day. This is not an exception. It is a pattern and I’ve seen that pattern up close.
One friend’s father lives with severe orthopaedic pain. His knees are so bad he feels like he’s going to fall over-even walking a few steps can take more than a minute.; he does fall. And yet, I found out that after a delayed review of his needs with his family, his pain relief has been withdrawn. Nurse visits have stopped. He has been left with just paracetamol. This is not pain managemen ; it’s abandonment. He is not comfortable; he gets upset because of the pain.
Another case is impossible to ignore as I . A young friend with a 9cm cancerous growth obstructing his lower bowel. He couldn’t sit in one position for long without agony due to pain in his spine. When he was literally howling in pain, the response was to add diazepam and tramadol. Both of these meds cause constipation, Tramadol in particular. Neitherl controlled the pain properly, just turned him into a zombie which he hated. It made an already critical situation worse.
So I told him directly: ask for something that actually works. Ask for Voltarol suppositories. They numb from the waist down. They control pain without turning you into a zombie. He asked. He wasn’t given them. Not until after surgery and when he finally had them, when the pain was actually controlled, his words were simple: “I see what you mean.”
That sentence should never have needed to exist. The relief was always an option. It was just not given. And this is where the quiet part becomes dangerous. When you speak to people one-on-one, they don’t come out shouting about this. They don’t say “this is systemic failure.” They say something else, like:
“Maybe it’s just us.”
“Maybe this is how it is.”
“Maybe I shouldn’t make a fuss.”
That thinking is exactly why this continues. Because when each family believes they are the only one experiencing it, nothing is challenged. Nothing is escalated. Nothing changes. But look at the numbers. Look at the repeated stories. Look at the consistency. This is not “just happening to me.”, this is either:
- happening to multiple people within the same area due to local healthcare decisions, or
- happening widely and being quietly brushed under the carpet
And the effect is the same either way: suffering that stays hidden.
There is a standard in the UK that is clear, enforceable, and widely understood: under the Animal Welfare Act 2006, it is a criminal offence to cause unnecessary suffering to an animal. That includes failing to provide adequate pain relief or veterinary care. If a dog is left crying in pain and the owner does nothing, that is not seen as unfortunate. It is investigated. It is prosecuted. It can result in fines, bans, or imprisonment. The expectation is simple: if an animal is in pain, you act to relieve it.
Now place that standard next to what is happening to some terminal patients.
People crying out in pain.
People falling because their pain is unmanaged.
People being given minimal medication that is clearly not working.
And yet, no investigation. No accountability. No clear breach being enforced in the same way. That contrast is uncomfortable, but it is real. The legal system recognises that leaving an animal in avoidable pain is cruelty. But when a human being at the end of life is left in avoidable pain, it is too often treated as a clinical judgement that goes unchallenged.
This is not about diminishing animal welfare. The protection is right. It is necessary. But it exposes a question that cannot be ignored: how have we reached a point where the standard for preventing suffering is clearer for animals than it is for some dying people? Because the principle should be identical. If suffering can be relieved, it must be relieved; anything less is a failure of care. Pain at the end of life is not rare. It is one of the most feared aspects of dying, and it remains common despite being treatable.
Studies show severe pain affects a significant proportion of patients in their final weeks. And yet the system still allows people to fall through the gaps. You see it in real stories everywhere:
- families calling for help while someone screams in pain and no one comes
- patients left waiting hours or days for medication adjustments
- people being told to “manage” when they clearly cannot
Even outside formal reporting, ordinary people describe watching loved ones deteriorate in constant pain, asking for help that never fully comes. This is not about rare edge cases. This is about a system that sometimes delivers excellent care in hospices, but inconsistent, fragmented, and inadequate care elsewhere. I understand that some treatments are expensive. I understand that decisions are made when someone is in the final stage of life.
But there is no justification for this:
- withholding effective pain relief
- failing to communicate with families
- waiting until the last days to act
- allowing someone to remain in visible, audible agony
Pain relief is not a luxury intervention. It is basic care. It is the difference between dignity and distress, a person being present with their family and a person reduced to surviving minute by minute.
When that relief is delayed, denied, or minimised, the result is not neutral – it is harm. Clear, preventable harm.
Takeaways / Call to Action:
- If someone is in clear pain, escalate immediately. Do not accept minimal responses if they are not working.
- Ask directly about all available pain relief options, including different delivery methods such as suppositories, patches, or injections.
- Do not assume “this is just how it is.” If it feels wrong, it likely is.
- Families must be included in decisions and kept fully informed. Silence is not acceptable.
- Patterns matter. If you see this happening more than once, treat it as a systemic issue, not a one-off.
- Raise concerns formally where needed. Documentation and escalation are often the only things that force change.
Every patient at the end of life should be comfortable. Not sedated into absence. Not left in agony and upset. Being comfortable is not an unrealistic standard; it’s the minimum that we owe everyone – anything less is inhumane.
