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The Assisted Dying Bill: A nurse’s perspective

Author: Jo Fernandes RGN BSc Hons, Practice Development Nurse, The Hospice of St Francis
14 August 2015
  • Jo Fernandes, practice development nurse, with a patient at The Hospice of St Francis

As the debate around assisted dying features prominently in the news again today, palliative care nurse Jo Fernandes asks her nursing colleagues to consider the implications for the profession if there were a change in the law.

With the Assisted Dying Bill due to be introduced in the House of Commons on 11 September 2015 by Rob Marris MP, I am appealing to nurses to carefully consider the implications for them were assisted dying to become legal in this country.

The bill explicitly states that obtaining and giving the lethal drug for self-administration can be carried out by “the attending doctor…or a registered nurse who has been authorised to do so,” after which that health professional must remain with the patient until death occurs or the person has decided against taking the medication.

It is impossible for me to explore every argument for and against assisting another to take their own life in this short essay, but I think that nurses must consider their position:

  • Could you assist another person to take their own life?
  • What motivates you to nurse? Is helping another to take their own life a part of nursing care?

From a personal perspective, as a palliative care nurse working at The Hospice of St Francis, Berkhamsted I am deeply committed to upholding dignity and choices at the end of life. However, I am also clear that helping another to die is not part of palliative nursing for the following reasons.

Compassion

Compassion is the bedrock of the nursing profession. There are many ways that compassionate acts are carried out by nurses, but I believe that it should never include the act of deliberately assisting death.

What motivates most of us to enter the profession is to care for people and crucially to do no harm.

Nurses currently have an unequivocal role in how they deliver care for people who are dying, that is supporting life until natural death occurs. Helping someone to die, irrespective of their “settled intention” must never be confused with good end of life nursing care because assisting someone to die is not a form of care.

The public need to be able to trust that the nursing profession is based upon sound ethical principles to which its members adhere. A nurse with a dual role in promoting “living and dying well” meanwhile also helping to hasten death could have serious consequences for his/her reputation as a trusted caregiver.

It is hard to see how an intention to cause death could be reconciled with the ethical principle of beneficence, embedded within nursing.

Autonomy

It is argued, however, that it is an ultimately compassionate act to help another to die when that person deems their suffering to be unbearable and their life burdensome, the rights of the individual who is suffering must surely trump any objections. Thus denying assistance to end this suffering is to deny a person a dignified death.

This is a very compelling argument in favour of assisted dying. Nonetheless, must the autonomy of an individual really invoke the duty of another to assist them to a hastened death when to do so requires such a radical shift in the values of nursing, which have never been involved with ending life? I suggest not.

Proportion

Furthermore, the argument of proportion is significant. Most people do not die enduring unbearable suffering, despite media portrayal, but are frail and elderly, dying of gradual organ failure.

To argue that a person has an autonomous right to have an assisted death is problematic since there are many other more fundamental rights that are currently denied to so many who are dying.

Surely it is imperative that nurses do all they can to enhance the dying experience for the majority through better access to excellent nursing care.

I believe that this is a much more important issue, affecting the 500,000 people who will die in the forthcoming year as opposed to the 1,500 who could take advantage of an assisted death under the proposed legislation.

Safeguards

Of further concern is that there are insufficient safeguards in the proposed bill, most particularly regarding how the risk of coercion can possibly be eliminated, and what a “free and settled intention” really means.

Since death is irrevocable, should nurses ever be involved with anything when the risk, no matter how small, of mistake has such devastating consequences for vulnerable people?

Indeed, the nurses will not be expected to appraise the legitimacy of the request for assisted death which will be done by two doctors and authorised by the courts, they will simply be required to carry out the “task” delegated to them of giving the patient the lethal medication.

It seems ironic that in an era when nurses are encouraged to be critical thinkers, working in partnership with their medical colleagues, we will be regressing to obeying “the paternalistic instruction of a doctor” to carry out what is arguably the most ethically and morally challenging act that a nurse would ever be required to do, yet having had no involvement in the decision making process.

Since we are allowed only to give a drug as innocuous as simple linctus having assessed its appropriateness, it is extraordinary that all such rigour is bypassed when it comes to assisting in a person’s death!

Finally, staying with a patient when they are dying is an emotional and often distressing experience, even if the death is deemed to be a “good one”.

Conjure your feelings the day that you are going to participate in an assisted death. What will the relationships be like with your colleagues? Will there be tensions between those in favour of your participation and those against? Is it really possible to hold a duplicitous role of delivering excellent, attentive care to one patient meanwhile delivering a lethal drug to another and then watching them die as a direct result of your action?

So, I would like to appeal to my colleagues to think carefully about the consequences of assisting in the death of a patient.

If the above leave you undecided, perhaps the 6 C’s of nursing are a useful conclusion.

  • Compassion: the bedrock of nursing does not encompass causing death which is contrary to its founding principles of doing no harm.
  • Care: to prioritise the delivery of excellent end of life care in every setting.
  • Communication: to respond to a request for hastened death as opportunity to explore with a patient their fears and anxieties. Evidence suggests that such desire is inconsistent and further suggests that compassionate communication and good symptom control are significant factors in people changing their minds to find further value in their lives.
  • Courage: to “be with” patients and their loved ones during their most vulnerable times, to respond creatively to their needs and to be clear in what it is that nursing can deliver.
  • Competent: to continue to develop the art and science of nursing so that we provide fit for purpose care in the future. There are limits to this competence which does not extend to causing death since this act, if required by society need not be performed within healthcare at all.
  • Commitment: to stand resolutely against any involvement in assisted dying as antagonistic to the values of nursing.

It is my belief that the law should not change, but if society wants this change to enable a person to have an assisted death, then this should categorically be kept outside the domain of healthcare since a right to an assisted death need not invoke the duty of doctors or nurses to participate in something that compromises their values. 

The Hospice of St Francis has today issued a statement outlining why it opposes the proposed change in the law as outlined in Rob Marris' Assisted Dying Bill.

See more articles in Opinion

Comments | 1

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Patrick McGuire

An interesting and valid discussion but also led by value laden judgements and assertions. "Compassion" could just as easily be argued to be a valid reason for Assisted Dying to become available to those who choose it. Primarily the Assisted Dying Bill is about the needs of patients which should always be the driving force behind any healthcare provision and not those of medical workers.

15/08/2015 17:43:02


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