Nurses must resist the temptation to “ignore” requests to assist their patients to die, the Royal College of Nursing has advised.
New RCN guidance published today, When Someone Asks for Your Assistance to Die, says the request should lead to a discussion to establish the patient’s reasoning, through a “non-judgemental assessment of needs”.
It warns that if the patient is “asking specifically for your help with assisted suicide it is essential that you acknowledge the request and resist the inclination to ‘ignore’ or abandon the conversation”.
RCN executive director of nursing and service delivery Janet Davies said it was “important to emphasise that this guidance in no way encourages nurses to raise the issue of assisted suicide with patients, as assisting a suicide remains illegal”.
But she added: “There are patients who talk about ending their lives as another way of expressing concerns about their condition or their level of pain. Nurses shouldn’t feel that asking them about these comments is giving the impression that they are assisting or encouraging that patient to take their own life.
“Such conversations might be the only time a patient discusses their worries, and it is an essential part of professional nursing practice to recognise and explore concerns with each and every patient where possible.”
In some circumstances a patient in England or Wales with an enduring wish to die can prepare an “advance decision to refuse treatment”, the guidance explains. This can cover advance refusal of clinically assisted nutrition or hydration, or cardiopulmonary resuscitation.
However, it warns that it would be “inappropriate and potentially illegal” for nurses to provide contact details or web addresses for organisations that provide support for assisted suicide.
It also warns nurses against accompanying friends or relatives abroad to assisted suicide clinics. “Although you say that you are doing this as a friend or relative, and not a nurse, this may not be the interpretation put on your actions by the prosecuting authorities,” it states.
Director of public prosecutions guidance from 2009 states that a suspect is more likely to be prosecuted for assisting a suicide if they were acting in their capacity as a healthcare professional at the time.
Sarah Wootton, chief executive of campaign group Dignity in Dying, said there was “considerable confusion among healthcare professionals as to what they ought and ought not to do under the current law and in light of the DPP’s guidance”. The RCN was “leading the way amongst the relevant royal colleges and the British Medical Association with such guidance, and we hope that the other professional bodies will follow suit,” she said.
Ms Wootton continued: “It is hugely important that dying adults can discuss their end of life choices with medical professionals – and this guidance reinforces that nurses can have this conversation with patients without passing judgment or offering advice about how to end their lives. At present there is a culture of secrecy around conversations about greater choice at the end of life, and this must change.”