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Nurses must not 'ignore' patients' requests for assisted suicide, RCN advises


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.”


Readers' comments (47)

  • michael stone

    Nurses should NOT perform assisted suicide - it is currently illegal, and very dangerous for a nurse.

    I WISH the medical profession would be clear about things such as the provision of 'permanent sedation on request', however, which do appear to be legal !

    There is definitely ENORMOUS confusion amongst health professionals, about what is, and isn't, legal around dying !

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  • michael stone

    By the way, the issue at the heart of much of this is what the MCA means, not assisted suicide, and this was an e-mail I received in May from the CPS:

    Dear Mr. Stone

    Thank you for your e-mail of 11 May 2011 and we apologise for the delay in replying to you.

    We cannot comment on the wider issues raised in the two attachments that you enclosed, but we can confirm that the Director of Public Prosecutions has not issued any guidance concerning any duties that bereaved relatives or the police may have under the Mental Capacity Act 2005.

    Yours sincerely
    Correspondence Unit
    Crown Prosecution Service

    Basically nobody who understands much about law, has issued sensible guidance relating to the MCA (Mental Capacity Act).

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  • michael stone | 20-Oct-2011 3:01 pm
    michael stone | 20-Oct-2011 3:07 pm

    You appear to have missed the point of the article.

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  • It's an interesting point that we should be aware of this issue outside of work. This is a discussion that I have had with my Dad previously, and it would be his wish to go abroad and be in control of his own death in the event of him developing MND, advanced MS, or another illness or disease which he considers likely to be detrimental to his quality of life. This is after watching his own father deteriorate and suffer with MS for many years.
    Professionally, it is 'easy' for us to brush aside the concerns of patients who mention that they no longer wish to live. This could be because assisted suicide and we don't wish to become 'caught up' in a difficult discussion or become implicated. However, this could also be due to our own discomfort with this area ; some nurses will agree with the law & others wont. An essential point to note is that everyone is likely to have a differing opinion and it is a very emotive area to discuss. Therefore it is essential that healthcare professionals brush up on their communication skills.

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  • Basically we are damned if we do and damned if we don't. As usual. Great.

    Anonymous | 20-Oct-2011 4:47 pm I see your point, but I think the biggest problems we face are the legal and professional ramifications rather than moral or communication issues.

    At the moment assisted suicide is illegal, Nurse or not. But not one prosecution has been bought out of this, despite the cases that have gone to court. That to me suggests the law in and of itself is fundamentally flawed.

    However, theoretically, if a Nurse assisted in suicide and was legally cleared after a court case (as would be the most likely outcome) then we would still almost certainly face professional sanctions from the NMC.

    Professionals cannot be expected to have clear best practice on the issue when the law itself is so flawed and professional guidance is so confused.

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  • Never mind, 'Nurses must not 'ignore' patients' requests for assisted suicide', I'd like nurses to try, with a little more conviction, to keep them alive in the first place!

    Firstly, by ensuring that they maintain the patients by ensuring they don't help in spreading those drug restent infections - super viruses.

    If the nurses did manage to maontain high standards of nursing care, perhaps ttheir patients wouldn't want to commit suicide!

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  • Oops!
    Apologies for the above typing/spelling errors above.

    Never mind, 'Nurses must not 'ignore' patients' requests for assisted suicide', I'd like nurses to try, with a little more conviction, to keep them alive in the first place!

    Firstly, by ensuring that they maintain the patients dietry needs, including fluid intake;

    Secondly,by ensuring they don't help in spreading those drug restent infections - super viruses.

    If the nurses did manage to maintain a high standard of nursing care, perhaps their patients wouldn't want to commit suicide!

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  • Anonymous | 20-Oct-2011 6:04 pm

    Take your cheap shots at Nurses and your spelling mistakes elsewhere!!!

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  • Anonymous | 20-Oct-2011 6:01 pm I don't know who you think you are, but you are more than welcome not to take advantage of our Nursing care and stay at home when you are beset by an illness, disease or injury. See how well you deal with it yourself eh?

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  • Little One

    So potentially you could be prosecuted if you discuss assisted suicide in terms of the clinics abroad but must not shy away from having conversations with patients about their desire to die and why they are asking for your help? This sounds overly complicated. Euthanasia is illegal and whilst patients may feel that suicide is the only option they have we should be discussing palliative care and arrangements for dying at home if they wish. As someone who does not believe that euthanasia should be legalised I do not want to be in a position where I have to discuss assisted suicide in detail with a patient and feel that I would not be comfortable having a conversation regarding suicide with a patient. I suppose I need to learn before I qualify though.

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