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The Assisted Dying Bill: a nurse’s perspective


With the Assisted Dying Bill due to be introduced in the House of Commons this September, palliative care nurse, Jo Fernandes, appeals to nurses to consider the implications for them if the law changes.

Ask yourself:

“Could YOU assist another person to take their life?”

“Is helping someone to take their life a part of nursing?”

As a palliative care nurse, I am committed to upholding dignity and choices at the end of life. However, I am clear that helping another to die is not part of palliative nursing for the following reasons:

Compassion is the bedrock of nursing. Nurses currently have an unequivocal role in how they care for dying people: 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 because assisting someone to die is not a form of care.

A nurse with a dual role in “promoting living and dying well” also helping to hasten death could have serious consequences for the reputation of a trusted caregiver.

“Helping someone to die, irrespective of their “settled intention”, must never be confused with good end of life nursing”

It is argued however that it is ultimately compassionate to help another to die when that person’s suffering is unbearable. Thus denying assistance to end this suffering is to deny a person a dignified death. This is a compelling argument. Nonetheless must the autonomy of an individual really invoke the duty of another to assist in hastened death when to do so requires a radical shift in the values of nursing which have never been involved with ending life? I suggest not.

Furthermore the argument of proportion is significant. Most people do not die enduring unbearable suffering, despite media portrayal, but are frail elderly, dying of gradual organ failure. It is imperative that nurses endeavour to enhance the dying experience for the majority through better access to excellent care.

Furthermore there are insufficient safeguards in the proposed bill, most particularly regarding how the risk of coercion can 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?

“It is extraordinary that all such rigour is bypassed when it comes to assisting in death”

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 doctor’s instruction” to carry out what is arguably the most ethically 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 death!

So, I would like to appeal to my colleagues to think carefully about the consequences of assisting in a patient’s death. If you are still undecided, perhaps the 6Cs of nursing are a useful conclusion.

  • Compassion: the bedrock of nursing does not encompass causing death which is contrary to the principles of doing no harm
  • Care: to prioritise the delivery of excellent end of life care for all
  • 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 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.

Jo Fernandes, Practice Development Nurse, Hospice of St Francis, Berkhamsted


Readers' comments (2)

  • I believe fear is holding us back from delivering gold standard care to end of life patients. Several times have I disagreed with doctors where they have been either reluctant to increase symptom control or stop escalating care for someone who is obviously dying and people in my opinion have suffered. All care needs to be on an individual basis, but how do we change medical attitudes? I have nursed many patients where they have expressed they would like to 'go' and even relatives have said the same thing.
    In my experience, patients die when they are alone, few die when families hold vigils around the bed or if someone is with them. Dying is such an intimate event and we need to improve this specialised care for all concerned.
    We either help people get well or help with a dignified end.......that will never change. Death is not a failure, it is an end to a life whatever the age.

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  • michael stone

    There are several issues with assisted dying - or, as I prefer to separate it from euthanasia and to be clear whose decision it is, assisted suicide.

    One would be who is involved: I am a supporter of assisted suicide [but not of the types of safeguard in the Marris Bill] but I would not want my usual doctors involved if I wished for AS, and I would not want ANY nurses present at the actual death - it is just too much role-reversal.

    But it isn't, in my opinion, 'compassionate' to simply accompany suffering. If somebody was going to hit me in face 20 times, I don't see how a person offering to stand next to me would actually help me. If a person stood next to me, and arranged to be struck for half of those blows instead of me - 10 each - I would be hit less. That, however, isn't 'just accompanying me'. And nobody 'can die for me'.

    An MP sent me some observations on the debate in the House of Commons:

    'In the absence of [a] faith reason being given, one heard a lot of the opposition to assisted dying which boiled down to opponents being patronising: "don't let people have a choice lest they exercise it; and lest they, heaven forfend, exercise that choice in a way that I would not and/or for reasons which I would not myself take into account." Another aspect is "No, you can't have a choice because I don't want that choice myself."'

    I had written something very similar during a BMJ debate about AD:

    It seems to me, that for some authors 'coercion' is being used to describe 'persuasion but in a direction I personally do not agree with'. That isn't very useful. Neither is only asking 'was the decision 'autonomous' ?' when [to the person raising the issue of autonomy] it 'seems to be the wrong decision'.

    Although, as I also pointed out in the BMJ piece, it isn't really AD/AS that I'm interested in:

    I have pointed out to Rob Marris, that the presence of 'judicial approval' in his Bill, appears at some level to be reversing the assumption of capacity present in the Mental Capacity Act. That would seriously undermine the MCA - and there is incomplete 'acceptance' of the assumption of mental capacity contained in the MCA even as things stand at present.

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