As nurses are now specifically mentioned in new policy on assisted suicide, they must consider their ethical obligation to patients in this debate, says Frances Trowell
New policy on the prosecution in cases of assisted suicide, which is outlined in more detail in this week’s Guidance in Brief article, specifically mentions nurses.
Assisted suicide is against the law in the UK and has been since the Suicide Act 1961. The new policy, launched earlier this year, provides guidance on whether a prosecution should take place, based on a number of “public interest factors” (Director of Public Prosecutions, 2010). These factors were collated after taking into account nearly 5,000 responses from a public consultation launched last September.
The policy focuses on the motivation of the suspect (the person who encourages or assists another’s suicide or attempt) rather than the characteristics of the victim (the person who commits or attempts to commit suicide).
This policy specifically mentions nurses in the section covering the public interest factors tending in favour of prosecution. It states: “A prosecution is more likely to be required if…the suspect was acting in his or her capacity as a medical doctor, nurse or other healthcare professional, a professional carer (whether for payment or not), or as a person in authority, such as a prison officer, and the victim was in his or her care.”
This is an important issue for frontline nurses working caring for people with long term and terminal conditions. A distinction is made between the ending of a life by a professional rather than by a family member, even on compassionate grounds.
Nurses may find themselves being asked about methods of suicide and even for assistance in carrying the act out. They may find themselves in an extremely vulnerable position as those professionals who are often close to their patients and thus potentially put under pressure to assist. Nurses must therefore be clear that they must act within the law even if they do not agree with the illegality of assisted suicide. However, as our survey revealed, 33% do not understand their legal position with regards to assisted suicide.
I believe that nurses need to understand the above clause in the DPP (2010) policy as a clear indication that their primary role is to protect the vulnerable people they care for; the NMC (2008) stated that “nurses must act in patients’ best interests”.
‘Nurses may be asked about methods of suicide and even for assistance in carrying the act out’
I would therefore argue that nurses should strongly resist moves to legalise assisted suicide until all people with long term and terminal conditions have care that is properly funded and expertly delivered, and all healthcare professionals are able to practise good quality end of life care. We live in an ageing society with increasingly limited resources; in such a society, assisted suicide could become a viable economic choice.
The Royal College of Nursing’s (2009) recent decision to adopt a neutral stance - neither supporting nor opposing a change in the law regarding assisted suicide - may increase the dilemmas nurses face when coping with the ethical difficulties of this subject. This position was made after a three month consultation involving 1,200 members, which represents a small proportion of the total membership.
The subject requires vigorous, ethical analysis and I do not believe the nursing profession has properly researched how the legalisation of assisted suicide would affect their role as professionals. Until this is achieved I do not see how the profession can effectively take part in a debate that is, by nature, emotive and difficult.
FRANCES TROWELL is clinical nurse specialist in palliative care, Bromley, Kent
Director of Public Prosecutions (2010) Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide. London: Crown Prosecution Service.
Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. London: NMC.
Royal College of Nursing (2009) RCN Moves to Neutral Position on Assisted Suicide. London: RCN.