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Practice comment

The profession should oppose calls to legalise assisted suicide  


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



Readers' comments (15)

  • You raise the issue that the RCN has adopted a neutral stance to this issue. The BMA however voted to oppose bothe assisted suicide and euthanasia back in 2006. I think it is important to stress that even though new guidelines have been issued the law has not changed. From my interpretation of the guidelines any nurse who either advises or assists another to commit suicide would very likely be prosecuted. Factor 14 of the guidelines excludes the involvement of all medical professionals. Not withstanding the slippery slope argument there is a view that medically assisted suicide might be a better alternative than a badly executed suicide by an individual who is commited to ending their own life. I do feel it would be helpful for the RCN to actually become involved in the debate on behalf of the profession rather than sitting on the fence. There will be further debate on this and bills such as that introduced by The Lord Joffe in 2004 will no doubt be proposed. As a profession we need to be able to communicate effectively our views in order that future legislation reflects the diverse range of options at the end of life.

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  • How dare the 'profession' deem fit to impose and dictate a belief system like this on us!

    This is a very emotive subject and there will be Nurses on both side of the fence, just as in abortion for example. Whatever we as an individual believe personally will not affect our professional work and we will act within the law and our professional boundaries, so the 'profession' should keep its damn nose out instead of trying to impose a set of ethics and beliefs.

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  • totally agree with Mike, this is a very emotive issue, and how on earth can the profession dictate our belief system.
    I believe in dignity in death, there is nothing worse than seeing a patient suffering just for the sake of it. I personally believe it is quality of time and not quantity of time, that is why should someone suffer to the bitter end?

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  • I do not believe in assisted suicide at all as I can see it escalating into an obligation for all those who are dependent on others.

    However neither does it mean I believe anyone at end stage care should suffer pain or distress. We have enough pharmacological knowledge to treat all symptoms and should not be troubled by legal implications if death is brought forward by days or even weeks. That is not euthanasia, that is caring.

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  • What right as a profession do we have to insist that someone should not commit suicide or Euthanasia if their quality of life is such that it is causing the patient and their family undue pain, discomfort and unnecessary distress.

    Quality and not quantity is my preference and should I become totally dependent or in intractable pain then I for one would buy a one way ticket to Switzerland at the drop of a hat if I were terminally ill but then why should I have to leave my own country and my family in order to have a peaceful death.

    Its about time that people in the UK were not so fearful of death and dying and adopt a mature outlook and understanding of Euthanasia as they do in the Netherlands.
    Sometimes professionals however well meaning do not always know whats best.

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  • Once someone has to ask for 'assisted' suicide, it is no longer, strictly speaking, just suicide anymore, is it?
    I don't think that anyone else should be asked to participate in an act of such emormous significance and consequence.
    The 'profession' should concentrate it's efforts on ensuring quality end of life care for everyone who needs it, then there would be no need for suicide under such circumstances, 'assisted' or otherwise.

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  • is this 21st century nursing? well i think am in the wrong profession. time for a career change if you ask me.

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  • Wether we as individuals agree with the notion of assisted suicide or not is slightly beside the point. Like I said, there will be Nurses on both sides of this very emotive issue. What is more important is why and how the profession should be able to dictate moral beliefs and attitudes on us as individuals. That is wholly wrong and I will oppose it bitterly. We do not (quite) live in a dictatorship yet, however much the NMC and RCN wishes it so.

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  • I am just a student, but I agree with Mike. How can the profession advise our opinions? And even then, how dare our opinions keep the terminally ill and suffering from having one last bit of control over their lives? My father suffered until his dying breath, dying from cancer, and no amount of medication was enough to completely take away his pain. He begged God to just let him die. I cannot say that, as a future nurse, I could ever see myself being able to assist with someone ending their life, but who are we to tell them they must continue to suffer?

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  • The NMC and RCN cannot impose a set of beliefs on anybody, but they have a duty to point out to members of the nursing profession their interpretation of the law of the land to give us guidelines for our practice. As to the member who wishes we had a system similar to the Netherlands, I am not sure we want a situation where vulnerable adults in our country can be "put to sleep" without their consent, which has happened there.

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