The Royal College of Nursing has published revised guidelines for nurses and healthcare assistants on how to respond to requests from patients related to assisted suicide.
The updated version of guidance first published five years ago contains new and additional resources to help guide nursing staff to “undertake and navigate these difficult conversations”, said the RCN.
“Nurses have to be empowered to give compassion as well as expertise”
Since the first edition of the guidance was published in 2011, public conversations about dying, death and bereavement have become “more prevalent”, noted the college.
It highlighted that intense media coverage of recent court cases had helped to project the current debate surrounding the legalisation of assisted suicide and voluntary euthanasia to the forefront of the public’s consciousness.
In addition, recent reports had highlighted the need for health professionals to adopt a patient and carer- centred approach and the importance of creating a supportive environment in which people are able to discuss planning for the future, death and the process of dying.
The RCN noted that most patients approaching the end of their lives in the UK did not ask health professionals to “hasten their death, but a minority do express a readiness or desire to die”.
“Most patients expressing such sentiments do not go further by asking a nurse to hasten their death, said the guidance. “However, when this does happen – or when someone close to the patient voices a request to hasten death – it can be difficult to know how to respond.”
The guidance – titled When someone asks for your assistance to die: RCN guidance on responding to a request to hasten death – sets out the legal position for healthcare workers in such situations.
The document reinforces that assisting a suicide is illegal in the UK, but also provides practical examples of how to deal with difficult conversations and deliver good quality end of life care.
The RCN added that the guidance had also been revised to reflect changes to organisations and sources of support for nurses, plus the phasing out of the Liverpool Care Pathway from 2013.
- Liverpool Care Pathway ‘to be replaced’
- New alliance to lead drawing up of end-of-life care guidance
- New ‘approach’ to end of life care replaces axed Liverpool pathway
It draws on the experiences of nurses working in all areas of care, and aims to support the relationship between patients and nurses and protect the vulnerable, said the college.
Amanda Cheesley, the RCN’s professional lead for end of life care, said: “Assisting someone to die remains illegal, and it is important to emphasise that this guidance does not encourage nurses to instigate discussions with patients on this difficult and emotive topic.
“However, we know that there is a real need to provide support to nurses and healthcare assistants when patients open up to them about their feelings,” she said.
Nurse-patient ratio found to be key to stroke survival
Ms Cheesley noted that sometimes patients talked about ending their lives as another way of expressing concerns about their condition or their level of pain.
“Nurses should feel confident that asking them about these comments is not assisting or encouraging that patient to take their own life,” she said. “Such conversations might be the only time a patient opens up and discusses their worries.
“There is only one chance to get the care right at the end of someone’s life, and nurses have to be empowered to give compassion as well as expertise, and recognise that each individual has complex physical and emotional needs,” said Ms Cheesley.
She added: “With this revised guidance, nurses can help patients to discuss and explore their feelings, a crucial element of nursing, without being concerned that their actions will be misinterpreted.”
In December 2015, the National Institute for Health and Care Excellence published guidelines on the care of dying adults in the last days of life. The RCN is due to review its guidance again in December 2018.
Topics covered by the new RCN guidance include:
- The law on assisted suicide in England, Wales, Northern Ireland and Scotland
- The law on advance decisions
- Sources of information on high quality end of life care
- Reasons why people may express a wish to die
- Responding to a request to hasten death
- Scenarios nurses may encounter and suggested responses