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MARK RADCLIFFE

'Nursing has for too long been outside assisted dying debate'

  • 8 Comments

I have been writing this column for some time and there has been only one subject that I have completely and consciously avoided: assisted dying.

There are several reasons for this. The first is that it seemed too complicated and sensitive to do in 600 words. The second was that I’m not sure all nurses feel engaged with the assisted dying debate, perhaps not wanting to have a position because it makes no tangible difference to their work or, as research suggests, because they do not always feel part of key ethical debates.

Furthermore, part of the problem in discussing assisted dying is clarifying what we mean. Say I have a terminal illness and am dying in pain. I am desperate for assistance in ending the pain, assistance that might hasten my death by say two weeks. But it would afford me a dignity otherwise not available. Is the ethical decision the same as if I am feeling old, miserable and have a long-term health problem that debilitates me, but will not take my life in the foreseeable future, but I want to die? No it isn’t. Unless we choose to premise all of our ethical decisions on principles such as the absolute sanctity of life.

But we don’t premise our decisions on that, do we? If we did we would be forced to do away with the National Institute of Health and Care Excellence (how could they ever refuse a treatment?), the defence budget and tax cuts because we would need the money to make more healthcare interventions. To act more.

We have a tacit understanding that there is a limit to what we do. Nurses know this. But acknowledging that and thinking about creating a legal, ethical and caring framework that extended that to intervening to end suffering in certain and very particular circumstances threatens us.

There are good reasons for this. The lazier one is the “slippery slope” argument. This suggests that we may apply a law of assisted dying only to terminally ill patients in pain but it’s just a matter of time before either that law gets abused and we start encouraging people to die so we can free up beds or, worse, take to the streets and start killing anyone who looks ill. The slippery slope argument assumes we cannot think. It’s silly because we can.

The more culturally pressing one is that health professionals are not trusted as they once were. They may do harm, they may misjudge. They may not care. Where once the public believed that doctors and nurses would always do what was right, now, after Francis, many of them don’t.

At the time of writing, Lord Falconer’s Assisted Dying Bill had not been debated. Regardless of the outcome, we are edging ever nearer to negotiating a more considered, sensitive, empathic and less fearful way of working with impending death.

It seems to me that nursing has stayed on the sidelines of this debate for too long. I understand that has been in part intentional, although I believe it is also because medics often diminish the nursing view when it comes to ethics (and nurses sometimes collude with that). Sometimes nurses choose not to engage with certain issues – striking has been a recurrent example, the debate around assisted dying may be another. But nurses need to be part of that debate, I think.

For my own part, I think Falconer’s bill is civilising and compassionate. I think assisted dying in certain circumstances makes ethical sense. I understand others may disagree. Primarily, I think it is a debate of which nursing needs to be more of a part.

 

Mark Radcliffe is senior lecturer, and author of Stranger than Kindness. Follow him on twitter @markacradcliffe

  • 8 Comments

Readers' comments (8)

  • Worst thing that can happen in medical/nursing profession is to become involved in killing patients. Bad for moral of staff and patients alike. There is an organisation called Nurses Opposed to Euthanasia (N.O.E) the aims of which are to have more palliative care specialists and more palliative care beds, outside of acute settings.Any one interested in learning more about the issues around Assisted Dying, or about the organisation, contact by e-mail teresalynch1@hotmail.co.uk)

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  • Medicine and nursing in the 21st Century ever seeks to increase the percentage of patients achieving a pain-free existence in the terminal phase of illness.

    Patients with end stage disease are a constant challenge to the vocational skills of their carers. In my experience, patients look to their carers to affirm their lives, not offer them death as a defeatist, cheap and easy option.

    No one of any age or degree of illness is granted a pain-free existence. To suffer is part of the human condition. We see practical love operating frequently in times of natural disaster, to make bearable the suffering of those having experienced loss, natural disasters, torture, persecution, injustice,or bereavement, in other words, in all forms of suffering, whether mental or physical.

    What makes suffering bearable is the constant, invaluable support by family and friends, and of course their carers in their loving concern,support, and practical care for pain, wounds and misery.

    No one should be unaware that rather than pain, 'fear of being a burden' underlies many people's request for assisted dying, where it is legally-sanctioned. What an incredibly sad premise for this proposed law.

    The worst pain then, experienced by dying people is the fear of abandonment by their carers. Do we now compound this fear by offering the abolishment of the burden of suffering together with patients’ lives in the increasing numbers as seen in other European countries?

    Nurses will be the ones expected to fulfill the requirements of this Bill. I know many will refuse the implementation of such a dangerous and unneccessary law. Such a stand will no doubt lead to their persecution for a lack of so called 'compassion'.

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  • How I applaud Teresa for writing so eloquently on such a sensitive and controversial subject. I have helped nurse a much loved mother and sister through terminal illness and never once felt I could not offer appropriate pain relief, and was supported in this by the GPs. I fail to see why pain relief and euthanasia are seen as inseparable, they are quite different. One is to ease suffering and one is to end life, and I think Teresa has hit the nail on the head when she states the 'fear of being a burden' will lead the requests for 'assisted dying' if we change the law.

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  • michael stone

    The BMJ was recently discussing this at length - medics, apparently, being less reticent than nurses. The debate was fairly intense, and very divided (as this one always is).

    But one nurse, whose now dead wife was also a nurse, did make the 'pro' argument very eloquently:

    http://www.bmj.com/content/349/bmj.g4349/rr/760507

    The 'forceful' part of his post, is:

    'Moving on, in Autumn 2011 Maureen became much more ill and it was then found that her benign tumour had become aggressively malignant and deposited secondaries in her liver and other organs
    and that no treatment options remained. Back at home, the Hospice Nurses were assiduous in their care, adjusting the drug types and dosages frequently but the pain was defeating their best efforts. By early December 2011 Maureen was crying and screaming with the uncontrolled pain and leaving me feeling helpless in my inability to comfort her as she wanted it to be ended. She had lived a full life and made massive contributions to her community both before and after retirement, and now wanted it to be over.'

    I support, subject to the actual wording of any Act, 'assisted dying'. But there are many problems, several of which are not 'assisted dying' but 'are closely related to it', some of which I've mentioned on BMJ so I'll just put the links up here:

    http://www.bmj.com/content/349/bmj.g4349/rr/759994

    http://www.bmj.com/content/349/bmj.g4349/rr/760472

    And there does seem to be confusion, between 'assisted dying' or 'assisted suicide' and 'euthanasia - I've covered that one on BMJ, as well:

    http://www.bmj.com/content/349/bmj.g4739

    There is, as I commented in that one, a very tricky issue, for 'suffering but [long-term] mentally-incapable patients' - unlike assisted dying/suicide, which wouldn't need a fundamental change in the law [because any change, would be further 'strengthening' patient autonomy, which is already a fundamental principle of English law], the problem I described in that piece (below) is much more difficult:

    'That does not resolve the serious issues of mentally-incapable patients who are suffering intensely during their dying – they cannot ‘ask for death’ in the same way, and I have enormous problems with the idea that anybody except the person who is suffering, should be able to make that decision'.

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  • For me there is no argument, " Thou shalt not kill" Care not killing and the above uncontrolled pain story is very rare, as any hospice nurse will tell you

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  • michael stone

    Anonymous | 5-Aug-2014 4:54 pm

    Well, not everyone dies in a hospice: a few years ago (2008), a friend of mine died in a nursing home, and very clearly fro about th efianl week of his life, he was aware only of pain (he would be creaming in pain, but totally unresponsive to any external events). And about a week before that final week of life, he had disappeared 'to get the pain sorted'.

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  • michael stone

    I was very time-pressed when i wrote the previous comment.

    My friend, was experiencing increasing pain levels, in the nursing home. He 'disappeared' for a few days - apaprently 'he had gone to some sort of specialist pain unit' to get his pain sorted out.

    Soon after returning, he became apaprently oblivious to everything except his very extreme pain: it wasn't possible to talk to him, and 'delirious and frequently screaming in pain' described his condition, for about the final week of his life.

    I found it very disturbing to watch that - it must have been MUCH WORSE, for his daughter who used to visit him regularly, to watch - and REMEMBER - such a death.

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  • To everyone who points out how wonderful hospices are, do not assume we will all get to die in one! Ideally of course we would, but realistically???

    All I know is that my loved ones can trust me never to stand by and watch them die an horrific frightening painful death. I hope I would be able to ensure that within the law, but who knows?

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