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