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Practice comment

There is no middle ground regarding assisted suicide

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The Royal College of Nursing’s neutrality on assisted suicide implies nurses have no good reason to take sides - but ‘the voice of nursing’ must make a choice, argues Paul Wainwright

 The Royal College of Nursing council has decided there is no ethical objection to assisted suicide and that it would be comfortable with a change in the law. This may not be quite the message the college intended to convey in its recent press release, in which it announced the RCN had “moved to a neutral position”, and that “the college neither supports nor opposes a change in the law” (RCN, 2009). However, it is the inescapable conclusion.

Neutrality sounds such a reasonable position. Neutral countries have declared they will not take part in wars. Boxers retreat to a neutral corner while their opponent takes a count. We often feel we do not need to take sides in an argument, because we are not directly involved or nothing of importance hangs on the matter.

If the debate is whether to have the Christmas party in the Chinese restaurant or the Tandoori house and I like both equally, I can declare myself neutral, other things being equal. But if I know that one of my colleagues suffers from a food allergy, reacts badly to spicy food and will have a miserable evening at the Indian restaurant, I may feel obliged to speak up on her behalf.

Thus, we might argue that neutrality is open to us if we are sufficiently detached from the matter or, although we may be involved, we have no good reason to take sides. And “good reason” in this context will often mean good in the moral sense.

The RCN claims to be “the voice of nursing across the UK” and council reached its decision following a consultation with members. The college sees assisted suicide as a question in which it, on behalf of the profession, should take an interest. It cannot, therefore, claim neutrality on the grounds that the question is of no relevance to nursing or that it will not affect nurses in their work. In coming to its decision, council must have considered the question of whether or not the law on assisted suicide ought to be changed and decided there were no good grounds on which to oppose change.

‘To state that the RCN no longer opposes a change in the law is to declare that they see no such moral objection’

Basing the decision to adopt neutrality on its consultation exercise presents two problems. The first is that the number of responses supporting assisted suicide was 49%, or approximately 619, while approximately 509 (40%) were opposed and 9% (113) were neutral. As the numbers were so evenly divided the decision to move to a neutral position may seem logical and democratic. However, as a proportion of the RCN membership and of the profession as a whole, these numbers are tiny. The responses in favour amount to 0.16% of RCN members. As an expression of “the voice of nursing” this seems inadequate.

But the greater problem is that the press release tells us nothing about the moral grounds underlying the decision. Moral questions are settled by ethical analysis, not by votes. Respondents to the consultation were asked eight questions about their views and their responses included detailed feedback. Unfortunately, this report is confidential.

But the fact remains that if council members thought there were moral grounds - “good reasons” - to oppose a change in the law they would have been obliged to ignore the simple numerical response to the consultation and continue to oppose assisted suicide. To state that they no longer oppose a change in the law is to declare that they see no such moral objection.

PAUL WAINWRIGHT is professor of nursing and associate dean (research), Faculty of Health and Social Care Sciences, Kingston University and St George’s, University of London

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