Nurses vote to back ‘principles’ of assisted dying in UK | Nursing Times

Assisted dying is in the process of being legalised in Jersey for those with terminal illnesses who experience “unbearable suffering”, and both the central UK and devolved governments have been considering similar legislation in recent years.

“I believe everybody has the right to choose how they die”

Cat Gibbons

As well as this, the Isle of Man’s parliament, in 2023, voted in favour of allowing adults who are terminally ill and “mentally competent” to opt for assisted death.

As part of RCN’s annual conference, delegates debated, and then voted on, a motion which stated that RCN Congress “supports the principles of assisted dying”. It passed, narrowly, after a lengthy and emotional discussion.

Proposing the motion, nurse Carmel O’Boyle said nurses should have a say in how assisted dying – should it be legalised – is implemented.

She said legalised assisted dying in other countries, such as the Netherlands, had “empowered” patients and supported people to make decisions about the end of their life.

“The issue is complex but we need to discuss choice and autonomy,” Ms O’Boyle said.

Cat Gibbons, an emergency care nurse from Oxfordshire, told congress she thought the RCN could not have a neutral opinion on assisted dying, given potential upcoming legislative changes.

She recalled caring for a patient who had survived a suicide attempt, which he had carried out after being diagnosed with brain cancer.

“He had survived, and seeing him in his pain after that it really affected me,” she said.

“I believe everybody has the right to choose how they die.

“A nurse is somebody who is an advocate for a patient, no matter our own beliefs I think we should support our patients’ decisions if they believe assisted dying is right for them.”

Community nurse Katie Nield said honest discussions about the impact of prolonged stays in end-of-life care on patients should be had, and said people should be given the choice to end their own suffering if they choose.

“When you work with people who are up all night vomiting… and can’t absorb pain relief, they’re too weak to go to the toilet, that’s the sort of thing [family members] don’t see when they go home,” she said.

The risk of patients dying by suicide, because they cannot legally seek assisted dying, and the impact this has on family members was also discussed by RCN members.

North West RCN member Maggy Heaton said she has had palliative care patients feel they were being ignored because they wanted to end their lives, but clinicians legally could not support that wish.

“One [patient] was found by his wife [having died by suicide] at home,” she recalled.

“I remember every single sentence that was told to me that night by his wife; it was a harrowing visit.

“We left that wife with those horrific memories, we have to remember we can’t be judgemental. I’m not saying [nurses] have to go ahead and assist, that’s something each of us has to think about carefully.

“But at the same time, we have to respect our patients’ wishes.”

Originally from the Netherlands, where clinician-assisted death has been legal since 2002, nurse Ewout Jackson strongly backed the RCN supporting the principles of it.

Mr Jackson spoke about a family friend who recently chose to take assisted dying due to life-limiting and deteriorating COPD.

“Though my heart hurt when she made the decision, having seen and heard about the deterioration, I felt privileged that she lived in a country where she had the right to end her life of her own accord,” he said.

Not every RCN member present was supportive of the motion, and some spoke about the potential risks of the RCN showing any form of support for assisted dying.

Chinenye Ubah, from the union’s eastern branch, warned about an “ethical burden”, particularly for those with personal views on the matter, if nurses are given a role in supporting patients who opt for assisted dying.

“I don’t know if this is truly what we want,” she said.

Northern Irish nurse Maura Buchanan said the resolution “pains” her, and said the RCN should retain its neutral position on assisted dying.

“We should be fighting for better end-of-life care, not just in hospices but everywhere where nurses care for people,” she said.

Other nurses felt concerned that legalising assisted dying would have the effect of ‘pushing’ end-of-life patients towards ending their life, which they otherwise would not do if they had better palliative care.

Fallon Scaife, a palliative care nurse, said: “Assisted dying has a place in certain circumstances.

“But what my concern is, is that there are a lot of inequalities in palliative care and access to care.

“People who struggle to access care for whatever reason may feel that assisted dying is a better option; I want us to be looking at palliative care services as a whole.”

Ms Scaife said improvements to palliative care should be made to avoid this.

“People who struggle to access [palliative care] may feel that assisted dying is a better option; I want us to be looking at palliative care services as a whole”

Fallon Scaife

A similar sentiment was shared by nurse Kiera Jones, who said she had observed end-of-life patients looking into assisted dying because of a fear of poor care, loss of control or lack of choice in their final months or years.

Ms Jones said that, in some cases, when patients’ concerns about these issues had been resolved by improvements to palliative care, they felt assisted dying was “no longer their only viable option”.

Despite this, Ms Jones said nurses “absolutely” need to be involved in the creation of policies and guidance around assisted dying if they were brought forward.

“Should legislation change, we need to be in a position to support our colleagues who will be involved with this, to be clear around the right for healthcare professionals to opt out,” she said.

“But most importantly, we need to safeguard our patients. Above all, any change in legislation needs to be very clearly distinct from palliative care provision and not to the detriment of investment in this area.”

Neil Thompson, a district nurse, added: “What we need to do before we get as far as assisted dying is sort out palliative care.

“We have got a postcode lottery for palliative care.”

A UK Parliament Health and Social Care Committee report into assisted dying, published earlier this year, also raised the issue of palliative care being underfunded in some parts of the country.

Some contributors to the report questioned if end-of-life care would be deprioritised if assisted dying was legalised.

This report, aimed at informing MPs should a vote on assisted dying be called, did not take a stance on whether it should be legalised.

RCN members voted to pass the assisted dying resolution, with 331 for, 271 against and 158 abstaining.

In response to the vote, Sarah Wootton, chief executive of assisted dying campaign group Dignity in Dying, said it showed nurses were at “the forefront of change”.

“This sends an indisputable message that the nursing profession is ready to take a seat at the table in shaping legislation that supports choice and provides protection for both patients and nurses,” said Ms Wootton.

Former nurse and Isle of Man MP Clare Barber backed the RCN members’ decision.

Ms Barber, who seconded a bill for assisted dying in the Isle of Man parliament, added: “Congress has spoken clearly and compassionately in support of the principles of assisted dying.

“It is now up to the RCN Council to adjust the college’s policy to reflect members’ wishes.”

She said: “As a nurse who has worked in hospice, nursing homes and intensive care among other settings, I have seen many times when end-of-life care has succeeded in palliating a person’s symptoms, allowing them peace and dignity as they die.

“But for others, those symptoms have remained so intolerable that the person questions why they should be permitted to suffer, and why we do not allow them the autonomy they desire over their death.”