RCN To Give Nurses Guidance On Discussing Assisted Dying

RCN to give nurses guidance on discussing assisted dying with patients, May 14, 2009.

Nurses are to receive detailed guidance for the first time on how to help terminally ill patients end their own lives.

Assisted suicide remains illegal in Britain but the Royal College of Nursing (RCN) says that many nurses are being asked by desperate patients about travelling abroad, such as to the Swiss clinic Dignitas, to end their lives.

The RCN has been opposed since 2004 to assisted suicide — actively helping people to die — but is consulting its 400,000 members about whether to reconsider this stance in the light of calls to change the law.

The review follows a number of high-profile cases in which Britons travelled to Switzerland to die, including Daniel James, 23, who was paralysed in a rugby accident, and Peter and Penny Duff, a couple from Bath who decided to die together in an apparent suicide pact.

Surveys suggest that up to 85 per cent of the public would like the option to take steps to end their own lives or allow others to do so if they became seriously ill or disabled or were experiencing intolerable suffering.

Peter Carter, the RCN’s general secretary, told The Times that regardless of whether the union relaxed its policy to become neutral on the issue or actively supported change in the law, healthcare staff needed better guidance to at least discuss assisted suicide and related legal issues with patients and their families.

“Our members are already being asked by people what their options are,” he said. “If they are asked by a patient about Dignitas, we would like guidance to be available to clarify how they can give advice without fear of the consequences or potential prosecution.”

The Crown Prosecution Service has not prosecuted anyone who has accompanied any of the 100 British citizens who have travelled to the Swiss clinic’s facilities in Zurich to end their lives. However, some medical practitioners have been struck off or suspended for assisting friends and family to die in this way.

Actively helping someone to kill themselves is a crime under the 1961 Suicide Act, but this law has been tested by recent cases.

In December the Director of Public Prosecutions, Keir Starmer, QC, signalled that the parents of Mr James would not face charges for accompanying their son to Dignitas. But Debbie Purdy, who has multiple sclerosis, recently failed in her attempt to clarify the law.

The Court of Appeal said that it would not rule for a prosecuting policy that would allow people such as Ms Purdy’s husband to assist her suicide, although prosecution would be unlikely. She intends to challenge this judgment in the House of Lords next month.

In a fringe debate at the RCN congress in Harrogate, nurses appeared divided on the issue.

Dr Carter said that he was not suggesting that nurses should break the law or professional codes of conduct, but added that the RCN’s written guidance, to be published later this year, would offer legal advice and note the duties of nurses to respect patients’ wishes as well as actively doing them no harm.

He said: “Assisted suicide may be illegal but the reality is that the public are talking about it, the media are talking about it and some politicians are talking about it.”

Current guidelines from the Nursing and Midwifery Council, he added, do not cover issues where patients might request advice.

The NMC said that its own Code of Conduct clearly stated that nurses are expected to act lawfully at all times. “Any nurse who is anxious about whether the advice they intend to give may breach the code should first discuss the matter with other appropriate members of the care team or contact one of our professional advisers for further guidance and support.”

Kath McHale, a nurse who is also a bereavement counsellor in North London, told the RCN conference that the number of people asking her for advice about assisted suicide was “growing considerably”. She said: “Who has got the experience and the information if people want choices?”

The Department of Health said there was currently no advice to nurses “on something that is illegal”. If a nurse discussed options with a patient for helping them die they could risk being prosecuted.

By David Rose, The Times, London