People feel a whole host of emotions when talking about assisted dying, and all are valid.
It is currently illegal in the UK, but the Assisted Dying Bill for England and Wales is moving through the UK parliament and has gone further than any previous legislation on the matter. Recent parliamentary debates and public petitions demonstrate how relevant this conversation is.
Death and dying in any context is a complex subject and as a community health care support worker, I’ve seen first-hand the importance of having relevant and appropriate support around nursing staff when caring for someone at the end of their life.
More than medical
While consultants, GPs and community nurses might be involved in discussions about dying, it’s the health care support workers who are often at the patient’s bedside who might be privy to more emotional and intimate conversations.
A patient might be more likely to initiate talking about their death with someone they have built a relationship with and who has been taking care of them for a considerable amount of time. We might even have been involved in their care long before their end of life journey begins.
It’s the health care support workers who are often at the patient’s bedside
Under the proposed Assisted Dying Bill, care would be led by a consultant and/or a GP, with support from nursing teams including those employed by the voluntary and independent support services, such as Macmillan Cancer support or Marie Curie.
Often health care support workers are at the centre of collaborative working. We play a critical role in assuring effective, linked-up working within the multidisciplinary team.
Above all else, it’s important that there’s clear and effective communication during conversations about assisted dying at all levels.
During the pandemic, we’ve all heard stories of patients dying alone, in a way they wouldn’t have chosen for themselves. As a result, the question of how and where we die has become more present.
Should the bill be passed, conversations relating to assisted dying as an additional choice within end of life care pathways may need to be initiated.
As always, the conversations will need to be approached with sensitivity, kindness and compassion and the workforce may need extra support to manage the challenges these conversations may evoke.
There will be an impact on the nursing workforce if assisted dying ever becomes legal in the UK – but it’s a long way off. As it stands, we need more details of what that might look like.
People back away from talking about it because it’s so emotional, but we’re missing out on important discussions
There are various forms of assisted dying, and four distinctive types: active, passive, indirect, and physician assisted.
My view is that we need to look at and discuss with our members what an assisted, well-informed, consultant/GP led death might look like, and what the expectation of nursing staff will be. We need to collate this information and then create structures and safeguards to ensure it can be carried out ethically and safely for all involved. At the moment, there are far too many unknown factors.
People often back away from talking about assisted dying because it’s so emotional, but in backing away from it, we’re missing out on important, practical information and discussion.
I want to hear from all sides of the discussion because this debate must be member-led.
Where are we now with assisted dying?
Kevin backed an RCN Congress agenda item this June asking RCN Council to review our current position statement that relates to the RCN's current neutral position on assisted dying.
Members at our annual nursing event voted in favour of the review, so the item passed. A new position will remain neutral, but it will do more to recognise assisted dying as a complex legal, ethical and medical issue, as well as ensure our support for members should it become a reality.
Assisted dying already looks different across the devolved nations. The Assisted Dying Bill currently passing through the UK parliament will be effective across England and Wales, while in Scotland, assisted suicide is not against the law, as long as certain considerations are met. There is a proposed bill seeking to legalise assisted dying as a choice for terminally ill, mentally competent adults. It was recently under public consultation, and the results are set to be published later this year.
In our membership, we have passionate views at both ends of the spectrum
In Northern Ireland, assisting someone to die is a crime, and there is no proposed legislation to change this.
The UK parliament recently held a debate on assisted dying following a public petition which called for its legalisation. Ahead of the debate, we issued a briefing to MPs outlining our neutral position and that we will be updating it.
While these type of debates in Westminster do not trigger any legislative changes, they do demonstrate the feelings of MPs towards a specific topic. Overall, more than 20 MPs spoke of their support for legalising assisted dying in England and Wales, while 10 were opposed.
Putting palliative care first
“Within our membership, we have people with really passionate views at both ends of the spectrum, and variations in between,” says Carolyn Doyle, RCN Professional Lead for Community and End of Life Care.
Carolyn has monitored the progress of the Assisted Dying Bill – a private member’s bill which passed its second reading in the House of Lords in October 2021.
Aside from the social and political debate, Carolyn believes we should be investing in high quality palliative care.
“I’ve witnessed many people throughout my 40-year career who may not have their symptoms managed effectively,” she says.
For now, improvements to palliative care must be at the top of our agenda
“In my experience, the key is to get on top of distressing symptoms. As quickly and effectively as possible. If symptoms become unmanageable, that’s when the situation changes and distress ensues. This includes physical and psychological symptoms.
“There are many ‘what ifs’ that need to be addressed in relation to assisted dying. But for now, putting improvements to palliative care must be at the top of our agenda,” she says.
“We’re mindful that we represent members with a whole range of views. We were the first Royal College to take a neutral position on assisted dying, because we listened to members.”
You can find out more about Carolyn’s understanding of the bill by reading her blog post.
It’s important to remember that all nursing staff can make their own choices, and their RCN reps will be there to support them in doing so. Their views and feelings will be respected.
Read the RCN’s current position statement on assisted dying.
Take a look at our guidance on what to do when someone asks for your assistance to die. It was developed to support nurses, health care support workers, and other health professionals in adult practice who may be asked by patients, or their families or carers, to become involved in assisting suicide.