As MPs prepare to vote on a divisive assisted dying bill, Madeleine Anderson explores what the bill includes and what it means for nursing. Read now to be informed as a healthcare professional.
The Terminally Ill Adults (End of Life) Bill would allow adults aged 18 and over, who are judged to have mental capacity, to request help from a doctor to end their own life if they are terminally ill and in the final six months of their life.
The House of Commons has not voted on the issue of assisted dying since September 2015 and it appears opinions are divided – both among MPs and within the nursing profession.
The bill applies to people living in England and Wales, and a separate assisted dying bill for Scotland is currently being considered by the Scottish Health, Social Care and Sport Committee ahead of an initial vote by MSPs, which is expected for February or March 2025.
CNOs not adopting ‘official professional stance’
Earlier this month, the UK’s chief nursing officers (CNOs) published advice to nurses and midwives wanting to take part in the assisted dying debate.
The CNOs said they would not be adopting an ‘official professional stance’ on the matter, instead choosing to wait for the outcome of the vote in Parliament.
They urged nurses to be ‘guided by the professional values enshrined in our code of practice, particularly around respect and confidentiality’.
MPs given a ‘free vote’
The English and Welsh bill was introduced as a private member’s bill (PMB) by Labour MP Kim Leadbeater, although the government has taken a neutral stance on the bill.
MPs have been given a ‘free vote’, meaning they can vote independently, rather than following a party line.
Health and social care secretary Wes Streeting has said he will vote against the bill, while social care minister Stephen Kinnock has said he will vote in favour.
The proposed bill sets out various safeguards for those who want to seek assistance to end their own life. These include:
- Patients must be 18, a resident of England or Wales and be registered with a GP for at least 12 months,
- They must have the mental capacity to make the choice to seek assistance and to have expressed a clear, settled and informed wish free from pressure or coercion,
- Two independent doctors must be satisfied that the person is eligible, with at least seven days between the assessments,
- A High Court judge must hear from at least one of the doctors and they can question others if appropriate.
- The patient must be expected to die within six months,
- They need to make two separate declarations about their wish to die, both of which must be witnessed and signed.
As it stands, the bill would require two doctors to assess each request for assisted dying, with at least seven days needed between each assessment to ensure the person meets the relevant eligibility criteria.
According to the bill document, a person is considered ‘terminally ill’ if they have an inevitably progressive illness, disease or medical treatment.
What would the nursing role be?
Under the bill, nurses are referred to under the title of ‘health professional’, which includes registered nurses, registered medical prescribers, a registered pharmacist or a registered pharmacy technician.
The bill states that the ‘coordinating doctor’ that is overseeing the patient’s end-of-life care provision may be accompanied by ‘other such health professionals’ – including nurses – that they think are necessary.
However, no registered medical practitioner or ‘other health professional’ would be under any ‘duty’ to participate in assisted dying provision.
The bill makes clear that employers must not impose any punishment or detriment on healthcare staff who exercise their right not to participate in the provision of assisted dying.
What have nurses said so far?
There appear to be a range of views across the profession, with a particular focus on the provision on end-of-life care services.
Earlier this month a group of nurses, including palliative and public health specialists, wrote a letter encouraging MPs to vote for the bill.
The letter, published by campaign group Dignity in Dying, stressed the need for ‘choice’ at the end of life and said nurses regularly see patients suffering against their will, which has a ‘lasting traumatic effect’ on nursing staff.
‘We want our patients to have the best care possible at the end of their life, and we believe this means empowering them with choice. For most, palliative care in hospice, hospital or at home will help them have the death that they want,’ the nurses wrote.
‘But we feel we have to speak up for those for whom palliative care cannot relieve suffering or provide the peaceful and painless death that everyone deserves.’
However, a separate campaign group of more than 3,400 nurses, doctors and healthcare professionals have this month written to the prime minister warning that assisted dying ‘not be introduced safely amid a broken NHS’, according to The Telegraph.
Organised by campaign group Our Duty of Care, the letter said: ‘The NHS is broken, with health and social care in disarray. Palliative care is woefully underfunded and many lack access to specialist provision. The thought of assisted suicide being introduced and managed safely at such a time is remarkably out of touch with the gravity of the current mental health crisis and pressures on staff.’
Paulette Hamilton is a former district nurse, an MP and member of the Health and Social Care Committee and All-Party Parliamentary Group for Hospices. She says she will be voting against the bill on Friday.
Sharing her thoughts in a letter to constituents on November 26, Ms Hamilton acknowledged the ‘strongly held’ views on both sides of the debate, but shared that she was ‘deeply concerned’ by the bill, particularly given years of underfunding for palliative care services.
‘I believe that assisted dying should not become an alternative to high-quality palliative and end-of-life care,’ she wrote.
‘People deserve dignity in dying and should feel reassured and safe, knowing they will receive the very best care in their final days.’
Ms Hamilton said she will continue to back calls for wider access to improved palliative care in England and Wales.
While the Royal College of Nursing (RCN) holds a neutral position, its members voted to ‘support the principles of assisted dying’ at RCN Congress in June this year.
Earlier this month RCN Scotland director, Colin Poolman, shared his thoughts on the Scottish Assisted Dying for Terminally Ill Adults (Scotland) Bill to Holyrood’s Health, Social Care and Support Committee.
Mr Poolman reiterated the union’s neutral stance, but added that the RCN is not satisfied that sufficient safeguards are currently in place to protect nurses and nursing practice around assisted dying in Scotland.
What is happening next?
MPs are set to vote on The Terminally Ill Adults (End of Life) Bill in Parliament tomorrow, November 29.
Nursing in Practice will be following the vote as it happens, with more content to follow.
If you would like to share your views with us, please do get in touch.
