The RCN is to be congratulated for publishing guidelines on how nurses should respond if someone asks for assistance to die. In so doing, the college faces up to the reality that some dying patients request help to die and that health professionals require advice on dealing with such difficult requests.
However, I am disappointed by the guidelines as drafted;it is a betrayal of dying patients not to be able to respect and, in conscience, respond more meaningfully, to a mentally-competent, terminally ill adult's persistent request to die.
This is not a failure of the RCN or the guidelines, but of the law itself. In effect we have a law that forgives compassionate amateur assistance to die, but not professional assistance - and this is clearly reflected in the guidelines.
The guidelines are a good start, and will no doubt add clarity to an ambiguous situation. The fact that the RCN is the first Royal College to have published anything like this is to be commended, and I sincerely hope that the other colleges will follow suit. It is incredibly important that nurses, in particular, are supported in this area as they are often the people who spend the most time with dying patients.
However, while the guidelines describe good palliative care, patient autonomy, which should be a central feature of care at the end of life, is not given sufficient prominence Patient autonomy should not take a backseat to nurses' concerns about culpability in situations where patients want to discuss their broader choices. The issue of the validity of 'Advance Eecisions' is rightly examined, but their usefulness needs to be stressed because Advance Decisions and Lasting Powers of Attorney are key to ensuring patient autonomy can be respected if a patient loses mental capacity.
I hope this document will encourage wider debate about how we can respond compassionately to those who are dying; an aim which unites all sides of this debate.
- Harriet Copperman is a retired palliative care nurse and member of Healthcare Professionals for Assisted Dying.