Analysis

Nurse backs challenge to law on assisted dying

As the issue of assisted dying comes under the spotlight once again, Nursing Standard speaks to a nurse involved in the latest High Court bid to change the law.

As the issue of assisted dying comes under the spotlight once again, Nursing Standard speaks to a nurse involved in the latest High Court bid to change the law

dying
Campaigners outside the Royal Courts of Justice in London. Picture: PA

When Alison Pickard was diagnosed with motor neurone disease (MND), she had a nursing career spanning five decades.

Now, more than five years on from her diagnosis, she has given written evidence backing a High Court bid to challenge current legislation and make assisted dying legal.

‘I decided to give evidence because I have seen too many “bad” deaths during my nursing career,’ says Ms Pickard.

‘Life is for living, not just existing,’ she adds.

Human rights

The 1961 Suicide Act makes it an offence to assist in a suicide in England and Wales

The case, which was heard at the Royal Courts of Justice in London last week, was brought to court by Noel Conway, a retired lecturer with MND.

He is supported by charity Dignity in Dying in his battle to have the option of an assisted death when he is in his final six months of life.

The 1961 Suicide Act makes it an offence to assist in a suicide in England and Wales, and the judges are considering whether current legislation breaches human rights laws.  

A decision on the case is expected in the autumn.

‘I believe it is up to each individual to decide at which point life has become intolerable and choose to end it’

Alison Pickard

Ms Pickard worked as a nurse for more than 42 years in paediatrics and later in general practice. She worked her last shift as a nurse for a GP out-of-hours service provider at the start of this year.

She is one of several witnesses who gave evidence in support of Mr Conway’s claim.

‘I feel there is a perception that all end of life symptoms can be well controlled. People also tend to think that the only distressing end of life symptom is pain,’ Ms Pickard said.

‘This is far from the case, particularly with neurological conditions such as MND, when difficulty breathing and communicating are huge issues, along with total immobility.

In 2015 MPs rejected the assisted dying bill, which proposed that terminally ill adults with less than six months to live should be able to end their lives with medical supervision

‘When I am no longer able to do things that give me quality of life, such as move independently, do the things I want to do, speak, eat, wash and go to the toilet independently, my quality of life will be very poor.

‘In short, I believe that it is up to each individual to decide at which point life has become intolerable and choose to end it.’

Ms Pickard, from Nottinghamshire, is still able to walk around the house, but uses a mobility scooter and needs help with tasks such as dressing, cooking and cutting food, as her left hand has very little function.

Although she currently has no problems with speech, swallowing or breathing, she uses voice recognition technology because her typing is much slower than it was.

‘Participation in assisted suicide will, I believe, have a long-term and damaging impact on the nurse-patient relationship’

Steven Fouch

Ms Pickard says her experience as a nurse has allowed her to look at the issue of assisted dying from both sides. But she felt it was more difficult to speak out on the issue while she was still directly involved in patient consultations.

Mr Conway’s case is opposed by the secretary of state for justice, with groups including Humanists UK, Care Not Killing and Not Dead Yet UK also making submissions.

During last week's hearing, James Strachan QC, on behalf of the secretary of state, described the case as tragic, but added that it was inappropriate for the courts to interfere with parliament’s decision on the ‘sensitive moral, social and ethical issue’.

Pressure

In 2015, 75-year-old palliative care nurse Gill Pharaoh ended her life at a Swiss clinic. She did not have a terminal illness, but said her experience as a nurse had shown her the ‘awful’ reality of old age.

In 2016 the RCN, which is neutral on the issue, published updated guidance called When Someone Asks for Your Assistance to Die

Care Not Killing, a group that campaigns against assisted dying, described the case as ‘deeply troubling’.

Charity Christian Medical Fellowship’s head of nursing ministries, Steven Fouch, believes that if assisted dying is legalised in a narrow range of cases the ‘pressure will be on’ to expand it to other patient groups.

He suggests that requests for assistance to die almost always disappear when fears about the dying process and management of symptoms are explained and dealt with effectively.

‘As nurses, our primary concern will always be the well-being of our patients. Once our role is changed to helping end their lives, how will that change our relationship with them? Participation in assisted suicide will, I believe, have a long-term and damaging impact on the nurse-patient relationship.

‘As many doctors are vocally opposed to being involved with assisted suicide for similar reasons, my real concern is that it will be nurses who will be obliged to step into the breach. I further fear that this will mean that any expression of a conscientious objection will lead to disciplinary action and dismissals.’

Assisted dying: implications for nurses

In December last year the RCN published updated guidance called When Someone Asks for Your Assistance to Die. It covers UK laws and provides practical examples, along with guidance on good end of life care.

It says nurses should resist the inclination to ‘ignore’ or abandon the conversation if a patient is asking specifically about assisted suicide and to document conversations, sharing insights with colleagues.

RCN professional lead for long-term conditions and end of life care Amanda Cheesley says: ‘While the RCN remains neutral on the subject of assisted dying, nurses should be prepared for these questions. 

‘They can form the basis of a non-judgemental discussion about the options available. Talking to the patient may uncover unmet needs that can inform future decisions about their care.

‘In certain circumstances, it may be appropriate to prepare an advance decision to refuse treatment. However, the law is clear: a patient cannot use an advance decision to request help with taking their own life.’

To read the RCN guidance click here


 

 

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