We need more nurses to ensure patients have ‘a good death’

The Assisted Dying Bill has pretty much split opinion in the nursing profession just as it has been dividing the House of Lords.

The proposed legislation would mean patients deemed to have less than six months to live could opt for a lethal dose of medication to end their lives.

It is hard to think of many ethical dilemmas as contentious in nursing and that have such passionate advocates on either side of the argument.

Professor Dame Jill Macleod Clark, board member of campaigning organisation Dignity in Dying, has written in this blog calling on nurses to back the bill so that patients’ wishes at the end of their lives are respected.

But Steve Fouch, from the anti-euthanasia alliance Care not Killing, argued that a change in legislation could leave many vulnerable patients feeling a ‘burden’ and under pressure to end their lives.

The government has not agreed to give the Bill parliamentary time so it is unlikely to make it to the House of Commons or become law.

However, whatever the fate of the Assisted Dying Bill, a lot can be achieved now when it comes to improving end of life care. The fact is that the NHS offers some of the best palliative care in the world, but it is not available for every patient and too many are left to die in extreme pain.

One move that could help address this problem is recruiting more nursing staff. The new guidelines from NICE on safe staffing on adult wards is a step in the right direction. But even if wards have a ratio of one nurse to eight patients that only amounts to 7.5 minutes per hour of nursing care for each person being cared for. No one can offer someone a ‘good death’ working under these sort of constraints.

In any case the majority of people would rather die at home. But that option is not always available because of a shortage of district nurses. The RCN has reported that district nurse numbers have nearly halved over the last 11 years. And staff working in the community spend only just over a third of their time on hands on care. Meanwhile people living in nursing homes are not always getting the care they need because there are often insufficient registered nurses.

Nurses have a key role to play when it comes to ensuring patients at the end of their lives have as good a death as it’s possible to have. Making sure that there are enough qualified staff in post to deliver gold standard palliative care is an essential first step to achieving that.

About the author

Elaine Cole is deputy editor of Nursing Standard, published by RCNi