Opinion

Why I support assisted dying

A change is the law is overdue, argues nursing professor Dame Jill Macleod Clark

I am committed to campaigning for a change in law in order to allow terminally ill, mentally competent adults the right to choose an assisted death. This is probably one of the most important social issues of our time and we have a professional responsibility to engage with the debate.

It is nurses who provide the vast majority of physical and emotional support to dying patients and their families and there can be few members of the profession who have not felt impotent when caring for those who suffer intolerably in their last weeks and days of life.

We know that sadly, in spite of excellent palliative interventions, some people will not have a good or peaceful death and will experience intractable symptoms such as pain, nausea or breathlessness as well as a loss of dignity and control. The National Bereavement Survey (VOICES) data found that approximately 2% of dying patients in a hospice had no relief of their symptoms during the last three months of their life.

Assisted dying has been legal in Oregon, USA since 1997 and we can learn a lot from their experience. We know that whilst relatively few terminally ill adults request this option, the greatest benefit is that it provides peace of mind gained from the knowledge that it is available. Only one out of 10 patients who discuss assisted dying with their doctor in Oregon go on to take life-ending medication; the vast majority are reassured that palliative care will prevent their suffering. An assisted dying law allows these conversations to happen.

The Oregon law was drawn up to provide clear, upfront safeguards, ensuring that the patient is always at the heart of the process and that potentially vulnerable patients are protected. Any healthcare professional, including nurses, would have the right not to participate in any part of the process on the grounds of conscientious objection.

The overwhelming majority of the public supports a change in the law and this includes increasing numbers of nurses and other healthcare professionals, as was shown by a recent letter to peers signed by 11 present and former presidents of royal medical colleges. Yet people at present are forced to fly to Switzerland, take their lives into their own hands, often with the assistance of a family member who risks prosecution, or continue to suffer against their will in the final weeks and days of their life.

Dying people need to have control over the manner and timing of their death. As nurses, we should ensure that patients' wishes inform every aspect of their care.

About the author

Dame Jill Macleod Clark is professor of nursing at the University of Southampton, a board member of Dignity in Dying and member of Healthcare Professionals for Assisted Dying (HPAD). This article was written in a personal capacity.

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