A Dangerous Road for Nurses to Tread

Here is an interesting article from The Times. What are your thoughts?

The Royal College of Nursing’s shift to becoming ‘neutral’ on assisted suicide is a disgrace

I am astonished — there is no other word for it — that the Royal College of Nursing has decided to move from a position of opposing assisted suicide to one of neutrality. This decision is simply not rooted in firm ground: it has emerged from the RCN Council like Athena springing from the head of Zeus. Worse still it seems to involve some potentially dangerous thinking.
It would appear that the RCN’s “consultation” with its members on its website produced “over 1,200 responses”. But the RCN has 390,000 members. No one would expect a majority — or even a sizeable minority — of members to respond: nurses are very busy people caring for sick patients and few of them have either the time or the inclination to pay much attention to the website. But to base a serious shift in the college’s stance on the opinions of 0.3 per cent of the membership is nothing short of irresponsible. It is reminiscent of some of the worst features of bad trade union activity in the 1960s and 1970s.

The message conveyed in a declaration of neutrality could encourage nurses to believe that the college thinks there are no serious ethical issues involved.

The general secretary of the college has been quoted as saying that the change in stance from opposition to neutrality will enable nurses “to engage in dialogue” with their patients on assisted suicide.

Let us put the spin aside and be clear what this means. Encouraging or assisting suicides is a criminal offence in this country, as it is in most others. Were a nurse to be convicted of such an offence, that would of course put into question his or her fitness to practise. Some people may not find this position to their liking, but we simply cannot have nurses — or anyone else for that matter — engaging in “dialogue” about something that is against the law. For the RCN Council to imply anything different is, frankly, dangerous.

If dialogue means listening to a patient’s anxieties about his or her medical condition and discussing how that can be better alleviated (including why committing suicide isn’t the way forward), fair enough. But that has been a normal part of nursing practice for as long as anyone can remember and it is not at all clear how it can be affected by the arbitrary shift in the college’s position on assisted suicide.

The only dialogue on this subject that nurses can engage in with patients is to point out that assisting suicides is illegal and that they cannot have any part in it. Nurses are as bound by the law on not assisting suicides as is any other citizen and they should remember that.
Those who are involved in healthcare know that appeals to be helped to die made by seriously ill patients are not uncommon, but invariably are a cry for help or reasssurance rather than a serious request. Sometimes the underlying issue is not even their health but something like money or personal relationships.

I recall the story of a man with a wife and young children who was suffering from a serious and disfiguring facial tumour. He pleaded to be allowed to commit suicide. Instead he was treated by a palliative care team. He got better and returned to his family, only for his wife to die suddenly. If he had committed suicide the children would have been orphans.

There is a possibility that the college is planning to go further on the issue of neutrality, by talking to the MSP Margo MacDonald about her proposals for legalising assisted suicide in Scotland. Ms MacDonald says that she would be “very grateful for the nurses’ input”. She goes on to say that “the RCN recognises that there is a public mood to deal with choices at the end of life”.

It is not clear whether Ms MacDonald is saying this on her own authority or whether it is what she has been told by the college’s leaders. But it is clear that the RCN should not be providing input to the development of proposals for assisted suicide. Is this what is meant by neutrality?
We should all be concerned about these developments. I say this not only because I oppose the legalisation of assisted suicide, which I believe would put thousands of vulnerable sick people at risk of self-harm, but also because it looks very much as though the RCN Council is using a microscopic sample of nursing opinion to steer the college on to a politically controversial course.

My experience of many years spent in the nursing profession tells me that the majority of nurses remain opposed to helping their patients to kill themselves and are more concerned with improving their healthcare. The RCN Council appears to think otherwise, but a judgment based on ignorance of what more than 99 per cent of nurses think hardly carries conviction.
If the college is to convince its members that it is not using them for its own political purpose, it should carry out a far more searching consultation.

Baroness Emerton is a crossbench peer and Fellow of the Royal College of Nursing