RCN issues revised guidance on assisted suicide requests

The RCN has published revised guidance for nurses and healthcare assistants on how to respond to requests from patients regarding assisted suicide.

The guidance, When someone asks for your assistance to die: RCN guidance on responding to a request to hasten death, sets out the legal position for healthcare workers.

It reinforces that assisting suicide is illegal, but also provides practical examples of how to deal with difficult conversations and deliver good quality end of life care.

The document was originally published in 2011 and has been revised to reflect changes to organisations and sources of support for nurses, plus the removal from use of the Liverpool Care Pathway.

Legal guidance

The guidance covers the legal position in England, Scotland, Wales and Northern Ireland, where assisting another person to commit suicide is an offence.

It draws on the experiences of nurses working in all areas of care, and aims to support the relationship between patients and nurses and protect vulnerable individuals.

Topics covered include:

• The law on advance decisions (where patients decide on treatments they do not want to receive in the future, such as life-sustaining treatment).
• Sources of information on high quality end of life care.
• Reasons why people may express a wish to die.
• Responding to a request to hasten death.
• Scenarios nurses may encounter and suggested responses.

Neutral stance

RCN Council voted to move to a neutral position on assisted suicide in 2009. This means that the college does not lobby for or against a change in the law in relation to assisted suicide.

RCN professional lead for end of life care Amanda Cheesley said: ‘Assisting someone to die remains illegal and it is important to emphasise that this guidance does not encourage nurses to instigate discussions with patients on this difficult and emotive topic.

‘However we know that there is a real need to provide support to nurses and healthcare assistants when patients open up to them about their feelings.

‘Sometimes patients talk about ending their lives as another way of expressing concerns about their condition or their level of pain. Nurses should feel confident that asking them about these comments is not assisting or encouraging that patient to take their own life. Such conversations might be the only time a patient discusses their worries, and it is an essential part of nursing practice to recognise and explore concerns.

‘There is only one chance to get care right at the end of someone’s life, and nurses have to be empowered to give compassion as well as expertise, and recognise that each individual has complex physical and emotional needs. The unique position of nurses, spending time with patients and families in all healthcare settings, means that they are the ones who can explore the feelings of patients and the people who are important to them.’

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