Nurses’ college criticised for suicide policy change

The Royal College of Nursing (RCN) has been criticised for changing its position on assisted suicide from opposed to neutral after hearing the views of a tiny proportion of its members.

Just 1,200 of the RCN’s 390,000 members responded to its consultation on the issue. Of those, 49 per cent said they would support assisted suicide.

  • A palliative care expert on why a premature death is not the answer to suffering
  • Dr Peter Saunders, General Secretary of the Christian Medical Fellowship, called the move “bizarre”.

    He said: “The number of respondents represents less than one third of one percent of the RCN’s 390,000 members and we are told that less than half were even reached by the consultation.

    “This is surely no basis for a shift in the stance of the RCN in this highly controversial issue especially given that this minute sample, in which lobby groups are no doubt disproportionately represented, predictably voiced a very broad range of opinion.”

    The Times reported on Saturday that RCN members are now to “receive new guidance on how to help terminally ill patients to end their own lives”, although its online report now says the guidance will focus on “how patients can deal with terminal illness”.

    According to RCN Chief Executive Dr Peter Carter, members are to receive “guidance around the legal, ethical, regulatory and clinical issues of assisted suicide”.

    To aid or abet anyone to commit suicide is illegal. An attempt to water down the law by allowing an exception where an individual is helped to travel to an overseas suicide clinic was recently defeated in the House of Lords amid concerns about vulnerable people.

    The Times claims that the RCN’s move is “the first sign of change in the medical establishment” in its view of assisted suicide.

    But the British Medical Association recently voted against legalising the practice, and their opposition is shared by the Royal College of Physicians, the Royal College of General Practitioners, the Royal College of Psychiatrists, the Royal College of Anaesthetists, the Association for Palliative Medicine of Great Britain and Ireland and the British Geriatric Society.

    The Times, which supports changing the law on assisted suicide, also reports a new poll showing public support for allowing doctors to help patients end their lives prematurely.

    The Care Not Killing alliance warned that the results reflected “Knee-jerk approval of assisted suicide from the worried well”.

    The alliance said the poll had been “carefully timed immediately to follow the media storm around recent high-profile celebrity suicides”.

    It said the findings should be seen within the context of opposition from groups representing doctors and disabled people who “have a good understanding of the dangers to public safety that would accompany any change”.

    Don’t change the law in fear of death

    Kathryn Mannix has been a palliative care doctor for 23 years. In her contribution to a series of letters on assisted suicide published in The Times, she explains why she believes a premature death is not the answer to suffering.


    Sir, The debate in these pages reads as though there is only ‘a good death’ or unbearable suffering at the end of life (“Be honest about the dying process”, letter, July 21). This may reflect the strong feelings of the contributors, but it does not reflect the reality of most people’s experience at the end of their lives.

    As a palliative care doctor for the past 23 years, I have seen the journey towards the end of life at close quarters for in excess of 5,000 people. Work in palliative care involves meeting each of these people as individuals. There is no “one size fits all”. Some people wish above all for relief from physical symptoms, and the attention to detail that the science of palliative medicine has brought to the practice of palliative care has enabled us to improve management of breathlessness, nausea, diarrhoea, itch and many other symptoms, as well as a continuing improvement in our ability to diagnose and manage causes of pain. Physical symptoms, though, are only one aspect of palliation.

    The emotional journey that people follow once it is known that they have a life-threatening illness is complex and personal. For some there is initial horror and dread, for others there is sadness and regret, and for others there is anxiety and fear. These are normal and natural reactions to such bad news, and most people move through this period of profound emotional disturbance to a calmer frame of mind where pleasure and joy are still part of their daily experience, even if punctuated by some sadness at the transience of life or anxiety about the uncertain future. A few get stuck in their emotional distress, and palliative care practitioners would see this as an emotional symptom just as important to address as any physical symptom.

    In parallel with these issues, each person is on a spiritual journey through which they interpret the meaning of their lives. For some this is a religiously based belief, while for others it is about personal worth and contribution to ideals they hold dear, such as family life, care for the environment or world justice. In palliative care we seek to support them in reaching their own inner peace as they measure their triumphs and failings against their own set of ideals.

    For some, physical symptoms are few, emotional adjustment proceeds smoothly and their spiritual framework consoles them and contributes to their resilience. For others, difficulties may arise transiently in any one of these domains, and may be met by personal resources or may require additional support from a variety of health, psychological or spiritual advisers. For a few, difficulties in one or more of these domains are severe, and specialist support from palliative care teams may be required.

    In other words, this is just real life. Some people appear to get by easily and meet few difficulties; others encounter difficulties and meet them with success; others need help to manage their difficulties and a few get stuck. As a society, we have developed resources to assist people in difficulty. We have not previously proposed that a useful response to being stuck in a difficult position is to offer premature death as an alternative.

    I am saddened by the number of contributors who feel anxious about dying. Perhaps they have been witness to one of the unusual difficult deaths that do still occur, or perhaps the way in which our society has increasingly hidden death away over the past five decades has deprived them of the comfort that comes from repeatedly seeing the end of life well-lived with courage, pleasure in each day and peace of mind despite the imminence of the unknown.

    Witnesses of good deaths do not appear to feel a need to enter into this type of correspondence. This unfortunately means that the difficult and tragic is overrepresented in the discussion. How can we redress this balance, so that we do not misunderstand and fear death as a society, and thus legislate in ignorance based on fear?

    Kathryn Mannix,Consultant in Palliative Medicine,Newcastle upon Tyne Hospitals and Marie Curie Hospice, Newcastle

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