Nurses guidance highlights gap in current law on assisted dying.

As a step towards addressing this problem, the Royal College of Nursing’s (RCN) guidelines on responding to requests for a hastened death, published today, are very welcome. However, as much as they try to fill the gap created by the current law, they also serve to emphasise it.

One of the factors the Director of Public Prosecutions has said weighs in favour of prosecution in cases of assisted suicide is that the assistor “was acting in his or her capacity as a medical doctor, nurse, other healthcare professional…”

Understandably, this has caused confusion amongst healthcare professionals and, potentially, damage to patients: As today’s RCN publication says, practitioners may “feel concerned about their legal position and be anxious about potential professional sanctions. As a consequence, they may close down the communication quickly, leaving the patient feeling isolated and with no outlet for discussion their wishes and concerns.”

So these RCN guidelines aim to support nurses and healthcare assistants to dealing with such conversations. This is positive in itself: it makes clear that nurses can and should have these conversations; that by doing so they are not breaching the law, so long as they do not assist patients in contacting organisations supporting assisted suicide.

Other than that, few actions are explicitly permitted or proscribed by the guidance (although of course it makes clear that any action to hasten death is illegal). This is not that helpful for professionals who are unsure whether a given act a patient has asked them to perform is legal; that is, whether or not it constitutes “assistance”. However, this is not the fault of the guidance, they could not do much else given the current state of the law, and the lack of clarity from the Director of Public Prosecutions as to what constitutes “assistance” by healthcare professionals.

It’s also notable that the guidance warns nurses and Health Care Assistants (HCAs) that their jobs potentially make them liable for prosecution if they assist a friend to die in a personal capacity. This would mean that a person’s profession determines how the law applies to their private (ie non-professional) conduct. Although this is not the DPP’s interpretation of his guidance, it goes to show the extent of the confusion, uncertainty and damage surrounding the current law.

The RCN have made a noble effort to help their members navigate this complex area, but to achieve real clarity for healthcare professionals we need further guidance from the DPP.