Royal College of Nursing changes stance on "Assisted suicide" to a neutral one.

[wrinklytum]

What does everybody think?

My view is that they should be concentrating more upon ensuring that "End of life" care is the best possible and that palliative care is perceived as vitally important.

Many areas now use guidance tools such a the "Liverpool care of the dying pathway" to ensure that those undergoing palliative treatment have a baseline to work with for what should at the very least be done for patients who are facing this situation.

Additionally I feel that issues such as addressing with the individual and family things such as resuscitation status if they are in the palliative stages of treatment or disease is another area that should be more adequately addressed.

(Ponders after feeling particularly angry at recent situation at work which involved having to put a crash call out on individual,which was futile and somewhat undignified for poor person concerned)

When you say "neutral" all well and good, but i still feel very vulnerable as a practitioner in this situation.

I just feel very sad when put into the situation that you describe.

Yes,very sad.

It is such a "grey area" isn't it?

Re situation.Ha sreally upset me.We worked for half an hour on person with an "Unshockable rhythm".Lots of secretions.Airway maintainence a joke.(Were aerating stomach).Was absolute non starter and very undignified.

It happens.

I get distressed at the little things, like the chest being exposed, i want to cover them up and keep them warm. The amount of people in the bed area, it is undignified, its not right.

yes it does.Bad day at office n'all that.I seem to have meandered off original thread point.Ho hum.Thanks for understanding.

Well, all i can go on is experience and they shouldn't have bought my grandma, with very advanced Alzeimers, back when she had her second heart attack.

Not because of us, because of her - she lay for days in the bed 'seeing' things, chewing on her own bile in the back of her throat and distressing my grandad who would have said the same.

Then she died - sorry - forgot to mention that.

I thought assisted suicide was OK until I read this diary of the son of a terminally ill woman who decided to take her life in The Guardian www.guardian.co.uk/lifeandstyle/2008/aug/23/euthanasia.cancer

The part at which she formalises the agreement I quote below. I found it terrifying in its efficiency. I also really felt that she never had the support of any women in her decision-making and she couldn't bring herself to say the words herself - her son had to. (the second doctor was also a bloke). She was a strong women who was used to the men around her doing what they were told. She was nervous about the suicide, and admitted so herself - I just couldn't help but wonder why they let her do it - I wasn't convinced of her own conviction. I should also add though that I read this not long after the sudden death of my father and the woman looks vaguely similar to my mum, so I am not sure I read it objectively, but I was just so saddened by it. Even if she was going to die anyway, it just seemed so brutal and she still had some quality of life. I think she felt she should do it this way, to be less trouble, and thats what worries me about legalising assisted suicide. People will come under pressure, whether by themselves or by others, to end their lives prematurely.

^The doctor says euthanasia can take place next week. Another doctor first needs to verify, though, that Mum cannot be cured, that her wish to die has been consistent, and that her suffering is unbearable.

Martin is convinced of the first two conditions but not of the third. If Mum is too energetic to stay in bed, then how is her suffering unbearable?

Mum puts her coffee down. "Well, I have to die anyway, don't I?" Then she asks us what we think.

I interrupt: "It should be your own decision. None of us is to say anything."

But Mum struggles to say she wants to die. Eventually I say, "I think what she finds unbearable is not so much her pain and sickness, but the fear of it getting worse and of losing control."

When Martin is finally satisfied that Mum wants to end it, he agrees to contact the second doctor. He leaves with an empathetic nod to us all.^

sausagerolemodel....The article was very touching but almost to realistic,i wanted moodlit champagne not bitching about the type of shoes her son wore...reality is shit sometimes.

Did you click on the link below entitled "life before death"? Very intresting.

wrinkly not related to your op question but wanted to empathise with putting crash call out on someone when they should have been allowed to die with dignity.

I once came on a night shift "lady in bed 12 very unwell, but couldn't get hold of the team today so for resus". I spent first few hours of night shift trying to get Med Reg on call (few years ago now) to make her DNR. He said, "I'm on call, I'll get the crash call, I'll come and sort it out then" !!!

So in the meantime I jump up and down on a poor old lady's chest who never had a hope but doctor too lazy to bother sorting it out beforehand... Was soooo furious.

She didn't die on my night shift but had died by 24hours later.

I think it says something in this day and age when a pet can die with dignity and end their suffering but I ( who has health issues that I do not look forward too) must face the prospect of suffering the pain and agony of degeneration and be made to watch my family suffer through my illness with me.

When my time comes where I can no longer function as I wish too and have become a burden on those around me (including medical staff who's time should be spent helping those who both want it and will benefit from it) I should be able to wave the piece of paper that says I have the right to choose how and when I die and am allowed by law to die with some form of dignity.

My mother had cancer, by the time they bothered to find it it was everywhere including her bones, she wanted the pain to end, she wanted to die with dignity, but because we hold onto some archaic notion that not taking your last pain filled traumatised breath will somehow make everything better in society and is more humane than allowing the peaceful passing of the terminally ill at a time of their choosing she had to endure chemotherapy for one session to kill off all of her cells so that she could then choose not to continue and death would not be some prolonged pain filled epitaph that stuck in the memory of those she loved who could do nothing to ease her suffering. Partitially blind and mentally impaired at the end from the bleed in her brain from the wretching caused by a tumour growing against her asophogus she called over and over again to die.

Life maybe sacred but death should be with dignity and pain free.

I am so torn on this one. On the one hand, I think that we should have the right to determine how and when we die (a wise man lives as long as he ought, not as long as he can), but I fear for the consequences if we do legalise euthanasia and that is what the issue is here in reality.

Not only do I think that some of the elderly would be forced into dying before they would choose to by their families (oooh! hasn't Granny got a big house, doesn't need it, does she?); but that the state would intervene and insist on those who have no families and are in residential care being bumped off. It would also be the ideal way to solve the pensions crisis, and to reduce the size of the social services bill. Do you want to live in a society where that happens, because I don't.

I actually think its a good thing that they have taken this neutral stance ,allows more space for a debate on the issue.
I remember looking after a 90yr old lady who had come into hospital because she was refusing to, eat and drink at the nursing home where she lived . When the consultant spoke to her ,he explained that by doing so she would enveitably die . She said thats the point my dear ,i want to die , all my friends are dead ,my husband is dead ,two of my children are dead ,the other lives in canada and i see her once every two years ,even my dog is dead .I am incontinent ,cant walk ,cant wipe my own bottem ,have pain pretty much all day long ,why on earth would i want to live ? If you had anything about you you would give me an injection now ,like the vet did to my darling dog and let me go in peace and join my family and friends .
Obviousley the dr could not do this ,he prescribed fluids ,that she repeatedly ripped out and eventually she died , six days later .
I agree that legalising euthanasia probably isnt the way forward ,and that end of life care still needs improvement . Oh and as for innappropriate crash calls ,how about jumping on the chest of an anorexic ,who had been dnr ,but whos husband screamed that we had to do something ,who the dr listened to and we broke everyone of her ribs in our futile attempt ,very dignified

I remember looking after a lady on a psycho-geriatric ward when I did a Nursing Auxiliary job post A levels, who was in much the same state as your 90 year old; except she had no family, and was on a ripple bed; and even though we turned her regularly she still had massive bed sores that I had to pack and dress.

This is why I'm torn, remembering her; but I don't want euthanasia legalised, as it is too easy for the powers that confers to be misappropriated; and for the elderly to be hounded to their deaths by unscrupulous relatives in some cases; and by just feeling that they are a burden in general.

I don't know what the answer is; but I would like those who assist a terminally ill relative to take their own life not to be prosecuted.

Agree that changing their stance to neutral is positive if it encourages more debate. Also agree that resuscitation issues should be looked at more closely.

Isn't it funny that assisted suicide is seen in a more favorable light when public finances are in a mess. There are probably health economic arguments for allowing it to happen as a dead patient is a cheap one, whereas good pallative care can be expensive. If the tide of opinion had turned during more prosperous times, I would feel less uneasy. Horribly cynical of me I know, but those of us at the sharp end can't help but wonder.

I think the world would be a better place if there was more emphasis and resources to fund good pallative care and perhaps the resuscitation guidelines were reviewed.

Im not sure assisted suicide is seen in a more favourable light though ,there is still plenty of vociferous opposistion around. I agree that the slippery slope argument is always going to be at the forefront of every health care professionals mind when mulling this one over . However there are always going to be individuals that want to choice a time of dying for themselves when faced with extreme circumstances and at least this change in tack means we can offer them support and information regarding the alternatives . Support doesnt mean standing over them with a syringe by the way

"My view is that they should be concentrating more upon ensuring that "End of life" care is the best possible and that palliative care is perceived as vitally important."

I agree 100%.

Face it, we live in a country where Shipman was only investigated after he tried to alter someone's will. Relaxation of the rules will lead too many elderly people being coerced by greedy relatives.

I am very disappointed by the news of this change.

I had a very similar experience to atlantis, but my response was entirely the opposite. I watch my mum die a terrifying and horrific death from cancer. Death is horrible, it just is. Cancer is awful. But legalizing assisted suicide is not the answer.

If we move into a world where assisted suicide is legal the abuse it would be open to would be horrific. Not to mention the subtle implications: you don't need a pushy relative to put pressure on someone to end it sooner rather than later, if the system and the general attitude towards terminal illness, is geared towards that.

We put down animals because they are not human and, as much as we may love our pets, their deaths are not as important as a human death.

Also, does anyone know what would happen to terminally ill children? Would parents have the right to decide to have them killed?

When hospitals go to court and win the right to turn off the life support machines of children in this country against the parents wishes I think the debate is already lost to the people who do not think anyone should be 'playing god'.

No other country with the right to die with dignity has had a rush of relatives queuing up their old folk for 'extermination' because the law says the person must be of sound mind and give a plausable explanation as to why they want to die and be in a terminal condition to be given that choice.

Why should people have to travel abroad earlier than they would need to pass away, some without their family around them so they can end their life with dignity before their symptoms get too bad that they can not risk losing the chance to be able to complete the task?

Time, money, worry, energy all spent that did not need to be if only this country would pull itself out of the dark ages and stop listening to myth and superstition from the bygone age of the church.

It's on a par with the arguement between Evolution and creationalism, if some still cling to myth and magic then they need not opt in but for the enlightened amoungst us who do not believe in a 'superior' being who chooses when our time is up then allow us to choose for ourselves.

My Great-Aunt had what I'd say was a good death, with excellent care, including a team of docs and nurses who discussed DNR with her and took note of her wishes. If only everyone could have the same treatment and respect, this world would be immensely better.

My sister, a nurse, and I went to see her as she lay very probably dying (although she had surprised everyone by pulling through pneumonia twice in her 90s, so we weren't sure...).

She told us she had had a very happy life, with lots of 'naughty fun' and was now ready to go and meet all the people who were waiting for her. She unburdened herself of a couple of messages she needed to send - this was not easy for her as she had very little breath left, but it was important. After that, she said she felt she could go now.

I was so happy/sad to discover she had died within 24 hours of that visit - as she had predicted. And grateful that no-one had felt obliged to jump up and down and break all her bones in an attempt to stop her going where she wanted to go.

RIP Auntie Hilda, you were fab. As were the docs and nurses at the Countess of Chester.

Morphine in some shape or form has been prescribed by doctors for 'breakthrough pain' for terminally ill patients, for years.

I realise that this is different to an otherwise healthy paraplegic wishing to end his/her life, but worth pointing out that nurses have had the ability to help people on their way for years.

Er ,morphine is used as pain relief in any circumstance that requires it .It is also a controlled substance and we cant skip merrily to the cupboard and help ourselves to help someone else pass away. In pallative care it is only one of many drugs used to combat symptoms ,often given via a syringe driver to allow the maximum benefit ,with additional prescribed doses given as required .We do not give morphine to end life ,we give it to stop pain and the suggestion that nurses can or do is frankly shocking