Following a vote yesterday (Thursday 9 June 2022) at the Royal College of Nursing (RCN)’s annual congress in Glasgow, the College will update its neutral position statement on assisted dying to reflect the changing landscape of the debate and to explore how it can best support and inform nurses on the issue, maintaining the neutral stance it first adopted in 2009 and reaffirmed in 2014. The resolution, submitted by the RCN Wales Board, passed with 69% of the vote yesterday, with 18% votes against and 12% abstained.
Please find a statement below from Sarah Wootton, Chief Executive of Dignity in Dying, which campaigns for a change in the law to allow assisted dying as a choice for terminally ill, mentally competent adults alongside high-quality end-of-life care, subject to strict safeguards. Further written comment is available on request from Prof Dame June Clarke, member of the RCN Wales Board and former president of the RCN, and from Alison Pickard, a terminally ill former nurse who campaigns for the choice of an assisted death. Please contact Molly Pike for requests or further information.
Sarah Wootton, Chief Executive of Dignity in Dying said:
“Nurses have a valuable role to play in the assisted dying debate, and yesterday’s vote demonstrates the RCN’s commitment to engaging constructively in it and truly representing the range of views among its members. The College should be commended for its sensible and pragmatic approach, which it has held since 2009 and which has led the way for a growing number of medical and healthcare bodies to follow suit, including the British Medical Association, the Royal College of Physicians, the Royal College of Psychiatrists and the Royal Pharmaceutical Society, all of which have since adopted neutral positions on assisted dying.
“The RCN’s decision yesterday recognises that assisted dying is an issue that is not going away and that nurses need to feel informed and prepared in the event of law change. Bills are progressing in the Scottish, Jersey and Isle of Man Parliaments, and a debate is due in the House of Commons after our government petition garnered more than 136,000 signatures. Safe, compassionate assisted dying laws are being introduced in ever more states and nations around the world, while the damaging impact of the UK’s outdated legislation is becoming increasingly apparent.
“Sixty-two per-cent of almost 250 nurses and midwives surveyed in a 2019 poll said they had personal or professional experience of caring for someone who has suffered at the end of their lives despite receiving high quality palliative care. Recognising the limits of current options but denied a safe, legal alternative, many dying people are forced to take matters into their own hands, either at home using unsafe and unregulated methods or travelling to Switzerland at huge expense. New data from the Office for National Statistics indicates that terminally ill people may be twice as likely to take their own lives than the general population. This is not simply a matter for debate but one of patient safety, so it is not surprising that nurses at the RCN congress voted overwhelmingly for the College to build on its neutral stance and explore how best it can support and inform nurses on the issue.”
For further information please contact Molly Pike, Media and Campaigns Officer, Dignity in Dying, at firstname.lastname@example.org or 07929731181.
Notes to Editor:
In 2009 the RCN’s governing council voted to move to a neutral stance on assisted dying for people with terminal illnesses after a consultation with its members. The RCN’s most recent position statement was published In 2014. The resolution passed at the 2022 congress yesterday requires the RCN to put in place a plan to review this statement, while maintaining its neutral stance, to reflect recent developments including sharing relevant information on legislative proposals.
Polling of nurses and midwives conducted by YouGov in March 2019, commissioned by Dignity in Dying as part of its report, The Inescapable Truth: How 17 people a day will suffer as they die
The British Medical Association (BMA) dropped its official opposition to a change in the law on assisted dying in favour of neutrality, following a debate at its Annual Representative Meeting in September 2021. The largest ever poll of British doctors on assisted dying, conducted by the BMA last year, found overwhelming support for a change to the BMA’s former stance of opposition to an assisted dying law (61%), and that half of doctors personally support a change in the law (50%).
In March 2019, the Royal College of Physicians (RCP) dropped its longstanding opposition to assisted dying in favour of neutrality following a member survey. The Royal Society of Medicine, Royal College of Nursing (and Royal College of Nursing Scotland), the Royal College of Psychiatrists and the Royal Pharmaceutical Society all hold neutral positions on assisted dying.
The Royal College of Surgeons of England announced in March 2022 that it would be surveying its members for its views on assisted dying and reviewing its current opposition to law change, a stance held since 2014.
The Academy of Medical Royal Colleges, Association of British Neurologists, General Medical Council, General Pharmaceutical Council, Royal College of Anaesthetists, Royal College of Obstetricians and Gynaecologists, Royal College of Ophthalmologists, Royal College of Paediatrics and Child Health, Royal College of Pathologists, Royal College of Physicians of Edinburgh, Royal College of Radiologists and Royal College of Surgeons of Edinburgh have no stated position on a change in the law on assisted dying.
In September 2020, Eminent GPs Prof Aneez Esmail and Sir Sam Everington launched a legal challenge to the Royal College of GPs (RCGP) alongside the Good Law Project and Dignity in Dying over RCGP Council’s decision to maintain opposition to assisted dying despite its own survey showing a dramatic shift in GP opinion. The Association for Palliative Medicine also holds a stance of opposition to a change in the law on assisted dying.
Dignity in Dying
Dignity in Dying campaigns for greater choice, control and access to services at the end of life. It campaigns within the law to change the law, to allow assisted dying as an option for terminally ill, mentally competent adults with six months or less to live.
Assisted dying is prohibited in England and Wales under the Suicide Act (1961), and in Northern Ireland under the Criminal Justice Act (1966) which states that anyone who “encourages or assists a suicide” is liable to up to 14 years in prison. There is no specific crime of assisting a suicide in Scotland, but it is possible that helping a person to die could lead to prosecution for culpable homicide.
In Jersey there is no specific legislation that governs suicide or assisting a suicide, however attempted murder and aiding, abetting, counselling and procuring murder are offences under Jersey law and it is conceivable that assisting another person to take their own life could be charged under one of these offences.
Dignity in Dying’s official government petition (136,325 signatures at time of writing, currently awaiting date for Westminster Hall debate):
Isle of Man Private Member’s Assisted Dying Bill
On 24 May 2022 Members of the House of Keys voted overwhelmingly (22-2) to allow a private member’s bill on assisted dying to be introduced by Dr Alex Allinson MHK. A public consultation is now expected over the summer before draft legislation is prepared by the end of the year for review by a Tynwald committee. This follows a motion on assisted dying proposed by Dr Allinson in January 2020 which was rejected at the time.
Assisted Dying Scotland Bill proposal
Liam McArthur, Lib Dem MSP for Orkney, lodged the ‘Assisted Dying Scotland’ Members Bill proposal with the Non-Government Bill Unit (NGBU) of the Scottish Parliament in June 2021. A Consultation on the contents of the bill launched in September 2021 and closed in December, after receiving an unprecedented response. The proposal seeks to introduce the right to choose an assisted death for terminally ill, mentally competent adults in Scotland. The consultation responses are currently being analysed and a report will be compiled in the coming months.
States of Jersey assisted dying debate
The States Assembly on November 25 voted in favour of a proposition to support a change in the law on assisted dying by 36 to 10. The Council of Ministers will now be tasked with preparing final proposals for debate by October 2022 (after the June general election) with draft legislation to be available for debate by the States Assembly by end of March 2023. As part of the preparation for the final proposals, a public consultation was launched in March 2022. The consultation will continue into the summer, before a States Assembly debate on detailed assisted dying proposals is held in November. Draft legislation with then be prepared and debated in May 2023, after which a minimum 18-month implementation period will be begin. The earliest date for assisted dying to become available in Jersey is therefore late 2024 or early 2025.
The debate follows a citizens’ jury on the subject, comprised of a random representative sample of islanders, which strongly recommended a change in the law to enable islanders who are terminally ill and unbearably suffering to be able to request medical assistance to end their own life.
House of Lords Private Member’s Assisted Dying Bill
Baroness Meacher’s Assisted Dying Bill passed its Second Reading unopposed in the House of Lords (Friday 22 October 2021). Further time for consideration at Committee Stage was not allocated before it fell at the prorogation of Parliament on 28th April.
The Bill was selected seventh in the House of Lords private members ballot in May and received its First Reading on Wednesday 26th May 2021. The full text can be found here: https://bills.parliament.uk/bills/2875. It is based on a bill introduced by Lord Falconer in 2014. Rob Marris MP introduced a similar bill in 2015 which was defeated in the Commons.
The functioning of the current law on assisted dying was the subject of a Backbench Business Committee Debate in July 2019 and a Westminster Hall debate in January 2020, at which a majority of MPs speaking called for a review of present legislation.
Lord Forsyth’s amendment to the Health and Care Bill
A vote on Lord Forsyth of Drumlean’s amendment to the Health and Social Care Bill which would have required the Government to present a draft assisted dying bill to parliament within a year was narrowly lost in the House of Lords on Wednesday 16th March. The amendment received 145 votes in favour and 179 against. The amendment, which stated that it would enable both Houses to properly consider the issue and that it should be a matter of individual conscience, fell after Government instructed Conservative Peers to vote in opposition.
Lord Forsyth recently revealed that he had changed his mind on assisted dying after his father, dying in pain of bladder cancer in 2020, criticised him for opposing previous Bills which would have allowed him the option.
Falkland Islands motions on assisted dying
In 2018 the Legislative Assembly of the Falkland Islands voted to support a motion that terminally ill residents should have the right to die at a time and place of their choosing, subject to robust legislation and safeguards. A second motion stated that should assisted dying legislation be introduced in the UK, the Falkland Islands would consider adopting it. Both motions passed by four votes to three with one abstention.
Special Oireachtas Committee on assisted dying in Ireland
In November 2021 the Dáil announced that a Special Committee on assisted dying would be established in early 2022 to examine the topic, which will run for 9 months.
In the US, assisted dying as an option for terminally ill, mentally competent adults in their final months of life is legal in 11 jurisdictions: Oregon (1997), Washington, Vermont, Montana, the District of Columbia, California, Colorado, Hawaii, New Jersey, Maine and New Mexico (legislation approved April 2021).
In Australia, assisted dying is a legal choice for terminally ill citizens in all states, with only the territories remaining: Victoria (June 2019), Western Australia, Tasmania, South Australia, Queensland and New South Wales (May 2021).
In November 2021 New Zealand implemented an assisted dying law which legalised this option for terminally ill, mentally competent citizens, following a public referendum on the End of Life Choice Act in October 2020.
Spain passed a law allowing euthanasia in March 2021.
Austria’s Supreme Court ruled in December 2020 that its blanket ban on assisted dying is unconstitutional. Assisted dying became legal for adults who are terminally ill or have a permanent, debilitating condition in Austria in January 2022.
In November 2021, an Italian ethics committee approved for the first time an assisted dying request, after a 2019 Constitutional Court ruling that assisted dying is lawful for terminally ill people and those with chronic and irreversible conditions that cause suffering the person considers intolerable. In February 2022 Italy’s Constitutional Court rejected a petition to hold a referendum on assisted dying.
In Portugal, the President of the Republic, Marcelo Rebelo de Sousa, rejected, for the second time, the assisted dying bill, which needed to be approved by him to enter into force. The Bill, which has already been approved twice by Parliament, will now need to be debated again.
Germany began considering potential assisted dying legalisation in January 2021 after its Constitutional Court struck down the ban in 2020.
Canada introduced assisted dying legislation in 2016 permitting those suffering from a grievous and irremediable medical condition.
In Colombia legislation was passed in 2015 which permits those with terminal illness or unbearable suffering to request access to life-ending medication.
Assisted dying is permitted in Switzerland, including for foreign nationals, and broader right-to-die laws are in place in Belgium, the Netherlands and Luxembourg.