The Royal College of Nursing (RCN) Scotland is calling for additional safeguards to be introduced for nurses in Scotland’s assisted dying legislation to ensure they are well supported.

If the legislation is passed by MSPs, it will introduce a key role for nurses in the assisted dying process and RCN Scotland Director, Colin Poolman outlines why further protections are needed for nurses.

While taking a neutral stance on the Assisted Dying for Terminally Ill Adults (Scotland) Bill, RCN Scotland must emphasise the importance of thoroughly engaging with healthcare staff on the Bill.

RCN Scotland is committed to supporting our members to provide high-quality end of life care, ensuring a comfortable and dignified death.

Since 2009, we have held a neutral position on whether the law on assisted dying should be changed, which reflects our members' differing views on the issue and means we neither support nor oppose attempts to change the law.

However, our neutral position does not mean we are silent on the issue.

If passed by MSPs, the Bill would see registered nurses play a significant role in the assisted dying process. The Bill sets out that, once a terminally ill adult has been assessed by two doctors as being eligible and has made two separate declarations that they wish to be provided with assistance to end their own life, assistance can be lawfully provided by a doctor or a registered nurse.

Providing someone with assistance to end their life will require time in order to provide individuals, and their families, with the necessary care, support and respect. We therefore believe that, if the Bill passes, in practice, it is likely that registered nurses will often be asked to take on this role.  

The RCN has a responsibility to engage in the parliamentary process to ensure that the Bill contains the necessary safeguards to protect nurses and nursing practice.

We are working to protect both nurses who may wish to participate in assisting a death under the framework established by the Bill, and those who may not wish to participate if the legislation progresses.

While we are neutral on the principle of assisted dying, if the Bill progresses beyond stage 1 when MSPs vote next spring, there are a number of changes we wish to see to strengthen the safeguards for nurses.

Choice for nursing staff – and no lone working

Nurses must have a genuine choice about whether or not they are willing to participate and, if they are, to what extent. We want to see the protections in the Bill go beyond the current conscientious objection clause with individuals able to object to being involved for any reason.

We also want to see an ‘opt-in’ model of delivery set out in the Bill, so that only registered nurses who positively choose to participate, and who have completed mandatory training, will be expected to do so.   

Registered nurses will be asked to make final assessments around capacity before providing an individual with assistance to end their own life. These decisions are complex, particularly for younger adults or older people with cognitive impairment, and it is therefore a highly skilled job and will require additional training. 

An ‘opt-in’ model will allow a core workforce to undertake the necessary training and gain valuable experience and confidence performing this role.

We are also deeply alarmed that, under the proposals, a registered nurse could attend alone to provide an individual with assistance to end their life.

Our position is that carrying out the final capacity assessment and providing the approved substance, while working alone, would leave our members open to accusations of coercion or wrongdoing and represents an unacceptable risk.

The Bill must require two registered health professionals to attend together to provide an individual with assistance to end their life.

If the Bill passes, the provision of assisted dying cannot simply be added to existing teams, such as district nursing, which are already under severe pressure.

Dedicated resources for establishing a workforce that has opted-in to provide this service, training and support would be essential.

We’re also acutely aware that many members have concerns about the provision of palliative care and agree that there is a real and urgent need to improve access to palliative care across Scotland.

In some parts of the country there are insufficient services to support people at the end of their lives.

We are clear that, if the Bill passes, there requires to be further investment in palliative and end-of-life care services to accompany the change in law.

Read more:  Assisted Dying Bill - The thin edge of the wedge?; New palliative care strategy for Scotland; Dementia long-term care services need urgent reform; Carers facing full force of health and care crisis; Health and care in the Scottish budget; Independent Living Fund to reopen; Feeley: Social care change can happen now