Select Committee on Assisted Dying for the Terminally Ill Bill Minutes of Evidence

Memorandum by the Nursing and Midwifery Council

  The Nursing and Midwifery Council (NMC) is an organisation set up by Parliament to protect the public by ensuring that nurses and midwives provide high standards of care to their patients and clients. As a regulatory body for nursing and midwifery, the primary function of the NMC is public protection through professional standards. One of the most important ways of serving the public interest is by the provision of advice and guidance to our registrants on professional issues.

  The Council has 23 voting members, of which 12 are practitioner members and 11 are lay members. Meeting quarterly, they set Council policy.

  The Nursing and Midwifery Council would like to submit evidence on the Assisted Dying for the Terminally Ill Bill [HL] by:

    —  Commenting on the relationship of the bill to the field of palliative care that nurses practise in both generalist and specialist roles.

    —  Commenting on the role of the nurse as defined in the bill.

  1.  The Nursing and Midwifery Council is aware that there has been an identification of inconsistencies in palliative care services in the report Palliative Care Fourth Report of Session 2003-2004 (House of Commons Health Committee 2004). The report recognises that there exists inequity by geographical area, by patient group and by disease group. This report also recommends that the skills of healthcare staff are raised and that training in palliative care becomes part of continuing professional development. Recurrent themes run throughout the report regarding issues of patient choice, equity of care, communication, recognition of cultural beliefs, workforce issues and quality assurance. Palliative care is defined by the World Health Organisation as an approach "that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of an early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual". The WHO declares that palliative care "provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process" and it "intends neither to hasten or postpone death". The NMC welcome the recognition within this Bill that the main concern is to relieve suffering. However, the Nursing and Midwifery Council is concerned that there is potential conflict for the role of the nurse working within palliative care. Specifically paragraph 3(1) which states that "the attending physician shall ensure that a specialist in palliative care who shall be a physician or nurse has attended the patient to discuss the option of palliative care" and the definition of "unbearable suffering" [paragraph 2:2(d)] defined as "suffering whether by reason of pain or otherwise which the patient finds so severe to be unacceptable and results from the patient's terminal illness". The NMC is concerned that due to the aforementioned report of inequalities around the provision of palliative care and the recognised need to improve the education of health professionals that nurses may be placed in challenging professional and ethical positions should a patient request assisted dying which might actually be a direct consequence of inequity of local service provision.

  2.  There is no comprehensive definition of the nurse within the Bill. The NMC is concerned that paragraph 2, provides clear definitions of the roles of the attending physician and the consulting physician but only identifies nurses as a member of the medical care team "assisting the attending physician". A diverse group of roles are practised within the specialty of palliative care by nurses with varying degrees of responsibility and autonomy. Nurses are more often than not the principal professional for patients who are in the end stages of life. This has not been adequately addressed by the Bill.

  3.  The NMC recommend that conscientious objection in paragraph 7(2) should not just be identified for medical staff and should include nursing staff. Although medication will be prescribed by the physician nurses may be ultimately responsible for the administration and titration of the medications to keep the patient free from pain and distress as stated in paragraph 15.

  4.  Paragraph 13 sets out the requirements for documentation. The NMC is concerned that there is no consideration of nursing documentation. The Nursing and Midwifery Council believes that record keeping is a fundamental part of nursing and midwifery practice and it is recommended that this is incorporated into the Bill.

  5.  Paragraph 14 sets out the monitoring commission and reporting requirements. The NMC is disappointed that there is no recommended nursing member on the monitoring commission. The NMC acknowledges that palliative care is undertaken within a broad multiprofessional framework, however, the role of the nurse within the speciality is a fundamental one and there are distinct regulatory and professional issues to be monitored.


  The Nursing and Midwifery Council recognises that there are strong views within the nursing profession regarding end-of-life issues.

  The NMC Code of Professional Conduct: standards for conduct, performance and ethics (2004) states that nurses must protect and support the health of individual patients and clients. The Code also clearly directs that nurses must respect the rights of the individual and the patient/client's role in planning their own care. Nurses are advocates for the patient/client and have a legal, moral and professional duty to care recognising the patient/client's right to individual choice at all times.

  The NMC welcomes the recognition within the Bill that the main concern is to relieve dying. However the conclusion of this organisation is that there requires to be more detailed consideration of the highly valued nursing roles that practise within this domain of care.


  House of Commons Health Committee (2004) Palliative Care Fourth Report of Session 2003-2004, Volume One, London: The Stationary Office Ltd.

Nursing and Midwifery Council (2004) The NMC Code of Professional Conduct: standards for conduct, performance and ethics, Nursing and Midwifery Council.

20 August 2004

previous page contents next page

House of Lords home page Parliament home page House of Commons home page search page enquiries index

© Parliamentary copyright 2005