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

Memorandum by the Royal Marsden School of Cancer Nursing and Rehabilitation


  The Royal Marsden School of Cancer Nursing and Rehabilitation, part of The Royal Marsden Hospital, is a provider of specialist post registration cancer and palliative care education to nurses and allied health professionals. The hospital has a staff of 10 teachers all of whom have a nursing or rehabilitation professional registration. All programmes are developed and delivered in close collaboration with clinical colleagues within the trust. This submission has been prepared by the Assistant Chief Nurse/Head of School, Sara Lister and Lecturer Practitioner Palliative Care Patricia Hunt, following discussion with Consultant in Palliative Care Dr Julia Riley and the Chief Nurse/Deputy Chief Executive Dr Dickon Weir Hughes. This submission has been reviewed by the staff of the School and represents the majority of their views.


  This response will focus on what we consider are the implications of the Bill from the perspective of post registration nurse education:


  3.1.  If this became legislation all nurses working in environments where the powers of this bill maybe enacted would need to undertake education about the implications for nursing practice and the role of the nurse if this circumstance arose. This would obviously have considerable manpower and resource implications in an environment where staffing is already very stretched and the education and training agenda to meet the requirements of clinical governance is already extensive. As a minimum a programme would need to include the following content:

    —  Exploration of the philosophy underpinning the Assisted Dying Bill because this is in significant contrast to the holistic approach underpinning palliative care. Currently palliative nurse education programmes are designed around the principles underpinning palliative care, which are defined by the WHO (2004) as an approach that improves the quality of life for patients with life-threatening illnesses and their families by early identification, assessment and treatment of pain and other physical, psychosocial and spiritual problems. The WHO (2004) principles continue by expressing that palliative care affirms life and regards dying as a normal process and intends neither to hasten nor postpone death. In essence, the current palliative care philosophy taught in palliative care programmes would need to be reviewed as it is contradictory to the legislation within the bill.

    —  A structured framework to enable practitioners to explore their own values and beliefs in respect of assisted dying and to be able to make a conscious decision about the extent they would be involved if the situation arose.

    —  Details of the alternative palliative care provision available. If a patient has developed a therapeutic relationship with the nurse directly involved in their care we suggest that they may first explore these issues with that nurse. Although specialists in palliative care are increasing in number through out the country and will be available to attend a patient to discuss palliative care, it is expected that the patient may want to further discuss this with the nurses directly involved in their care.

    —  Legal background and standing of the Bill.

    —  Implications for their professional practice of the Bill.

    —  Spiritual perspectives of assisted dying.

    —  The practicalities of how a patient will be assisted to die. (The Bill does not make this explicit) If it is going to be through the administration of a drug, the mode of delivery, the action of the drug, potential side effects must be included. This will be necessary; as a patient will want to know what will happen.

    —  How to respond to a patient who expresses a wish to die, the questions to ask and areas to explore.

  3.2.  It is estimated that as a minimum two days would be required to cover the content.

  3.3.  If this legislation was introduced a considerable amount of time in existing palliative care programmes would need to be dedicated to this area of practice. This would detract from the content dedicated to the holistic care of the patient and family including symptom management, pain relief, spiritual and psychosocial issues.

  3.4.  This Bill includes legislation to make provision for pain relief for a person who is terminally ill. Currently there are no legal restrictions to the prescription of appropriate pain relief by a medical practitioner to a person who needs it, so we don't know why this has been included. The restriction to appropriate pain relief is often due to poor access to appropriate palliative care facilities or lack of healthcare professionals with the expertise to prescribe appropriately. We suggest that the funding is increased to improve education for pain management in the terminally ill. Appropriate education with adequate funding is essential.

  3.5.  Section 3 suggests a choice between Palliative care and assisted dying. The approach to palliative care is a holistic one and begins at the point of diagnosis. It is not a treatment option when the pain or symptoms get unbearable. The philosophy of Palliative care is to be involved early in the course of the disease, involving the patient and family so symptoms and pain never become unbearable. Palliative care should be available to an individual who chooses assisted death. This should not be an either/or situation. From the education perspective it is essential that the bill doesn't suggest this.


  We oppose this legislation. We suggest that the interests of dying patients and their families would be better served by increasing the funding available for palliative care, specifically improving the opportunities for healthcare professionals to access appropriate education to enable them to develop the competencies required to give patients effective palliative care.


  WHO (2004) WHO Definition of Palliative Care (Electronic Version) retrieved 20 August 2004 from

August 2004

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