Select Committee on Assisted Dying for the Terminally Ill Bill Written Evidence

Letter from Nessa Coyle, RN, PhD

  I respectfully submit the attached papers[9]as evidence to the Committee in the House of Lords as its members review the Bill before the House on Assisted Dying for the Terminally Ill.

  I am a nurse, who originally trained at St Bartholomew's Hospital in London, but have been working for the last 30-years at Memorial Sloan-Kettering Cancer Center in New York City. Since 1981, my clinical practice in our Pain and Palliative Care Service at Sloan-Kettering has focused on working with highly symptomatic advanced cancer patients and their families on both an inpatient and outpatient setting.

  I am very familiar in working with terminally ill cancer patients who have expressed a desire for hastened death and the work that has been done by others suggesting that psychological and social factors have typically appeared to have more influence on the desire for death than physical symptoms. My own interaction with patients who had expressed a desire for hastened death made me realise that such an expression had many meanings and uses to the patient, and that such an expression was a form of communication and not necessarily a literal request.

  In order to understand better what patients were asking for when they expressed a desire for hastened death, I recently undertook a small exploratory qualitative study with seven patients who were living with advanced cancer and had expressed a desire for hastened death. Through their own words—their narratives—of what it was like to live with advanced cancer I learned that the expression of desire for hastened death had many meanings and uses and was a tool of communication. It was a language that "ratcheted up the noise" and caused those who were involved in the patient's care to sit down, listen and "hear" what was being asked for and what was needed by the patient.

  What struck me especially not only through the findings of this study but also through my ongoing work with these patients and families over many, many years, is their incredible vulnerability—their vulnerability to their environment and their vulnerability to the verbal and non-verbal communication of those around them—family, friends and staff.

2 September 2004

9   Not printed, see Oncology Nursing Forum, Vol. 31, No 4, 2004 and Journal of Supportive Oncology 2003, 1: 206-215. Back

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