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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