The following speech was made in today’s debate in the House of Lords on the Assisted Dying Bill 2013-2014 by Lord MacKenzie of Culkein:
My Lords, I am sorry that I am unable to support the Bill in the name of my noble and learned friend, although I know that it has been introduced from the very best of motives. I speak as a nurse who has been on the nursing register for some 39 years. It is some time since I practised, but I have spent a good deal of my working lifetime representing nurses and nursing. Of course, nursing has changed in that time; social attitudes have evolved since my first entry into nursing as a student nurse. But I am clear about this: what has not changed is the ethical basis and ethos of nursing.
I have always understood the central tenet of nursing to be duty of care—about promoting and maintaining health, preventing and/or treating illness and injury and helping patients to recover and, where that is not possible, giving the best quality of life until death. I do not believe that giving the best quality of life until death can include the nurse delivering and assisting the patient to ingest a lethal lytic cocktail on the authorisation of an attending physician.
Doctors are busy people with time at a premium. It is nurses who are with patients for 24 hours out of 24, so it likely to be the nurse who would be, in the words of the Bill, the “assisting health professional” duly authorised to carry out the function of actually assisting the death of the patient by preparing these lethal drugs. I hesitate to use the word “medicine”, which is in the Bill, because medicine, if my Latin is any good, is something to do with healing and not death. The nurse would prepare the medical device, load the syringe driver or, as the Bill says, assist the patient to ingest.
The Bill tries to give safeguards by saying that the final act of self-administration lies with the patient. How will a patient with motor neurone disease who cannot swallow and cannot move their arms because they are paralysed carry out that final act? They will not. They are excluded from the Bill. So the compassion, which we all share, is selective. It does not apply to all people with serious, progressive neurological conditions, for example.
I do not want nurses to be in a position where in the course of their normal duties a patient might say—it could be said as a joke, but it might be said seriously out of concern by a vulnerable patient—“I hope, nurse, you’re not one of these who assist dying”, or perhaps in the more vernacular, “I hope you’re not one of these who bumps people off”.
Many in the medical profession say, rightly, that assisted dying facilitated by a physician will fundamentally alter the patient/doctor relationship. In my opinion, that applies in exactly the same way to the nursing profession. I see any legislation based on the Bill as leading inexorably, maybe a long time in the future, to assisted suicide as a right rather than an exception. We have heard about slippery slopes. I am sure that the noble Lord, Lord Steel of Aikwood, when introducing the Abortion Bill in 1967, said many of the same things that have been said today. Now we see how society has evolved and that position has changed.
If that happens in this country to the public perception of assisted dying, it could follow that there will be seen to be a duty on nurses and doctors to be involved. That is not something that I want any part in facilitating, conscience clauses notwithstanding. This is an enormously difficult area, but there are too many unresolved issues at the heart of the Bill, not the least of which, as it is presently drafted, is that it would lead to nurses being in serious contravention of the Nursing and Midwifery Council code.
Given the intervention of the Supreme Court, there is a powerful argument, despite what my noble and learned friend has said, for a royal commission to take a long, hard look at this issue before it returns to Parliament. For those reasons, not the least of which is the potential for serious damage to the ethics and ethos of nursing and the public trust of nurses, I regret that I cannot support the Bill.