The debate around assisted dying has been revived in the UK with the presentation of the Terminally Ill Adults (End of Life) Bill to the House of Commons, which, at the time of writing, is at the committee stage. This bill proposes the legalisation of assisted dying (alternatively known as ‘assisted suicide’ or ‘medically assisted death’) in England and Wales, with specific caveats incorporated regarding how and when an individual would be able to access a medically assisted death. To be provided with assistance to end their own life, a person must:
Only after approval from the High Court can provisions be put in place for a medically assisted death, which must be performed by the coordinating doctor, deemed by the bill to be a registered medical practitioner with the necessary training, qualifications and experience (UK Parliament, 2025). The coordinating doctor may be accompanied by other healthcare professionals considered eligible to assist by the bill, which includes other registered medical practitioners, registered nurses and/or registered pharmacists or registered pharmacy technicians (UK Parliament, 2025).
If passed into law, the Terminally Ill Adults Bill, with its inclusion of nurses into the assisted dying process, will have a significant impact on the nursing profession, especially in those domains of practice where a practitioner might be most likely to encounter patients desiring an assisted death, such as palliative care and community nursing. It is worth noting that the bill already establishes a framework for legal protections against coercion or punishment of healthcare professionals who do not wish to participate in the assisted dying process, and exempts healthcare professionals who provide assistance from any criminal or civil liability if their participation is executed in accordance with the conditions set out in the Act. However, ethical concerns, training needs and management of nurses’ psychosocial wellbeing will comprise some of the many areas requiring research, education and guidance.
The ethical conundrum
In terms of the ethical challenges encountered by nurses in assisted dying, lessons can be learnt from other countries where medically assisted death has been legalised, such as Canada, New Zealand and the Netherlands. Pesut et al's (2020a) qualitative study, drawing from semi-structured interviews conducted with 59 registered nurses and nurse practitioners, provides insights from the Canadian context. The study clearly demonstrates the moral and ethical paradoxes often encountered by nurses participating in assisted deaths. Clinical experiences of watching patients suffer were a significant factor in nurses’ decisions to participate, with participants speaking of the moral distress they experienced when they were unable to alleviate suffering in high-acuity care or end-of-life scenarios (Pesut et al, 2020a). Medically assisted death provided a definitive way to end a patient's physical and emotional distress, thereby offering relief for nurses who had to witness that suffering, with one interviewee stating:
‘Seeing [patients] transition from a state of desperation and exhaustion to a state of relief and knowing that we're actually able to do something for these individuals was not just empowering, but it actually felt like we were doing something’ (Pesut et al, 2020a).
However, in contrast, some nurses expressed feeling as if they had ‘killed someone's mother’ or ‘killed someone today’. Others spoke of their commitment to professional values clashing with the concept of assisted death, with those who were palliative care nurses referencing the palliative philosophy of neither hastening nor postponing death (Pesut et al, 2020a). A narrative review of nursing ethics literature on medically assisted death confirmed this moral contradiction: nursing's tacit values of alleviating suffering, preserving dignity, addressing meaningfulness, guarding sanctity of life, altruistic beneficence and acting with compassion were used to argue both for and against assisted dying (Pesut et al, 2020b).
Nurses’ close relationships with patients may also pose ethical dilemmas. This was highlighted by Karen Sanders, former Chair of the Royal College of Nursing (RCN) Ethics Forum Steering Committee, in a memorandum submitted as evidence for a House of Lords Select Committee for the eventually rejected Assisted Dying for the Terminally Ill Bill of 2005. She stressed that nurses are the healthcare professionals who ‘…day in and day out, witness the severe and intolerable distress that can accompany patients who are dying’ (UK Parliament, 2004).
Sanders also noted that, in relation to their close proximity to patients, ‘one in four nurses had been asked by patients to help them die’ (UK Parliament, 2004). This kind of scenario will continue to present challenges if the nurse is not willing or able to assist the patient with their request for assisted dying.
The emotional impact
Research on the emotional and psychological impact of nurses’ involvement in assisted dying offers mixed results. A qualitative meta-synthesis on nurses’ experiences of supporting patients through a medically assisted death identified several themes and subthemes related to the nurses’ psychological wellbeing (Sandham et al, 2022). This included an existential awareness, where nurses were conscious that they were engaging in a critical moment in the patient's and their family's history (Sandham et al, 2022). Nurses were also navigating their own feelings alongside supporting their team or patient's family members who were visibly moved or shaken by the experience, carrying both their own and others’ emotional load. The empathy that the nurses expressed had an impact, although the opportunity to share that emotional space with the patient was mostly seen as a privilege (Sandham et al, 2022). A minority of nurses reported feeling emotionally drained and somewhat resentful of patients engaging in assisted dying (Sandham et al, 2022). Certain tasks and strategies were used to avoid or cope with the difficult emotions that the experience triggered, even if the nurse was in support of medically assisted death:
‘I have a drink of Scotch; I don't sleep; I think about it the next day; I ruminate. I never forget these people and situations. I'm okay because I know that it's the right thing and I've relieved the suffering’ (Pesut et al, 2020a).
Some nurses felt that they had crossed a line, experiencing ethical discomfort about the act of ending a patient's life, fear of legal repercussions if they did not follow protocol and concerns about what could happen if they became desensitised to the gravity of what they were doing (Sandham et al, 2022).
Contrastingly, some nurses described their participation as a spiritual and enriching experience, sharing that the emotional impact sometimes lasted for weeks after the death. These lingering feelings occasionally caused dissonance, as nurses expressed both internal and external expectations that they had fulfilled a role in a professional capacity and should therefore be able to move on (Sandham et al, 2022). Whichever emotions were felt in response to a patient's death, nurses continually stated the importance of teamwork, preparation and the need for supportive structures and guidance during a procedure that carried high emotional and professional risk (Sandham et al, 2022).