Mary Ann (pictured) works in a nursing home in Surrey and is vehemently opposed to a change in the law to legalise assisted suicide.

“My work is caring for people who have lived a life which is now coming to an end. Each one is coming to terms with this in their own way. But we always want to make these last days as positive and as happy as possible.” says Mary Ann. “Where I work we say ‘every day is a little life’ and that’s our focus. If assisted suicide was an option, this positive focus would change.”

Mary Ann qualified as a general nurse in 1979 at St Thomas’s Hospital in London.  She then went on to train as a midwife. Later on in her career she turned to elderly care and has worked for over twenty years in nursing homes. Now she works part time.

A reward for me

“We take people when they can no longer be cared for at home. The nursing home is another home. People come with their own, familiar belongings. There are no restrictions on visiting,” says Mary Ann. “My role is to do all the work which then leaves families free to enjoy the last months or days of their relative’s life. A reward for me is seeing a man sitting quietly, holding his wife’s hand. Or someone enjoying a meal.”

Anyone who is dying is accepted at the nursing home where Mary Ann works. Her work involves enabling a good death for each person by controlling symptoms such as pain, sickness and breathlessness.

“We don’t withhold medication. This can sometimes create the double effect that death may come more quickly. But we are careful to help patients keep a clear mind,” says Mary Ann. “If we need more expert advice, or we feel we are not managing a patient as well as we could, we call in a specialist palliative care nurse.”

Zest for life

Mary Ann sees the zest for life people can have even when death is close. “I remember one man who was so proud and pleased that he had lived beyond the three months he was told he had left. He was happy to be alive. Then during a doctor’s appointment, he was told exactly how ill he was. After that, he seemed to give up. He stopped eating and drinking and died shortly afterwards. The physical and emotional are closely linked.”

It was Dame Cicely Saunders (1918-2005) who made the link between physical and emotional pain. She pioneered the modern hospice movement where pain and symptom control were to be combined with compassionate care.

“England is a world leader in care for the dying thanks to Cicely Saunders, “says Mary Ann. “If assisted suicide is legalised, caring and killing would both be happening in nursing homes.  It is a travesty to conflate the two. Helping people to kill themselves has no place in the holistic, sensitive care I have been trained to give.”

Emotional needs

Mary Ann is alive to the emotional needs of those she cares for and their families. “There can be huge family issues to resolve at the end of life. Conflict between siblings is very hard. I try to support and help families. This is part of helping my patients. Assisted suicide would take away the opportunity for families to find closure.”

“I try to look after the spiritual needs of my patients too. Sometimes the offer of a visit from a priest is rejected. One patient said that the last time she was in a church was the funeral of her son who committed suicide. She couldn’t move beyond that. She was constantly asking for painkillers when we knew she didn’t need them. Her pain was spiritual not physical.”

Bringing calm and acceptance

In the course of her work Mary Ann shares intimate moments with families when a patient is very near death. She tries to bring calm and acceptance to a distressing time. “Once I was with a patient right at the end. Her daughter and son-in-law right were in the room and were very upset. The daughter told me that her mother had been baptised a Catholic, so I asked if it would help if I said a prayer. They said yes. I knelt down and began to say the Our Father. Suddenly the daughter said, ‘Look, mum is making the sign of the cross’. The lady died shortly afterwards. Hopefully that brought some peace to them all.”

For Mary Ann looking after people at the end of life is so much more than controlling symptoms and alleviating pain. Yet this is the lens through which advocates of assisted suicide see death. The solution to pain and difficulty is to choose death.

 “Sadly some people in my profession are starting to agree with it,” says Mary Ann.

Yet if assisted suicide is legalised the great danger is that the million little details of care, compassion and love which nurses like Mary Ann give their patients would disappear. It would take the heart out of making every day a little life for their patients.