Assisted Dying Legislation in the UK

This article is co-authored by Cathleen Ong and Luo Xuhong. Cover image by authors.

Introduced by Kim Leadbeater (MP for Spen Valley), the Terminally Ill Adults (End of Life) Bill aims to legalise assisted dying in the UK. Image credit: Dignity in Dying

“Who has lived in dignity, dies in dignity. The greatest dignity to be found in death is the dignity of the life that preceded it.” Sherwin B. Nuland left these efficacious words at the end of his book, How We Die, but how does one genuinely die with dignity? Would it be through dying naturally and guarding the sanctities of life? Or through bearing agency in their last waking moments and making the choice to end their lives? The United Kingdom (UK)’s House of Commons has been thoroughly contemplating the motivations behind assisted dying, amidst a myriad of other considerations in their debate on the Terminally Ill Adults (End of Life) Bill. 

A controversial bill by nature, this piece of legislature will permit the terminally ill, who are 18 or above at time of passage, ordinarily resident in England or Wales to take their own lives. This is privy to some conditions, namely – bearing sufficient mental capacity prior to taking their lives as per the Mental Capacity Act 2005, having registered with a GP for minimally a year and being assessed by 2 registered medical practitioners at least 7 days apart from each other. The bill’s key definition is that of terminal illness. The term is defined as “death in consequence of that illness, disease or medical condition can reasonably be expected within 6 months”.  

The bill also includes the preclusion of criminal/civil liability for medical practitioners and for conscientious objectors in assisted dying. This effectively resolves preliminary concerns on whether medical practitioners have the freedom to oppose the bill in practice if it conflicted with their ethos. As for sections in this bill concerning criminal law, punishable offences constitute dishonesty, coercion and pressure with relation to causing the assisted death of someone, which does not exceed 14 years imprisonment, as well as producing false documents or destroying them, translating to a maximum of 5 years imprisonment. 

When introduced, Leadbeater claimed that her proposed bill “contains the strictest safeguards of any legislation anywhere”. On paper, this may appear true. Her bill imposes significantly more restrictive conditions than its counterparts in the 6 countries across Europe that have also legalised assisted dying. In some of these nations, euthanasia is not limited to the terminally ill -  unbearable suffering from incurable illnesses as well as mental illness are also considered eligible in some of these nations. Meanwhile, Swiss law permits foreigners to access assisted suicide regardless of nationality. Even Oregon state’s Death with Dignity Act that Leadbeater’s bill is likely modeled after, was recently amended in 2023 to grant out-of-state patients access. However, we see that numerous loopholes appear in Leadbeater’s bill upon closer inspection. 

In a bill like the Assisted Dying one, safeguards are crucial to protect the intrinsic value of one’s life, and to prevent potential exploitation or coercion. Prior to February 2025, the proposed bill declared it mandatory for all declarations to seek approval from a High Court judge. These judges are also requisitioned to hear from the two doctors assessing the patient as well as other parties before making their decisions. This requirement, lauded as the strictest path to approval in any Assisted Dying bill was a clause that reassured critics. While such a form of checks and balance is plausible in theory, it in reality is too challenging to safeguard. According to the Court Statistics for England and Wales in 2024, there are still about 400,000 outstanding cases in the Magistrates Courts, and hearing time for a court case spans from 30 to 120 weeks. This means that an individual attempting to legalise their assisted death would have reached their 6 month prognosis before their case was heard in court. Therefore, this renders the law a “theoretical” one which struggles to effectively oversee cases requiring urgent attention. Further, if the bill were to continue mandating High Court judges to preside over cases, the legal service’s issue of severe backlog would be severely exacerbated.

More analysis of the safeguards - a myriad of other legal issues with the “Assisted Dying Panel”

This limitation was recognised by the government, and Leadbeater seeded a proposed amendment in February 2025, replacing the High Court Judge’s approval with a trusted board of psychiatrists and social workers chaired by a legal expert. Whilst this partially alleviates the situation, some concerns remain. A panel, regardless of its experience, may not bear the same impartiality a judge is sworn to, especially with their inability to take evidence on oath. This is further exacerbated by the paid nature of the job, which surfaces threats of ideological or political influence. Overall, this can render judgments more unreliable.  Another key concern lies with the panel’s diversity – varied perspectives from the medical, ethical and legal standpoints can make consensus harder to attain. The nature of an expert panel without judicial backing also raises the possibility of inconsistencies in rulings. 

Lastly, with this new amendment, the open justice principle fails to apply to each case. Therefore, patients can make the decision to privately seek approval for their assisted death without their family’s knowledge. This results in them being more susceptible to coercion by external parties, or feeling like a burden and hence considering assisted death without palliative care. For instance, in the proposed bill, practicing doctors are currently not required to document any formal substantiation for the assisted death. This means that there is potential for patient exploitation, which should be mitigated by obtaining more information on the case and assessing it under the purview of the High Court. However, the expert panel amendment removes the anchor of legal review, and does not grant the panel power to compel witnesses and request medical records. The veil of privacy, as well as lack of substantiation for an assisted death declaration may lead to cases of exploitation and coercion. If these cases were to slip through the gaps without legal enforcement, terminally ill patients could be subjected to unnecessary and unfair deaths.  

All too late

Regrettably for a bill discussing the sanctity of human life, there remain few safeguards for victims of domestic abuse. At present, Leadbeater's draft stops at the introduction of the new criminal offence of dishonesty, coercion and pressure with relation to causing the assisted death of someone in clause 26. Unfortunately, this language falls short of extending the umbrella of protection to potential victims of domestic abuse. Already, disabled women are twice as likely to experience domestic abuse as compared to their able-bodied counterparts. The presence of a chronic illness renders victims especially vulnerable if they are dependent on their abuser for essential care such as medication and mobility aids. Recent developments in UK law have also reflected the recognition of the causal link between domestic abuse and suicide: Domestic Homicide Reviews were renamed to Domestic Abuse Related Death Reviews were specifically introduced in May 2024 to highlight this link when investigations into fatal domestic abuse cases are commissioned. 

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Moreover, several expert organisations have also expressed concerns that assessing doctors may be insufficiently trained in identifying signs of coercive and controlling behaviour, let alone specific training that helps detect the true intent of terminally ill patients opting for an assisted death in order to escape from domestic abuse. Underlying symptoms of domestic abuse are often exceedingly difficult to detect, with the victims themselves usually lacking awareness of their situation. Worse still, signs of physical abuse (that are more easily detected by medical professionals) are often well-hidden from prying eyes or explained away with innocuous reasons. While the proposed panel does consist of social workers and psychiatrists who would have sufficient training and expertise in flagging potential cases of domestic abuse, the panel's lack of legal power to review evidence and compel witness testimonies render it essentially toothless when it comes to unearthing these subtle signs before it is too late. 

Curiously, Leadbeater indicated that she did not support an amendment that would extend the terminal prognosis from 6 to 12 months for patients with neurodegenerative disorders despite evidence suggesting that these patients might not have sufficient mental capacity to make such a decision towards the last 6 months of their lives. This decision potentially subjects neurodegenerative disorder patients to further risk of coercion, especially when they lack the mental capacity in this time period. If she wants to head on a coercion-free path, she should reconsider the further implications of rejecting said amendment. 

The Bill and its Achilles Heel

In addition to issues with the legal aspects of the bill, critics have more worryingly pointed out that Leadbeater’s bill lacks language mandating doctors to discuss the alternative of palliative care with patients. 

What's the issue with palliative care? A long neglected field, extensive debate over Leadbeater’s bill in December 2024 has finally drawn renewed scrutiny of palliative care in the UK and plans for a commission on palliative care are finally on the agenda. While palliative care in the UK is usually fully subsidised by the NHS, hospices themselves have faced crippling funding shortfalls in recent years. Under the present funding model, the state only provides around one-third of necessary funds while the remaining sum is expected to be raised by the hospices through various charitable events. In 2024 alone, the hospice sector reported an estimated deficit of £60mn, a sum that is only set to increase as demographic changes imply ever greater numbers of older people with long-term medical conditions seek out hospice care towards  the end of their lives. 

Already, various estimates have suggested that palliative care in the UK is far from ideal: a research paper from King’s College London estimates that more than 100,000 die in the UK with unmet palliative care needs. Since assisted dying was legalised in several Australian states, reports have emerged that several patients have opted for euthanasia when faced with extensive waits for access to healthcare. Thus arises the main concern raised by the bill’s opponents: a similar situation may arise in the UK in which people opt for a premature assisted death rather than facing an uncertain wait spanning months to secure an affordable hospice bed. Certainly not improbable, given the notorious backlogs and chronic funding shortfalls that the National Health Service faces. While the bill is pitched by Leadbeater as an alternative for individuals who are in chronic pain as a result of their terminal illnesses, statistics provided by Danny Kruger, MP East Wiltshire suggest that palliative care in the UK is often offered far too late - the median time of referral is 48 days before death for patients with terminal cancer, and the timeframe is even closer to death for those with non-cancer conditions. Is assisted dying a convenient and quick fix to the UK's palliative care shortfalls? 

To expand on this point, this bill furthers indifference towards improving the UK’s state of palliative care, and could be a potential shortcut for the system’s faults. For instance, this applies to elderly people living with multimorbidity, dementia and frailty. Care towards these sub-groups do not fall under the conventional models of palliative care, as defined in the Health and Care Act 2022. This is why, despite introducing the statutory requirement for Integrated Care Systems (ICS) to provide palliative care, the above act fails to properly practice “patient safeguarding”. With its ineffectiveness in protecting patients’ welfare and safety, the current approach towards taking care of said elderly people in their golden days culminates in neglectful care in some settings, including abuse and societal negativity about ageing. As this festers and pressure is imbued unto them, they begin to develop a negative sense of self-worth and live in poor conditions. The passage of the Assisted Dying bill could exacerbate negligence following the state of palliative care in the UK, and proclaim it a “lesser” option than assisted death. 

The Bill and its Time Race

Beyond the multitude of concerns surrounding this bill, there are also various hurdles that it as a Private Member Bill will have to overcome before being passed. As a “private member’s bill”, this bill is not part of the manifesto introduced by the Labour Party in 2024. Hence, the House of Lords could hypothetically block the Assisted Dying bill as they are not subjected to the convention of letting manifesto promises pass through. However, the House of Lords rarely rejects full bills, with the last instance being in 2004. Hence, the outright blockage of the Assisted Dying bill is not likely to occur. 

What could happen would be the bill running out of time before it is passed. In 2022, crossbencher Molly Meacher’s bill, which was in its Second Reading in the House of Lords, lapsed after running out of time. Both the 2022 bill and Leadbeater’s one fail to factor in a firm commitment and pocket of time which can be utilised for Lords amendments. Hence, the Labour MP must be careful to not repeat the mistake of her predecessor, or risk her bill lapsing as well.  

Public support? With mental illness as an implicit clause, not really.

Whilst there is overall major support for the Assisted Dying bill, in a survey conducted by YouGov revealed that only 59% of Britons support the legislation in practice and in principle, which is lesser than the 78% who support it in principle. These individuals cite their disbelief in these safeguards’ ability to sufficiently govern assisted dying. There are also fundamental concerns raised for specific groups who are more vulnerable, especially for the mentally ill. Only 16% of Britons think those suffering mental health reasons alone, like serious chronic depression, should be allowed to apply for assisted suicide. 

However, another loophole in the current bill, which legally enables patients with severe anorexia to apply for assisted death, exists. Amendment 283, proposed by Labour MP Naz Shah sought to justify that individuals with one or more comorbidities alongside a mental disorder, defined by the Mental Health Act 1983, would not be considered terminally ill because of their comorbidities. This amendment was ultimately tabled, with a vote of 8 for and 15 against. Consequently, this gaping fault, in tandem with the suggestion to replace High Court judgment with an expert panel, may weaken public support, intensifying the dangers of a poorly executed Assisted Dying bill. 

Although the current bill includes a clause that explicitly rejects mental illness as a valid reason for assisted death, ethical concerns have been raised – prisoners could seek assisted death on grounds of unbearable psychological suffering. If that were to be debated in court, judges could rule that denying access to this bill would be deemed as discriminatory. Afterwards, the UK could possibly expand eligibility of the act to include this clause, which would follow in the footsteps of countries such as Belgium and Switzerland. Another foreseeable possibility is the UK granting those whose natural death is not reasonably foreseeable eligibility for an assisted death. In other words, an alternative pathway similar to Canada’s “Track 2” medical assistance in dying program (having a grievous or intolerable medical condition but not assessed to be imminently likely to die) may open up in the UK. 

Understandably, Leadbeater is also keen on avoiding a potential repeat of backlash from the now-postponed mental health clause of Bill C-7 (2021) in Canada. The expansion of the Track 2 pathway to include mental health patients was deeply divisive - studies have revealed that most of these patients lack sufficient mental capacity to opt for assisted dying. The mental health section of the expansion was eventually postponed twice till 2027 after widespread public backlash. 

If those incarcerated can in future, choose to end their lives legally, this would significantly undermine the UK’s rule of law, and mould into a slippery slope. However, foreign precedent suggests that even though these requests are technically eligible, they are rarely made or granted in practice: a total of 3 out of 11 requests made by Canadian prisoners were granted as of 2020 while all 17 requests were declined by the Belgian authorities. Nevertheless, Leadbeater must consider stronger safeguards to ensure that the bill is not left vulnerable to a potentially unsafe future. 

Conclusion

Ultimately, with the loopholes in the UK’s Assisted Dying Bill, a lot of work has to be done before it can be considered safe enough for the population. Thus, this bill may have to be reintroduced in a future, where there can be stricter regulations against slippery slopes. Alternatively, proposed amendments could be revitalised to bandage the bill’s current wounds. It will be interesting to see where the debate heads towards, and whether it can get past Parliament in April’s vote. 

References

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