Terminally ill patients in England and Wales look likely to join more than 300 million citizens worldwide who have the right to a doctor’s help in dying at a time of their choosing, after members of the UK parliament voted to give the Terminally Ill Adults (End of Life) Bill a second reading.12 MPs supported the private member’s bill, introduced by Kim Leadbeater, Labour MP for Spen Valley, by an unexpectedly large majority of 330 to 275. The bill is thought to have a reasonably good chance of becoming law.
The bill would allow terminally ill adults whose death “can reasonably be expected” within six months to have help in ending their lives, with the agreement of two doctors and the approval of a High Court judge. Doctors would provide the drugs that would end the patients’ lives but patients would have to administer the substances themselves.
How would the process work?
People seeking assisted death would have to be at least 18 years old, resident in England and Wales, and registered with a GP for at least 12 months. They must have the mental capacity to take the decision and be deemed to have expressed a clear, settled, and informed choice, free from coercion or pressure. They must be terminally ill and expected to die within six months and must make two separate declarations, signed and witnessed.
Two doctors must be satisfied that the patient is eligible: the “coordinating doctor” and a second, independent doctor who is not a partner or colleague in the same practice or clinical team. A High Court judge must hear from at least one of the doctors—which can be done by live video link—and may also question the dying person and anyone else the judge considers appropriate.
There must be at least seven days between the assessments by the two doctors, and a further 14 days must pass after the judge’s ruling, although the 14 day period could be reduced to 48 hours if death is expected within one month. The coordinating doctor must either give the patient the approved substance for self-administration or prepare a medical device that would enable the patient to administer it themselves. There is currently no information on how much the system would cost or who would pay.
Which jurisdictions have already legalised assisted dying and which model, if any, does the bill follow?
Canada, Australia, New Zealand, Switzerland, the Netherlands, Belgium, Luxembourg, Spain, Austria, and 10 US states and the District of Columbia have all legalised assisted dying. The bill for England and Wales is unusual in requiring the approval of a judge. A separate bill is under discussion in Scotland, and politicians in Jersey and the Isle of Man have backed plans to introduce assisted dying.
Would the bill create an opt-in or opt-out model for doctors?
Effectively it is an opt-in model, although the BMA pointed out in a briefing that this was not made explicit in the bill.3 However, the association notes that no doctor would be under any duty to participate and that “it is our understanding that it would only be the doctors who actively choose to do the training who would in effect be opting in to provide the service.” The BMA’s briefing adds, “If the bill progresses, we would want it to be made explicit on the face of the bill that this is an opt-in arrangement for doctors.” The bill provides that any doctor can refuse to carry out activities related to assisted dying, for any reason, not just conscientious objection.
Would doctors be allowed to propose assisted dying to patients or would they have to wait for a patient to raise it?
Doctors would not be under a duty to raise assisted dying but would not be prohibited from raising it. It would be a matter of professional judgment.
What are the training needs, and where in the NHS will assisted dying services be provided?
Much of this detail would need to be worked out. As in other parts of the world where assisted dying is legal, GPs would probably provide most of the services. The BMA has suggested a separate specialist service that uses a network of specially trained doctors, with GPs able to assist their own patients provided that they had received the training. Sam Everington, a London GP and member of the BMA council and the Royal College of General Practitioners’ council, agrees. “It should be a specialist service—it’s vital it’s done well,” he said.
What would be the effect on GPs’ workload?
Cases of assisted dying would require extra work for GPs. An Australian doctor has estimated that a consultation involving assisted dying took three times as long as a usual consultation.4 But the number of patients requesting the procedure is not expected to be large.
What drugs would be used?
This is not specified in the bill and, like many details about the process, would be dealt with by regulations.
What would be the effect on the availability of palliative care?
The House of Commons Health and Social Care Committee, which took evidence from several jurisdictions that allow assisted dying, commented in its report in February this year, “In the evidence we received we did not see any indications of palliative and end-of-life care deteriorating in quality or provision following the introduction of AD/AS [assisted dying/assisted suicide], indeed the introduction of AD/AS has been linked with an improvement in palliative care in several jurisdictions.”5
What protections does the bill provide for doctors?
No doctor or other health professional would be under any duty to participate in providing assisted dying, and the bill specifies that no employer must subject an employee to any detriment for either participating or not participating in the process. The bill also rules out criminal or civil liability for assistance provided in accordance with its provisions.
What happens next with the bill?
A. The bill will go to a public bill committee of MPs—yet to be selected—who will scrutinise it and propose amendments. The committee, which is expected to include supporters and opponents of assisted dying, will be able to take evidence from witnesses, and the government is likely to table amendments. The report stage will happen on or after 25 April 2025.
If the bill receives a third reading after the report stage it will go through similar stages in the House of Lords. If it passes the Lords it will be sent for royal assent and will come into force two years after the king gives his assent or at an earlier date specified by the health secretary. This is likely to be 2027 at the earliest if it proceeds without challenges.
During this period, if the bill passes, the health secretary will have to take a number of decisions, including the forms of identification that patients must provide, the substances to be used, the records to be kept by doctors, and the codes of practice governing the assisted dying process.
