Where are we and what next?
Under current proposals, the Assisted Dying Bill would only apply to persons aged 18 or over who have mental capacity and have been a UK resident for at least 12 months. Eligibility requires a diagnosis of terminal illness (defined as an inevitably progressive illness, disease or medical condition which cannot be reversed by treatment) with two doctors confirming a prognosis of 6 months or less to live. Those who meet these criteria may request, and lawfully be provided with, assistance to end their own life, which they must then self-administer.
This, in itself, is not new - we have been here before. There was Lord Falconer’s Bill in 2014, Rob Marris MP’s Bill in 2015 and then Baroness Meacher’s Bill in 2021 – all attempted very similar reforms but all failed to cross the finish line. However, on 29 November 2024 MP Kim Leadbeater’s Private Members Bill made history when it passed its second reading in the House of Commons by 330 votes to 275, surpassing all previous attempts at bringing this into law.
The Assisted Dying Bill was then scrutinised again at the cross-party committee stage, where a great many amendments were proposed. Undoubtedly, the most significant of these being an amendment to replace the requirement for a High Court judge to oversee and adjudicate on every application, with instead, a three person multi-disciplinary panel (made up of a senior legal figure, a psychiatrist and a social worker) which will decide on each case, itself being led by a judge-led Voluntary Assisted Dying Commission. The change arose following concerns about the practicality of requiring courts to oversee every single case, especially where there is already a significant backlog in the system.
The Bill then returned to the Commons for its third reading on 20 June 2025 and following a second Commons vote in June 2025 – 314 in favour and 291 against – it has now progressed to the House of Lords.
Although during the Commons stage there was some initial concern that the Bill might be deliberately blocked by the Lords (with some commentators citing the narrow voting margin and there being no absolute majority), this now seems unlikely. The argument for a change in the law has been won and it is now about debating the practicality of the Bill and its application within the current legislative framework.
Support for the Bill has narrowed, which appears to stem from concerns about the specific provisions, rather than the principle of reform. One area of unease was around the fact that as a Private Members Bill, it did not undergo the full pre-legislative scrutiny it might have otherwise had. Arguably this now gives the Lords the procedural mandate to examine every aspect in detail, which is likely to result in a series of amendments around safeguards and operational processes before the Bill is brought back to the Commons.
The clock is ticking
A further consideration is that this lengthy process needs to be quickly concluded, in that the Bill must return to the Commons, before the State Opening of Parliament - usually in November – which marks the end of one parliamentary session and the beginning of the next. If this deadline is missed then the Bill will fall and would then need to be reintroduced from scratch in the next session. The clock is therefore ticking and there remains a real risk that time will run out.
From Ethical Debate to Clinical Practice: The future of End-of-Life decision making
Following the first Commons vote in January 2025, the BMA published an updated position statement entitled: The BMA’s views on legislation on physician-assisted dying. It emphasised that healthcare professionals should not be under any professional duty to initiate discussions about assisted dying with patients. The BMA made clear that assisted dying is not a standard “treatment option” within clinical care and as such the legal principles established in Supreme Court judgments surrounding consent to treatment – such as in Montgomery v Lanarkshire Health Board [2015] UKSC 11, and McCulloch and others v Forth Valley Health Board [2023] UKSC 26 do not apply, therefore there would be no duty to raise assisted dying as a treatment option.
Others have raised concerns that assisted dying is not a “treatment” as it does not aim to improve a person’s health. Without explicit clarification in the proposed legislation there may be inconsistent approaches across clinical settings, particularly given professional guidance that prioritises patient autonomy and informed decision-making, which will have significant legal implications.
For the avoidance of doubt, the Bill has always contained a provision which states “no registered medical practitioner is under any duty to raise the subject” of assisted dying (currently clause 5(1) of the Terminally Ill Adults (End of Life) Bill). However, is this safeguard enough or should, as some have recommended, the legislation go further to explicitly state that assisted dying is not a “treatment option”?
This distinction is crucial because the legal framework surrounding consent to treatment – particularly following Montgomery – requires clinicians to inform patients of material risks and reasonable alternatives to treatment. If assisted dying is not clearly excluded from the category of “treatment,” there is a risk that clinicians may feel uncertain about their legal obligations, leading to tension between the Bill and the current law surrounding consent.
Prescribing lethal drugs under the Bill is fundamentally different to withdrawing ineffective life-sustaining treatment. Many would argue to the role of clinicians is to support patients to live as well and comfortably as possible until their death and not to intentionally end life. This distinction has legal and ethical implications, both in medicine and law.
Whilst the Bill includes a conscientious objection clause – which states that clinicians are not obliged to raise this topic but, instead, must either refer the patient to a colleague or ensure the patient is directed to where they can obtain information and have a preliminary discussion – ambiguity remains and if assisted dying is framed as appropriate treatment, this could undermine a clinician’s ability to ‘conscientiously object’.
This theme has been explored in a recent BMJ article which questions whether assisted dying is a treatment option or an existential choice, and helpfully references how other jurisdictions have approached this question: Assisted dying is an existential choice, not a treatment,. Canada, for instance, does consider assisted dying to be “treatment” but other jurisdictions take a different view or are ambiguous, so this is clearly not a settled point.
The need for clarity before the law is changed is overwhelming. Without it, there is a very real prospect that, in the not too distant future, test cases involving clinicians caught up in legal and ethical uncertainty will emerge – played out across all sectors of the media.
The medical community seemingly lacks consensus, and the GMC, which has a history of being passive rather than helping to shape the law, has yet to issue any direction or guidance. Therefore, to whom does the clinician seeking advice turn to? The most likely answer is their medical defence organisations and this is where the foreseeable risk may arise.
As someone who advises medical defence organisations daily, it is not a giant leap to foresee clinicians being advised to err on the side of caution and raise the issue of assisted dying with a patient, even if they are not obliged to do so, which would circumvent the risk of criticism. The Bill (as currently drafted) allows clinicians discretion but tension with the current law surrounding consent may, understandably, lead to clinicians adopting a defensive mindset, which could prompt unnecessary conversations when they may not otherwise have taken place. Many would argue the Bill should not be promoting the option of assisted dying, but this may well have the effect if there is ambiguity as to whether it is a treatment option or not.
Comment
Assisted dying now appears to be a matter of when, not if. Even if the Bill falls at the end of this parliamentary session, there is every likelihood that it will be reintroduced. Attention now turns to the practicalities of the intended framework, with the Lords tasked with scrutinising and proposing amendments to refine the Bill. While Commons debates were respectful but emotionally charged, the Lords must take a dispassionate approach to ensure the legislation integrates safely into the already complex systems which exist, with appropriate safeguards.
This is one of Parliament’s most complex and sensitive tasks. Both Chambers must deliver a clear, robust framework – one that protects clinicians from legal uncertainty and media-driven trials, while also safeguarding the public.
If you are impacted by any of these issues and/or wish to discuss the impact of the proposed legislation, please get in touch with our expert Healthcare Team.
