Terminally Ill Adults (End of Life) Bill

Assisted dying and the right to die have been at the forefront of debate for decades. There have been many high profile legal cases challenges since the turn of the millennium including: Diane Pretty, Debbie Purdy, Tony Nicklinson and Noel Conway. It is, quite understandably, a highly emotive subject. Most recently, the debate has occurred before Parliament through the Terminally Ill Adults (End of Life) Bill (‘the Bill’) which was introduced by Kim Leadbeater MP. The Bill proposes to legalise assisted suicide for terminally ill adults in England and Wales. If enacted, it will be the first Act of Parliament of its kind in the United Kingdom, and it will fundamentally change the legal landscape surrounding assisted dying.

In a practical sense, if (more likely when) the Bill becomes an Act of Parliament, the first cases are not anticipated to be immediate. There is a longstop date for the commencement of the Act, which is no later than four years from the date of the Bill becomes an Act of Parliament (clause 58(4)).

In this article, I wanted to provide an overview of the most important components of the Bill based on the most recent debates in Parliament (the version of the Bill from the House of Commons can be found here). At the time of writing, the Bill has passed its Second Reading and is about to enter the Committee Stage in the House of Lords (the 'Second House' for the purposes of this Bill). The Committee Stage process will start on 14 November 2025, and no clear date has been given for the conclusion of the Committee Stage. It is unlikely that this will be a short period of time, given the gravity of the implications of the Bill if passed.

It will then be for the House of Lords to vote on the Third Reading of the Bill, before any proposed amendments are sent back to the House of Lords. The proposed amendments from the House of Lords remain to be seen, so no comment is made on how much the Bill will change in scope at this stage. Whether they are accepted by the House of Commons is an entirely separate matter. I recently wrote about what can happen in the event of a deadlock between the Houses, which can be viewed here.

The key components of the current version of the Bill which will be explored in this article are:

• The relevant definitions which explain who is eligible to apply to end their own life.

• A rough summary of the procedure which will need to be followed.

• The protection which is given to health professionals who do assist someone in ending their life.

• New offences which have been created to curb any abuse of the system.

It should be stressed that this is subject to change given the further steps required in the legislative process. This article does not explore the entirety of the current provisions of the Bill, therefore professional legal advice should always be sought for your own case.

Definitions

The Bill provides specific definitions which will go to the question of whether someone is eligible to be provided with lawful assistance to voluntarily end their own life. The three main definitions which fall to be considered are: "terminally ill", "capacity" and "eligibility".

• Under the Bill, to be classified as "terminally ill", there are two parts which need to be satisfied. First, the person must have an inevitably progressive illness or disease which cannot be reversed by treatment. Second, the person must have a life expectancy of six months or less due to that illness or disease. The Bill also explains that:

  
  

  • A person cannot be classified as "terminally ill" just because they have voluntarily stopped eating and drinking.

  • Treatment which temporarily relieves the symptoms of an inevitably progressive illness or disease will not count as "reversing" that illness or disease.

  • A person is not considered to be terminally ill only because they are a person with a disability or mental disorder (or both).

• Capacity in this Bill is considered in the same was as the Mental Capacity Act 2005 ('the 2005 Act'). In summary, under the 2005 Act, a person must be assumed to have capacity unless it can be shown that they lack capacity. The statutory definition of lacking capacity is when at the material time, a person is unable to make a decision for themselves in relation to something because of an impairment of, or a disturbance in the functioning of, the mind or brain. A person will lack capacity if they are unable:

• To understand the information relevant to the decision;

• To retain that information;

• To use or weigh that information as part of the process of making the decision; or

• To communicate his decision (whether by talking, using sign language or any other means).

• Therefore, to be eligible to make a request to end their own life, a person must:

  
  

  • Be classified as "terminally ill" as defined in the Bill;

  • Have capacity as defined under the Mental Capacity Act 2005;

  • Be aged 18 or over at the time of their first declaration;

  • Have lived in the England & Wales for at least 12 months; and

  • Be a registered patient at a GP surgery in England or Wales.

Procedure

The procedure is found in clauses 8 - 22 of the Bill. A rough summary of the process is below:

• A first declaration would need to be made by the person wishing to end their life. This will need to be made prior to the formal assessment of medical professionals. The signature of the declaration will need to be witnessed by both the "co-ordinating doctor" and a witness. There will be a prescribed form which will need to be used, although a template has not been produced yet. However, the person will need to include:

  
  

  • Personal details (such as their full name, address, NHS number and details of their GP practice);

  • Confirmation that they meet the criteria for eligibility above;

  • They have had a preliminary discussion with a registered medical practitioner;

  • They were aged 18 or over when they had that discussion;

  • That they are content to be assessed by medical practitioners;

  • That they are making the first declaration voluntarily and have not been coerced or pressured by any other person into making it; and

  • That they understand that they may cancel the first declaration at any time.

• There would then need to be an assessment from two doctors. The first would be from the "co-ordinating doctor" who is likely to be the person's GP or the doctor they speak to first. The second would be from an "independent doctor" who is not attached to the first doctor. They will both consider the eligibility criteria given above to ascertain that the declaration is legitimate, along with having regard to their medical records and discussing their prognosis, diagnosis (and any treatments). This is to provide a safeguard from rogue decisions being made and will require agreement from two medical professionals. Each of the doctors will provide a report.

• There is to be a “period of reflection” between each assessment; this is a period of 7 days starting from the date of the first report, as outlined in clause 11(3) of the Bill.

  
  

• If both doctors agree, the applicant will then need to satisfy multidisciplinary “Assisted Dying Review Panels”, consisting of a senior legal figure, a consultant psychiatrist, and a social worker. The panels would determine, among other things, that a person was terminally ill and had capacity to make the decision to end their own life. They must hear from (and may question) the individual, at least one of the doctors, and any other person to reach their decision. The decision must be unanimous. An Assisted Dying Review Panel would provide a "certificate of eligibility" if satisfied. If they are not, then the application will be refused. There are avenues for reconsideration, but the person will need to show that the decision contains an error of law, is irrational, or is procedurally unfair (see clause 18(2) of the Bill).

• If the "independent doctor" does not agree with the "co-ordinating doctor", then a third report from another medical professional will be required.

• After a certificate of eligibility is given, the person will enter the second period of reflection. This will be for a period of 14 days (unless they are expected to pass away within a month, then this is lowered to 48 hours). This is found at clause 19(2) of the Bill. At the expiry of this period, the person will need to make a second declaration. This will contain much of the information above, including that the first declaration has not been cancelled. It will again need to be witnessed by the co-ordinating doctor and a witness. After this, the co-ordinating doctor will make a statement that they are satisfied that all legal requirements have been complied with.

  
  

• The co-ordinating doctor will then be able to give the person an approved substance so that they are able to take their own life. The co-ordinating doctor must explain to the person that they do not have to go ahead and self-administer the substance and that they may still cancel their declaration. The above considerations of capacity, possibility of coercion and the other safeguards will again be considered. The decision to self-administer the approved substance and the final act of doing so must be taken by the person themselves, and the co-ordinating doctor is not allowed to administer it themselves. The substance must be taken there and then. If it is not, the co-ordinating doctor must remove it. If the substance is taken and the person dies, the co-ordinating doctor must then produce a final statement to that effect.

Protections for Health Professionals

• Under the Bill, a health professional is not under an obligation to provide assistance; this is found clause 31 of the Bill.

  
  

• There will be no criminal liability for providing assistance in accordance with the Bill as per clause 32.

• Subject to narrow exceptions, there will be no civil liability for providing assistance in accordance with the Bill, as per clause 33.

Offences

• There are to be new offences for dishonesty, coercion or pressuring an applicant in the following circumstances:

  
  

  • If someone is induced by another into making a first or second declaration, or not to cancel such a declaration (and there is dishonesty, coercion or pressure), such an offence can lead to a term of imprisonment not exceeding 14 years.

  
  

  • If someone is induced by another into self-administering an approved substance which causes their death (and there is dishonesty, coercion or pressure), they will be liable on conviction to life imprisonment.

Analysis

• Overall, the Bill overall shows the importance of medical professionals and the need to show deference to them in making clinical decisions given that this is their area of expertise. This quasi-legal approach to assisted dying for terminally ill adults can be seen to be an attempt to strike a happy medium whereby medical and legal professionals are able to work together effectively.

  
  

• There has been a significant amendment to the initial version of Bill. Initially, the oversight of the High Court was required in order to obtain a second declaration. This has since been replaced by oversight from "Assisted Dying Review Panels". This is arguably better suited to dealing with declarations as opposed to the High Court for two reasons. First, there is to be expert psychiatric knowledge on that panel (which would work in tandem with a senior legal figure) to assist in making the decision. Secondly, there is a stark lack of court resources at the time of writing; this would generate delays and have a detrimental impact on both the justice system and applicants.

• Any reconsideration of a refusal by an Assisted Dying Review Panel is, given the strict wording of the Bill, going to require the application of public law principles in order to be successful.

  
  

• Once a declaration is obtained (either a first or second) they can be cancelled at any time in writing or orally by the person in question. The cancellation will have effect from the moment that the notice or indication is given.

• There are provisions within the Bill which address the issues of replacing either doctor where they are unable or unwilling to continue acting. Again it must be stressed that there is no expectation on medical professionals to sign up to this regime in the first place. It is understandable given the nature of this debate, that there will be proponents on both sides; some medical professionals may, for understandable reasons, wish to withdraw despite their prior involvement.

  
  

• A previously articulated point in opposition to the Bill is that it targets those with a disability. Under clause 2(4), this issue is addressed in direct terms: "For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)." This should go some distance in providing reassurance that the point has been properly considered.

• If a patient is in receipt of treatment which provides a temporary relief from their symptoms (such as pain relief or palliative care), it will not prohibit them from making an application, should they wish to.

  
  

• The creation of new offences under the Bill provide a strong safeguard against abuse of the system. It is hoped that the numerous steps and consultations that a person will need to go through will help identify and prevent situations of abuse arising.

Please note that our posts should not be intended to be legal advice and should not be construed as such; they are merely discussions and therefore readers are encouraged to seek professional legal advice for their own matters.