This article examines the adequacy of safeguards incorporated into the proposed Assisted Dying (Terminally Ill Adults) Bill 2024, which passed its first reading in the House of Commons as a Private Member’s Bill presented by Kim Leadbeater MP of the Labour Party.
What is the Assisted Dying Bill?
This Bill proposes to introduce a mechanism whereby adults who are terminally unwell with a life expectancy of 6 months or less, are able to apply to the High Court for permission to end their own life by administering to themselves an approved substance.
This, as the law currently stands, is a criminal offence in England and Wales. The Suicide Act 1961 makes it a criminal offence for any person to ‘encourage or assist’ the suicide of another person, carrying with it a maximum sentence of 14 years’ imprisonment.
For example, a doctor providing a patient with a lethal dose of painkillers could be prosecuted for assisting in that patient’s suicide. This Bill endeavours to provide a framework to allow medical professionals to assist in the ending of a patient’s life.
What is the New Proposed Process for the Assisted Dying Bill?
The Co-ordinating Doctor
Should a terminally ill patient wish to end their own life, they would need to engage the assistance of their GP in making a ‘declaration’ to this effect. This declaration entails one doctor (‘the First Doctor’ or ‘coordinating doctor’) assessing the applicant based on a series of criteria provided by section 7(2) of the Bill. The doctor is required to satisfy themselves that (amongst other things):
The patient is ‘terminally ill’;
The patient has capacity to make the decision to end their own life;
The patient was aged 18 or over at the time the first declaration was made;
The patient has a clear, settled, informed wish to end their own life;
The patient made the first declaration voluntarily, and has not been coerced or pressured by any other person into making it.
Should the coordinating doctor be satisfied of the above, a statement must be made by the Coordinating Doctor, signed and dated.
A copy must be provided to the patient, and the patient must then be referred to a second doctor (‘the Independent Doctor’) for a second assessment to be carried out.
The Independent Doctor
The Independent Doctor must carry out a further assessment as soon as is reasonably practicable after the statement of the Coordinating Doctor is made (and after the ‘first period of reflection’ – 7 days since the first statement– has passed).
This assessment is identical to the first, and is intended to act as a fail-safe before the Independent Doctor’s statement is made in regards to the patient. This assessment is to be conducted entirely independently of the Coordinating Doctor. A copy of the statement, once made, is to be provided to the Coordinating Doctor and the patient.
Referrals for Special Assistance
Should either the Coordinating or Independent Doctor be unable to draw a conclusion as to any of the criteria, referrals can be made to specialists to assist. For example, should one of the two doctors feel that they are unable to certify that the patient is ‘terminally ill’ with a life expectancy of 6 months or less, a specialist in the illness afflicting the patient must be called upon to provide an opinion. This Bill imposes a positive obligation in this regard.
Similar would apply if, for example, one of the two doctors were concerned that a patient lacks capacity or understanding of the decision they are attempting to make, and a referral could be made to a psychologist or psychiatrist to assist with an opinion.
The difference here is that, when concerning capacity, the assessing doctor with doubts is given discretion in obtaining further supporting evidence.
Should the Independent Doctor refuse to make such a statement, the Coordinating Doctor is able to refer the matter to a second Independent Doctor, who will then be treated as the Independent Doctor for the purposes of the declaration process.
The Coordinating Doctor and Independent Doctor Make Statements Supporting the Patient’s Wishes - What Next?
The patient must then apply to the High Court for, effectively, permission. The Court’s proposed role is to examine whether all necessary steps have been taken per the legislation.
The court must make a declaration if it is satisfied that all matters have been complied with, and so the role of the court in cases where all steps have been complied with is extremely limited.
There is no discretion to refuse to make a declaration if it can be shown that all steps have been taken in line with the proposed law.
In coming to this decision, the Court is able to hear from and question in-person:
The person making the declaration (the patient);
The Coordinating Doctor;
The Independent Doctor;
Any other person.
The Court is also to be able to order another person to report to the Court on such matters relating to the person applying for the declaration (for example, a psychiatrist or medical specialist may be appointed to provide a report to the Court where it is deemed necessary).
The High Court Agrees – What Now?
Upon the High Court reaching a decision in favour of the patient’s application for a declaration, the Court must make a declaration that all provisions have been complied with.
There must then be a ‘second period of reflection’ (this time for 14 days from the date of the Court’s decision, unless the Coordinating Doctor reasonably believes the patient will die in less than a month from the Court’s decision, in which case this period is reduced to 48 hours) before the patient is permitted to make their second and final declaration. Note that this is technically the third declaration when counting that which is made by the Court, however, this is the second declaration made by the patient themselves in these proceedings.
The patient does this by filling out a form provided in Schedule 4 of the proposed legislation, having this witnessed by the Coordinating Doctor and another person (NOT the independent doctor).
The Proposed Process of The Assisted Death
Once all elements are complete at this point, the Coordinating Doctor may provide the patient with an approved substance (as defined by s.20 as substances approved by regulations introduced by the Secretary of State only).
The Coordinating Doctor must be sure at the time of the administration of the substance that the patient has capacity to make this decision, and a clear/settled/informed wish to end their own life. The Doctor must also be satisfied that the patient is doing so voluntarily, free from coercion or pressure into doing so.
The substance is then prepared for self-administration. The doctor is permitted to prepare a medical device which will enable the person to self-administer, for example a medicine driver, and may assist the person to ingest the substance or otherwise administer it to themselves.
The decision on self-administration, and the final act of doing so, must be taken by the person to whom the substance has been provided.
The doctor is not permitted to administer the substance themselves, and must remain with the patient until that person has died, or until such a time that the procedure can be considered to have failed. Although the doctor needs to remain with the patient, the doctor need not be in the same room as the patient at the time of self-administration.
Once a patient has died, a Final Statement must be made by the Coordinating Doctor to that effect, and sign/date it. The Statement must then be recorded in the patient’s medical record as soon as practicable, with a copy of the statement being communicated to a member of the patient’s GP practice (if the Coordinating Doctor is not a member of that practice already).
Coercion, Pressure, and Safeguards: Can We Trust Medical Professionals to Protect the Vulnerable?
One of the most significant challenges in domestic abuse cases is proving controlling and coercive behaviour. Such an offence is notorious for resulting in acquittals, with cases often falling apart at the final stages due to insufficient evidence or lack of support from the complainant.
This issue raises serious concerns when applied to the proposed ‘right-to-die’ Bill.
How can a medical professional reliably identify whether a patient is being coerced or pressured into ending their own life?
In domestic abuse cases, we frequently encounter allegations of control over a victim’s personal choices—what they wear, who they associate with, and how they spend their time and money.
Legal arguments often centre on defining the threshold for “coercive and controlling” behaviour. Courts regularly hear debates about how cultural, social, and economic factors should influence this definition. And all too often, the only evidence to support these accusations is the complainant’s evidence. While such claims may certainly be valid, the absence of corroborating evidence requires a forensic level of scrutiny from all parties involved.
Some may argue that the most suitable professionals to assess such claims are police officers, Solicitors, or social workers, who are experienced in identifying signs of coercion, and assessing whether the bar is met for such behaviour to class as coercive and controlling.
Whilst medical professionals have a wealth of knowledge and experience in identifying individuals who may be subject to physical abuse, the signs of coercion, influence or pressure are much more pervasive, leaving no physical empirical evidence behind.
Consider how often text messages, which initially seem damning, are later explained by defendants, casting a new light on the intended message behind the words used. Or how many times a complainant has withdrawn their support, asserting that they were mistaken or acting out of anger when they made the initial claim.
These situations raise an important question: when a doctor suspects coercion, should the process of gathering evidence and verifying claims be left to their discretion alone?
Indeed, as seen often with complainants in domestic abuse cases alleging coercive and controlling behaviour, it is highly unlikely that the patient themselves would admit to being pressured or coerced. Indeed, it may often be the case that the person in question completely lacks awareness of the pressure being applied. Moreover, an ailing grandparent, seeing their descendants suffer with the current cost of living crisis, may be pressured into making this decision without any positive act on behalf of those around them.
In truth, the complexity of these cases suggests that leaving the decision in the hands of a single medical professional might not provide the safeguards necessary to protect vulnerable individuals.
A doctor may not think to consult a police officer, Solicitor, or social worker, leading to a risk of misjudgement. A case that should be straightforward could quickly become tangled in a web of reports—from social workers to psychiatrists, psychologists, and beyond—each needed to address the various forms of coercion that can manifest in such cases. Indeed, with the National Health Service and almost every other publicly funded institution ailing under budget cuts and mismanagement, where will the funding come from to facilitate this level of scrutiny?
How Will The Assisted Dying Proposed Process be Funded?
Another concern for those seeking to make a declaration to end their life is access to justice. We see concerning examples every day of people who are disenfranchised by the current Legal Aid system.
Are we to further stretch the Legal Aid budget by providing legal assistance to those who seek to make these applications, or are we to instead insist that these are privately funded – squandering away any inheritance for relatives left behind after the ultimate outcome is achieved? This would then, of course, infer that there is a price tag on dying with dignity.
Robust Safeguards Are Needed Should the Assisted Dying Bill be Passed
It seems unwise to rely solely on discretion. Instead, a more effective safeguard would be to establish mandatory checks within the Bill—clear criteria that medical professionals must adhere to before making any decisions on coercion or pressure.
Furthermore, it may be beneficial to include the court in this process (before the final hearing of the matter), and proposing a comprehensive funding mechanism to ensure the issue receives the thorough scrutiny it deserves, regardless of the patient’s socio-economic background.
The purpose of this article is not to argue for or against the ‘right to die’, but to highlight the critical need for robust safeguards if such legislation is to be passed.
The consequences of getting it wrong are irreversible, and the potential for coercion—especially among vulnerable individuals—cannot be ignored.
While these situations may seem rare, the number of domestic abuse cases involving coercion awaiting trial in the court backlog, would beg to differ.
As the Bill stands, could we be opening the floodgates to even greater risks for those it intends to protect? One must ask how criminal prosecutions will take place in cases where there is such tenuous evidence of coercion and pressure.
After all, the terminally ill person subject to pressure and coercion may not live to give the evidence required for a conviction.
February 2025 Updates to the Proposed Assisted Dying Bill
The Bill is currently at Committee Stage in the House of Commons, and has not yet been passed into law.
As of 11 February 2025, a potential amendment has been suggested to implement a system whereby qualified experts have greater statutory oversight in the assisted dying process.
This has been suggested as a potential additional safeguard, however, debate continues as to whether these experts are able to obtain the same level of impartiality as a High Court judge. Will personal ethics influence these individuals?
Will these experts require training on the law and its processes? What infrastructure will be implemented to reach this point, and what will the cost be to the public purse?
Details at this stage are sparse and this is an evolving story – further reading is recommended, and further articles are being considered as this issue develops
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Legal disclaimer: Articles are intended as an introduction to the topic and do not constitute legal advice. The information contained herein is accurate at the date of publication but please note that the law is ever changing and evolving. If you require advice in relation to any matter raised in this article please contact a member of the team.