(C) OpenDemocracy
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Assisted dying bill would harm far too many of the patients I care for [1]
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Date: 2025-06
On Friday, MPs look set to vote for the final time on the assisted dying bill, which would allow terminally ill patients in England and Wales to be assisted to end their lives provided their life expectancy is thought to be six months or less and certain other conditions are met
Many MPs have already told of being moved to support the bill after hearing heartbreaking stories that inspire a desire for a simple, compassionate solution to reduce pain and suffering at the end of life.
Yet as a palliative care doctor, I see a far more complex and troubling reality. My clinical experience – supported by evidence from countries where assisted dying is legal – is that the desire to hasten death is rarely driven by uncontrollable pain. More often, it arises when people feel stripped of autonomy and dignity or are made to feel that they are a burden.
Tragically, such feelings are common among those struggling to access help in our overstretched NHS – and are usually eased by support that not only relieves symptoms but also affirms their fundamental human need to feel valued.
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MPs who support the principle of legalising assisted dying must, therefore, confront some of the most difficult questions of their career: What conditions must be in place for a decision to end life to be truly free? How can we offer the option of death without creating pressure to choose it? And how can we make such an offer while still affirming each person’s value and humanity?
These questions cannot and should not be answered lightly. Each demands that any legislation be bound to a clear, enforceable commitment to fully funded end-of-life care for all, with genuine safeguards in place to prevent unnecessary deaths.
This bill fails to address any of this. As a private member’s bill, it reduces a profoundly complex issue to a narrow, campaign-led agenda. Enormous influence rests with the single Labour backbencher who tabled the bill, Kim Leadbeater, and a campaign lobby whose moral certitude dismisses sceptics as “scaremongers” and labels opposition “cruelty”. Nuance is reduced to slogans.
The result is legislation designed to reassure rather than protect, with largely symbolic safeguards. Serious and well-founded concerns raised by the Royal College of Psychiatrists, Physicians and Pathologists, palliative care organisations, disability rights advocates and civil rights groups have been brushed aside, while declarations that this is the safest assisted dying law in the world have been used to shut down the very scrutiny needed to make that claim a reality.
Nowhere is this clearer than in the failure to learn from international experience. The bill’s proponents may have gone quiet on similar legislation in Canada, which they once hailed as exemplary, but are still offering up a law in the US state of Oregon as an example of what ours would look like in practice.
Both Oregon and Canada’s laws were passed with very similar conditions to the bill proposed in England and Wales: restricted to adults near the end of life, approved by two doctors. Oregon’s law remains relatively limited but has stretched eligibility to include conditions like anorexia and arthritis; nearly half of those assisted to die report feeling like a burden.
The Canadian law’s trajectory is even more alarming. There, unlike in Oregon, assisted dying is embedded in the public healthcare system, where the requirement to ensure equitable access to care has seen the terminal illness restriction overturned as discriminatory.
The has led to the scope of the law being rapidly expanded in the ten years since it was passed. What was meant to be a personal choice has become a system-led offer that doctors are encouraged to proactively promote, with some patients being repeatedly offered assisted death.
As a result, an increasing number of disabled and chronically ill people from marginalised communities are turning to assisted death in the absence of adequate care, housing or social support, as has been starkly documented by Ontario’s chief coroner. In Quebec, one in 14 deaths are now “assisted” – the highest proportion anywhere in the world.
Rather than acknowledging and addressing these risks, England and Wales’ bill enshrines them into law. It would be the first law to both guarantee state funding for assisted death – a guarantee not extended to any other form of treatment, care or support on the NHS – and explicitly enshrine a doctor’s right to proactively offer it to patients. This is normalisation and prioritisation not by accident, but by design.
And while the bill seeks to embed assisted death firmly within the NHS’s routine medical practice, it abandons core medical safeguards. Checklists drafted by politicians reduce complex clinical care to a series of bureaucratic sign-offs – a process the Royal College of Psychiatrists has described as inconsistent with the core duties of their profession.
The eligibility criteria for assisted death does not reflect an evidence-based evaluation of who should qualify, but political expediency and unspoken assumptions about which lives warrant less protection. Unusually among assisted death laws – even, in theory, Canada’s – Leadbeater’s bill contains no requirement that a patient be experiencing intolerable suffering, or that such suffering could not be relieved by other means.
Even a modest proposal to ask patients why they were seeking assisted death was dismissed by MPs on the Public Bill Committee, with one member suggesting that a patient may feel the answer is “none of your business”. A proposal to guarantee even a single palliative care consultation was also rejected. The only medical intervention intended to end a patient’s life would bypass the first step in medical care: assessing the patient’s needs.
I’m far from alone in my concerns. Among its nine specific objections to the bill, the Royal College of Psychiatrists points out that doctors would not be required to offer terminally ill patients with suicidal thoughts – which are common shortly after diagnosis and are often transient – an assessment to explore treatable aspects of their situation.
The bill is riddled with other red flags, such as setting a dangerously low bar for consent, leaving people with learning disabilities exposed. It then offers them advocates to facilitate access to assisted death, while they often struggle to access basic care. It also exempts assisted death from the rigorous scientific evaluation required before the introduction of every other medical intervention and from the mandatory coroner referral that uncovered the scale of the law's misuse in Canada.
This is not a considered, compassionate, evidence-based law. It’s dangerously unbalanced: assisted death is treated like standard medical care but stripped of normal medical safeguards, access to death is made easier than access to care, and while doctors may opt out of providing assisted death, patients cannot refuse being offered it, including repeatedly.
The stakes could not be higher — once passed, the harm cannot be undone. MPs must reject this bill and support a Parliamentary Commission to ensure any future law is grounded in compassion, evidence, and the equal value of every life.
Lucy Thomas is a doctor working in both palliative care and public health, with a particular focus on health equity and inclusion health.
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