The House | Big changes will need to be made to the assisted dying legislation for success next time

Supporters and opponents of the assisted dying bill gather in Parliament Square June 2025 (Vuk Valcic/Alamy)

6 min read17 min

Feelings are running high following the failure of the Terminally Ill Adults (End of Life) Bill to progress. Trust between supporters and opponents is low, and the space for those who are neutral (or even supportive) as to the principle, but concerned about the practicalities, appears to be diminishing.

Some are talking up the potential for bringing matters back by way of a Private Members’ Bill in the new session, and using the Parliament Act to ensure its passage through the Lords. Other parliamentarians are floating the idea of a commission based on the Kim Leadbeater bill. 

Here, we identify some of the lessons that have been learned since October 2024 and set out a proposal for a way to progress – the aim of which is neither to find the long grass nor simply put forward a further iteration of a bill even its own sponsors are not content with.

Lessons learned

Having closely observed, and at stages been in the room for, the process to date, we suggest that the parliamentary debates have helpfully brought out the following five points. 

First, the six-month criteria in truth satisfies nobody. For those who wish precision, it offers false hope, given the impossibility of accurately judging prognosis. For those with degenerative conditions, it excludes unfairly. It is acutely telling in this regard that still no explanation has been advanced why this apparent unfairness does not, in fact, amount to discrimination for purposes of the European Convention on Human Rights.

Second, the arrangements for the panel proposed in the Leadbeater bill satisfy nobody either. For those who wish an additional pre-death safeguard, the panel is neither judicial fish nor truly inquisitorial fowl. For those who wish assistance to be easily accessible, it is simply a bureaucratic (and expensive) hurdle.

Third, seeking to house assisted dying within healthcare is both unnecessary and causes avoidable problems. It is unnecessary because, as Switzerland has demonstrated for over 80 years, there is no reason why the provision of assistance to die needs to be seen as a ‘treatment;’ or why those providing assistance – even if some may be medical practitioners – need to be doing so as part of medical practice. 

It causes avoidable problems, including the distortion of laws as fundamental as the NHS Constitution and the Mental Capacity Act, for the benefit of (objectively) a very small number of people. And medical opposition to assisted dying would probably diminish markedly if delivery were taken out of healthcare.

Fourth, the interaction with suicide prevention is something that cannot be wished away. The state’s duty to secure life, and obligations to address suicidality through the prism of the Mental Health Act 1983, are not discharged simply because a person is terminally ill. Nor is this a dilemma that can be resolved by policing the language used to describe death following assistance under a framework provided for by the bill.

Seeking to house assisted dying within healthcare is both unnecessary and causes avoidable problems

Fifth, a Private Members’ Bill is simply not the appropriate way to bring forward legislation with such significant, and systemic, impacts. Campaigners have every right to seek to put matters on the agenda; they do not, however, have responsibility for, nor expertise in, making law. The undue weight that the Private Members’ Bill process gives to single issue lobby groups creates unhelpful distortions. An issue as complex as assisted dying requires a clear boundary between the role of the campaigner and that of the legislator. 

The way forward 

We urge the House of Commons not to seek to reintroduce the Terminally Ill Adults (End of Life) Bill as a Private Members’ Bill following the ballot later this month. Instead, we suggest the need to develop a route that could lead to a government bill. That requires recognition that – while the question of whether assistance with death should be available, and to whom, are quintessentially questions of conscience – the question of how such assistance should be provided is, paradigmatically, ‘government business’.

So, how to proceed? We suggest an independent review, whose terms of reference provide for it to move forward on a twin-track basis:

(1) Operationalising assisted dying (without reference to eligibility criteria), drawing on the work done in Jersey, and as well on work done by bodies such as the Nuffield Trust in its August 2025 report, Assisted dying in practice: international experiences and implications for health and social care. Operationalisation would include consideration of safeguards (for instance pre-death confirmation), commissioning and delivery (including outside of the NHS). It would also require operationalisation on a ‘whole systems’ approach, requiring – for instance – the review to consider how assisted dying is to be made to work alongside palliative care and suicide prevention.

(2) Facilitating an informed debate about the eligibility criteria for receipt of assistance. This would enable discussion about whether ‘suffering’ should be a criterion and whether dementia or frailty should be within scope, for example. Many who have followed the debates to date might be surprised to learn that, despite the rhetoric, ‘suffering’ was not a word which in fact appeared in the bill, and also that the bill effectively excluded dementia.  

In relation to (2), the question would inevitably arise: discussion by whom? We suggest that the independent review can – and should – outline suggestions as to the best way to achieve this, for instance a Jersey-style citizens’ jury, or free vote in Parliament, or some combination. 

The overall mechanism must be a government bill, however. Whether this is a matter for the current government, or whether it requires a manifesto commitment, depends on the perceived priority of this issue. What is immediately clear is that good law will not be achieved either by persisting with the model contained in the Terminally Ill Adults Bill, nor by seeking to reintroduce it as a Private Members’ Bill. 

Alex Ruck Keene KC (Hon) is a barrister and professor focused on mental capacity

Gareth Owen is a consultant psychiatrist and professor of psychological medicine, ethics and law

Katherine Sleeman is an honorary consultant in palliative medicine at King’s College hospital, and Laing Galazka chair at King’s College London

All three are members of the Complex Life and Death Decisions research group at KCL