When it comes to candidates for most blatant attempt to bury bad news, the government’s release of its impact assessment of the Terminally Ill Adults (End of Life) Bill is right up there. Releasing the publication at 4pm on the Friday before a Bank Holiday weekend, when the nation’s media is preoccupied by the most exciting set of local election results in decades and a seismic shift in UK politics, takes some beating. On 1 May a government source denied the timing was a deliberate attempt to dampen media coverage: “When something like this is ready, you can’t sit on it,” they said (the IA had originally been planned for release nearly a month ago).
If it was a deliberate tactic, it worked, with Saturday’s front pages filled with either the local election results, or Prince Harry’s latest ill-advised public comments. Less attention was given to potentially the most significant change to British society for a generation. The bill would allow adults with fewer than six months to live to legally end their lives, if approved by two doctors and a panel.
At 149 pages, the impact assessment will now be pored over by MPs before the report stage on 16 May. But those hoping it would fill in the many gaps left after 23 MPs went through the legislation line-by-line, will be disappointed. The detail is simply not there. What we have is numbers and costs – lots of figures, but imprecise, and with enormous ranges. Were “voluntary assisted dying” (VAD) to be introduced, in the first six months between 164 and 787 people in England and Wales would choose to end their lives this way. That rises to between 1,042 and 4,559 per year in the tenth year. That upper figure would, the document states, represent less than 1 per cent of all deaths. But it’s a stark reminder of what’s at stake: each is an individual human being, with friends and relatives who will mourn for them. Not that the document looks at that. “The impact of this provision on relatives has … not been quantified,” it says.
The bill could save the NHS close to £60 million over 10 years from hospital or hospice care, medicines and other care costs that someone choosing an assisted death would not need. Focusing on the economic benefits is, arguably, not a good look. But regardless, it is in fact impossible to say whether VAD would save or cost the country money. Training in the first six months could cost up to £11 million alone, the Whitehall document says; the combined costs of a panel and Voluntary Assisted Dying Commissioner – brought in after the requirement that cases be approved by a High Court judge was dropped – is estimated to cost an average of £10.9m to £13.6m per year.
One assisted death would likely involve six health and care professionals working 32 hours, it’s estimated, inevitably taking staff away from existing services. But, again, the overall impact is uncertain. On page 109 there’s an acknowledgement that we don’t know how many staff would be required. No professional would be compelled to take part in such a service, and surveys conducted by the various medical royal colleges and professional bodies suggest those refusing to participate range from 35 per cent to 76 per cent for specific groups of staff. “Consideration would need to be given to the impact of a high level of opt out on the workability of a national service model (including equity of access), as well as the impact of shifting resources from one area of the health and care system to another,” the IA advises.
The scale of the uncertainty is laid out in black and white at the top of the document. “Monetised impacts” are “for the most part uncertain with wide ranges attached,” it says. Upper bounds “should not be interpreted as maximum values, nor as representative of the full range of potential costs, given there are significant aspects of the Bill that have not been possible to quantify at this stage”.
It is not just on cost that we are flying blind. We also do not know who would likely take up the opportunity to end their lives. There are no data in England and Wales to base estimates on, so those compiling the document have looked to several US States and New Zealand. But most of these do not have full data sets either. While the bill mandates that professionals involved in VAD must undergo training in abuse and coercion, the IA points out that no such training currently exists in this context: “at a minimum, existing training provision would need to be modified and/or expanded.” Then there’s the drug, or cocktail of drugs, used to end someone’s life. This is “still to be determined”. Moreover, the “safety and efficacy of those substances used for assisted dying is currently difficult to assess,” with “no single substance or combination of substances… understood to be the most appropriate for assisting death”. What we do have is “some evidence about complications”. The choice of drug, like so much of the bill, is a decision that the secretary of state will have to make should the legislation pass. Wes Streeting will have to weigh up the evidence “that certain medications can lead to prolonged deaths and unpleasant side effects,” alongside the fact that “certain suppliers may not want their medication to be used for assisted dying purposes.”
The government’s adviser on suicide prevention and mental health Professor Louis Appleby described the impact assessment as “stripped of moral values.” Everything is set out in purely economic terms “to the penny”, he posted on social media. Perhaps it is not surprising that the document avoids venturing into the ethical or philosophical arguments for and against legal assisted dying; after all the government has stated it is neutral on the policy. But two things are obvious: this impact assessment is a guesstimate and – more worrying to those with reservations – it places blind faith in the claims that the bill contains adequate safeguards to protect the vulnerable.
Accompanying the IA is an equality impact assessment (EQIA). It does not, however, provide any attempt at assessing the impact on vulnerable groups more likely to suffer wrongful deaths as a result of the bill. It’s a bizarre read, speaking of the need for information to be translated, for services to be accessible to those with disabilities, and how the “the bill may have a positive impact on those from lower socioeconomic backgrounds by making assisted dying available without incurring cost”. It is framed solely in terms of the question, “can all people access this?” rather than “will implementing this adversely affect vulnerable groups?” This is negligent, particularly given the fears that have been raised in Parliament and elsewhere.
In one sweeping sentence, the EQIA does away with any concerns. “The safeguards provided for in the bill… would help to minimise the risk of any eligible person, including disabled people, from being coerced or pressured by another person into requesting or proceeding with an assisted death,” it says. How has it arrived at this decision, when so many have made cogent arguments why this might not be so? We are not told. The potential risk to women who are victims of domestic abuse or coercion, raised by those scrutinising the bill, as well as experts in coercive control and dozens of female faith leaders, for example, are dismissed in just two paragraphs. Despite acknowledging both the “scarcity of applicable evidence” that the EQIA has been able to call upon and that “healthcare professionals lack ‘training and education’ regarding domestic abuse and may be ‘unwilling to engage in conversations about domestic abuse’”.
In less than a fortnight, MPs will have their first look at this Bill since they first voted in November 2024. It has been subject to around 150 amendments in the interim. These impact assessments will do little to help those struggling to make up their minds. They confirm we have no idea what the impact will be. None of this is good enough. As the Labour MP Naz Shah, who scrutinised the bill line-by-line in committee, told the New Statesman in March, this bill is currently “not fit for purpose”.
[See also: We need to talk about dying]
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This article appears in the 07 May 2025 issue of the New Statesman, The Peace Delusion