12 September 2025

The Lords must fix the dangerous assisted dying bill

As a doctor, I support assisted dying in principle. But this bill will cause irreversible harm.

Illustration by Gary Waters / Ikon Images

MPs who backed the assisted dying bill acted out of compassion, hoping to relieve suffering and expand choice. As someone who cares for people at the end of life, I share these goals. Yet, as a doctor expected to implement this law, I see how its contradictory logic will undermine both choice and care. As the bill moves to the Lords, peers must look beyond good intentions and confront the contradictions at its core.

The bill promises “the ultimate freedom” – the right to choose how and when we die. Yet this “right” is limited to people who meet an arbitrary life expectancy threshold. The bill frames assisted death as healthcare, but discards clinical standards in the name of autonomy. Caught between a personal right and a clinical procedure, it offers neither the protections of medicine nor the freedom of choice.

The problems begin with the bill’s eligibility criteria, which serve neither of its stated aims. Unlike most assisted dying laws, it contains no requirement that someone be suffering – let alone that their suffering cannot be relieved. Nor is autonomy the guiding principle. Rather than a free choice, access depends on a doctor’s “reasonable expectation” that someone has six months or less to live – a threshold that is arbitrary, highly unreliable and lacks clinical or ethical justification.

By basing eligibility on life expectancy, not suffering or personal choice, the bill offers assisted death to terminally ill patients who need not be suffering, but denies it to those living longer with prolonged intractable distress. Patients often tell me they feel “abandoned”, or “cast on the scrap heap”, after receiving a terminal diagnosis. The bill confirms what many already fear – that once deemed “terminal”, their lives are devalued – and enshrines that into law.

Once any doctor estimates you’re in your last six months, the consequences are profound. They can raise the option – suggesting you consider ending your life, even if you’d never thought of doing so. However well-intentioned, this can feel like pressure. Yet those same doctors can certify your “choice” was freely made. Meanwhile, assisted death is guaranteed state funding – but palliative care and social support are not.

This isn’t “the right to choose when to die”. It’s the state deciding when ending life is acceptable, promoted and prioritised over care. Yet autonomy is invoked to justify removing protections. Far from “the strongest safeguards in the world”, the bill omits basic ones found elsewhere – like requiring irremediable suffering or prohibiting doctors from raising it unprompted. Even an amendment requiring doctors to explore why someone wants to die was voted down as “none of your business.” The first step in medical care – understanding a patient’s needs – dismissed as unwarranted intrusion. All to preserve the appearance of choice.

In practice, rather than gaining a new right, terminally ill patients lose the care and protections everyone else receives. If a person is considered to have less than six months to live, them saying they want to end their life won’t trigger the usual healthcare response – even though suicidal thoughts are just as common and just as treatable in the terminally ill as in anyone else. Any desire to die is deemed a “choice”, regardless of the needs that lie beneath it.

One Commons exchange laid bare what this means in practice. Pressed on whether a doctor could assist someone to die solely to save their family money, bill sponsor Kim Leadbeater called even this “a question of autonomy, dignity and choice for patients.” Life-ending decisions, even if they are driven by poverty or fear of burdening others, would need to be treated as straightforward personal choices.. Social and economic hardship would become acceptable grounds for state-sanctioned, doctor-facilitated death.

Leadbeater says such scenarios would be “very unusual”. International data shows otherwise: feeling like a burden is among the most common reasons for medically assisted death worldwide – reported in up to 59 per cent of cases – exceeding the pain or physical suffering this bill claims to address.

Canada – with nearly a decade’s experience framing assisted death as both a personal right and a state-sanctioned medical procedure – shows where this logic leads. Under legal challenge, restricting this “right” to those near end of life was ruled discriminatory. Now, increasing numbers of disabled and chronically ill people, disproportionately from marginalised communities, are “choosing” death amid poverty, housing insecurity and social isolation. This bill’s supporters say that could never happen here. The same assurances were given in Canada, yet the same contradictory logic made it inevitable.

Switzerland provides a striking contrast. There, assisting a suicide has been decriminalised, but not legalised as a medical intervention: it is a “legally permissible activity”, but not one sanctioned by the state. Their unregulated approach is far from a model to follow. Yet there is one important lesson: by not medicalising assisted death or singling out certain patients as “eligible”, Switzerland avoids pressuring those patients to consider ending their lives or compromising their medical care.

Some argue that any assisted dying law is better than nothing, that problems can be ironed out later. But different approaches reflect profoundly different aims and values. Any UK law must, therefore, be clear about its true purpose: is it a last-resort response to suffering that cannot otherwise be relieved, or is it the creation of a “right to choose how and when to die”? Each requires a very different kind of law, with far-reaching consequences for the type of society we would become.

Supporters warn any delay will increase “suffering, suicides and trips to Switzerland”. The evidence does not support this. Most of the 50 or so British residents who end their lives in Switzerland each year wouldn’t qualify under this bill. In countries with similar laws, suicide rates haven’t improved – and in some they have worsened. Meanwhile, every year an estimated 118,000 dying patients lack the palliative care they need – the most urgent issue to address if we’re serious about reducing suffering at end of life.

The real risk is not delay, but passing a law that singles out the very patients whose care is so neglected and presenting them with the “choice” to end their lives. It would subject them to pressures no patient should ever face and enshrine discriminatory treatment of the terminally ill at the heart of our healthcare system.

Peers must ensure this complex issue finally receives the rigorous, independent scrutiny it has lacked. A parliamentary commission could be established to develop legislation that is clear in purpose, ethically coherent, and grounded in the needs of those most affected. This is the last chance to get it right, before a law that undermines both choice and care is imposed on those least able to navigate its harms.