By Tim Spencer-Lane
The Terminally Ill Adults (End of Life) Bill was introduced into Parliament on 11 November 2024. This bill makes provision for a person who is terminally ill and meets the eligibility criteria to choose to request and lawfully be provided with assistance to end their own life.This will be of particular interest for social workers who work with people who have a terminal illness or practise in specialist palliative care settings, and there is now a specific role for social workers in the assisted dying multi-disciplinary review panel (see below).
This is a private member’s bill, introduced by the Labour MP Kim Leadbeater. The government is officially neutral on the bill but advises on its technical workability.
The bill has now completed its passage through the House of Commons, having passed its third reading by 314 to 291 votes on 20 June 2025. It will now move over to the House of Lords for consideration.
This article summarises the bill, including the amendments made in the Commons.
Who would be eligible for assisted dying?
Under the bill, there are four main criteria that must be met before a terminally ill person can, on request, be assisted to end their own life. The person must:- have capacity “to make a decision to end their own life” (with capacity to be read in accordance with the Mental Capacity Act 2005);
- be aged 18 or over;
- be ordinarily resident in England and Wales, and have been ordinarily resident there for at least 12 months, and
- be registered as a patient with a GP practice in England or Wales.
A person must not be considered as terminally ill only because they are a person with a disability or mental disorder (or both). Also, a person would not be considered terminally solely as a result of voluntarily stopping eating or drinking. This is intended to exclude people from accessing assisted dying on the basis of an eating disorder.
The bill also requires that steps be taken to ensure that the person has a clear, settled and informed wish to end their own life. They must also have made the decision voluntarily and have not been coerced or pressured by any other person into making that decision.
Voluntary Assisted Dying Commissioner
As a result of amendments passed by the Commons, the bill now includes provision for the creation of a new role of the Voluntary Assisted Dying Commissioner.They will be appointed by the prime minister and must be a senior judge. The commissioner’s functions including listing people eligible to sit on assisted dying review panels and referring cases to such panels; the commissioner will be supported by staff.
What will the process be?
The process of seeking assisted dying is designed around four main stages:- Preliminary discussion.
- The person makes a “first declaration” (and two medical statements are provided).
- The approval of an Assisted Dying Review Panel.
- The person makes a “second declaration” (and a medical statement is provided).
Preliminary discussion
Where a person wishes to seek assisted dying, there must first be a preliminary discussion with a doctor.The discussion should be about the requirements that need to be met for assisted dying to be provided, as well as other matters including the person’s diagnosis and prognosis, any treatment available, and all appropriate palliative and hospice care (and the doctor should offer to make a referral to a palliative care specialist).
The first declaration
Following the preliminary discussion, if the person still wishes to seek assisted dying, they must make a declaration to that effect which also confirms a number of specified matters, including that they are “eligible” for assisted dying and understand they can cancel the declaration at any time.This is known as the “first declaration” and must be signed by the person themselves and witnessed by the “co-ordinating doctor” and another person. The co-ordinating doctor is a registered medical practitioner who meets certain requirements and is willing to carry out the functions under the bill in relation to the person.
After the first declaration, the co-ordinating doctor is required to assess the person and confirm a number of matters, including that the person has the requisite capacity and has not been subject to coercion or third-party pressure.
Following the assessment, they must refer the person for a second assessment by another registered medical practitioner (referred to in the bill as “the independent doctor”). There is a period of at least seven days (“the first period of reflection”) between the first and second assessments. If the independent doctor is not satisfied as to any of the matters they are required to confirm, a referral can be made for a second opinion by another doctor.
Both doctors must consider whether to consult a health or social care professional with relevant qualifications of experience in a matter relevant to the person, and consult such a professional if there is a need to do so.
Assisted Dying Review Panel
Once the first declaration and two medical reports are completed, the case must be referred to an Assisted Dying Review Panel. The Voluntary Assisted Dying Commissioner is responsible for making these referrals.The role of the panel is to confirm that specified criteria are met, including that the person has the requisite capacity and there has been no coercion or pressure. Individual panels are appointed by the commissioner and must consist of a lawyer (who is or has been a senior judge or is a King’s Counsel), psychiatrist and social worker.
If the panel is satisfied that the relevant criteria are met it must issue a “certificate of eligibility”. Where the panel refuses to grant a certificate, the person can appeal to the commissioner in certain cases and the case can be referred to a different panel.
The second declaration
When a certificate of eligibility has been granted, if the person still wishes to be provided with assistance to end their own life, they must then make a further declaration (referred to as “the second declaration”). This again confirms a number of specified matters, including that they have not been coerced or pressured by another person.There must be a period of at least 14 days (“the second period for reflection”) between the certificate being granted and the person making the second declaration, unless the person is expected to die within one month of the certificate being granted, in which case a period of at least 48 hours applies.
The second declaration must be witnessed by the co-ordinating doctor and by someone else (other than the co-ordinating doctor or independent doctor). The co-ordinating doctor must also sign a statement confirming certain matters, including that the person has the requisite capacity, and that must be witnessed by the same witness as witnessed the second declaration.
Independent advocacy
The secretary of state is required to make regulations to make provision for the appointment of independent advocates. The role of independent advocates is to provide support and advocacy to people with a learning disability, autism or mental disorder seeking to understand options around end of life care, to enable them to effectively understand and engage with the provisions in the legislation.This applies where the individual experiences substantial difficulty in understanding relevant information or communicating their views, wishes and feelings.
How would assisted dying be provided?
The bill sets out that in order to administer assisted dying, an “approved substance” must be provided directly, and in person, by the co-ordinating doctor. Approved substances are not defined in the bill but will be specified in regulations. The cecretary of state is required to establish a regulatory regime for approved substances.The co-ordinating doctor must be satisfied that the person has the requisite capacity, has a clear, settled and informed wish to end their life and there has been no coercion or pressure by another person.
The co-ordinating doctor may prepare that substance for self-administration by that person, prepare a device that will enable that person to self-administer the substance, and assist that person to ingest or otherwise self-administer the substance.
The bill sets out that the decision to self-administer the approved substance and the final act of doing so must be taken by the person themselves, not by the co-ordinating doctor. The co-ordinating doctor is required to remain with the patient until they have died but need not be in the same room.
The co-ordinating doctor may authorise another named registered medical practitioner to exercise the co-ordinating doctor’s functions on providing assistance.
Professionals who don’t want to participate in assisted dying
The bill sets out that no doctor is under a duty to raise the subject of the provision of assistance under the bill with a patient nor to conduct a preliminary discussion. Doctors are also not required to become a co-ordinating or independent doctor.The bill explains that no person is required to participate in the provision of assisted dying, and health and social workers are not required to respond when consulted by a doctor carrying out an assessment under the bill.
Also, the bill provides protections for employees and other workers from being discriminated against because they choose to participate or not participate in providing assistance or performing any function under the bill.
Protections against legal liability for providing assistance
The bill sets out that a person is not guilty of an offence by virtue of providing assistance or performing any function in accordance with the bill.The Suicide Act 1961 is, accordingly, amended to ensure that the provision of assistance to a person in accordance with the bill is not an act which constitutes an offence under section 2 of that act (criminal liability for complicity in another person’s suicide).
The offence under section 2 of the Suicide Act 1961 will continue to operate for other cases where assistance is provided. But the amendment to that act also provides a defence to a charge under section 2 of the Suicide Act 1961 where the person proves that they:
- reasonably believed they were acting in accordance with the bill, and
- took all reasonable precautions and exercised all due diligence to avoid the commission of the offence.
What new criminal offences are created?
The bill creates a number of new criminal offences, including the following:- where dishonesty, coercion or pressure is used to induce a person to make (or not to cancel) a first or second declaration, or self-administer an approved substance;
- to make or knowingly use a false first or second declaration, or to willingly destroy one;
- to knowingly or recklessly provide a medical or other professional opinion which is false or misleading.
Codes and guidance
The secretary of state is required to issue codes of practice in relation to the bill, such as on the assessment of whether a person has a clear and settled intention to end their own life and the assistance which a person may be given to ingest or self-administer an approved substance.The Welsh ministers may issue guidance which deals with devolved matters.
Voluntary assisted dying services
The Secretary of State is required to make regulations to secure that arrangements are made for the provision of voluntary assisted dying services in England. This could include services under the NHS.The Welsh ministers may by regulations make provision about voluntary assisted dying services in Wales.
Prohibition on advertising
The secretary of state is required to make regulations prohibiting the publication, printing, distribution or designing (anywhere) of advertisements whose purpose or effect is to promote a voluntary assisted dying service under the bill (or causing such publication, printing, distribution or designing).The regulations may contain exceptions to the prohibition.
Monitoring and review
The secretary of state to provide regular progress updates on implementation through published reports which must be laid before Parliament.
The Voluntary Assisted Dying Commissioner is required to appoint a disability advisory board to advise on the implementation of the bill and its impact on disabled people. The board must include disabled people and representatives from disabled person’s organisations, and is required to report to the secretary of state and the commissioner on the implementation of the bill and for the report to be laid before Parliament.
The Commissioner is also under a duty to monitor the operation of the bill, investigate and report on any connected matter and publish an annual report. The commissioner’s report must include information about the application of the bill in relation to persons who have protected characteristics and other persons as described by the Secretary of State in regulations.
The secretary of state is also required to review the operation of the bill. The review must take place at least five, but not more than six, years after the passing of the bill. The report of the review must be laid before Parliament.
Tim Spencer-Lane is a lawyer specialising in adult social care, mental capacity and mental health and legal editor of Community Care Inform
