Assisted Dying Bill – progress amidst ongoing controversy

With the Terminally Ill Adults (End of Life) Bill (“the Bill”) due to move to Report Stage on 16 May 2025, we recap some of the key changes and remaining areas of debate.

On 12 March 2025, there was a significant milestone in the progression of the Bill as the Parliamentary Committee voted 15 to 7 in favour of removing the requirement for High Court judge approval in assisted dying cases. The decision aligns with recommendations from legal experts, including a former Supreme Court judge, who described judicial sign-off as "unnecessary and in some ways undesirable."

In our earlier article, Assisted Dying – is the UK ready for assisted dying to become a real option of choice?, Labour MP Kim Leadbeater, who proposed the Bill, had previously stated that the provision necessitating High Court approval had made the legislation "the strictest in the world". Notably, no other jurisdiction permitting assisted dying mandates such approval, nor does the draft Scottish Bill looking to legalise assisted dying.

Those who voted in favour of removing the requirement for High Court approval argued that the High Court's involvement could lead to delays and inefficiencies in the decision-making process given their already heavy caseload which in turn could potentially prolong patients' suffering. Additionally, some MPs felt that judicial oversight might not be the most appropriate mechanism for such deeply personal and medical decisions, suggesting that specialised expert panels could offer more nuanced and timely evaluations.

Alternative Safeguards Proposed

Following concerns raised about the requirement of court approval, Ms Leadbeater proposed an alternative “Judge-plus” system, replacing the current framework of High Court judges with the introduction of a Voluntary Assisted Dying Commissioner (“the Commissioner”) to oversee multi-disciplinary Panels to be known as Assisted Dying Review Panels.

The amended Bill published on 28 March 2025 details these new safeguards. The Commissioner must hold or have held the office as a judge of the Supreme Court, Court of Appeal or the High Court. The Bill sets out that the Commissioner receives the first declaration and the assessment reports from the coordinating doctor and independent doctor, then must, as soon as reasonably practicable, refer the case to a Panel for a determination. The Panels will consist of a legal member who will Chair the Panel, a psychiatrist member (who must be practising) and a registered Social Worker. The legal member can be King’s Counsel, a current or former judge of the Supreme Court, Court of Appeal, or High Court or current or former Deputy judge of the High Court, or someone who has at any time been requested to act as a judge of the Court of Appeal or High Court. The Bill requires that the Panel must hear from specific people such as the coordinating doctor and/or independent doctor and gives them discretion to hear from any other person they consider may assist. Additionally, the Bill sets out monitoring to be undertaken by the Commissioner including an annual report to be published, containing specified information, for example, how it applies to persons with protected characteristics and occasions when a Panel has refused an application for assisted dying.

In relation to the new proposed safeguards, Ms Leadbeater emphasised that the panel would be "wholly independent" and responsible for ensuring that decisions were voluntary, free from coercion, and made with full mental capacity. This approach, she argued, would enhance the decision-making process by incorporating a broader range of expertise which would make safeguards "even more robust". In our previous article, we discussed concerns raised during the Second Reading regarding judicial oversight, with critics arguing it may become a “rubber-stamping” exercise. Judges, while impartial, may not possess the specific expertise or experience needed to address the complexities and sensitivities surrounding assisted dying. Ms Leadbeater’s alternative system now contained within the proposed Bill incorporates other professionals (psychiatrists and social workers) who it has been suggested are better equipped with the skills and knowledge to navigate these delicate issues. It is argued that the involvement of these professionals is potentially more beneficial in ensuring that decisions are made with the necessary sensitivity and understanding.

However, despite the vote to remove oversight of the High Court, opposition remains. Some Labour MPs warn that scrapping High Court approval “fundamentally weakens protections for the vulnerable” and undermines previous commitments. However, Labour MP Jo White defended the amendments, arguing they would strengthen the Bill by facilitating a “fast and effective decision” rather than face court delays. Andrew Copson, chief executive of Humanists UK, welcomed the change, calling judicial approval “unworkable”, while Conservative MP Danny Kruger condemned it as “a disgrace,” criticising the lack of judicial involvement. Critics argue that the Panel's perceived lack of authority and transparency typically associated with formal judicial proceedings could potentially undermine the robustness of the safeguards.

Wider Implications of the Bill

Although the introduction of the Panel addresses concerns on the impact on the court system and potential delays, there remain broader implications for the NHS with the provision of assisted dying services. As was highlighted in our earlier article, the Health Secretary, Wes Streeting has previously warned that legalisation could require reallocation of NHS resources, potentially affecting existing services. He expressed concerns about funding priorities, stating, “there would be resource implications for doing [assisted dying]. And those choices would come at the expense of other choices.”  Wes Streeting has further stated that he will continue to vote against the Bill, although if it does come into force, he wants to ensure it is a “workable law”.

The allocation of limited NHS resources remains a key concern in ensuring that existing healthcare services are not compromised by the introduction of assisted dying services and could play a critical role in determining the success of the Bill. There continues to be much debate as to how assisted dying services could be delivered in the event that the Bill is successful. Some consider that outsourcing the services to private providers to prevent additional strain on NHS resources is the answer whereas others suggest a hybrid model, akin to dental services. These suggestions have led to concerns about the commercialisation of assisted dying being raised. Mr Kruger MP warned that without appropriate safeguards, assisted dying could become a “money-making enterprise”. During the Commons debate, MPs discussed the likely need to put regulations in place for private providers offering assisted dying services. MPs emphasised the need for the services to not only be trustworthy, but to be seen as being trustworthy.

Ms Leadbeater has maintained her commitment to ensure that assisted dying remains free at the point of use, regardless of whether services are provided privately or within the NHS. Whilst this is explicit in the amended Bill, concerns in respect of private provider profiteering have not been addressed. This is likely to continue to be an area subject to fierce debate with the potential for the introduction of a profit cap (included recently in the Children's Wellbeing and Schools Bill (see our earlier article)) to ease concerns in this regard and possibly prevent a halt to the Bill’s progression. 

Next Steps

The government is due to publish the impact assessment of the Bill which moves to Report Stage and has its third reading on Friday 16 May 2025 (originally listed for 25 April 2025). The impact assessment and next stage are keenly awaited particularly following reports this week of warnings in legal advice commissioned by The Christian Institute that the Bill breaches the European Convention on Human Rights by unfairly discriminating against people with conditions such as autism, bipolar disorder and depression. Although, it is reported that the Bill has been carefully looked at by government lawyers who held no such concerns.

With continued scrutiny and growing criticism, the future of assisted dying in England and Wales remains highly contested and its progression remains uncertain. Our team remain available to assist with advice concerning any areas arising from this.

Co-authored by Areesha Qureshi, Solicitor Apprentice and Sophie Mahon, Senior Legal Advisor