Assisted Dying – where are we now and what happens next?

The Terminally Ill Adults (End of Life) Bill – also known as the Assisted Dying Bill – passed its second reading in Parliament on Friday 29 November, attracting a huge amount of media attention and causing some confusion among the public, with some people thinking that the law has now changed. This article attempts to answer some of the questions around assisted dying and signpost to some useful resources.

Is assisted dying legal now?

No. Assisting somebody to end their own life remains illegal in all parts of the UK. This includes assisting somebody to travel to a country where assisted dying is legal with the intention of helping them to end their life.

So what changed on 29 November?

On 29 November, the Terminally Ill Adults (End of Life) Bill passed its second reading in Parliament. This Bill, if passed into law, would legalise assisted dying for people who meet certain criteria in England and Wales. A ‘second reading’ is the first time that MPs debate and vote on a Bill. (The ‘first reading’ is when a Bill is introduced to Parliament – this is a formality and no debate is held during the first reading). By approving a Bill at second reading, MPs are giving approval for the Bill to proceed to the next stage of the parliamentary process.

What happens next?

The next stage of the process is called committee stage. A committee of MPs will be formed to scrutinise the Bill line by line and to consider and vote on proposed amendments to the Bill. The committee may also take evidence from experts and interest groups outside of Parliament. After the committee stage concludes, the Bill will return to the House of Commons for a report stage, followed by a third reading which is when MPs will next vote on the Bill. If the Bill passes its third reading, it will then proceed to the House of Lords where Peers will take it through the same process of first and second reading, committee and report stage, followed by a third reading. If the Bill does not pass its third reading in the Commons, it will not proceed to the Lords and fails.

Once the Bill completes third reading in the House of Lords, it will go back to the House of Commons for consideration of the Lords’ amendments. Both Houses must agree on the exact wording of the Bill before it proceeds. Once the Commons and the Lords agree on the Bill, it then goes for Royal Assent and becomes an Act of Parliament.

While membership of the committee has been announced, there are not yet any timescales available for when the next stage will commence. However, the parliamentary process is quite lengthy and is likely to continue for many months. This Bill is not guaranteed to become law and even if it does, it will take up to two years after being legalised to be implemented.

Why does this apply to England and Wales? I thought health was devolved…

Health is a devolved issue which means that health issues in Scotland, Wales and Northern Ireland are the responsibility of the relevant administrations. However, although we may think of assisted dying as a health issue, the law considers it to be a justice issue. Justice is a devolved issue in Scotland and Northern Ireland but not in Wales which is why this Bill, if passed, would apply in both England and Wales.

In Scotland, a separate Bill is currently being considered by the Scottish Parliament which would give people in Scotland who meet certain criteria the right to end their lives. This Bill is currently at Stage 1 of a three-stage parliamentary process which is when a committee examines the Bill and takes evidence from experts and external organisations. The committee then makes a recommendation to Parliament about whether they should support the principles of the Bill. Parliament will then debate the Bill and vote on whether it should proceed to the next stage. During Stage 2, MSPs can propose amendments which are debated and voted on by a committee. An amended Bill is then debated and voted on by Parliament in Stage 3 and, if passed, proceeds to Royal Assent and becomes an Act.

We are not aware of any moves to legalise assisted dying in Northern Ireland.

What does BGS think?

The BGS is opposed to assisted dying. A group of BGS members, led by the Law and Ethics SIG, have recently reviewed and updated our position on assisted dying, informed by a survey of the BGS membership. The BGS is not confident that effective safeguards can be developed to protect older people from unwarranted harms of assisted dying. We also believe that end of life and palliative care provision needs to be improved before assisted dying is introduced and that more needs to be done to de-medicalise death and ordinary dying. You can find our position statement here: https://www.bgs.org.uk/resources/bgs-position-statement-on-assisted-dying

We are aware that we may need to review our position again if there is a change in the law on this issue.

What do I tell my patients?

If your patients ask about an assisted death, it is very important that you emphasise that assisted dying is not legal in the UK and therefore you cannot advise them on this issue. However, it may be a good opportunity to have a conversation about advance care planning with the individual and their families. BGS has some information about advance care planning which may help to guide the conversation and Age UK have produced some helpful patient information.

If you are concerned about your patient’s immediate safety, organisations such as the Samaritans or Age UK’s Silver Line can provide support.