The Terminally Ill Adults (End of Life) Bill

On 20 June 2025 the House of Commons voted in favour of The Terminally Ill Adults (End of Life) Bill, at its third reading, which will legalise assisted dying in certain cases. It will now be considered by the House of Lords, but it is likely to be enacted. The key provisions in the Bill are set out below, followed by an outline of a few potential challenges relating to the Bill that might be considered.  

The criteria

Under the Bill, an adult may, on request, be provided with assistance to end their own life, if certain criteria are met. These include that the adult:

1. is terminally ill;
2. has the capacity to make a decision to end their own life;
3. has a clear, settled and informed wish to end their own life; and
4. has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it.

A person is terminally ill if: 

1. they have an inevitably progressive illness or disease which cannot be reversed by treatment, and 
2. their death in consequence of that illness or disease can reasonably be expected within six months.

The person must be ordinarily resident in England and Wales, and have been so resident for at least 12 months ending with the date of the first declaration. They must also be registered as a patient with a general medical practice here.

The procedure

There are various procedural requirements, which include the following: 

The person who wishes to be provided with assistance to end their life (“the person” must make a declaration to that effect, witnessed by a coordinating doctor. 

1. The coordinating doctor must assess whether the person meets the necessary criteria (“the first assessment”). Each assessing doctor must examine the person, and make certain other enquiries. 
2. If the coordinating doctor concludes that the criteria are met, then after a period of at 7 days, an independent doctor must assess whether the person meets the necessary criteria (“the second assessment”). 
3. If they conclude the criteria are met, the Commissioner must refer the case to a multidisciplinary Assisted Dying Review Panel for a determination of whether the requirements and criteria are met. If so, the Panel must issue a certificate of eligibility.  The Panel must hear from one doctor and the person.
4. If the Panel refuses to issue a certificate, that decision may be reviewed by the Commissioner. 
5. After a 14 day period of reflection the person must make a second declaration, witnessed, that they wish to be provided with assistance to end their own life.
6. A proxy may actually sign either declaration, if the person is unable to do so.

If this is all completed, the coordinating doctor may provide the person with an approved substance, and a device for administering it, with which the person may end their own life. That doctor may assist the person to ingest or otherwise self-administer the substance. 

However, the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided. The coordinating doctor may not administer an approved substance to another person with the intention of causing that person’s death.

Provision is made for appointment of an independent advocate for someone with a learning disability or mental disorder. 

A person is not guilty of an offence by virtue of providing assistance or providing any other function under this Bill. It is a defence to an offence under s.2 of the Suicide Act 1961 if the person proves they reasonably believed they were acting in accordance with the Bill. 

A death pursuant to this Bill is certified by a medical practitioner and is not investigated by a coroner.  

Fairly detailed Regulations are required by the Bill, which must be approved by both Houses of Parliament. So it is likely to be some time until the Bill is enacted and Regulations come into force. 

Potential challenges

The practical utility of the Bill will depend on how quickly the various procedural requirements can be completed. It is unclear whether one can expect them to be completed within, say, a few months after the first assessment. Since, on the date of the first assessment, the person must be reasonably expected to die within 6 months, this may mean the person dies or is right at the end of their life, by the time the process has completed.   

The government may be required, by article 8 ECHR, to provide a framework, information and procedure which ensures practical and effective access to assisted dying: (in the context of abortion) P & S v. Poland [2013] 1 F.C.R. 476, §99, 102, 108 and 111; and R.R. v. Poland (2011) 53 E.H.R.R. 31 §191, and 196-197. This may require resources to ensure the process takes place expeditiously, and an administrative framework that functions properly. Or, if there are substantial delays, it may be arguable that the Bill must be interpreted to mean that the expected date of death is within 6 months after the date of the second declaration. 

It is arguable that the provisions are discriminatory and contrary to article 14 ECHR, for example, on the basis that they exclude: 

1. Someone who has mental capacity until shortly before/part way through the process, but loses capacity before the end of it. 
2. Someone who has a terminal illness, which will cause serious suffering until death, but who has more than 6 months left to live. 
3. Someone who has a terminal illness, and is severely disabled, but who has more than 6 months left to live. This is a variation of (b), but the reason for the distinction is that this category (c) may be unable to travel to one of the nearby jurisdictions where assisted suicide is lawful, such as Switzerland. 
4. Someone who was not ordinarily resident in England and Wales for 12 months prior to the first assessment, in certain limited circumstances (e.g. a Windrush reason, or someone with EU pre-settled/settled status). 

The obvious difficulty with these arguments, is that a wide margin of appreciation is given to Parliament in this context. That is, given the “extremely sensitive moral and ethical questions” involved, a considerable margin of appreciation is given to States “both to their decision to intervene in this area and, once they have intervened, to the detailed rules laid down in order to achieve a balance between the competing interests”: Karsai v Hungary (32312/23) 13 June 2024, §144. But the court also accepted that “even when the margin of appreciation is considerable it is not unlimited and is ultimately subject to the Court’s scrutiny”. That margin may depend on factors like the particular ground of discrimination, and the extent to which that was considered during the passage of the Bill. 

All attempts domestically to challenge the pre-existing ban in England and Wales of assisted suicide failed. However, there may be arguments around those decisions. For example, none of them concerned a challenge to the scope of a law which permitted assisted dying: they were all about outright bans. Some of the key reasons why the Supreme Court rejected the challenge in Nicklinson no longer apply. One of them was that it would be premature for the courts to intervene when Parliament was about to consider the issue (see R (Steinfeld) v. Secretary of State for International Development [2018] 3 WLR 415, §57). 

Similarly, most of the reasons why the Court of Appeal rejected the challenge in R (Conway) v. Secretary of State for Justice [2018] 3 WLR 925 are no longer applicable. It is worth noting that one of the reasons for the conclusion in that case was that there was insufficient evidence before the court to show that the criteria proposed for the scheme could be determined with confidence. If a challenge is brought, it would be important to consider what evidence is necessary to prove any new criteria can be confidently applied. 

It is likely that the DPP’s Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide will need to be amended[1]. An alternative to an article 14 challenge to the terms of the Bill, may be a challenge based on that provision, to the DPP’s policy. 

An increasing number of nearby and similar states have legalised assisted dying (See Karsai v Hungary, §60 and 62; and Explanatory Notes to the Bill[2], §8). They include Switzerland, Netherlands, Luxembourg, Austria, Spain, Portugal, Belgium, and Germany. It is lawful in the Canada, New Zealand, and a number of states in Australia and the US. It appears it will soon be legalised in France, the Isle of Man and Jersey; and in Scotland a Bill to legalise assisted dying has passed its first vote[3]. However, the majority of EU states still prohibit it, and there is no consistency in the criteria which are applied.  

While the Bill is welcomed by many, there is arguably still some work to do to ensure it functions properly and not arbitrarily. 

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[1] www.cps.gov.uk/legal-guidance/suicide-policy-prosecutors-respect-cases-encouraging-or-assisting-suicide

[2] https://publications.parliament.uk/pa/bills/cbill/59-01/0012/en/240012en.pdf

[3] www.parliament.scot/-/media/files/legislation/bills/s6-bills/assisted-dying-for-terminally-ill-adults-scotland-bill/introduction/bill-as-introduced.pdf