Assisted Dying – What do Professionals Need to Know?

As of the time this blog is published, it is illegal to assist someone to die; however, the upcoming Terminally Ill Adults (End of Life) Bill will change this in England and Wales. This private members’ Bill makes provision for a person who is terminally ill to choose to end their own life, as long as all of the robust safeguards apply to the person.

Whilst we do not know for certain if the Bill will become law, it is starting to look increasingly likely that it will.

There will be further scrutiny by the House of Lords and Commons to follow. This blog post details what we know so far. Just to note, the Bill will go through the parliamentary process.

Who would be eligible for assisted dying?

Under this bill, the process takes a holistic, rather than just a clinical approach. This means that the person’s wishes, feelings, values, and relationships are also part of any assessment and or process. As a result, a multi-disciplinary response is necessary and required.

For individuals who are terminally ill and looking to be assisted in ending their lives, there are 3 criteria they must satisfy to have their request approved:

• The person must have the capacity to make the decision (with the capacity to be assessed under the existing Mental Capacity Act 2005).
• They must be aged 18 or over, and be a resident of England or Wales for at least 12 months, and
• They must be registered with a GP Practice in England or Wales.

The term “Terminally Ill” has been defined as having 6 months or less to live, and the person must have a progressive illness or disease that cannot be reversed by treatment.

Additionally, a person must not be considered as terminally ill if they are a person with a disability, mental disorder, or both. Also, individuals suffering from an eating disorder would not be considered terminally ill.

The person should have an informed wish to end their own life, should be fully informed and cannot be coerced or pressured in any way.

The process itself entails:

• There should be a 6-month window for assessment, or less if necessary.
• Preliminary discussions with a doctor once the person has a prognosis of terminal illness, and the person decides they want an assisted death.
• The individual makes a “First Declaration” (two independent medical statements must be provided that assess eligibility, separated by at least a week). This is where the issue of capacity may arise.
• The matter is then referred to the Assisted Dying Review Panel, where every member of the panel has to be satisfied that a collective decision has been reached. The panel then signs off on their eligibility for assisted dying.
• Then, the person makes a “Second Declaration” (and a medical statement is provided).

The person can withdraw from the process at any point, and all declarations need to be signed and witnessed.

Assited Dying Review Pannel and Decision-Making Process:

The role of this panel is to confirm that all the eligibility criteria are met. Professionals will then work with the person who has opted for assisted dying to form their assessment.

At present, it is unclear how this will be funded, but it could be a new service or linked to the NHS.

Additionally, individual panels will be appointed by the Commissioner and must consist of a Legal Representative, Psychiatrist, and Social Worker, with the Legal Representative being the chair of the panel.

The Legal Representative would ensure that the panel’s decision and procedures align with the relevant legislation and regulations, including those relating to capacity, informed consent, and that there has been no coercion of the person.

Social Workers who are Best Interest Assessors under the Mental Capacity Act will be recruited to the Social Work role on the panel dealing with capacity and safeguarding issues.

The Psychiatrist’s role will be to assess whether the person has a mental disorder, and whether or not this is influencing the individual’s decision-making.

Once the panel is satisfied that the relevant criteria are met, they will issue a “Certificate of Eligibility”. If the panel refuses to grant the certification, the affected individual can appeal to the Commissioner in certain cases.

Additionally, the person seeking assistance to end their live must self-administer the approved lethal substance, as doctors would be prohibited from administering the dosage.

Implementation of the Terminally Ill Adults (End of Life) Bill:

If passed, the Bill is expected to gain Royal Assent by the end of 2025, with the rollout beginning in 2029 due to the required four-year implementation plan.

The first projected assisted death would be set for 2030, as it provides a responsible timeline to ensure that all legal safeguards and ethical standards are firmly in place.

Final Thoughts:

Many professional organisations are divided on the Bill, with others opting to take a neutral stance until more details are available.

Professionals can also choose to opt out of working with a person who wants to be considered for assisted dying.

However, there are several unanswered questions if the Bill were to become law, such as:

• How will this affect Palliative Care provision?
• How easy will it be to safeguard vulnerable adults in reality?
• Can you judge if a person is going to die within six months?
• How robust will a non-binding expert panel be?
• How many people will want to use this? And
• What will be the cost implications going forward?

We will have to wait to see what happens in the House of Lords and Commons in the coming months, and what further details are shared going forward.

This blog was brought to you by the Lead Consultants at tri.x.