Assisted dying

Warning: This briefing discusses issues around end of life and suicide which some readers may find distressing.

There is no consensus on which terminology to use when debating the issue of whether people should be legally permitted to seek assistance with ending their lives. A range of terms are used internationally, and the choice of term often reflects underlying views on the debate. The terms used in this briefing are not intended to endorse or reflect any particular stance on the debate about changing the law.

‘Assisted dying’ refers here to the involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. It includes healthcare professionals prescribing lethal drugs for the patient to self-administer (‘physician-assisted suicide’) and healthcare professionals administering lethal drugs (‘euthanasia’).

It is an offence (in England and Wales) to assist or encourage another person’s suicide under section 2(1) of the Suicide Act 1961. Euthanasia is illegal across the UK under the Homicide Act 1957 and could be prosecuted as murder or manslaughter.

This POSTbrief provides a brief overview of assisted dying, including ethical debate and stakeholder opinion. It examines how assisted dying functions within health services in countries where it is a legal option, focusing on jurisdictions where most data are available on outcomes: Belgium, Canada, the Netherlands, Oregon (United States), Switzerland and Victoria (Australia). It also covers evidence and expert opinion on key practical considerations that are raised in the context of assisted dying.

Further information on the criminal law on assisted suicide (a subset of assisted dying), human rights challenges and previous parliamentary activity is provided in the Commons Library briefing on The law on assisted suicide.

Key points

Key ethical debate centres on autonomy and the protection of vulnerable groups. Robust data on UK public perspectives on assisted dying and variations between different groups are limited. Public understanding of the term ‘assisted dying’ is low in the UK, but some recent UK polls and surveys suggest that a majority of the UK public support some form of assisted dying.

No medical Royal College has expressed support for changing the law on assisted dying in the UK. Several medical bodies are opposed, while others have moved from opposing assisted dying to a position of neutrality, meaning that they neither support nor oppose a change in UK law.

At the time of writing, some form of assisted dying is legal in at least 27 jurisdictions worldwide. Legislation on eligibility and governance of assisted dying varies:

• In almost all jurisdictions, it is restricted to adults (including Canada, Oregon, Switzerland and Victoria), while in a few it can also include children with parental consent (including Belgium and the Netherlands).
• In some jurisdictions, assisted dying is restricted to people with terminal illness (including Oregon and Victoria). In others, it can also be accessed by those experiencing “constant and unbearable” suffering that cannot be relieved, but who are not terminally ill. This can be restricted to suffering arising from serious physical illness only (including Canada until 2023), or also include those whose suffering arises from psychiatric illness (including Belgium, Canada from 2023 and the Netherlands).
• In many jurisdictions where it is a legal option, assisted dying is provided as part of the healthcare system; in Switzerland it is not part of the healthcare system.
• Recent official data show that use in different jurisdictions varies. For example, recorded deaths from assisted dying were 0.59% of the total deaths in Oregon in 2021 and 4.2% of the total deaths in the Netherlands in 2019. Research suggests that there is underreporting of assisted dying in some jurisdictions where it is a legal option. Official figures show increasing use over time.

Research and stakeholders highlight a range of key practical considerations in the context of assisted dying. Many of these issues are interrelated and are raised in ethical debates:

• There are different perspectives on whether it is difficult to prevent incremental extension of legislation and eligibility criteria once assisted dying is legalised, and whether this is perceived as a concern or as removing barriers to access.
• Determining prognosis of terminal illness can be difficult and there is debate on how to evaluate whether suffering is “constant and unbearable”. For patients with mental disorders, debate also focuses on how to assess whether suffering is irremediable or whether it could be relieved over time.
• Assessing patients’ mental capacity for assisted dying requests is complex and can be particularly challenging where the person has psychiatric disorders, such as severe depression, which can impair decision-making capacity. There is also debate on who is best placed to assess capacity and identify potential coercion. The practice of relying on advance directives to authorise euthanasia and the use of assisted dying in those aged under 18 years is controversial.
• There are limited empirical data on the impact of assisted dying on vulnerable groups, including older people and people with disabilities, in jurisdictions where it is legal. Available studies do not report evidence that assisted dying has a disproportionate impact on vulnerable groups. However, concerns about potential abuses in some jurisdictions have been reported in academic literature and several studies have called for detailed monitoring of assisted dying practice and further research.
• There is debate on whether assisting dying is compatible with the role of healthcare professionals. Research on the effects of their involvement in assisted dying on healthcare professionals in jurisdictions where it is a legal part of healthcare suggests that healthcare professionals have a range of experiences, both positive and negative.
• None of the drugs used for assisted dying are approved by a regulatory authority for medicines for a lethal purpose. There is not consensus on the most effective drug or drug combination for ending a human life and specific drugs, doses and monitoring vary.
• There is very limited research on the social and cultural impact of legalising assisted dying.
• There is debate on whether legalising assisted dying has an adverse or beneficial impact on palliative and end of life care (P&EOLC) resources and services. Evidence is mixed and suggests that the relationship between P&EOLC and assisted dying is varied and that impacts in any jurisdiction may not be the same as in other jurisdictions, even within the same country.

Getting help

If you are affected by the themes of this briefing, you can call Samaritans on 116 123 (UK and ROI) or visit the Samaritans website to find details of the nearest branch.

If you are covering a suicide-related issue, please consider following the Samaritans’ media guidelines on the reporting of suicide, due to the potentially damaging consequences of irresponsible reporting.

Acknowledgments 

This POSTbrief was based on literature reviews and interviews with a range of stakeholders and was externally peer reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

Members of the POST board*

Professor Sam H. Ahmedzai, University of Sheffield

Zeynab Al-Khero, Not Dead Yet UK and parliamentary Researcher at the House of Lords to Baroness Campbell of Surbiton*

Ruth Campbell, Nuffield Council on Bioethics

Professor Kenneth Chambaere, Ghent University and Vrije Universiteit Brussel*

Dr John Chisholm CBE, British Medical Association*

Tom Davies, Dignity in Dying*

Dr Ezekiel J. Emanuel, University of Pennsylvania*

Professor Baroness Ilora Finlay of Llandaff FRCP, FRCGP, FHEA, FMedSci, FLSW*

Dr Zoë Fritz, University of Cambridge*

Professor Rob George, Guy’s and St Thomas’ NHS Foundation Trust

Professor Linda Hantrais, FAcSS, London School of Economics and Political Science and Loughborough University*

Rees Johnson, University of Essex*

Professor David Albert Jones, Anscombe Bioethics Centre*

Dr Gordon MacDonald, Care Not Killing*

Dr Adam McCann, University of Exeter

Dr Claud Regnard, St. Oswald’s Hospice, Newcastle-upon-Tyne*

Dr Naomi Richards, University of Glasgow*

Lloyd Riley, Dignity in Dying*

Rabbi Dr Jonathan Romain, Dignity in Dying*

Professor Sir Thomas Shakespeare CBE, FBA, London School of Hygiene & Tropical Medicine*

Professor Katherine Sleeman, King’s College London*

Dr John Troyer, University of Bath

Dr Tony Wainwright, University of Exeter*

Professor Ben P. White, Queensland University of Technology*

Professor Lindy Willmott, Queensland University of Technology*

Dr Gillian Wright, Care Not Killing*

*denotes people and organisations who acted as external reviewers of the briefing.