King’s College London researchers warn that the new assisted dying legislation could put terminally ill patients at risk. Key gaps in safeguards and oversight spark urgent calls for amendments
King’s College London experts are raising the alarm: the proposed assisted dying law could fail those it aims to protect. Researchers say the Bill is riddled with loopholes, lacks clear definitions, and offers insufficient safeguards for terminally ill patients. Their report recommends urgent reforms—mandatory palliative care checks, detailed medical guidelines, and strict monitoring—to prevent potential ethical and safety disasters.
The Bill needs fundamental changes
Professor Alex Ruck Keene KC (Hon), Professor Gareth Owen, and Professor Katherine Sleeman are all members of the Complex Life and Death Decisions (CLADD) Group, based at King’s, and have combined their knowledge to explore the Assisted Dying Bill.
The researchers have proposed multiple fundamental amendments to the Terminally Ill Adults (End of Life) Bill, which is currently undergoing a Second Reading in the House of Lords, following MPs’ vote to support the Bill in June.
The experts state that the Bill requires several changes before it can function as a workable framework, ensuring the safety of patients, professionals, and the wider society.
They proposed the introduction of compulsory palliative care assessments, explicit guidelines on what to do when medical complications arise during the assisted dying process, and a detailed reporting system to evaluate the Bill and ensure continuous patient safety.
Nine crucial reforms the Assisted Dying Bill must include
In a briefing note shared with Peers in the House of Lords, medical advisory boards and professional bodies, the researchers outline nine overarching reasons for change, arguing that the assisted dying Bill:
- Fails to define which terminal patients are likely ill patients and therefore clearly.
- Applies a test for determining a person’s ability to seek assistance, which is not fit for its purpose.
- It is unclear whether the provision of assistance should be considered medical treatment, and hence whether it falls within the remit of conventional medical practice.
- Does not appropriately address the role of palliative care in the process.
- Does not facilitate input from multi-disciplinary experts early enough in the decision-making process when determining a person’s eligibility for assisted dying.
- Provides for independent advocacy without clarity on whether it is a service to enable navigation of the processes provided for under the Bill, or a service to support people to have the capacity to decide to end their own life or make requests for assistance to end their own life.
- Establishes an authorisation body which is both over- and under-protective, by being too complex for entirely straightforward cases, and not equipped with sufficient powers to address more difficult cases.
- Fails to adequately address what will happen in a situation where a person experiences complications following the provision of assistance.
- Lacks an effective monitoring system in place to track how the law is being applied and ensure patient safety.
“This legislation needs to reflect the realities of the issues at stake. Determining eligibility to seek assistance in ending one’s own life is inherently multifaceted. That, in turn, means that multi-disciplinary consideration is vital. At present, the Bill provides for such consideration too late, with the wrong people, and in the wrong form,“ added Professor Alex Ruck Keene KC (Hon), Professor of Practice.
“Any legislation that gives terminally ill adults the right to request that clinicians and the NHS assist them with the decision to end their own lives must be approached with the utmost caution and clarity. The decision is an existential choice, not a treatment, and the roles are not conventional ones for clinicians or the NHS. The criteria for assessing a person’s capacity to make such a profound decision must be explicitly defined and smartly safeguarded. This isn’t just another policy decision or legal formality — it is an ethical imperative,“ commented Professor Gareth Owen, Professor of Psychological Medicine, Ethics and Law.
“Any legal framework around assisted dying must recognise the essential role of palliative care in relieving the symptoms and suffering of people approaching the end of life. Without access to high-quality palliative care, there is a risk that individuals may decide to have an assisted death, not because their suffering is untreatable, but because they haven’t had access to the care that they need. Although we know that palliative care is most effective when provided over several months, by ensuring that everyone who requests an assisted death has at least one palliative care assessment, we would reduce – though not remove – this risk,“ added Professor Katherine Sleeman, Professor of Palliative Care.
