The Terminally Ill Adults (End of Life) Bill – historic legislation passes through the commons - A practical guide as to its application

On 20 June 2025, The Terminally Ill Adults (End of Life) Bill (the Bill) was passed through the House of Commons, with 341 MPs voting in favour of the Bill and 291 MPs against the Bill, with a narrow majority of 23 votes.
 

MPs were given a free vote on the Bill, meaning they were allowed to vote on their own personal beliefs, rather than with a party line stance.

Ahead of the final vote on the Bill, MPs passed several new amendments, including two from opponents of the Bill. One would bar those who refused food and water from being classified as having a terminal illness. The other amendment commissions the Health Secretary to report on the state of palliative care.

The Bill will now move to the House of Lords to be scrutinised.

The primary outcomes of the Bill, as described by the sponsor, Kim Leadbeater are:

• to give those who are already dying a choice over the manner of their death;
• for the choice of assisted dying to be part of a holistic approach to end-of-life care, rather than a substitute for palliative care;
• to create a robust legal framework for assisted dying to happen in a manner that is subject to strict eligibility criteria and multiple layers of checks and safeguards; and
• to protect individuals from fear of, and actual, criminalisation, where they assist another person to end their own life, in accordance with the provisions of the Bill.

To clarify, there are certain eligibility criteria to access the “Voluntary Assisted Dying” (VAD) Service. These include that the individual must be/have: 

• aged 18 and over at first declaration;
• terminally ill (less than 6 months to live);
• capacity to decide to end their own life;
• ordinarily resident in England or Wales;
• registered with a general medical practice in England or Wales;
• clear and settled intention; no coercion; and
• ID verified at points throughout the process to confirm identity.

The Bill defines a person as terminally ill if they have both:

• An inevitably progressive illness or disease which cannot be reversed by treatment; and
• Their death in consequence of that illness or disease can reasonably be expected within 6 months.

The Bill also states a person is not to be considered terminally ill only because they are a person with a disability or mental disorder (or both); however, having a disability or mental disorder does not prevent a person from being regarded as terminally ill if they meet the definition of terminally ill as set out above.

Treatment which only relieves symptoms of a progressive disease or illness, temporarily, is not to be seen as treatment which can reverse that illness or disease.

1. Preliminary discussion with registered medical practitioner

No medical professional will be under a duty to raise the subject of the provision of assistance. However, there is nothing to prevent a medical professional exercising their professional judgement to decide if it is appropriate to raise it with an individual. Where a person indicates to a registered medical practitioner that they wish to seek assistance to end their own life, the professional may conduct a preliminary discussion on the requirements that need to be met for assistance.

During the preliminary discussion, the medical practitioner must explain and discuss:

• the individual’s diagnosis and prognosis;
• any treatment available and the likely effect of it;
• all appropriate palliative, hospice or other care, including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion.

If a medical practitioner is unwilling to conduct the preliminary discussion, they are not required to refer the person to another medical practitioner, but they must ensure that the person is directed to where they can obtain further information to enable a preliminary discussion.

The record of preliminary discussion must as soon as practicable be recorded within the person’s medical records.

2. Initial request for assistance: first declaration

The first declaration will be signed and dated by the person making the declaration. A proxy can be appointed by the person if they are unable to sign their own name (by reason of physical impairment, being unable to read or for any other reason). The declaration will be witnessed by the coordinating doctor and another person, both of whom must see the declaration being signed.

Current drafted regulations include that the first declaration will contain a declaration that:

1. they meet the initial conditions for eligibility;
2. they have had a preliminary discussion with a registered medical practitioner, that they were aged 18 or over when they had that discussion, and that they understand the information that was provided during that discussion;
3. they are content to be assessed, for the purposes of this Act, by medical practitioners;
4. they are making the first declaration voluntarily and have not been coerced or pressured by any other person into making it; and
5. they understand that they may cancel the first declaration at any time.

3. First doctor’s assessment (coordinating doctor)

The coordinating doctor must, as soon as reasonably practicable after a first declaration is made by a person, carry out the first assessment.

“The first assessment” is an assessment to ascertain whether, in the opinion of the coordinating doctor, the person meets the criteria as set out above in respect of access to the VAD service. After carrying out the first assessment, the coordinating doctor must make a report about the assessment, which must contain a statement indicating whether the doctor is satisfied that all requirements have been met.

In order to act as a coordinating doctor, it is mandatory for the qualified medical practitioner to have training in respect of domestic abuse, including coercive control and financial abuse.

4. First period of reflection: 7 days

The period of 7 days begins with the day on which the first assessment was performed.

5. Second doctor’s assessment (independent doctor)

This begins with the day the coordinating doctor made the report following the first assessment.  

Once a referral is made, the independent doctor must carry out the assessment of the person as soon as reasonably practicable after the first period of reflection has ended.

“The second assessment” is an assessment to ascertain whether, in the opinion of the independent doctor, the person who made the first declaration meets the criteria as already set out above. This assessment acts as a check.

After the second assessment, the independent doctor must make a report on the assessment and contain a statement indicating whether the doctor is satisfied that all requirements have been met.

In order to act as the independent doctor of a person, the practitioner:

• must not have provided treatment or care for the person being assessed in relation to that person’s terminal illness;
• cannot be a relative of the person being assessed;
• cannot be a partner or colleague in the same practice or clinical team as the coordinating doctor;
• cannot have been a witness to the first declaration made by the person being assessed, and
• cannot know or believe that they -

(i) are a beneficiary under a will of the person, or

(ii) may otherwise benefit financially or in any other material way from the death of the person.

6. Panel review of eligibility (legal representative, a psychiatrist, and a social worker)

The Commissioner must, as soon as reasonably practicable, refer the person’s case to an Assisted Dying Review Panel (the Panel) for determination of the person’s eligibility to be provided with assistance. The Panel must be satisfied that aforementioned criteria has been met.

The Panel must hear from and may question the coordinating doctor or the independent doctor who conducted the assessments. The Panel must also hear from the person seeking assistance, unless there are exceptional circumstances which justify otherwise.

If the Panel is satisfied that all requirements have been met, it will grant a certificate of eligibility.

7. Second period of reflection: 14 days (or 48 hours if less than 1 month to live)

The period of 14 days begins with the day on which the certificate of eligibility was granted.

8. Confirmation of request for assistance second declaration

Following the issue of a certificate of eligibility and the end of the second period of reflection, if the person wishes to be provided with assistance to end their own life, the person must make a second declaration.

The second declaration will include a declaration that they:

1. have made a first declaration and have not cancelled it;
2. understand that they must make a second declaration in order for assistance to be provided under the Bill;
3. are making the second declaration voluntarily and have not been coerced or pressured by any other person into making it; and
4. understand that they may cancel the second declaration at any time.

The coordinating doctor may witness this second declaration if they are satisfied that the person is terminally ill, has the capacity to make the decision to end their life, has a clear, settled and informed wish to end their own life and is making the declaration voluntarily (has not been coerced or pressured).

9. Approved substance is dispensed to coordinating doctor

It is intended for the Secretary of State to make provisions on the prescribing and dispensing of approved substances; the transportation, storage, handling and disposal of approved substances and about the records to be kept in relation to the prescribing, dispensing, transportation, storage, handling and disposal of approved substances.

10. Provision of assistance

The approved substance must be provided directly and in person by the coordinating doctor to the individual. The coordinating doctor may be accompanied by such other health professionals, and such other persons, as the coordinating doctor thinks necessary.

The coordinating doctor may:

• prepare that substance for self-administration by that person;
• prepare a medical device which will enable that person to self-administer the substance; and/or
• assist that person to ingest or otherwise self-administer the substance.

The decision to self-administer the approved substance and the final act, must be taken by the person to whom the substance has been provided for.

The coordinating doctor must remain with the person throughout.

11. Final statement made by coordinating doctor

Where a person has been provided with assistance to end their own life and has died as a result, the coordinating doctor must issue a final statement to that effect. This statement must then be provided to the Commissioner.

Key points
 

Following the first panel decision, an individual can apply to have the case reconsidered on a ground that the decision contains an error of law, is irrational or procedurally unfair.

At each stage, the doctor or Panel has to be satisfied that the person satisfies the eligibility criteria, has a clear, settled and informed wish to end their own life, and has not been coerced or pressurised by another person.

A VAD Commissioner is to be appointed, who will have previously held office in either the Supreme Court, Court of Appeal or High Court. The Commissioner’s role will be to review documentation, make appointments to those eligible to sit on the Panel, make arrangements for referring cases to panels, determining applications for reconsideration and monitoring the operation of the Act.

The drafted legislation makes clear that no registered medical practitioner is under any duty to become the coordinating doctor, independent doctor, or under any duty to participate in the supply of an approved substance to a registered medical practitioner for use.

There are two ‘periods of reflection’ built into the process, with the ability to withdraw from the process at any time.

A provision has been included to provide clarity that persons who are (i) providing assistance in accordance with the Bill, (ii) performing a function under the Bill or (iii) assisting a person in connection with doing of anything under the Bill, will not, of itself, give rise to a civil or criminal liability.

New criminal offences are intended for:

• Dishonesty, coercion or pressure in respect of another person to make a declaration to end their own life or self-administer the approved substance.
• Falsification or destruction of documentation - where a person makes or knowingly uses a false document purporting to be the first declaration, second declaration or certificate of eligibility or intentionally or recklessly conceals or destroys the first or second declaration of another person.
• Falsification of documentation with intent to facilitate provision of assistance.

Concerns raised
 

Various bodies such as the British Geriatric Society, Royal College of Physicians, Royal College of Psychiatrists and Disability Rights UK had raised safeguarding concerns about the risk of abuse and coercion of terminally ill people.

The Royal College of Physicians raised concerns following the second reading that that the introduction of assisted dying and the requirement to have discussions relating to this with patients would fundamentally change the relationship between the doctor and patient. They also shared concerns raised by the Royal College of Psychiatrists on the limitations of the current Mental Capacity Act and its use in this situation.

Concerns were also raised that patients would not have equitable choice of services because of the inequity of availability, and under-provision of end of life care and palliative care in England and Wales. This includes a risk that some patients may chose assisted dying because they fear their needs will not be met, by services that are currently inadequate.

The Royal College of Psychiatrists also raised concerns prior to the third reading, including concerns surrounding terminal illness being a risk factor for suicide; uncertainty on the role of psychiatrists in the multi-disciplinary panel and insufficient consultant psychiatrists to meet the new range of demands. Requests for a provision to assess unmet needs was voted against in the reading.

Kingsley Napley’s Healthcare Regulatory team is closely monitoring the progress of this legislation and its potential implications for healthcare providers and professionals. As developments unfold, we’ll continue to share insights into the emerging issues and what they could mean in practice.

If you’d like to discuss how these changes may impact you or your organisation, please reach out to Shannett Thompson or Lucy Reast from our team.

About the authors

Shannett Thompson is a Partner in the Regulatory Team and is the firm’s Training Principal. She trained in the NHS and commenced her career exclusively defending doctors. She provides regulatory advice predominantly in the health and social care and education sectors.

Lucy is a trainee solicitor at Kingsley Napley and is currently sitting in the Regulatory team as her fourth seat.