The Terminally Ill Adults (End of Life) Bill (‘the Bill’) is a private member’s that was first introduced into Parliament in November 2024, originating in the House of Commons. The Bill makes provisions for a person who is terminally ill to choose to request and lawfully be provided with assistance to end their own life, provided they meet the eligibility criteria. Previous attempts to implement this were seen in 2014, 2015 and 2021.
Eligibility
To be eligible, adults must be eighteen or over, be registered as a patient with a GP practice in England & Wales, have mental capacity, be terminally ill and be expected to die within six months. Sufficient mental capacity is required throughout the whole process, and this must be assisted by medical, legal and social care professionals. Assistance must be given on at least five occasions to be sufficient. The Bill also ensures to exclude adults with disabilities and/or mental illnesses if they are not terminally ill.
What is the process?
- Preliminary Discussion:
The first step is for the individual to take part in a Preliminary Discussion with a registered medical practitioner. This discussion will cover the eligibility criteria, alternative treatment, and all appropriate palliative and hospice care. The discussion must cover options for symptom management and psychological support.
- First Declaration made by the person wishing to seek assistance:
After the Preliminary Discussion, the individual wishing to seek assistance must make a declaration to be signed and dated by a co-ordinating doctor and a second independent individual. Following the first declaration, the co-ordinating doctor must create a comprehensive assessment on the person seeking treatment to be referred to another medical practitioner to complete a second, independent assessment. The second medical practitioner must not be a colleague or in the same practice as the co-ordinator to allow full independency when making an informed decision.
- Referral to the Assisted Dying Review Panel:
Following completion of the above criteria, all information must be submitted to the Voluntary Assisted Dying Commissioner. This is a new role created by the Bill and is yet to be confirmed. The Commissioner must then refer the case to the Assisted Dying Review Panel consisting of a legal professional, psychiatrist and a social worker. The panel will ensure that all necessary criteria are met and that there is no evidence or pressure or coercion. Provided all criteria are met, the panel will issue a certificate of eligibility.
- Second declaration made by the person wishing to seek assistance:
Once the certificate of eligibility has been provided, the individual seeking assistance must make a second declaration confirming multiple specified matters. This must be completed at least fourteen days after the certificate of eligibility has been granted to allow time for reflection. The second declaration must be witnessed by the co-ordinating doctor and a second individual.
Safeguarding Precautions
One of the largest ethical issues with the Bill is establishing whether the individual seeking assistance genuinely wishes to die. Therefore, significant safeguarding precautions are being implemented into the Bill to ensure individuals are fully aware of the decision they are making and that decisions are not being made under any adverse influence or coercion. The Bill emphasises the importance of capacity. The individual seeking assistance must confirm their decision at every stage, and they must have knowledge that they are able to change their mind at any point. The individual must have access to information about all alternative options available to them such as pain management at all stages throughout the process.
At least two doctors must independently confirm that the person seeking assistance meets all elements of the eligibility criteria and both doctors must be sure that the individual is making the decision on a voluntary basis. An independent consultant will be informed if there is any doubt as to capacity or free will.
The Bill ensures that safeguarding is in place for any professionals involved by stipulating that no professional is obliged to participate. In particular, doctors will not be under any duty to take on the role of a co-ordinator or independent doctor. Whilst registered medical practitioners will also be able to decide whether they would like to conduct a Preliminary Discussion, they will be under a duty to guide individuals in the correct direction to where they can find further information and have a Preliminary Discussion.
The Bill will also ensure there are criminal penalties in place for any coercion involved when an individual is considering any decision regarding assisted dying. There will also be criminal penalties in place for any falsification of documents or breaches of the rigid process to ensure no advantage is taken.
What could the new Bill mean for Health and care decision Lasting Powers of Attorney ?
A Lasting Power of Attorney (‘LPA’) is a legal document that allows an individual to appoint up to four people to make decisions on their behalf once mental capacity has been lost. There are two types of LPA, one covers financial affairs, and one covers health and care decisions. An attorney who is appointed by a heath and care LPA will have the power to make decisions in relation to medical care, and in some cases, can accept or refuse life-sustaining treatment.
Under current regulations and the Mental Capacity Act 2005, an LPA does not allow attorneys to consent to any illegal action such as assisted suicide or euthanasia. At present, we do not know what the Bill will mean in relation to the use of heath and care decision LPAs. However, it is expected that strict safeguards will be implemented to ensure that assisted dying is a personal choice made with sufficient capacity by the individual seeking assistance.
What are the next stages for the Bill
The Terminally Ill Adults (End of Life) Bill has now passed the House of Commons and is proceeding in the House of Lords. In January 2025, the bill was considered by a public bill committee where over five hundred amendments were suggested. It is expected that the Bill will face further detailed examination in the House of Lords due to the safeguarding issues for all involved.
How we can help
When considering the process of assisted dying, it is very important to ensure that all your affairs are in order, and that you have a valid and up to date Will in place. This will ensure that your estate can be administered easily, and the process can run as smoothly as possible, ensuring your wishes are accounted for.
If you would like assistance with estate planning, the preparation of a Will or Lasting Power of Attorney or indeed administering an Estate, or have any questions, please do not hesitate to contact our Wills, Trusts & Estates Department on 01244 354800 or email: Heather.Lally@dtmlegal.com
Disclaimer
This article is not intended to be comprehensive or to provide specific legal advice. It should not be relied upon in the absence of specific advice given in relation to particular circumstances.
