As the Terminally Ill Adults (End of Life) Bill, also known as the Assisted Dying Bill, is making its way through the UK legislative process, we must consider implications for care services.
Though a new concept in the UK, assisted dying has a history spanning decades. In 1942, Switzerland allowed assisted suicide under certain conditions. Oregon in the United States legalised physician-assisted dying in 1997. Other milestones include the Netherlands and Belgium (2002), Canada (2016) and New Zealand (2021), each developing unique frameworks and regulations.
As of January 2025, various regions permit assisted dying in some form. These include the Netherlands; Belgium; Luxembourg; Switzerland; Spain; parts of Germany; Canada; several US states; all Australian states; and New Zealand. Euthanasia or physician-assisted dying are legal in Colombia and Ecuador, with strict regulations. Portugal has passed a law on assisted dying, but it is not yet in force.
Across these systems, there are broadly similar rules:
- Eligibility often requires a terminal or unbearable condition, though what counts can vary. Some countries include chronic mental illness, while others restrict eligibility to terminal physical conditions.
- Capacity and consent are crucial. Someone must deem the person capable of making an informed decision.
- The process often involves multiple medical assessments; written requests; waiting periods; and reviews by oversight bodies.
Should the UK legalise assisted dying, we will need to address similar concerns. One major issue is the quality of existing palliative care. Experts say better pain relief, hospice access and emotional support are crucial alongside new laws.
Safeguarding at-risk groups remains paramount. Proper oversight prevents pushing of individuals, particularly those who feel they burden their family or care systems. Strong legal systems use open processes, regular reviews and independent bodies to maintain public trust.
Assisted dying laws could create ethical and practical challenges for care providers. Drawing from international experience, several key considerations emerge. For example, care services must train staff in both practical and emotional care. Staff must understand the legal framework, eligible requests and response protocols. Emotional support is vital for care staff who may struggle with people’s decisions or face moral distress.
In addition, clear guidelines are essential for managing assisted dying requests within care settings. This includes documentation procedures, communication protocols between healthcare providers and mechanisms for conscientious objection. Care services must work with external assessment teams and plan care transitions.
Other countries show assisted dying works better with excellent palliative care. People need access to comprehensive end of life care, such as better pain management and emotional support. This approach helps ensure assisted dying remains a choice rather than a last resort because of inadequate care alternatives.
Protection of vulnerable people is paramount. Care providers need sophisticated assessment procedures to identify potential coercion or depression-driven requests. Regular checks and clear reports will help maintain public trust and ensure we meet regulations.
The success of assisted dying legislation depends on ethical and careful implementation.
As the UK considers this significant step, the care sector must be involved in shaping the legislative framework. We can learn from other countries whilst developing our own approach and the system must protect citizens and care professionals while respecting personal freedom.
For more content discussing the topic of assisted dying, catch up on the last issue of CMM here or leave a comment on this column or join the conversation to share your thoughts.
Dr Jane Townson OBE is Chief Executive Officer at the Homecare Association. Email: [email protected]Â X: @homecareassn