The Assisted Dying Bill may have fallen, but for hospices and healthcare leaders, the work it has prompted is far from over. The dial has already shifted on how people talk about autonomy, suffering, choice and death – and that means as healthcare professionals we need to be ready for more, not less, conversation.
One of the challenges for those of us working in palliative care following the introduction of Kim Leadbeater MP’s Terminally Ill Adults (End of Life) Bill, and its subsequent passing in the House of Commons, has been uncertainty over how the service would work. That uncertainty has been propagated with the legislation then ‘timing out’ of the House of Lords in April – leaving any future change of law up in the air.
Continuing the conversation
While those who oppose Assisted Dying law may think this marks an end to the conversation for a moment, there are already plans from supporters of the Bill to bring it back to Parliament. Whether it returns imminently or not, it has already influenced how the people we work with, and society at large, think about end of life, meaning healthcare leaders would be wrong to disengage with the topic.
At St Christopher’s, which is neutral on a change in the law, we were engaging with the subject of assisted dying before Ms Leadbeater’s Bill was introduced to Parliament. This included the establishment of an Assisted Dying Working Group with individuals from across the workforce to try and ready the organisation. Engaging with this topic from a neutral perspective has not damaged our organisation but provided us with great opportunities.
Political engagement
Together, as a multidisciplinary team, we have been able to explore in-depth, ethical grey areas within palliative care. We have had a chance to highlight the importance of hospice care and the devastating funding crisis. We have also begun to try and understand what our role might be if any future assisted dying service was introduced.
We have spent time thinking about, researching, learning and discussing assisted dying, through staff and volunteer workshops, and qualitative research with community members. We have provided reports and briefings to MPs in the Commons and Peers in the Lords, hosted clinicians with experience of working in a system which has assisted dying, run educational seminars and conferences connected to its themes and spoke publicly about the legislation.
Sharing workforce-wide expertise
Crucially, however, assisted dying is not the kind of topic that can be managed by a single team or department. It needs organisational breadth and leadership which engages with the spectrum of views within the multi-disciplinary team (MDT), many of whom we know struggle to get their voice heard in health and care as it is.
From our nursing workforce, we heard that they had been left feeling underrepresented, unheard and uncertain by the legislation. When we raised this with politicians at the House of Lords, we were told it would come out in implementation. Discussions about assisted dying frequently prioritise medical authority and legal frameworks, with limited attention paid to the perspectives of nurses who are central to providing end of life care.
In current clinical practice, nurses can feel they are left to ‘deal with’ the dying process once a doctor decides to withdraw treatment for a patient, research published in 2025 found, highlighting the emotional and ethical strain they can face when supporting patients in situations that may be seen as death hastening.
Victoria Ali, a nurse herself, shared her research during a learning session with our MDT and colleagues from across the organisation. Experiences such as this helped us as an MDT to focus and reflect more often on tricky and complex cases. They also helped us to create a culture where we are able to question doctor decision making when there is uncertainty.
It has also prompted better conversations and guidance around some of the aforementioned ethical grey areas within palliative care, including voluntary stopping eating and drinking, terminal sedation, as well as informing how we hold conversations with people who choose to travel abroad for an assisted death, and how we support families through what can be a complex bereavement. These are not new areas for us, and we were already actively engaging with these challenging ethical issues.
Raising awareness
At St Christopher’s, we have relied on a clinical ethics committee that can be used both in planned discussions and in urgent cases. That kind of structure is worth considering more widely. If leaders want staff to handle complexity well, they need a clear route to expert support when the right answer is not immediately obvious.
Another element of our work over the past two years has been to use the media spotlight on end of life care to raise awareness of the hospice funding crisis. This crisis preceded the legislation moving through Parliament. The financial pressure on hospices intensified as MPs from all persuasions stood up to talk about the importance of the hospice and palliative care sector. Politicians spoke in glowing terms as the cliff edge drew closer.
Nearly 60% of hospices in England have made or are considering cuts to frontline services, according to Hospice UK data. While the Bill has timed out, we cannot allow the pressure on Government to relent. The Modern Service Framework, promised to be unveiled this Autumn, must provide a fair funding plan so that everyone has access to high-quality palliative and end of life care.
Pressures remain
As the debate has continued, those of us working in palliative care have seen what we already knew play out in public. A system which cannot reach everyone. Heartfelt stories of people in distress, unable to access the expert support they need. In a country where we have expert palliative care, this is heartbreaking and unacceptable. The falling of the Bill does not remove the underlying pressures that helped fuel the debate in the first place.
Our community research points to concerns about over-treatment, poor communication, unequal treatment and systems that do not always support dying well. A better response is not simply to wait for the issue to return, but to improve the quality of care now. That means stronger funding arguments, better workforce support, more culturally safe care which meets diverse needs, backgrounds, cultures and religions, and a more honest national conversation about death and dying. It also means accepting that assisted dying has become part of a wider debate about how our systems treat people at the end of life.
We must remain engaged. The law remains unchanged, but I can see every day that questions that the debate has raised remain alive in the minds of the people we work with, their families, their carers, our colleagues, volunteers and the public. Anyone working in health and social care, on any side of the debate, must now work to prepare better for the conversations that have already changed.
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Sara Robbins is Medical Director at St Christopher’s Hospice.
Email: [email protected] LinkedIn: @St-Christopher’s