In 2024, Kim Leadbeater MP put forward the Terminally Ill Adults (End of Life) Bill, a Private Members’ Bill that would have introduced assisted suicide to England and Wales. The text of the Bill was only published three weeks before its Second Reading in the House of Commons, and a number of MPs who voted for it made it clear they were voting in principle only. They wanted to see changes before it was voted on again.
Leadbeater’s Bill ran out of time in the House of Lords after Peers tabled more than a thousand amendments. Although Leadbeater claimed her Bill was safe, with protections that were “the strongest in the world”, the scrutiny of the upper chamber revealed its weaknesses. While proponents of assisted suicide talk a great deal about safeguards, there are a number of fatal flaws in Bills like Kim Leadbeater’s that undermine the claim that such assurances can work.
1. Most assisted suicide legislation relies on an accurate prediction that a patient has a terminal diagnosis and an accurate prediction of how many months or years a patient has to live. Leadbeater’s Bill, for example, would have allowed assisted suicide for those with six months or fewer to live. But anyone who knows anything about medicine knows that predicting someone’s death is notoriously difficult. Doctors suggest that generally a prognosis can only really be predicted with any confidence in the final few days, or in some cases, hours, of someone’s life. A recent report indicated that doctors providing a six-month prognosis were wrong in around half of cases, and that a third of those they had predicted to die within that time were still living twelve months on. Within the debate at the Second Reading of the Leadbeater Bill, MP Mary Kelly Foy spoke of her daughter Maria, who was non-verbal and had cerebral palsy; she was often given just six months to live. She lived for 27 years.
2. There can be a very brief period from asking for assisted suicide to being granted the medication to end your life. In Oregon, for example, a mere 17 days could have elapsed between a patient’s initial request and them receiving the prescription. The Leadbeater Bill allowed for only three weeks, and Canada’s system can take as little as two weeks or even less. This ‘waiting period’ can be dressed up as a safeguard, but that is still a really short period of time. Does this properly allow for due diligence? Are we confident that courts will have time to consider all the requests that will come their way in detail? The courts are still dealing with huge backlogs. This is likely to mean that requests will be rubber-stamped, rather than properly considered.
3. Complications can and do occur when taking the lethal drugs that end your life. Legislation often acknowledges this when it says that doctors involved must discuss the patient’s wishes with them, in the event of complications. But the mere fact it makes this concession is significant. In other countries, like Belgium, where both euthanasia (doctor administers the lethal drug) and assisted suicide (where the patient takes it) are legal, there was a recent case where a patient did not die after the lethal drug, and so the doctor and nurses suffocated them. Palliative care doctor Ilora Finlay recently wrote for The iPaper about how taking these lethal drugs does not necessarily result in instantaneous deaths, and that in Oregon, about half of patients had taken between 53 minutes and 137 hours to die.
4. The family can be left out of the decision-making. All the Leadbeater Bill said about talking with family is that if the doctor thinks it appropriate, they should advise the patient to ‘consider’ discussing the request with their next of kin. That’s a shockingly low bar for family involvement given the gravity of the decision. It is the product of our culture’s obsession with autonomy. But no man is an island. All our decisions have an impact on our nearest and dearest. For example, Noelia Castillo, a 25-year-old Spanish woman, died by euthanasia in 2026. Nobody within her family agreed with her decision and a former friend was stopped by police from trying to dissuade her from going ahead. Here in the UK a woman grieving her son sought assisted suicide in Switzerland. She died without her family being consulted or even informed.
This kind of legislation does not do justice to the role of the family. While courts might be involved, it is slanted one way. If the High Court says no to your request for assisted suicide, you can appeal. But if the High Court approves, there is no appeal process open to family members who are concerned about abuse. How is this right?
5. It is doctors who are expected to spot the signs of coercion, despite not being formally trained to do so. Coercion is notoriously difficult to identify, and can take many forms. It is rare that it is as simple as someone trying to outright convince another person to take a course of action. Generally it is much more subtle, and in this case, there will not be a witness around to ask about it afterwards. The MP Diane Abbott spoke in the Commons about how “Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.” There is also a strong chance that some will fall prey to an unspoken ‘societal coercion’, where they feel they do not want to be a burden, on their friends and family, or even upon the NHS.
6. Much assisted suicide legislation does not make provision for palliative care. As a number of people have pointed out, choosing between the prospect of an assisted suicide and non-existent or sub-standard palliative care (in much of the country) is no choice at all. We need to properly invest in and support the provision of palliative care, so that people are not faced with a postcode lottery. The genius of this approach is that it provides holistic care for the patient, and in the vast majority of cases, it makes a good, dignified death possible.
In discussions and debates about assisted suicide, there have been attempts to fix some problems during the legislative process. Certainly the work of the House of Commons, and especially the House of Lords, is to highlight issues with Bills and propose ways to address them. However, assisted suicide legislation ends up being unworkable.
The one thousand amendments added to the Leadbeater Bill in the House of Lords show how flawed such proposals can be. It has the potential to cause chaos in our healthcare, in our justice system, and to create pressure on some of the frailest in our society. Whatever the talk about ‘strongest safeguards’ for this kind of legislation, the truth is that assisted suicide cannot be made safe.