Assisted dying

The Assisted Dying for Terminally Ill Adults Bill is again being considered by parliament. It aims to legalise assisted dying for terminally ill, mentally competent adults who have six months to live or less.

What’s happened so far

The bill, introduced as a private members’ bill by Labour MP, Kim Leadbeater, was given a third reading in the House of Commons by MPs in June 2025 by 314 votes to 291. It then ran out of time and stalled in the House of Lords where more than 1200 amendments were tabled. Critics said it didn’t have enough safeguards to protect vulnerable people. Supporters accused them of using delaying tactics. Both are true. VAR is not available to adjudicate on foul play in The Lords, but – unlike in football – they’re going to get another go because another Labour MP, Lauren Edwards, who struck lucky in the private members’ bill ballot for this parliamentary session, is using her winning ticket to put assisted dying back on the agenda.

Nothing has stirred up as much angst as this since David Steel’s private member’s bill led to the abortion act of 1967.

Ways of dying

Since first stepping onto a hospital ward as a clinical student in 1978 I have seen many ways of dying. Some have been welcomed by the patient and their family and peaceful in nature, but most have not passed any or all of these requirements for a good death. For every one of these I’ve seen dozens of Dylan Thomas’, ‘burn(ing) and rav(ing) at close of day’: going into ‘that good night’ has not been gentle. Not for the patients. Not for their families. Not for their nurses and doctors. In fact, it’s often been bloody awful for everyone.

I knew one man, aged ninety something, who died in his sleep overnight immediately after a wonderful family gathering. After the initial shock of discovery, the universal next thought was, ‘what a wonderful way to go’. If not like this, then I direct medical students and junior (resident) doctors to Roger McGough’s request for a young man’s death: I hope to get beyond his youngest departure (aged 73), but think I’d settle for his later departures (aged 91 and 104). You can ask me when I’m 90 if I’ve changed my mind.

Patient choice

It’s universally agreed that patients with capacity should be able to make decisions about their treatment. Their decision is the one that matters if they have the ability to use and understand the relevant information and can communicate any decision they make. The doctor needs to explain possible options and their likely outcomes in as fair and balanced a manner as possible.

Choosing to die – some statistics from kidney units

Some patients are able to choose to die by stopping their medical treatment. For instance, someone with Type 1 diabetes will perish if they stop their insulin, but very few do this.

Kidney doctors look after a group of patients, those receiving artificial kidney (dialysis) treatment, who are unusual in that it’s not uncommon for stopping treatment to be the cause of their death, normally a few days to a few weeks later. Indeed, in rich countries withdrawal from dialysis is one of the main causes of death in patients with end-stage kidney disease. In 2022 in the United States, withdrawal was responsible for 18% of dialysis patients’ deaths, most frequently in those who were older (34% of those aged over 85) but not uncommon in the younger (11% of those aged under 44). Similar figures have been reported from Scotland, where dialysis withdrawal was the cause of 23% of all deaths in 2017.

Choosing to die – what it looks like on kidney units

The blunt statistics cover a range of scenarios.

At one extreme is the patient who is clearly dying: they’ve been stuck in hospital for weeks with one medical problem after another; these problems aren’t reversible and they’re getting frailer and frailer; their blood pressure is low and their breathing is weak; if they’re put on a dialysis machine it seems very likely they won’t survive the treatment; the doctor says ‘stop’ and no more dialysis is given.

At the other end of the spectrum, but just as common, is the patient who’s at home, coming up to the dialysis unit three times a week for a treatment that lasts for three or four hours (the usual dialysis ‘prescription’). They’re finding the travel and the treatment utterly draining. There isn’t anything that I or my colleagues can do to improve the situation, which has been discussed many times. They say, ‘I feel as though I haven’t recovered from one session before the transport calls to take me for the next’, ‘I feel as though I’m just existing, not living’. When I acknowledge this and ask them what they’re thinking, they often say, very quietly, ‘I’d like to stop’ or ‘can I stop?’, as if they’re worried I’ll be cross at the suggestion (‘how ungrateful can you be?’). And if they don’t say this, but I can tell it’s what they’re thinking, I say ‘have you thought about stopping?’, which very often leads to ‘yes’ or a nod and frequently to tears of relief. Further discussions follow and practical arrangements are made.

‘Thank you for looking after me so well for so many years, and for letting me go’, is the most moving thing a patient has ever said to me.

Allowing patients to die

It’s clearly essential that any legislation that permits assisted dying has safeguards to protect the vulnerable, but those who argue against it must explain why they wish to deny this choice to people with capacity when they would allow them to make any other decision about their medical care. In Paul Kalanithi’s impressive book, When Breath Becomes Air, he argues that having direct experience of life and death questions is essential for generating substantial moral opinions about them. Most people don’t, and those who are set against assisted dying would do well to reflect on this.