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Articling Weekly No.5: The Terminally Ill Adults (End of Life) Bill 2024-25 in United Kingdom

There has been an ongoing debate amongst various jurisdictions in the world governing principles respecting the right to control one’s own death. But, as more countries prepare to legalise medically assisted dying, the reality of legalizing the practice is sparking fresh ethical arguments. Eligibility, permitted circumstances, and authorized methods for assisted dying vary considerably internationally. In Canada, the 2016 Bill C-14 legalized Medical Assistance in Dying (MAiD). MAiD permits both physicians and nurse practitioners to assist eligible and consenting adult patients with foreseeable death to end their life by medication with specific safeguards. In March 2021, an additional criminal code amendment was passed by Canadian Parliament with Bill C-7 expanding the MAiD eligibility criteria, by including individuals who are at risk of losing their capacity to consent regardless of whether their death is foreseeable or not.[1] A dignified death looks different for everyone and is deeply personal. For some, this will mean the choice of palliative care and end of life care alone, and for others, it could be a combination of this and assisted dying. There has been extensive debate of the policy options related to choice at the end of life in the U.K for many years among academics, legal experts and health professionals. On November 29, the British lawmakers gave their initial approval for a bill to help terminally ill adults end their lives in England and Wales. The broad aim for the Terminally Ill Adults (End of Life) Bill is to allow adults aged 18 and over, who have mental capacity, are terminally ill and in the final six months of their life to request assistance from a doctor to end their life.[2][3] In order to fully understand this development, it is essential to consider its context, including existing U.K. laws and global perspectives.

The existing criminal law in England and Wales

The Suicide Act 1961: Assisting the suicide of another

Suicide and attempted suicide are not criminal offences.[4] However, under section 2(1) of the Suicide Act 1961 it is an offence for a person to intentionally encourage or assist the suicide (or attempted suicide) of another.[5] The maximum available sentence is 14 years.

A prosecution for an offence under section 2(1) can only be brought by or with the consent of the Director of Public Prosecutions (DPP).[6]

In practice, Crown Prosecution Service (CPS) data shows prosecutions under section 2(1) are relatively rare. In prosecution the person accused of committing an offence under section 2 of the 1961 act will not automatically be prosecuted but prosecutors will instead use discretion on a case-by-case basis to determine if prosecution is in the public interest.

The “End of Life” Bill

If passed, the Terminally Ill Adults Bill will apply the principles of the Mental Capacity Act 2005 (the “MCA”) when assessing the ability of certain terminally ill individuals to take the decision to seek assistance in dying.[7]

The Terminally Ill Adults Bill, more commonly referred to as the ‘End of Life Bill’, proposes giving terminally ill people the right to choose to end their life in a more dignified way than currently available. However, anyone who wants to end their life through the use of this Bill must fit certain criteria’s, which include:

The applicant must be resident in either England or Wales, and two doctors must have assessed each request, at least seven days apart, to ensure that the person meets the eligibility to make such a decision.

The eligibility criteria include that the person has a “clear, settled and informed wish to end their own life” and that they have reached this decision voluntarily, without coercion or pressure. If both doctors state, independently of one another, that the eligibility criteria have been met, the person may apply to the High Court for approval of their request.

If the High Court decided that the applicant met the requirements of the bill, there would then be a 14-day reflection period (this would be shortened to 48 hours if death is imminent). After this time, the applicant may make a second declaration to request assistance to end their life. If the doctor continues to be satisfied that the person meets the eligibility criteria set out in the bill, a life-ending “approved substance”, to be self-administered, would be prescribed.[8]

The Bill also includes a “conscience clauses”, ensuring medical professionals are not obliged to advise on or participate in the assisted dying process. It would, presumably, be open to the attorneys appointed under lasting powers of attorney (LPAs) to resign their appointment if they were uncomfortable helping to make arrangements that might help facilitate an assisted death.[9]

Assisted dying is already legal in several countries across the world with Switzerland being the first nation to introduce it back in 1942. This bill serves as a way to give people who are suffering, the choice and autonomy to die in a more dignified and comfortable manner than current systems allow.[10]

On the other hand, the bill might put people already suffering under pressure to end their lives, opening up new possibilities for abuse and exploitation of the sick and elderly, who are already some of the most vulnerable populations of society. The elderly and disabled could be coerced directly or indirectly to end their lives to save money or relieve the burden of care on family members. As there does not seem to be legitimate safeguards in place that could prevent vulnerable people from feeling the pressure to make a request to end their lives, who might need palliative care instead.

The Terminally Ill Adults Bill introduces a legal framework for assisted dying in the U.K., following similar developments several other countries.[11]  For instance, Canada’s Medical Assistance in Dying (MAiD) legislation has evolved over time to expand eligibility criteria while addressing safeguards for vulnerable individuals.[12] As more jurisdictions legalize or consider assisted dying, this Bill reflects a growing global trend towards aiming to provide terminally ill individuals with greater autonomy in end-of-life decisions. However, questions remain about the effectiveness of safeguards to prevent coercion or undue pressure, particularly for vulnerable populations such as the elderly or disabled.

[1] Ho, A., Norman, J. S., Joolaee, S., Serota, K., Twells, L., & William, L.  “How does Medical Assistance in Dying affect end-of-life care planning discussions?” online: Palliative Care and Social <How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers – PMC>

[2] The Associated Press, World News “British Lawmakers give initial approval for a bill to allow terminally ill adults to end their lives”  online: AP News <British lawmakers give initial approval to a bill to allow terminally ill adults to end their lives | AP News>

[3] Rowland, L., Rough, E., Dawson, J., Lipscombe, S., “The Terminally Ill Adults Bill 2024-25” House of Commons, U.K Parliament, online: Commons Library <The Terminally Ill Adults (End of Life) Bill 2024-25 – House of Commons Library>

[4] Section 1 of the 1961 Act provided that “the rule of law whereby it is a crime for a person to commit suicide is hereby abrogated”

[5] Section 2(1) was amended by the Coroners and Justice act 2009. For background see Ministry of Justice Circular 2010/03, Encouraging or Assisting Suicide: Implementation of Section 59 of the Coroners and Justice Act 2009, and Library Research Papers 09/06, Coroners and Justice Bill: Crime and Data Protection, and 09/27 Coroners and Justice Bill: Committee Stage Report.

[6] Suicide Act 1961, s2(4)

[7] Michael Armstrong & Hannah Mantle, Forsters “The Terminally Ill adults (End of Life) Bill”, online: news <The Terminally Ill Adults (End of Life) Bill – difficult decisions ahead? – Forsters LLP | Leading London law firm>

[8] Commons Library Research Briefing, “The Terminally Ill Adults (End of Life) Bill 2024-25”, at pg 8, online : <CBP-10123.pdf>

[9] Michael Armstrong & Hannah Mantle, Forsters “The Terminally Ill adults (End of Life) Bill”, online: news <The Terminally Ill Adults (End of Life) Bill – difficult decisions ahead? – Forsters LLP | Leading London law firm>

[10] Dr. Seewoodhary, The Shuttle “The terminally Ill Adults Bill”, online : <The Terminally Ill Adults Bill: What it means for people | Kidderminster Shuttle>

[11] Ho, A., Norman, J. S., Joolaee, S., Serota, K., Twells, L., & William, L.  “How does Medical Assistance in Dying affect end-of-life care planning discussions?” online: Palliative Care and Social <How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers – PMC>

[12] Department of Justice “Eligibility for medical assistance in dying for persons suffering solely from mental illness extended to March 17,2024”, News release, online: Canada.ca <Eligibility for medical assistance in dying for persons suffering solely from mental illness extended to March 17, 2024 – Canada.ca>

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