An attempt to make assisted dying legal in England in Wales continues to make its way through parliament, with MPs currently scheduled to have a final vote on the bill in June.
Authors
- Suzanne Ost
Professor of Law, Lancaster University
- Nancy Preston
Professor of Supportive and Palliative Care, Lancaster University
The bill has sparked both passionate support and strong opposition, raising vital questions: how would such a law work in practice? Who would deliver it? And what would it cost?
While much attention has focused mostly on the ethics of assisted dying, the government's recently published impact assessment looks at the practical side and it deserves closer attention.
Of course, we shouldn't base a decision about life and death solely on financial or logistical grounds. But if assisted dying is to become part of the law in England and Wales, we need to understand how it would work in reality. The report highlights a number of key challenges:
1. The medication question
The assessment draws mainly on data from 11 other jurisdictions, especially Oregon , where assisted dying has been legal for years. It found that the drugs used can lead to prolonged and unpredictable deaths, in part due to inconsistent drug availability.
However, the report doesn't compare this to Switzerland, where assisted dying must be self-administered and is tightly regulated. There, a single barbiturate is typically used, leading to death within two to ten minutes depending on whether it's taken orally or via injection. This raises questions about what kind of medications would be used in the UK and how reliably they would work.
2. Opt-outs: who will deliver the service?
Experience from countries like Canada shows that most doctors opt out of providing assisted dying. In Canada, over 5,000 assisted deaths were carried out by just 80 people. Similarly, in the US and New Zealand , entire institutions - especially palliative care services - have opted out.
Kim Leadbeater, the MP sponsoring the bill, has confirmed that it would not oblige hospices to participate. While this protects individual conscience, it may leave patients struggling to find willing clinicians or being discharged home to die.
3. Can the NHS cope with a new service?
The bill assumes the NHS would be responsible for delivering assisted dying. But is the system ready?
Switzerland uses volunteer doctors outside the healthcare system, which may be more sustainable. In the UK, oversight is expected to come from a panel including a senior judge or lawyer, a psychiatrist and a social worker.
However, the Royal College of Psychiatrists (RCP) has raised serious concerns , both about the role psychiatrists would play and whether there are enough professionals to fulfil that role. The RCP currently opposes the bill.
4. Funding: a two-tier system?
The impact assessment suggests assisted dying would be free at the point of delivery. Yet palliative care - the alternative end-of-life support - often receives less than 40% government funding, relying heavily on charity .
Could this create a two-tier system, where assisted dying is fully funded while palliative care remains under resourced?
5. Legal costs and challenges
If passed, the bill could trigger human rights challenges, particularly around mental capacity and access. Legal experts suggest several grounds on which it might be contested and these cases would need to be defended, incurring additional costs.
Families might also seek judicial review of a panel's decision to permit a request for assisted dying. And public protests outside clinics or hospitals offering the service could require increased policing and security - all of which have financial and social implications.
This bill tackles one of the most morally sensitive issues in society. But if it is to succeed, and be implemented safely, it must be built on more than good intentions.
The government's impact assessment lays out the many practical hurdles: medication protocols, workforce readiness, conscientious objection, legal protections, and funding disparities. These aren't technicalities. They're the framework that would determine whether assisted dying is accessible, safe and ethically delivered.
As the bill progresses, the debate must move beyond principle alone. The future of this legislation - and its real world impact - will depend on how well we address these deeply human, and deeply complex, practicalities.
Suzanne Ost has previously received funding from the Arts and Humanities Research Council and the British Academy for research that she has conducted.
Nancy Preston receives funding from Horizon Europe but not for her work on assisted dying. She is affiliated with European Association of Palliative Care where she Co-Chairs the Task Force on the role of palliative care professionals in supporting patients and families considering assisted dying.
