What is the assisted dying Bill and how will it work?

Britain’s proposed law to legalise assisted dying will make it legal for terminally ill people to end their lives

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Britain’s proposed law to legalise assisted dying is to be voted on by MPs for the first time on November 29 and, if passed, will make it legal for terminally ill people to end their lives.
It’s an option already available to more than 200 million people across the world, including those in Canada, Switzerland, Belgium, Luxembourg and the Netherlands – as well as 10 American jurisdictions and Victoria in Australia. The Labour MP Kim Leadbeater, who has introduced The Terminally Ill Adults (End of Life) Bill, insists that in Britain assisted death would include “the strictest safeguards anywhere in the world”.  
The first step would be to discuss your wishes with a doctor, presumably your GP, who will become, in the terms of the Bill, the “coordinating doctor”, guiding you through the assisted dying pathway. Somewhat controversially, the Bill will allow doctors proactively to suggest assisted dying to their patients. The legislation states that while doctors are not obliged to raise it, they can use their “professional judgement” to decide if and when to discuss the issue with a patient. They must, however, also detail the patient’s diagnosis, prognosis, treatment options and the possibilities for palliative and hospice care. 
Candidates for assisted dying must be residents of England and Wales and must be registered with a GP for at least 12 months. This is to stop “suicide tourism”, with people coming from overseas to end their own lives in the UK. They must be terminally ill and expected to die within six months, yet also have the mental capacity to make the choice. According to the Bill, it must be deemed to be a clear, settled and informed wish, free from coercion or pressure. 
Those deciding to end their lives will need to be terminally ill with six months to live, and go through a rigorous three-week process, declaring their wish to die in front of witnesses and seeking doctors’ approvals and a ruling from a High Court judge. The Bill specifically excludes those with disabilities or mental illness alone.
The candidate must make two separate declarations of their wish to die, which must be signed in front of a witness. Afterwards, their co-ordinating doctor plus another independent doctor will be responsible for assessing their eligibility. The Bill deems that you must have the mental capacity to make the decision, your condition must be terminal and that you will die within six months. 
To make an informed judgement, the doctors will consult with specialists in the particular condition and arrange an evaluation of the patient’s mental capacity. There will need to be at least seven days between each doctor’s assessment. Then a High Court Judge will hear from at least one of the doctors and might also question the patient or anyone else they deem appropriate before ruling that they should be allowed to self-administer a fatal medication. Then a further 14 days must pass after the judge has made the ruling before they can go ahead with their wish to end their life.
According to a guide prepared by the University of California San Francisco, people who take these medications typically fall into a deep sleep within 10 minutes, followed by a coma, respiratory depression and death shortly afterwards. Death typically occurs within two to five hours, although it can happen very quickly. 
The University of California San Francisco prepares loved ones for the dying experience, warning them that their relative or friend will exhibit symptoms of dying that “don’t cause them to suffer but can be startling for loved ones to witness”. These can include deep gasping breaths, gurgling sounds and changes in facial colour to pale or blue. 
At least three weeks, given the required seven days between the doctors’ assessments and 14 days following the judge’s ruling. It could take longer, depending on the availability of the doctors and the judge, although there will be flexibility if the person is likely to die sooner. The dying person’s decision must be confirmed at every stage and they could change their mind at any time.
There are strict protocols within the Bill to ensure the safe prescribing, transportation and administration of all medication.  The medication must be self-administered: “Neither a doctor nor anyone else can administer the medication to the terminally ill person. If they choose not to self-administer, the medication is immediately removed from their possession.” 
This is different from certain other jurisdictions, where a fatal mediation can be administered by doctors if you are unable to do it yourself. “The assisted dying process must be overseen by a trained medical practitioner who will be expressly forbidden from taking any action to end the person’s life.”
The medication will be prepared by a doctor – unlike in Victoria, Australia, where patients receive a powder in a locked box, which they must mix up themselves. The Bill states that a doctor can prepare the substance for self-administration and also prepare a medical device enabling the person to self-administer. 
They can also assist the person to ingest or otherwise self-administer the substance. “But the decision to self-administer the approved substance and the final act of doing so must be taken by the person to whom the substance has been provided.” The Bill isn’t specific about where the medication should be taken but information guidelines provided to patients in California and Victoria, suggest the medication can be taken at home, or in a hospital or hospice. Patients in those jurisdictions are encouraged to think carefully about where they take it, who is with them and the arrangements for their body afterwards. 
The Bill does not specify a medication. It simply says that the Secretary of State will be required to state one or more drugs. In other countries where assisted dying is legal, high doses of the barbiturates pentobarbital and secobarbital are the preferred medications. Patients will most likely be required to take anti-nausea medications beforehand and drink juice or lick lollipops to counteract the bitter taste and soothe any burning sensations. 
Dame Esther Rantzen, who has been diagnosed with stage four lung cancer, advocates the Bill, maintaining it will give those suffering from terminal illness the dignity of choice. Dr David Nicholl, a neurologist and human rights activist, believes it will improve the quality of conversation between doctors and patients. 
Meanwhile the neurosurgeon Henry Marsh wrote in the Bulletin for the Royal College of Surgeons that there is clear demand for assisted dying in this country despite good palliative care “as is shown by the fact that many people (who can afford it) go to Switzerland for an assisted death.” Indeed, Dignitas helped 571 Britons to die between 1998 and 2023. The new law would only apply to England and Wales, although a separate bill is being discussed in Scotland and legislation is underway in Jersey and the Isle of Man. 
There are many opposers to the Bill. Dr Gordon Macdonald, the chief executive of campaign group Care Not Killing, believes that safest law is the one we already have, while Dr Gillian Wright, a former palliative care doctor, maintains that the Bill’s safeguards are too difficult to manage. Paralympian and House of Lords crossbencher Baroness Grey-Thompson told the BBC that she fears for the impact on vulnerable and disabled people, as well as the risk of coercive control and the ability of doctors to make a six-month diagnosis. A Telegraph poll shows readers are divided equally on the matter, with 47 per cent against the Bill and 53 per cent in favour. 
Any change in the law would not be implemented until next year at the earliest. There is still a way to go before the Bill becomes law. If it passes the first debate and vote in the Commons, it will go to committee stage where MPs can table amendments, before facing further scrutiny and votes in both the House of Commons and the House of Lords.
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