Legislation Watch: Death by Design -The Assisted Dying Bill’s Lethal Flaws

How Proxies and Shaky Safeguards Could Turn Choice into Coercion

Today I am diving back into the UK’s Terminally Ill Adults (End of Life) Bill, focusing on some of the changes and retentions made during the committee stage, pinpointing the most serious ones for potential repercussions, and unpacking the potential legal ramifications of the bill if it passes in its current form. This is a hot topic, and I want to try and highlight the cracks that could lead to courtroom chaos and show why the law does not look like it will shield the vulnerable very well at all.

Changes Made and Provisions Retained During the Committee Stage

The bill, introduced by Labour MP Kim Leadbeater in October 2024, originally aimed to let terminally ill adults in England and Wales with six months or less to live end their lives with medical help, subject to strict safeguards: approval from two independent doctors and a High Court judge. It passed its second reading on November 29, 2024, with a 330-275 vote. Since then, the committee stage—which kicked off in January 2025—has seen some big amendments to the bill as well as some awful provisions being retained:

1. Scrapping High Court Approval

   • Change: The requirement for a High Court judge to sign off on each case was axed on March 12, 2025. Instead, a new system is being considered: a “Voluntary Assisted Dying Commission” —a death Czar—led by a senior judge or ex-judge, along with three-person panels (a senior legal figure, a psychiatrist, and a social worker) to review applications. In a statement issued after the vote, 26 Labour MPs who previously voted against the bill said: "It does not increase judicial safeguards but instead creates an unaccountable quango and to claim otherwise misrepresents what is being proposed”. They raised concerns that the new panel process could be held in private, would not have the power to make witnesses appear before it or take evidence under oath. "They will inevitably drain public services of vital frontline staff without any idea of how much this will cost the taxpayer or any assessment of its impact upon the vulnerable," they added.

   • Why It Happened: Retired judge Sir Nicholas Mostyn warned the High Court couldn’t handle the caseload—potentially tying up three-quarters of the Family Division. Right from the start I and others said that the High Court would not be able to handle applications and that they would become rubber stamping exercise due to volume. However, this change doesn’t improve things for people by offering more protections. It just takes the load off the Court

2. No Family Notification stays intact

   • No Change: The committee upheld Clause 5 on March 5, 2025, which doesn’t mandate notifying family members before an assisted death. A person could end their life without loved ones knowing until after the fact.

   • Why It Happened: This reflects the bill’s focus on individual autonomy, but critics say it ignores family dynamics and potential coercion, which of course it does.

3. Proposed Eligibility Expansion

   • Change: An amendment from Liberal Democrat MP Tom Gordon pushes to include neurodegenerative diseases like Parkinson’s, extending eligibility from six months to twelve months to live.

   • Why It Happened: Advocates want broader access, but opponents fear a “slippery slope” to wider criteria – exactly what all opponents of this bill have been warning about.

4. Over 300 Amendments Tabled

   • Change: By February 2025, over 300 amendments were proposed, with more expected. Beyond the ones above, many tweak definitions (e.g., “capacity”), adjust safeguards, and refine processes—though many are still under debate.

   • Why It Happened: The bill’s complexity and ethical weight has sparked a flood of suggestions, and all of these changes show that MPs and others are wrestling with its details.

One change and one retention stand out as ticking time bombs:

1. Ditching High Court Oversight

   • Why It’s Serious: The original judicial safeguard was a legal anchor—ensuring impartial, expert review. Replacing it with a commission and panels risks inconsistency and bias. A psychiatrist or social worker might miss legal nuances a judge wouldn’t, and the commission’s oversight could become a rubber stamp if they are overstretched. Imagine a panel approving a case under coercion—say, a vulnerable person pressured by a relative—without a judge’s scrutiny to catch it. This could flood courts with cases, undermining trust in the process, and cause terrible upset for families.

2. No Family Notification

   • Why It’s Serious: This is a gut-punch to families. Picture a daughter waking up to find her mum’s gone, no chance to talk it out or spot coercion. This Clause prioritises secrecy over transparency, risking hidden abuse and all sorts of other problems. If families suspect foul play—like financial motives—they will no doubt head straight to court, claiming the system failed to protect their loved one. By then it will of course be too late. I see a spiral into a legal and emotional mess.

Other Amendments

Another amendment which has sparked intense debate involves whether doctors must proactively suggest assisted suicide to eligible patients, even if the patient has not brought it up. The British Medical Association, which holds a neutral stance on the bill itself, argued strongly against any prohibition on doctors raising the topic, suggesting it would be an "unacceptable intrusion" into the doctor-patient relationship. They have stated that doctors should have the discretion to broach the subject sensitively when they believe it aligns with a patient’s needs, based on their professional judgment. This was a point of contention during the committee stage. An amendment, tabled and debated on March 4, 2025, sought to explicitly prohibit doctors from raising assisted suicide unless the patient mentioned it first, out of concern for undue pressure. The amendment was rejected (13-8) and leaves us in the position that whilst doctors are not forced into an awkward sales pitch, there is room for inconsistent practice or subtle coercion, especially with vulnerable patients.

As of now, there is no requirement mandating that all doctors must raise the option of assisted suicide with patients— so we have at least thankfully stopped short of requiring doctors to bring up assisted dying universally. Also, as reported on February 5, 2025, in The Guardian, doctors cannot raise assisted suicide in isolation during initial discussions and doctors must discuss palliative care and alternatives before approving a request. However, this latter requirement applies only after a patient has raised assisted suicide, not as a general obligation. The Committee also rejected an amendment that would require someone to have a consultation about palliative care options before being able to have an assisted suicide, so that all other options are made available to them.

Rejections

In other rejections, the Committee voted down amendments, supported by a number of eating disorder charities, designed to explicitly prevent people with anorexia from being eligible for assisted suicide, as well as rejecting amendments which would prevent a condition that can be managed by treatment, such as diabetes, from counting as a terminal illness eligible for assisted suicide.

Legal Ramifications

If this bill passes as drafted, (post-committee changes as of March 18, 2025), here is how it could interplay with existing UK law:

1. Laws Potentially Broken or Challenged

   • Suicide Act 1961: The bill amends the Suicide Act to exempt assisting death within its framework, but anything outside this—like a doctor fudging eligibility—may still carry a 14-year sentence. Example: A GP refers a patient with 7 months to live, not 6, and they are panel approved for death—could prosecution follow?

   • Human Rights Act 1998 (Article 2 - Right to Life): If safeguards fail (e.g., coercion goes unchecked), families could argue that the state didn’t protect life. Example: A coerced patient dies; relatives sue, claiming the state funded panel missed red flags.

   • Equality Act 2010: Critics say limiting the bill to terminally ill adults discriminates against others (e.g., chronically ill). Example: A Parkinson’s patient denied access (if the 12-month amendment fails) could sue for unequal treatment, pushing for broader laws, and forcing us all onto that slippery slope.

2. Impact on Redress

   • Current Gaps: The bill does not provide family members with a right to appeal a positive assisted suicide decision. Example: A patient dies after a rushed panel decision; relatives would have objected to the decision if they could and find out after the death that there was a mistake with the decision. What is the accountability for an avoidable death after the fact, when an appeal before the fact may have stopped the death?

   • No Family Oversight: Concerns have been raised—voiced by MPs like Danny Kruger during committee debates—about the lack of family ability to challenge an assisted suicide decision, especially given the potential for coercion or oversight failures (e.g., with proxies - see below). Critics argue this omission leaves families powerless to intervene if they suspect undue influence or error,

3. Liability for Mistakes

   • Doctors: The bill shields them from prosecution if they act “in accordance with” it, but errors (e.g., misjudging capacity, wrong diagnosis) could lead to negligence suits. Example: A doctor misses dementia in a patient who “chooses” death—can the family sue for negligence and is the doctor criminally liable?

   • Panel Members: It is unclear if they will be personally liable or protected by the commission. Example: A social worker overlooks coercion; could they face a civil claim or be criminally prosecuted?

   • Commission: As overseer, does it bear ultimate responsibility. Its legal status (will it be a public body?) is fuzzy at the moment. Example: Systemic failures—like underfunding panels—could this see the state sued for negligence if the commission is a public body?

   • State/NHS: If the process fails vulnerable people, taxpayers foot the bill for lawsuits—again. Example: Mass coerced deaths spark a group litigation for inadequate safeguards.

   • Proxies: If a proxy signs off assisted suicide for someone that we later find out was coerced, or who lacked capacity to understand the decision, will the proxy face any accountability at all?

In my opinion this bill has got holes big enough to drive a hearse through. Ditching judges for panels might sound efficient but it risks sloppy decisions. No family notification invites secret abuses, and the current law is too flimsy to stop them. Legal challenges could pile up—human rights, equality, negligence—while families and doctors start to drown in uncertainty over redress and liability. The UK is not ready for this bill: the safeguards are more promise than protection, and the legal fallout could be a nightmare. This is a ticking timebomb waiting to go off.

Private Companies Involvement & The Cost of Assisted Suicide

Moving on now to the talk about private companies stepping into this process— this idea is a potential powder keg in my opinion. As of now, outsourcing the assisted suicide process to private companies is not locked in—it is a suggestion that has gained traction during the committee stage. The bill’s original framework leaned on NHS doctors and a High Court judge for approvals, but the shift away from judicial oversight as mentioned above opened the door to whispers of private involvement. Reports like this from The Times—suggest the government is indeed eyeing private firms to handle the nuts and bolts, perhaps right from assessments to doling out the lethal meds. The bill does not explicitly say “private companies,” but its silence on delivery specifics leaves room for it. No formal amendment on this has been nailed down yet—but the idea is alive and hence the alarm is sounding that “it’s a disaster in the making”.

Catherine Robinson, spokesperson for Right to Life UK, said the move would be a mistake. “Introducing assisted suicide to the U.K. would be a disaster waiting to happen, made potentially even worse if outsourced to the private sector,”. “Under such a system, the existing checks and safeguards will likely be increasingly viewed as an inconvenience and a barrier to business. The welfare of vulnerable patients will be especially at risk due to the profit motive.”

Of course, liability also gets murky when private companies are involved—and paves the way for court battles and all the costs and legal fees made from the same. As we know, the bill shields anyone acting “in accordance with its rules” from criminal or civil liability, amending the Suicide Act 1961. If private companies take over part of the process of assisted suicide, would they get the same immunity, provided they stick to the script? What happens if they mess up? The talk of private companies being part of this process has been glossed over in a woeful way, along with what legal immunity they may or may not get if something goes wrong. Perhaps directors or employees could face negligence claims—we simply do not know—but the company itself would likely be able to dodge accountability if it is structured as a limited entity. Compare that to the NHS: public bodies carry systemic liability—although the taxpayer eats the cost of legal action. Private firms could also just go bankrupt and vanish, leaving families with no redress. It is a legal Wild West waiting to happen.

As an added complication, no hard rule seems to exist about NHS doctors being involved or not if private companies are tasked with assisted suicide. NHS doctors may of course need to be involved due to staffing issues, although The British Medical Association has pushed for a separate service—not baked into NHS pathways. In such a set up doctors could refer patients to private companies, so an NHS GP could flag a case, hand it off to a private outfit, and wash their hands of it—nice. Alternatively, private firms could hire their own medics—ex-NHS or otherwise—to run the show end-to-end. The bills coordinating doctor, (needing specific training), could be an NHS worker moonlighting for profit—who knows! However, nothing in the bill mandates NHS involvement or no NHS involvement. For me I feel that if private companies dominate, NHS doctors might sidestep the messy bits entirely, leaving the dying to corporate hands. This is a headline begging for outrage.

Funding for assisted suicide is another issue. As this bill is a Private Member’s one, it sidestepped government cash commitments upfront, needing a money resolution to unlock public funds. The money resolution passed on January 22, 2025, and authorised the Secretary of State for Health and Social Care to incur expenditure, suggesting that public funds—likely via the Department of Health and Social Care (DHSC) and the NHS—would cover implementation costs. This aligns with Kim Leadbeater’s assurances during committee debates that NHS resources would support the process, although she has not detailed how. The British Medical Association has since emphasised that if assisted suicide is legalised, the government must ensure additional funding so that it does not strain existing NHS services, which are already under pressure. Given this, speculation that the government will outsource assisted suicide aspects to private providers seems well founded.

If private firms step in, options could be: self-funding via patient fees, government contracts, (taxpayers still pay, just through a middleman), or a hybrid where firms profit while the NHS covers basics like doctor consults. This screams “NHS profiteers,” and hints at firms like those already gouging the health service. Health Secretary Wes Streeting has been very cagey about funding, only saying he has asked for cost estimates. Without a solid plan, we could have a recipe for either a cash grab or a broken system, both ripe for scandal.

Private companies running assisted suicide is a neon sign for chaos. No High Court backstop means panels—potentially bankrolled by profit-hungry firms?—could greenlight deaths with shaky oversight. Liability is a guessing game: if a firm botches it, who pays the price? NHS doctors might duck out, leaving patients to faceless corporations with no skin in the game beyond the bottom line. And funding? Whether it’s your wallet or the Treasury’s, someone’s getting fleeced. This isn’t just a process—it’s a pressure cooker for abuse, lawsuits, and public fury.

Pallative Care Issues

This bill has real potential to gut funding for quality palliative care, if assisted suicide is fully publicly funded—and set up a two-tier mess leaving the wealthy comfy with an array of choices, and the poor with a one-way ticket to assisted suicide. This is because there have been no explicit concrete promises of extra palliative care funding from the UK government tied directly to the bill’s passage or implementation. As of now, there is silence on how assisted suicide will be bankrolled, and not much being said about how palliative care will be bolstered alongside any new law on state assisted death. Hospice UK has been screaming for a while that their members are severely underfunded and having to slash services. The Health and Care Act 2022 tried to glue palliative care into the NHS, but it is a patchwork, charities pick up the slack, and inequality is rife.

The NHS budget is a fixed pie. The level of NHS funding each year is set by central government through the Spending Review process. Divvy this funding up with a new assisted suicide setup, (panels, drugs, maybe private firms), and palliative care could get even less crumbs, leading to a two-tier trap where the rich snag top-notch end-of-life support through private hospices and bespoke pain management, whilst the poor, stuck with limited NHS options, see assisted suicide as the only escape from a stretched system. This bill will no doubt kill the push for better palliative funding, turning it into a luxury good while the state shrugs and says, “You’ve got a choice now.”

Revisiting Canada

Medical Assistance in Dying (MAiD) kicked off in 2016 and hit 4.7% of deaths by 2023. Claims have been made that poverty is the main driver for assisted dying applications. Is this true? Canada’s system lets terminally ill adults (and since 2021, some with chronic conditions) opt in, with two doctors signing off. It’s state-funded, no private firms involved. However, the stats and stories still paint a dark picture. Articles flag that socially deprived folks—those on low income, or with poor housing—are more likely to go for MAiD. Why? Because palliative and social care is uneven in Canada just like Britain: rural and poorer areas get scraps, and home care is a postcode lottery. Reports tell of people choosing MAiD because they can’t afford decent care or housing, and/or do not want to burden broke families.

The official data from Canada is cagier—Health Canada’s 2023 MAiD report says 96.5% of recipients had “adequate” palliative care access, but “adequate” isn’t “quality.” If you dig a little deeper 13% of applicants cited “burden on family” as a reason for choosing MAiD, often tied to cash woes. So, whilst poverty may not be THE main driver for MAiD in Canada—unbearable suffering tops the list—it is a hefty shove. Compare this to what could happen in the UK: Canada’s got a head start on us and palliative care funding did not soar post-MAiD and is still a battleground. The UK, with its NHS already gasping, could mirror this—assisted dying as a budget-friendly “fix” while palliative care stagnates.

This bill is dangerous with no safety nets. It risks siphoning focus—and funds—from palliative care, leaving a system where only the well-off get a soft landing and the poor are handed a stark choice: suffer or sign off. Canada is proof that this theory is not just paranoia or “conspiracy”—poverty is not the sole engine, but it has most definitely got its foot on the gas where good quality care is thin on the ground. If the UK does not lock in ring-fenced substantial palliative funding alongside this bill, we could be staring at a future where assisted dying is the default for those the system has failed. This isn’t choice—it is a class trap dressed up as compassion.

And Finally

I want to finish by reminding everyone that this bill allows someone else—a proxy—to make a life-ending declaration on behalf of a terminally ill person if they are physically unable to sign themselves “or for any other reason.” Imagine a scenario where a patient, muddled by pain or pressured by family, cannot scribble their name. A proxy steps in, no training required, no need to even know the patient well. The bill does not demand they prove the patient’s true wishes, just that they are willing to put pen to paper. This is a gaping loophole begging for abuse. Critics, including MP Danny Kruger, have pointed out that this vagueness could let coercion slip through the cracks—think desperate relatives or cash-strapped heirs nudging a proxy to seal the deal. The British Medical Association’s insistence on doctor discretion gets drowned out when a random stand-in can bypass the patient’s voice entirely. Kim Leadbeater, the bill’s champion, calls it a “limited” role, but without tight rules—who qualifies as a proxy? Who checks their motives? —it’s a free-for-all. Safeguards? More like a welcome mat for manipulation.

Useful resources if you want to help try and stop this bill

Right to Life – lots of useful information about the committee stage and the changes and expansions of the bill

Christian Concern – updates, resources and suggestions to challenge and stop the bill

UK Medical Freedom Alliance – updates and a template letter to send to your MP asking him/her to vote down the bill at the next reading

Unherd article – further reading on the proposed role of private companies in this process

An infographic showing all of the safeguards that have been rejected at the committee stage

Source Dan Hitchens on X https://x.com/ddhitchens/status/1901382005532643562