On 29 November 2024, a majority of the UK Parliament backed the Assisted Dying Bill in a vote described by some in the media as ‘historic’. With around 54.55% of members voting in favor, the bill will now move on to further stages of scrutiny, amendments, and further votes. If the bill receives Royal Assent, the UK will become the 16th country to decriminalize assisted dying. In addition, the advancement of this law could encourage discussions on assisted dying legislation in other parts of the world with which the UK maintains close ties. This might include the United States, where only one-fifth of jurisdictions have legalized assisted suicide. However, the bill contains one measure that is unique worldwide: a requirement that all requests for assisted dying must be reviewed by a judicial body.
According to the bill, after obtaining the approval of the coordinating doctor and the independent doctor, the applicant must go to the High Court, which will verify that they meet all the requirements — including being terminally ill and having decision-making capacity. This measure, involving court verification, is not present in other countries and raises concerns for at least two reasons.
The first issue is the possible impact of prolonging the process. Considering that only people with terminal illnesses are eligible for this practice, it is highly likely that individuals with a limited life prognosis and experiencing severe suffering may be unable to complete the process before dying naturally. In Spain, according to the latest official government report, one in four individuals who requested assisted dying passed away before the process could be completed in 2023. Some Spanish healthcare professionals attribute this to the fact that many patients are only informed about the option of assisted dying at an advanced stage of their illness. In this sense, the addition of judicial oversight to the necessary assisted dying deliberation process, along with the handling of potential conscientious objections by healthcare professionals, risks undermining the effectiveness of the proposed law. Judicial intervention, originally designed as a safeguard, may inadvertently prevent applicants from accessing a dignified assisted death within the limited time available.
In this sense, it is important to note that the High Court, unlike dedicated commissions in countries like Spain, has broader responsibilities. This raises a reasonable risk that its assessments, combined with those of the two doctors, may exceed the six-month period defining a terminal illness. Not to mention that, after the Court’s approval, the bill provides for a second reflection period for the patient.
The second reason is the legal and emotional complexity that this additional step could impose on the applicant, which may discourage some from initiating the process. According to the bill ‘the High Court may also— (a) hear from and question any other person; (b) ask a person to report to the court on such matters relating to the person who has applied for the declaration as it considers appropriate’. Therefore, in addition to the potential delays that judicial hearings may cause, there is a risk that the process might take on an inquisitorial tone, with requests for assisted dying being questioned on non-clinical grounds by third parties. Moreover, the assessment of requests would be largely judicial in nature, unlike in other jurisdictions where it is primarily a health-related process.
On the other hand, the requirement that the applicant for assisted dying should be able to self-administer the lethal substance is questionable. While this is consistent with the fact that it is a bill intended to regulate physician-assisted suicide and not euthanasia, the condition that ‘the final act of doing so must be taken by the person’ may in practice exclude persons physically incapable of doing so, such as those with advanced ALS. In other words, such a condition would mean that the law would not be applied equally, as access to assisted dying would depend on the person not having a physical disability—a critique that has been made regarding the assisted dying model in U.S. jurisdictions where it is legal. In contrast, in the Australian states, medical staff may administer substances only if the patient is unable to do so. While the UK Bill states that the coordinating doctor may assist the patient ‘to ingest or otherwise self-administer the substance’, there is no certainty that this will occur. Indeed, in the case of a person with a physical disability, the correct completion of the process would depend on factors such as the skill of the doctor or the tools available to facilitate effective self-administration. Furthermore, even those who are physically capable may, for various reasons, prefer to entrust this delicate process to medical staff. This preference has been observed in Spain since assisted dying was legalized in 2021. For example, in 2023, the most recent year for which data are available, 95% of those who chose assisted dying opted to have the doctor administer the lethal substances.
For the above reasons, it is crucial that these clauses be thoroughly examined in the upcoming parliamentary debates, with a focus on questioning whether such safeguards are adequate and proportionate. Nevertheless, figures like Labour’s Diane Abbott have claimed that ‘these safeguards were not sufficient,’ introducing the risk of additional requirements that could undermine the law’s ability to ensure real access to assisted dying.
Acknowledgements: The author would like to thank the members of the INEDyTO II project, led by David Rodríguez‐Arias, for their support
Luis Espericueta is a lecturer and researcher at the University of Granada