Prospective approval in assisted dying legislation: safety over access?

Ruthie Jeanneret and Stevie Martin consider how requirements for prospective approval affect access to assisted dying Access to assisted dying is being considered in several countries, and the Isle of Man recently became the first part of the British Isles to approve it. In England and Wales, the Terminally Ill Adults (End of Life) Bill passed its second reading in the UK House of Commons in November 2024 and has undergone detailed examination (and extensive amendment) in the committee stage. Given increasing public support in England and Wales,1 discourse has shifted from the permissibility of assisted dying towards how it should be regulated, including appropriate balancing of safety and access. The bill’s proposer, Kim Leadbeater MP, says it has “the strictest safeguards anywhere in the world.”2 The bill is limited to self-administered death (assisted suicide) for mentally capable adults with a terminal illness who are expected to die from their illness within six months. People with a mental disorder or disability are not considered terminally ill solely for this reason. Individuals seeking an assisted death would need to complete a detailed assessment process. As initially drafted, the bill required that all assisted deaths be approved by the High Court. After parliamentary committee review, the bill has been amended to remove the requirement for High Court approval. In its place, the bill proposes creating the role of voluntary assisted dying commissioner and a multidisciplinary assisted dying review panel. Declarations for assisted dying will be sent to the commissioner, who will then refer them—together with the requisite doctors’ declarations— to the assisted dying review panel. The panel will then determine whether the individual has satisfied the eligibility criteria (box 1).3 Box 1 ### Proposed steps for accessing assisted dying under latest amendments #### Preliminary discussions and first declarationRETURN TO TEXT