Decision-making and physician-assisted suicide: capacity assessment in the Terminally Ill Adults (End of Life) Bill is inadequate

The Terminally Ill Adults (End of Life) Bill1 currently before the House of Lords seeks to legalise physician-assisted suicide following a request from an individual who is predicted to have 6 months or less to live as a result of a life-limiting illness. Providing the request has been made freely and is not under coercion from a third party, the only requirement for assessment of the individual’s psychological and social state is that they have mental capacity as defined by the Mental Capacity Act 2005.2 In this editorial, we argue that the Bill’s approach to assessment of decision-making is inadequate for three reasons. First, the Mental Capacity Act2 was not drafted with the present scenario in mind and does not provide for a sufficiently rigorous assessment of cognitive deficits that are relevant in the context of end-of-life decision-making. Second, there is substantially more to impairment of decision-making in this setting than cognitive impairment: important psychological and social factors can influence decisions in ways that are not in the individual’s best interests. And third, decisions are potentially modifiable when attentive support and interventions are offered. This requires that decisions be explored and discussed rather than taken at face value. If the Bill becomes law, we propose: