'In this world nothing can be said to be certain, except death and taxes'
Benjamin Franklin, 1789
Abortion
Our British Parliament, the largely Labour one, together with the Liberal Democrats, just voted for a Bill which decriminalises abortion. The Bill received a vote of 379 in favour, and 137 against on 17th June, 2025. This Bill prevents the investigation, arrest, prosecution and imprisonment of women who are suspected of having ended their pregnancy.
The Bill does not change any of the existing rules for abortion. The legal requirement of carrying out abortion before 24 weeks still applies, apart from in exceptional circumstances. In clinics two doctors will still need to abide by existing rules, and women seeking abortion would still need to meet one of the grounds laid out in the Abortion Act of 1967. These grounds are that two doctors should agree that the person believes continuing the pregnancy would harm their physical or mental health, or that having the baby would cause harm to the health of existing children. Two doctors can also agree that there is a risk to life or health of the pregnant female, or that the baby is likely to be born with a serious disability or is unlikely to survive after birth. Any doctor or other person acting outside of the law to assist a woman seeking an abortion outside of the law can still be prosecuted.
The Bill also needs to pass through the House of Lords before it becomes law.
This Bill comes in the wake of the case of Nicola Parker, who was arrested, tried and imprisoned for taking an abortion pill whilst 26 weeks pregnant during the height of Covid. She said that she believed she was only 6 weeks pregnant at her trial. She has since been exonerated.
However....
…how do those who voted for the Bill, imagine that women would be able to bring on an abortion of their baby, other than in a clinic? Is there going to be a revival of back street abortionists and money handed under the table? Or do those who voted in favour of the Bill imagine that every woman seeking an abortion would be prepared to lie to their doctor in order to obtain the abortion pill. There is of course no guarantee that such a pill would absolutely succeed in aborting a baby. The woman might have to lie again in order to obtain another pill, or give birth to the baby and any damage the pill may have done to it. Would desperate women even stick to the 24 week deadline?
Have any of the 379 members of Parliament actually thought this Bill through? What they have agreed to is the protection from possible murder charges by expectant mothers who have aborted their unborn babies.
It feels like we are returning to the dark ages. The darkness continues to eat away at the sanctity of life at the other end of the spectrum too.
Photo by Thomas Bormans on Unsplash
Assisted Dying
On Friday 20th June 2025, the Assisted Dying Bill (Terminally Ill Adults (End of Life) Bill) was debated and a Third Reading voted on in Parliament. As expected, the majority of Ayes came from the Labour and Liberal Democrat benches with a total of 314, with the Nays numbering 291. The Bill was passed with a margin of just 23 votes. Members of Parliament were allowed to vote with their conscience. Now the bill must pass to the House of Lords. If there are amendments to be made in the House of Lords, the Bill must come back through to the House of Commons once again to be voted on. Rumours suggest there may well be changes even at this late stage.
Kim Leadbeater, in her address to Parliament, said that the concerns with the Bill from Medical Professionals were a matter of opinion and belief. Many of the voices against the Bill are concerned with the way that it is written. It does not do enough to safeguard people who are already vulnerable - this is a fact, not a belief. James Cleverly picked up on the point that there was significant danger that some people, in their deference to people in positions of power, for example a GP, would be at risk of feeling that the doctor must know best, and therefore effectively relinquish their decision making power to end their life, to their doctor.
One of the critical amendments made to Leadbeater's Bill was the removal of the High Court Judge from the sign off process. Instead now we have, alongside the sign off by two doctors, a panel of three people assessing a person's right to die. So in lieu of a judge there will be a psychiatrist, a high ranking legal person and a social worker reviewing and signing off on, the request of a person with a terminal illness to die.
Diane Abbott said that she would not put her life in the hands of such a panel of professionals. She also pointed out that the most powerful coercion in households is the use of silence. The key concern across the House of Commons seemed to be the lack of palliative care. Where there is no palliative care in certain areas, there are only two other choices - either living out their last months (if the doctor's estimate was correct) in pain and discomfort, or to die using the Assisted Dying Bill.
What is also concerning is that medical professionals have admitted that they sometimes get things wrong. In other words, their predictions of 6 months left to live could turn into a year, or many more years, depending on the individual. A research paper by Orlovic et al (2023) showed that just 32% of doctors giving patients an estimate on how long they were expected to live, estimated correctly. Doctors were able to estimate correctly for imminent death, and on long term survival amounting to years, but they were much less able to predict by weeks and months. This is what is called a 'prognostic uncertainty' in the paper.Once a person has been assisted in dying, there is no way to tell if they would have lived much longer than the 6 month window.
Would doctors become the subjects of law suits regarding the appropriateness of floating the idea of assisted death to their patients whom they considered to be terminally ill? What if the patient sought a second opinion and the second doctor finds the person has much longer than 6 months to live, or that there is a treatment that might work?
The Bill, according to a number of Members of Parliament, is fundamentally unsafe. Royal Societies, medical practitioners and many charitable societies disagree, not with the principle of the bill, but with the way that it is written.
The Bill in its current form is just 42 pages long, for the extremely heavy burden it carries.
There are defined stages involved in the process. The co-ordinating doctor can be one who knows the patient and may bring up, if they feel it is relevant, the process of assisted dying. But the co-ordinating doctor does not need to be known to the patient, in which case they would need to develop a speedy grasp of the person's medical history. They must not be a relative or benefit in any way from the death of the person. As a small comfort to those with concerns, the doctor should also outline all of the possible treatments remaining to the person. In their opinion the patient must be terminally ill and not expected to live beyond six months.
See comment above on how doctors get it wrong when estimating expected time to death in weeks and months. Dr Thomas Parkes in written evidence to Parliament notes that 'To make a terminal diagnosis a ground of eligibility for PAS introduces the tragic likelihood of patients who are not actually terminally unwell taking their lives.'
Also of concern is that assisted dying is not a treatment. There is a danger that, because a doctor has tried treatment that has not worked or not been available for the person, that they will offer assisted dying as an alternative to treatment. The same could be said of palliative care. If it is not available to that person the doctor might offer assisted dying in lieu of palliative care. The doctor must be certain that all avenues have been exhausted in the attempt to cure or provide suitable end-of-life care for the person, before bringing up assisted dying in our view.
In addition to the above criteria, the doctor must be assured that the person seeking assisted death has the mental capacity, is aged 18 or over, has been resident in England or Wales for at least 12 months and registered with a GP. The person must be clear, settled and informed in their wish to end their life. They must not have been coerced or pressured by anyone. The doctors and panel members assigned to the case must all undergo training not only in the processes leading to assisted dying, but also to recognise coercive control, domestic abuse, and financial abuse.
In written evidence given by Dr Thomas Parkes on coercion he says:
'3.2 Doctors have no validated tools for detecting coercion or pressure from others in a single consultation. In my experience the person involved often does not recognise that they are being coerced. It can take years of a clinical relationship to identify patterns, co-ordinate with other agencies and conclude that someone is being coerced.'
It is possible that the co-ordinating doctor would not know the person requesting assisted death, therefore being at a distinct disadvantage of being able to recognise that they were being coerced.
Dr Thomas also questions the capacity of a person being able to seek assisted death. He is concerned that often people with terminal illness may be viewing the concept of assisted death through the lens of depression. Does that then impair their capacity to make the decision?
The second doctor and panel members must also not be relatives of the person seeking to end their life, or have any financial or other interest connected to the person. i.e they cannot benefit from the estate, or in any other way, from the person's death.
The Stages of Assisted Dying (current document link)
The stages which the person seeking to die must go through are clearly defined. All stages must be fully documented and the checks listed above are repeated with each stage:
The initial discussion - the doctor is obliged to discuss not only the process of assisted dying, but they must also discuss the diagnosis, prognosis, treatment available, the effect of the treatment, palliative care, hospice provision and symptom management.
The co-ordinating doctor is the doctor who coordinates all aspects of the assisted dying process for the person. If a person's doctor is asked for details on assisted dying, but does not want to discuss this with them, the doctor must tell the person where they can get all of the relevant information. The person must then seek out a co-ordinating doctor who is willing to help them through the process.
The First Declaration - As long as the doctor is satisfied that the person seeking assistance in dying has fulfilled all of the parameters as laid out by the Bill, and the Voluntary Assisted Dying Commissioner, the First Declaration can be signed, dated and witnessed. The doctor and person will both sign and another witness must sign. They must all be in the same room together during the signing.
The witness cannot be a relative, anyone who may be a beneficiary of the person's estate, any healthcare person who has provided care for the person in their terminal illness, and anyone under the age of 18.
The First Assessment - The doctor will carry out the first assessment and record it in writing. There is provision in the Bill for if the co-ordinating doctor dies. The replacement co-ordinating doctor must provide 'continuity of care' to the person. It is unclear if that means clinical care or just care during the process of assisted dying.
First Period of Reflection - this is like a cooling off period for the person applying for assistance in dying. The period of reflection lasts for 7 days.
The Second Assessment then takes place and is done by an independent doctor who does not work with the co-ordinating doctor. They also must have not provided care to the person seeking assisted dying. The independent doctor must not have witnessed the First Declaration. Again they must not be a relative or have any financial or other interests by which they would benefit from the death of the person.
Going back to the point made by Dr Thomas Parkes, the second doctor is going to be dealing with a patient about whom they have no prior knowledge, of them as a person, making it difficult for them to assess whether they are being coerced.
The second doctor may disagree with the first doctor's prognosis or other assessments. The Bill states that if either assessing doctor has any doubts particularly regarding the terminal status of their patient they should seek advise from a specialist in the field of the illness the person suffers from. If there are doubts as to the capacity of the person the doctor would consult a psychiatrist. The findings must be taken in to account in the assessment.
The patient may request a second opinion from another independent doctor. There can only be one referral for a second opinion unless the second independent Doctor has died.
The Assessments consist of an examination of the person and their medical records, speaking to others providing health and social care to the person, diagnosis/prognosis, treatment available, palliative and hospice, symptom management and the psychological effects of the illness and prognosis.
The doctors doing the first and second assessments would give details of the substance that would be used to enable the person to kill themselves and how it works. The doctor would also talk about what would happen if something goes wrong and the person does not die, and reiterates that the person can choose to cancel the process at any time.
Dr Thomas Clarke also finds that information on the substance used to bring about death is scant. There have been no such substances approved for assisted death and he also points out that it is not uncommon for such a substance not to work. The Bill does not go into enough detail about what would happen in the case of the substance's failure to work. There is also no adequate provision for warning the patient that this could happen.
Determination by the Panel - Once the First Declaration and the First and Second Assessments are completed the Panel will determine if the person's case meets all the criteria. The members of the panel will have been appointed by the Commissioner. They will interview the two doctors, the person seeking assisted death and their proxy if appropriate. They may question other healthcare personnel or specialists in the case and anyone with relevant knowledge.
In exceptional circumstances the Panel do not need to hear from the person about whom they are deliberating. The Bill does not lay out what those exceptional circumstances might be.
The Panel makes their decision based on the assessments and their findings, and if in agreement with each other, will issue a Certificate. Copies of the certificate go to the person, the doctors and any other relevant people.
If the Panel rejects the person's request, the case can be referred to the Commissioner on the basis of 'error of law', irrationality or if the decision is deemed to be 'unfair' in terms of procedure. A review panel may look over the case if it is referred onwards by the Commissioner. The Commissioner can dismiss the case, but must give reasons.
Second Period of Reflection - once the certificate is issued the person then has another 14 days of reflection. If the person is considered by the doctor to be within one month of their death, that period of reflection reduces to 48 hours.
Second Declaration - Once the 14 days (or 48 hours) of reflection are over, the second declaration can be signed. This is confirmation that the person has requested assistance to help them die. The coordinating doctor must provide a signed statement that the person has met all the criteria laid out. Again the witness should not be related to the person, or benefit in any way from their death. Both doctors should be present at the signing and witnessing of the Second Declaration.
Proxies - the person may have a proxy if they are unable to sign. The proxy signs the declarations on the person's behalf and must sign in front of the person. The Proxy must have known the person for a minimum of 2 years.
Independent advocate - the person may have an independent advocate to provide a supporting role if the person has learning disabilities, a mental disorder, autism, difficulty understanding processes or any other criteria laid out by the Secretary of State.
Provision of Assistance - Again the coordinating doctor must carry out all the necessary checks, and confirm that the person still wants to continue with the process. The person can cancel the process at any point, right up to the moment they are about to administer the 'substance'.
The doctor will prepare the substance for self-administration directly or via a medical device by the person. Confusingly the doctor may also assist with the ingestion or administration, though the final act must be by the person. What if the person is completely immobilised and unable to do anything without assistance from another human or machine? It is unclear how the person would be able to take the final act themselves. Is the final act the swallowing of the substance? Or is it the indication that they are ready for the substance to be administered.
The doctor must stay with the person until their death, or if the process has failed or the person cancelled the provision of assistance at the last moment. If they decide to cancel, the substance should be removed swiftly.
The doctor must issue a full statement after the person's death, together with all other documentation. They must log which substance was used, and the time and date of the person's death. Detailed records must be kept at all stages.
Protection
By this point in the Bill we are about half way through. Next come the protections for the doctors, who are under no obligation to provide this service to patients. GPs also cannot force their staff to provide the service either. There is no criminal liability for those helping the person die, nor for the person seeking to die as long as they have all adhered to the guidelines in the Bill.
This is where things get a little hairy for those who are professionally involved in the Assisted Dying process on behalf of the patient. In section 29 of the Bill the following appears
'(2) It is a defence for a person charged with an offence under section 2 to prove that they—
(a) reasonably believed they were acting in accordance with the Terminally Ill Adults (End of Life) Act 2025, and
(b) took all reasonable precautions and exercised all due diligence to avoid the commission of the offence.”'
In effect this suggests that if there is any doubt that the Bill has not been followed to the letter, the doctors or even panelists could be subject to prosecution. If for example there was doubt in the family's mind about whether their relative was terminally ill with less than six months to live, or that the doctors have not explored all possible avenues to care for the person instead of initiating the Assisted Dying process.
Offences
The Bill details the difference circumstances under which someone may be prosecuted. These include 'Dishonesty, coercion or pressure'. Being found guilty of making a person sign declarations, or not cancelling declarations when necessary, carries a jail term of up to 14 years. Being found guilty of making a person take the lethal substance carries a life sentence. As discussed earlier, it might be that one or both of the doctors assessing the person who is seeking assisted death do not know the person. Recognising that someone is being coerced requires some level of familiarity with the person and their circumstances. This type of familiarity would have been gathered over years of consultation with the person as a general practitioner. If neither doctor was familiar with the person's history or their character, there would be a very real risk of failure, therefore, to recognise coercion. The panelists would be unable to accurately assess that there has been no coercion for the same reasons.
There should be no 'falsification or destruction of documentation' or 'falsification of documentation etc with intent to facilitate provision of assistance'. If this is suspected the Director of Public Prosecutions should start or instruct others to start proceedings. The former carries a jail term of up to five years and/or a fine, the later a jail term for up to 14 years. This section of the Bill does not explain what happens to paperwork that is perhaps filled in incorrectly and needs to be redone. Do all copies, including the incorrect copy need to be kept in the paperwork bundle. Do all records need to be printed, or is everything filled out online? Digital paperwork of course can be altered later on down the line. What are the safeguards in place to ensure that a cancellation request has been accurately logged for example.
In an age where increasing amounts of procedural paperwork is being digitised, the Bill should make very clear which parts of the process must be in solid format and which, if any, can be solely digital. There is no provision for this in the Bill.
There are worrying gaps in this Bill. A Bill that has been designed to help people die with dignity and on their own terms. The flaws are not simply a matter of opinion, as Kim Leadbeater would have it, but a matter of fact.
There is a chance that the Bill will be amended or even rejected by the House of Lords. According to Professor Mark Elliott either is possible. But at this late stage is it likely and would any amendments to the Bill serve a useful purpose? The issues regarding detection of coercion would still remain, as would the question over errors in the judgement of either doctor, as to the length of time someone is likely to survive.
Esther Rantzen, a strong advocate of the Bill and suffering from a terminal illness herself, has urged the House of Lords not to block the Bill.
Whilst nobody wishes prolonged suffering on anyone, we need to be certain that legislation allowing them to end their life on their terms, does not lead to the early deaths of vulnerable and coerced people.
This Bill does not do that.
All eyes on the House of Lords.