Key takeaways
Amendments are still outstanding
Numerous amendments to the Assisted Dying Bill by the House of Lords reflects widespread hesitations from legal and medical perspectives.
Key debate points are still being considered
These points include coercion and pressure and the assisted dying panel.
Expert opinion suggests the bill will pass
Healthcare providers need to keep an eye out for further amends as they come through to ensure they are compliant with future legislation.
This article is an interview between Paul Allerston and Fiona Murphy MBE and Alex Ruck Keene KC.
With my expertise in Court of Protection cases and Mental Health law, I’ve been thinking about the impact the Terminally Ill (Adults) End of Life Bill (“the bill”) might have. I sat down with Fiona Murphy MBE, expert in end of life and bereavement care, and Alex Ruck Keene KC, barrister and one of the leading academic experts on mental health and capacity law to gain their expert perspectives.
Wherever one stands on the principle, the Terminally Ill Adults (End of Life) Bill (‘the TIA Bill’) as it stands raises a number of potentially difficult legal issues. One of my key concerns are the safeguard mechanisms that the bill proposes (or does not propose for that matter). Much of the recent debate about this bill in the House of Lords has centred around this, particularly focusing on vulnerable adults who would be in danger of coercion or pressure.
Coercion and pressure
Presently, the bill seeks to address this through Section 34, which creates an offence for “a person who, by dishonesty, coercion or pressure, induces another person” into an assisted death. This is striking as it introduces a strict liability offence without defining what would constitute a criminal act of “pressure”. A strict liability offence is one where the prosecution does not need to prove intention or recklessness – they don’t need to know they have done anything wrong. This concerns me: to effectively protect individuals from such behaviour, we must be able to identify what that behaviour looks like.
When we asked Alex about this, he echoed our thoughts. Alex explained that if the wording is intentional and presumably not erroneous, the word “pressure” must mean something different to “coercion”, yet there is no definition of pressure anywhere in any piece of legislation. At present, Alex foresees this causing a lack of clarity which will need to be considered b the Courts.
The Section 34 offence applies regardless of whether the pressure was successful or whether the person died, and as a strict liability offence, it also means that intent does not need to be proven. Given that the maximum sentence is life imprisonment, the stakes do not match the clarity of the legislation.
Such serious legal consequences may mean that families, friends, and even healthcare professionals will struggle to discuss assisted dying openly out of fear. There must be a balance between safeguarding and allowing compassionate dialogue. For Fiona, who is specially trained in supporting the dying, the best way to protect vulnerable people is to listen to them. In her experience, coercion can take many forms and affect even the strongest of people. To best determine what a dying person really wants, a skilled workforce will be required.
“We need the skills to be able to facilitate pro-choice” – Fiona Murphy MBE
Assisted dying panel
Another safeguarding measure is the assisted dying panel. Initially, the bill required approval from a High Court judge, however the capacity of the judicial system and inappropriateness of a lone legal figure, without medical or social care expertise, led to the introduction of a multi-disciplinary panel. The members will include a retired judge or KC, a psychiatrist, and a social worker. One obvious flaw in this composition is that the Royal College of Psychiatrists have expressed their extremely dubious view of the bill, which calls into question the willingness of psychiatrists to participate.
This panel is designed to implement multi-disciplinary oversight. Section 17(2) of the bill explains “the panel’s function is to determine whether it is satisfied of all of the following matters”. It then goes on to list 9 separate requirements.
Although lengthy in prescribing what the panel should be satisfied of, Alex is concerned that it is not clear what being “satisfied” would mean:
Is it a tick-box exercise?,
Is there a reasonableness element?
What is the threshold of satisfaction?
Example: Procedurally, the panel has no power to call for evidence.
The example Alex gave is that, if there were mention of safeguarding concerns, the panel would have no power to request disclosure of safeguarding reports from the Local Authority.
In exploring the different ways to increase the utility of this panel, various suggestions were made:
Alex made various suggestions, one of which chimed with Fiona’s view as to how this legislation could be utilised to improve palliative care in the UK. Alex proposed that the panel should record the dying person’s reason for seeking assisted death. This would not be concerned with morals or a value judgment, but instead, could be used as a data source to understand whether there are any service failings that are contributing to the decision-making. For example, poor palliative care.
Fiona also reflected on this need to look upstream. Her wish is for better investment in quality end of life care as it may alleviate the requests for an assisted death. Fiona added that a person seeking assisted death should, in the first instance, speak to a palliative specialist. Currently, Section 5(5) of the bill requires medical practitioners to discuss “all appropriate palliative, hospice, or other care” with the person seeking assisted death.
Currently, these wider considerations as to why a person may make this decision is not of interest to the bill. Alex noted that “the policy of this bill is so focused on individual choice in a very procedural way”. It sets out a specific process for a specific cohort of terminally ill adults. One key characteristic of the cohort is that they must have capacity.
At Section 3, the bill states that “references to a person having capacity are to be read in accordance with the Mental Capacity Act 2005”. The bill also confirms at Section 1, that capacity means the “capacity to make a decision to end their own life”. This alarming shorthand means there is no guidance as to what information a person must understand to make this decision.
The unease, as Alex articulated, is that the MCA’s purpose was to support individuals to make decisions about their life, and in that spirit, the MCA provides for a presumption of capacity. This framing seems malapropos when the decision is about a decision to die. As Alex put it, “the bill is incompatible with that”.
The MCA is a framework for what to do when a person does not have capacity, in other words, best interest decision-making. The decision to end one’s own life cannot be made as a best interest decision, and so much of the MCA is not applicable to assisted dying.
Overall, my view is that there are widespread hesitations from both the legal and medical perspectives. This wariness is reflected in the numerous amendments being made to the bill in the House of Lords. As of 6 November 2025, the latest list of amendments spans 130 pages. Both Fiona and Alex agree that this bill will pass, so keep an eye out for Hill Dickinson’s continuing updates as we follow its progression.
A note about the experts
Fiona Murphy MBE has been a Registered Nurse since 1986. She founded the SWAN model of care which is now implemented in 70 hospitals across the UK and across 40 countries worldwide. SWAN is recognised by the International Collaborative for Best Care for the Dying Person. Fiona is also a patron of The Good Grief Trust and has held various Director of Nursing roles across multiple North West NHS Trusts. Fiona led on the bereavement support for the victims of the Manchester Arena bombing and gave evidence to the Thirlwall Inquiry about the important of bereavement care.
Alex Ruck Keene KC is the leading legal expert on mental health and mental capacity law. He contributes to a vast amount of publications and created the popular Mental Capacity Law and Policy website, which is beholden by legal and medical professionals alike. Alex is a Professor of Practice at King’s College London amongst other academic feats. He has also acted as an adviser to the Independent Review of the Mental Health Act 1983, and to the Joint Committee on Human Rights. Alex is recognised as a Tier 1 Silk by the Legal 500.
This article was co-authored by Caroline Watson.
