Assisted dying

The legalisation of assisted dying

England and Wales are one step closer to legalising assisted dying after the House of Commons passed the Terminally Ill Adults (End of Life) Bill on 20 June 2025. The Bill currently sits with the House of Lords, where the second reading is due to take place imminently. 

We have already seen a huge increase in requests for legal advice about patients who are seeking an assisted death. Once passed into law there will hopefully be greater clarity on this hugely difficult and emotive area. Until then, healthcare professionals and organisations must continue to delicately tread through the current legal provisions.

Mental health care – future impact

For patients receiving care and treatment for mental health diagnoses, the full impact of this Bill will not be known until the provisions are passed and the legislation enacted.  

Key elements are that individuals will only be eligible if they have:

• Mental capacity: to make the decision to end their own life.

• Terminal illness: the individual’s death is expected within six months because of that illness.

In terms of mental health, it is important to note the following within the Bill’s definition of terminal illness:

"(3) For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both). 

Nothing in this subsection results in a person not being regarded as terminally ill for the purposes of this Act if (disregarding this subsection) the person meets the conditions in paragraphs (a) and (b) of subsection (1)."

The Royal College of Psychiatrists has raised reservations about the Bill in its current form, commenting that mental health illnesses, such as anorexia nervosa and dementia, can lead to a terminal diagnosis.  In addition, that diagnosis of a terminal illness of itself can be a risk factor for suicide.

The current Bill sets out that: 

"References to a person having capacity are to be read in accordance with the Mental Capacity Act 2005."

A key element of any capacity assessment is the relevant information that a person should be able to consider as part of that decision making process.  This is likely to be exceptionally complex for those with a diagnosis of a mental health illness that results in a terminal diagnosis.  Clear guidance is going to be needed on what relevant information is considered necessary to be able to make this very important decision about your own life.

Mental health care – present impact

Both public and private mental health in-patient units, together with community mental health teams, are already grappling with patients who are seeking to choose an assisted death. 

We are seeing an increase in requests for advice where patients are informing their healthcare provider of their intention to travel abroad to an assisted dying facility. For those patients detained under the Mental Health Act 1983 (‘the Act’), this becomes a difficult decision for the Responsible Clinician to consider when they would normally be granting Section 17 leave under the Act for that patient.

By way of background, Section 17 allows for leave of absence to be granted to a detained patient (‘Section 17 leave’).  The leave can be for a specified period of time or can be indefinite.  It can be subject to certain conditions, for example where the patient stays whilst on leave, Section 17 leave does not equate to a discharge from detention under the Act and the patient could be recalled to hospital where it is considered in the interests of the patient’s health, safety, or for the protection of other persons.

Ultimately Section 17 leave is utilised to assist with a patient’s recovery whilst still being liable to be detained under the Act. Clearly travelling for an assisted death cannot fall under this umbrella.  

Should the Responsible Clinician cancel Section 17 leave if a patient tells those caring for them (professionals or family) that they wish to travel abroad for an assisted death?

We suggest that healthcare professionals and organisations consider:

1. As with any expressed wish of suicidal ideation from a patient, consideration will have to be given regarding the appropriateness of Section 17 leave. The expressed wish should be clearly documented in the notes.

2. How realistic is this expressed wish? Was it stated in a moment of frustration or has it been a long-standing plan?  

3. What does the patient’s family think?

4. The risks of leave being given need to be carefully considered and documented as should the benefits to the recovery of the patient’s mental health. 

5. What conditions could be stipulated as part of that leave?

6. Should the patient remain in the custody of another person authorised by the hospital managers under Section 17(3)?

7. If accompanied leave with family or friends is authorised, they should be reminded of the offences under Section 128 of the Act.

The balance of risk needs to be clearly thought through by the multi-disciplinary team and any steps to protect the patient carefully documented in the patient’s notes.