Introducing assisted dying has major implications for health systems – and the way our health service works today will influence how it could happen. This briefing draws on our research into how 15 jurisdictions have designed and implemented assisted dying across the world, and on our work studying inequalities and spending on care at the end of life.
The briefing brings together evidence on the standard and consistency of end-of-life care, and on who accesses assisted dying in countries where it is provided today. It summarises the implications from other countries for key issues under consideration by the House of Lords, including the balance of safeguards, advertising and promoting assisted dying, opt-outs, training, and the collection and use of data.
Key points
- Not everyone is receiving the end-of-life care they want or need. People living in a deprived area are more likely to die in hospital despite most people preferring to die at home. People from Asian, Black or mixed ethnic groups who die at home are prescribed fewer medications for symptom control at the end of life.
- Evidence from other countries shows that people accessing assisted dying tend overwhelmingly to be older, to have a terminal diagnosis (even in countries where this is not a requirement for eligibility), and to already receive palliative care. Cancer is the most common diagnosis. The minimum age set in the 15 jurisdictions we studied was usually 18, except where it was lower or unspecified.
- Other countries that have legalised assisted dying have often seen concerns quickly emerge that the system cannot be accessed by some of those who are meant to be eligible. Barriers to access include geography, health literacy and socioeconomic factors. Safeguards and protections are important to ensure safety, but their complexity can become a barrier that prevents eligible people from accessing the service.
- The Bill includes an advertising ban for assisted dying, which the DPRR Committee and the Select Committee on the Bill have queried for more detail on what it may or may not cover. A common challenge in other countries is that individuals and clinicians are often not aware of what is permissible in the law, and this can be a barrier to access. Several countries have established public information services to improve awareness and help individuals understand their different options at the end of life.
- Some countries also require organisations like care homes or hospitals to state their position on assisted dying, so that individuals and their families can make informed choices. If the advertising ban is spelt out in more detail, these legitimate forms of communication should be allowed for.
- Plans for training, awareness and providing support are needed for a wide range of staff, not just doctors and nurses, and not just those directly involved in delivering assisted dying.
- Spelling out more detail on the infrastructure around assisted dying in primary legislation could help to ensure the system works as Parliament intends. However, going too far could mean not having enough flexibility, making the service unfit for future changes to the NHS or other relevant organisations and laws.
- Clauses 44, 45, and 49 specify how information and events will be recorded. If they are being revisited, Peers should reflect further on how this could give the deep overview of assisted dying implementation some other countries have achieved, and whether the duty to collect some data on different protected groups will generate enough data to ensure equity.