The Terminally Ill Adults (End of Life) Bill establishes a statutory process by which adults who are terminally ill, ordinarily resident in England and Wales and registered with a GP, can request and be provided with an approved substance to end their own life. The process requires a signed first declaration, two separate medical assessments (a coordinating doctor and an independent doctor), panel review and a second declaration after reflection periods.
Supply must be in person and self-administered; doctors may assist but may not administer the substance to cause death.
The Bill also creates a Voluntary Assisted Dying Commissioner and Assisted Dying Review Panels, mandates reporting and codes of practice, sets out training and advocacy requirements (including for people with learning disabilities or autism), creates criminal offences for coercion and fraud, introduces civil and criminal protections for professionals who follow the Act, and requires the Secretary of State to make regulations on approved substances, commissioning and advertising. The statute therefore affects clinicians, regulators and health commissioners as well as patients and their families, and embeds monitoring and a five‑year review into the framework.
At a Glance
What It Does
Permits a terminally ill adult in England or Wales who meets residency, age and capacity requirements to request assistance to end their life. The pathway requires a witnessed first declaration, a first assessment by a coordinating doctor, referral to an independent doctor after a mandatory reflection period, panel determination of eligibility, a second declaration after a further reflection period, and in-person provision of an approved substance by the coordinating doctor for self-administration.
Who It Affects
Terminally ill patients (expected death within six months), coordinating and independent doctors, GP practices (recording duties), regulators (GMC, CQC, General Pharmaceutical Council) and the new Voluntary Assisted Dying Commissioner and Assisted Dying Review Panels; the Secretary of State and Welsh Ministers for regulation and commissioning; employers and workers through added employment protections.
Why It Matters
It is a comprehensive statutory regime that replaces legal uncertainty with detailed procedural safeguards, creates new criminal offences for coercion and fraud, obliges government to regulate approved substances and to commission services, and builds in monitoring, reporting and disability-focused oversight — all of which reshape clinical practice, commissioning and regulatory oversight at end of life.
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What This Bill Actually Does
The Bill defines who can lawfully receive assistance to end their own life: adults (18+) ordinarily resident in England and Wales for at least 12 months, registered with a GP, and terminally ill such that death from the illness can reasonably be expected within six months. ‘Terminally ill’ excludes qualification arising solely from voluntary cessation of eating or drinking; capacity references are to the Mental Capacity Act 2005.
A person starts the process by making a signed, witnessed first declaration (forms and witness rules set by regulation). The coordinating doctor records the preliminary discussion (which must cover diagnosis, prognosis, treatments and palliative options and include language/literacy adjustments).
The coordinating doctor then carries out the first assessment, writes a regulated report and — if satisfied — refers the case to an independent doctor after a seven‑day reflection period. The independent doctor conducts a second assessment, produces a report and, if also satisfied, the Commissioner refers the case to an Assisted Dying Review Panel.Panels (a legal member, a psychiatrist and a social worker) decide whether statutory conditions and process requirements were met and, if so, issue a certificate of eligibility.
After a second reflection period (14 days, or 48 hours where death is expected within a month), the person may make a second declaration. The coordinating doctor must then make a statutory statement and may provide an approved substance in person for the person to self-administer; the doctor may prepare the device and assist ingestion but must not carry out the final act causing death.
The doctor must remain with the person until death or until the procedure has failed or been declined.The Bill creates a Voluntary Assisted Dying Commissioner (judge‑level appointment), establishes Assisted Dying Review Panels with a published list of eligible members, and requires codes, guidance and monitoring. It mandates mandatory training for doctors and panel members on capacity, coercion, domestic abuse and reasonable adjustments for autistic people and those with learning disabilities, and provides for independent advocates for qualifying people.
The Act provides legal protection from criminal liability for acts carried out in accordance with it, but creates new serious offences—most notably coercion offences (up to 14 years) and a life sentence where a person induces another to self-administer by coercion. It also amends coroners’ and medical certification rules, sets regulatory powers for approved substances (supply, storage, transport, enforcement), bans promotional advertising, and imposes duties on the Secretary of State to commission services and report regularly, including a five‑year statutory review.
The Five Things You Need to Know
Eligibility is limited to adults (18+) ordinarily resident in England and Wales for 12 months, registered with a GP and terminally ill with an expected death within six months; stopping eating or drinking voluntarily does not make someone eligible.
The decision pathway requires a first declaration, a first assessment by a coordinating doctor, a seven‑day reflection period, an independent second assessment, panel review and a second declaration after a 14‑day reflection (48 hours if death likely within a month).
The law creates a Voluntary Assisted Dying Commissioner (judge‑level appointee) who appoints panel members; panels must consist of a legal member, a psychiatrist and a social worker and grant a certificate only if every member is satisfied on statutory points.
Criminal penalties are substantial: inducing a declaration by coercion can carry up to 14 years’ imprisonment; coercing a person to self‑administer an approved substance can carry a life sentence; prosecutions require DPP consent.
Coordinating doctors must provide the approved substance in person and remain until death or procedure failure; professionals have a statutory right to opt out and the Bill adds employment protections against detriment for non‑participation.
Section-by-Section Breakdown
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Who may request assistance and the definition of ‘terminally ill’
Sections 1 and 2 set the eligibility gate. A person must be over 18, ordinarily resident in England and Wales for 12 months, registered with a GP and have an inevitably progressive illness with death reasonably expected within six months. The text clarifies that eligibility is not established by voluntary cessation of food and drink and that short‑term symptom‑relieving treatment that only temporarily relieves symptoms does not count as reversal. Capacity is governed by the Mental Capacity Act 2005. For practitioners this is the first compliance hurdle: clinical evidence and records must clearly support the six‑month prognosis standard before the process can proceed.
Voluntary Assisted Dying Commissioner: powers and structure
The Commissioner is a corporation sole appointed by the Prime Minister and must be or have been a senior judge. The role receives and stores statutory documents, makes appointments to the list of panel members, refers cases to panels, determines reconsideration applications and publishes annual reports. Schedule 1 details governance, staffing, accounts and a Deputy Commissioner. The Commissioner centralises oversight, which matters for data flows, inter‑agency cooperation and transparency — and creates a public body that must be funded, staffed and audited.
Preliminary discussion, declarations and dual medical assessments
These sections fix the clinical pathway: a voluntary first declaration (regulated form, witnessed by the coordinating doctor and another person) follows a preliminary discussion that must cover diagnosis, prognosis, treatment and palliative options and include reasonable adjustments (interpreters, autism, learning disabilities). The coordinating doctor performs the first assessment and, if satisfied, refers to an independent doctor after a seven‑day reflection period. Regulations prescribe training, qualifications and mandatory training topics (capacity, coercion assessment, domestic abuse). There are detailed rules on identity checks, disqualified witnesses and proxy signing. Practically, this creates regulatory obligations on medical records, training programmes and the availability of clinicians who are both willing and qualified to serve in these roles.
Assisted Dying Review Panels and reconsideration
Once both medical reports indicate satisfaction with statutory criteria, the Commissioner refers the case to a panel composed of a legal member, a psychiatrist and a social worker. Panels must be trained in domestic abuse, may sit publicly or privately, must hear from doctors (and ordinarily the patient) and must give written reasons. A panel issues a certificate of eligibility only if satisfied on all statutory points; a single vote against or an abstention results in refusal. The Commissioner handles applications for reconsideration where the person argues error, irrationality or unfair process and can refer the case to a fresh panel. This design embeds an adjudicative safety valve but also imposes logistical demands for convening panels rapidly and producing reasoned determinations.
Reflection, second declaration and provision of approved substances
After a certificate of eligibility a 14‑day second reflection period applies (shortened to 48 hours where the coordinating doctor reasonably believes death likely within a month). The person must make a second declaration in prescribed form, witnessed by the coordinating doctor and another non‑disqualified witness; the coordinating doctor must make and sign a statement that statutory conditions persist. Only then may the coordinating doctor personally provide an ‘approved substance’ or a device for self‑administration; they may prepare the substance and assist ingestion but may not perform the final act to cause death. The doctor must remain with the person until successful self‑administration and death or until the person declines or the attempt fails. These provisions set tight procedural and physical safeguards around supply and act‑of‑death boundaries.
Protections from liability and new offences
The Act shields persons from criminal and civil liability for acts done in accordance with the statute, but creates serious new criminal offences for coercion in obtaining declarations (up to 14 years) and coercing someone to self‑administer (life imprisonment). It also criminalises falsifying declarations or certificates and providing knowingly false professional opinions (penalties up to 14 years). Most prosecutions require the Director of Public Prosecutions’ consent. In practice, the regime both protects compliant professionals and raises the stakes for malpractice or coercive conduct, meaning clinicians will need robust documentation and defensive procedural compliance.
Approved substances and regulatory regime
The Secretary of State specifies approved substances and has broad powers to regulate their supply, storage, transport, disposal and record‑keeping; regulations may mirror or adopt provisions of the Human Medicines Regulations 2012. The Secretary of State must also provide enforcement tools and civil penalties. The Bill contemplates regulation of devices for self‑administration and requires regulations on enforcement and monitoring — creating a medicines‑regulatory sub‑regime that interfaces with existing pharmacy, prescribing and import controls and will require practical guidance for safe handling and reporting.
Commissioning, advertising prohibition and Welsh provisions
The Secretary of State must make regulations to secure arrangements for voluntary assisted dying services in England, including ensuring services are provided free under the NHS where appropriate. Welsh Ministers may make parallel regulations for Wales and the Bill contains specific Welsh language and devolved competence safeguards (communications, forms and panel membership where Welsh is requested). The Bill also empowers the Secretary of State to ban advertising that promotes voluntary assisted dying services, with fines for breaches, but allows limited exceptions in regulation. These provisions create system‑level obligations for NHS commissioners and interplay with devolved policy in Wales.
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Explore Healthcare in Codify Search →Who Benefits and Who Bears the Cost
Every bill creates winners and losers. Here's who stands to gain and who bears the cost.
Who Benefits
- Terminally ill adults who meet the statutory criteria — gain a clear legal route to request assistance to end their life, statutory safeguards and a structured decision pathway with reflection periods and panel oversight.
- Clinicians who choose to participate — receive statutory legal protection from criminal and civil liability when they follow the Act’s procedures, and clear guidance on training and documentation to reduce legal uncertainty.
- Families and proxies — are given structured opportunities to be involved (and to be excluded where disqualified), clearer timelines and records, and protections against third‑party coercion through explicit offences.
- Disabled people and those with learning disabilities — benefit from mandated independent advocacy, a Disability Advisory Board to advise implementation and reporting requirements focused on the Act’s impact on disabled people.
- Regulators and health system planners — gain a central oversight body (the Commissioner), mandatory reporting, and statutory powers to regulate substances and services, which enables system‑level monitoring and standardisation.
Who Bears the Cost
- Coordinating and independent doctors — face administrative burdens, mandatory training obligations, detailed documentation and potential reputational and legal risk if procedures are not followed.
- GP practices — must receive and record multiple statutory documents and notifications, maintain continuity when clinicians change role, and accommodate identity checks and record copy obligations.
- NHS commissioners and the Secretary of State — must establish commissioned VAD services, ensure free‑at‑point‑of‑use provisions where required, and resource monitoring, reporting and Commissioner functions.
- Regulatory bodies (GMC, General Pharmaceutical Council, CQC) and the Commissioner — must process increased regulatory interactions, handle notifications and data‑sharing requests, and establish inspection and enforcement policies.
- Public bodies and disability advocacy organisations — will need to supply and fund independent advocates, contribute to consultations and participate in monitoring and the Disability Advisory Board, with attendant resource demands.
Key Issues
The Core Tension
The central dilemma is between enabling autonomous choice for competent terminally ill adults and implementing sufficiently robust safeguards to protect vulnerable people and clinicians: tighter checks reduce wrongful approvals but create delay and potential denial for those who urgently seek assistance; looser rules increase access but heighten risks of coercion, error and professional unease.
The Bill builds a procedural wall around assisted dying but leaves several practical and normative questions for implementation. The six‑month prognosis threshold will require clinicians to make inherently uncertain judgments; the obligation to refer to specialists where doubt exists may slow access and create regional inequality if specialist capacity is limited.
The dual‑doctor plus panel model increases scrutiny but also adds layers that may be difficult to convene quickly in cases where death is imminent; the Act addresses this with shortened reflection periods but that introduces trade‑offs between speed and safeguards.
The Act places wide regulatory power in the Secretary of State’s hands (approved substances, advertising bans, operational regulations) and centralises oversight in the Commissioner. That centralisation aids consistency but depends on resourcing decisions outside the bill text; under‑resourcing would shift burdens back onto clinicians and local services.
Data flows and disclosures to the Commissioner are authorised but constrained by data protection law — implementing practical templates for lawful, secure sharing will be essential. Finally, mandatory training and advocacy aim to protect vulnerable people (including those with learning disabilities), yet the effectiveness of those measures will depend on the quality and availability of advocates and of properly trained clinicians; poor delivery risks either inappropriate exclusions or safety failures.
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