Terminally Ill Adults (End of Life) Bill

The letter below has been written by Amanda Hunter, founder of Families Against Involuntary Medical Euthanasia (FAIME). A shorter version is hosted by Together Declaration, for which Amanda is the Health & Social Care lead.

If you haven’t already written to your MP or are in any doubt about their voting intentions, do write again today. The vote is this Friday 11th September.

Dear [Name],

I am writing as your constituent to express my deep concern about the return of the Terminally Ill Adults (End of Life) Bill to Parliament, and to ask you to vote against it at Second Reading on 11 September. I understand this is a conscience vote, but wherever you stand on the principle of assisted dying, I urge you to read the text of this specific Bill as it is currently drafted, and to reflect deeply on what is being proposed. I hope you will give consideration to the concerns I raise below, particularly in regard to the inadequacy of the safeguards.

This is not a vote on the abstract principle of assisted dying, nor a vote merely to continue the debate; it is a vote on this specific Bill. In substance, the current draft of Lauren Edwards’ Bill is virtually identical to the 2024 Leadbeater Bill, which ultimately ran out of time in the Lords in April. As such, it retains the same safeguarding flaws, loopholes and inherent dangers.

I believe that the Bill before Parliament is unsafe, undemocratic, and could not come at a worse time for the NHS, for our struggling hospices, for our crumbling social services and, above all, for our vulnerable communities who are struggling to access the care and treatment they need. My concerns fall into four broad areas: the current state of health and social care, the adequacy of the safeguards given the circumstances in which they would operate; the profound ethical and social implications for the NHS, hospices and care homes, and the democratic legitimacy of introducing such legislation without a manifesto commitment or direct public mandate.

Why health and social care reform must take priority

Britain is a nation with a proud history. We pioneered the first universally accessible national health service, gave birth to the hospice movement led by Dame Cicely Saunders, and as citizens give generously to those in need.  We all want the terminally ill to be treated with compassion, kindness, and dignity as they approach the end of their lives.  However, the fundamental question MPs must ask themselves is whether the Terminally Ill Adults Bill currently before Parliament is the right Bill? Are its safeguards sufficiently robust when considered in the context of current healthcare realities? Is it safe to introduce legislation providing for the intentional ending of life when the systems charged with protecting and sustaining life are in such a parlous state that they are failing to meet the needs of those who require assistance to live?

Our Prime Minister, Andy Burnham, is right when he says that palliative care and social care need to be fixed first before we contemplate changing the law. The previous Health Secretary, Wes Streeting, when asked whether the legislation could be safely implemented, could not bring himself to confirm that it could. Instead, he pointed to the absence of high-quality palliative care and the risk that people might feel compelled to request an assisted death due to unmet need. Currently, over 100,000 people die every year without access to the specialist palliative care that would enable them to live the remainder of their lives with dignity and minimal suffering.

Access to fully-funded nursing care through NHS Continuing Healthcare (CHC) is also heavily rationed. While it was never intended to be limited to people at the end of life, the vast majority of new CHC awards are made via the Fast Track route, effectively limiting access to those already approaching their final days and weeks. 81.4 per cent of applications assessed under the standard route are rejected. Inevitably, this includes people with terminal illnesses who have been given a six-month prognosis. Thousands of our most vulnerable citizens are being denied the nursing care they need and are left wholly reliant on inadequate local authority provision or exhausted family caregivers for the essential  support they need. Inevitably, this only reinforces feelings of helplessness and being a burden on others.

Age UK has found that more than 28,000 older people in a single year died while still waiting for the social care they had requested. The Association of Directors of Adult Social Services has reported tens of thousands waiting six months or more for a care assessment. These realities matter because choice cannot be separated from the circumstances in which it is exercised. A person who cannot obtain adequate treatment, palliative care, social care or support is not making the same choice as someone whose needs are properly met. Someone who feels they are a burden on family carers, or an overstretched NHS, may come to regard death as the responsible choice. In a system where resources are scarce and rationed, what begins as a choice can become an expectation, an obligation or even a duty. Choice is not exercised in a vacuum; it depends upon the range of real alternatives available.

Why I believe the safeguards are illusory

This brings me directly to whether the Bill can be considered safe. I do not believe that the  safeguards, as currently drafted, are sufficiently robust. Safeguards cannot be considered in the utopian abstract; their efficacy can only be assessed in the context of the circumstances in which they would operate. When those circumstances are shaped by inadequate resources, unequal access to care, unmet need, and fear of becoming a burden, it becomes evident that the Bill’s safeguards are not simply inadequate, they are illusory. In illustration, I draw your attention to some of the flawed assumptions underpinning the Bill’s safeguards below.

Protections against coercion and domestic abuse

The Bill relies on the two doctors involved in the decision process being satisfied that the person requesting an assisted death has not been coerced or pressured. How that judgement will be reliably made is not made explicit on the face of the Bill, other than vague references to additional training. Professor Jane Monckton-Smith, a leading authority on domestic violence and coercive control, told the Lords’ Select Committee that throwing additional training at the problem was not an adequate safeguard. She questioned the assumptions implicit in the Bill, warning that coercion is notoriously difficult to detect, even for specialists in the field. Her considered view was that it was unrealistic to expect doctors without that in-depth knowledge and insight to be able to reliably establish whether the patient’s decision was reached autonomously or was subject to undue influence, particularly in the timeframe of what would likely be a short consultation. It is also important to understand that abuse frequently intensifies after a terminal diagnosis, when the person who is ill is most dependent on those around them.

Protections for people with eating disorders

Chelsea Roff, founder of Eat Breathe Thrive, has documented at least 60 people with eating disorders who were able to access assisted death services in Canada and elsewhere, despite not being diagnosed with a terminal illness.  Her research demonstrates that the Bill’s safeguards on eating disorders do not go far enough. Even with the amendment added during the Lords Committee, the focus is too narrow and does not close the loophole that would enable people with conditions other than anorexia to make themselves eligible for an assisted death. The Bill does not take into consideration conditions such as bulimia, or people with Type 1 diabetes who deliberately restrict their insulin in order to lose weight. These behaviours can lead to serious physical complications that would render the person eligible under the six-month prognosis criterion, even if the condition itself is treatable.

Protections for disabled people

Despite claims to the contrary, disabled people could become eligible under the eligibility criteria set out in the Bill. Disabled people are not immune from terminal illness. They are also more susceptible to developing life-threatening complications as a result of their conditions. Furthermore, all terminally ill patients given a six-month prognosis are classed as disabled under the terms of UK welfare law.

However, where the safeguards particularly fall short is in the assumptions made about equality of access to healthcare. Disabled people already suffer disproportionately from discriminatory treatment decisions and inadequate access to palliative and social care. The ONS Winter Survey found that 41 per cent of people with disabilities were on an NHS waiting list, compared with 10 per cent of people without disabilities. It is no wonder, therefore, that disabled people deeply fear this Bill and the potential risks it poses their community.

The organization Assist Us To Live, which campaigns against the Terminally Ill Adults Bill from the perspective of disabled people, has warned that introducing assisted dying at the current time will “put sick and disabled people’s lives at risk.” The disability activist Nicki Myers has echoed these concerns: “ In the UK, we do not have sufficient health and social care support or adequate palliative care or hospice services for legalisation to be safe.“ Andrew Clark, chair of BuDS (Buckingham Disability Services) has raised similar fears: “There is a broad consensus that this bill is fatally flawed and dangerous”. Clark has called for “a legal right to independent living, rather than a legal right to a medical death.” The systemic inequalities already faced by disabled people in accessing the support they need to live, explains why no organisation of or for disabled people supports the proposed legislation.

Protections for people with learning disabilities

 In his evidence to the Lords Select Committee, Ken Ross of the National Down Syndrome Policy Group questioned the assumptions on which the Bill is premised. He drew specific attention to acquiescence bias. People with Down’s syndrome, he explained, are highly suggestible, more likely to place great weight on a doctor’s suggestion, and may be unduly influenced towards choosing an assisted death. They also tend to have an obliging disposition and are keen to please. Tommy Jessop, actor and ambassador for the Group, put the fear in his own words: “A lot of people with Down syndrome are worried about the assisted dying law. We are worried about being pressurised into it. We know that some healthcare staff do not think our lives are worth living. They are wrong. Please protect us from this.” Around two in five people with learning disabilities already die from avoidable causes, evidencing discriminatory care cultures that deny equal access to treatment.

Protections for the mentally unwell

Terminal illness is itself a risk factor for suicide, and treatable depression is common in people given a six-month prognosis. The Royal College of Psychiatrists, while remaining neutral on the principle, has stated that it cannot support the Bill in its current form. It has urged Parliament to address three points in particular: that there should be a requirement for a holistic assessment of unmet need; that assisted dying is not a treatment and should be stated as such; and that the Mental Capacity Act does not provide a framework for assessing a decision to end one’s own life. Those concerns remain unanswered on the face of this Bill.

Protections for people in care and nursing homes

If this Bill becomes law, the majority of assisted deaths are likely to take place in care and nursing homes: communities that care for those living with dementia, frailty, disability or advancing illness, and where dependency is a condition of daily life rather than an exception. Approximately 70 per cent of people living in institutional care settings suffer some form of cognitive impairment. However, a significant proportion of residents live with dementia for several years before a formal diagnosis is made. rates remain well below the population estimated to be living with the condition. This has hugely important implications when it comes to assessing a person’s mental capacity to make an informed, autonomous and settled wish to seek assistance to end their life.

The Bill, as currently drafted, relies on the Mental Capacity Act to assess capacity, yet the Act was never intended to support decisions of irreversible consequence, and is therefore wholly unsuited to the task. Routine assessments miss a substantial proportion of genuine incapacity in older patients, and clinicians frequently fail to recognise transient impairments.

People in care and nursing homes are particularly susceptible to dehydration, infection, depression, and the harmful effects of medications, all of which are common causes of delirium and fluctuating capacity. The whistleblowing charity Compassion in Care reported that fluctuating capacity was the predominant concern raised by the 1000 plus care workers who contacted the charity to express their reservations about the Bill. The British Geriatrics Society estimates the prevalence of delirium among care home residents to be as high as 60 per cent. Fluctuating capacity is missed in 15 to 20 per cent of reassessments, and coercion and undue influence are encountered in 30 per cent of end-of-life decisions yet formally detected in only 10 per cent of assessments.

Where life is lived in institutional settings due to frailty, disability, or cognitive vulnerability, it is incumbent upon Parliament to ensure the evidential threshold for establishing capacity in irreversible end-of-life decision making matches the gravity of the decision it authorises. Without a heightened evidential standard, demonstrable through professional clinical assessment, it is impossible to establish authenticity of consent. As currently drafted, the risks posed by the Bill are too serious to ignore.

Projected harms — Terminally Ill Adults (End of Life) Bill 2026: Impact Assessment

In addition to familiarising yourself with the Bill as currently drafted, I strongly encourage you to read the recently published Terminally Ill Adults (End of Life) Bill 2026: equality impact assessment before casting your vote on 11 September. Its substantive analysis makes explicit the harms the legislation would inflict were it to reach the statute book. Its alarming projections make for disturbing reading, laying bare what it would mean for the elderly, the sick and disabled. It has rightly been greeted with public consternation and alarm, and with horror and fear by those most at risk.

It is particularly damning not because it hides the scale of what is proposed, but because it sets that scale out in fiscal terms. The new 2026 impact assessment revises its earlier (upper) estimate of applicants from 1,078 to 4,610, marking a four-fold increase in projected applicant numbers in the first year of implementation alone. Given the startling evidence coming from Canada and the Netherlands, where assisted deaths now comprise 5 per cent and 6 per cent of all deaths respectively, it was patently obvious at the time of the previous assessment that the original figure was a gross underestimate of the likely uptake.

However, given current unmet need, the dire state of health and social care provision, and the discriminatory care cultures that continue to gatekeep access to care, I strongly believe that even these revised estimates significantly underestimate the potential number of assisted deaths over the ten-year period. I am inclined to agree with the calculations reached by the disability advocacy organisation BuDS, which projects four times the number of deaths in the first year alone.

This has further implications for the projected cost savings that will ensue should the Bill pass. The latest impact assessment estimates financial savings of between £13.6 million and £59.6 million by Year 10 in NHS and other healthcare treatment (assuming death is brought forward by four months, with 79 per cent of remaining healthcare costs treated as no longer required); between £316,000 and £10.5 million in social care costs from care no longer required; and, in pensions and benefits, between £1.05 million and £18.3 million in state pensions and between £354,000 and £6.20 million in Attendance Allowance by Year 10.

Against a backdrop of economic decline, health and social care rationing, and calls for sweeping welfare reforms to balance the books, it is difficult to accept the claim that assisted dying legislation is motivated purely by compassion. One strongly suspects, looking at the figures, that one of the key drivers is utilitarian resource management and reducing the cost of caring for the sick and vulnerable. Is this the kind of society that MPs wish to impose on their constituents? A dystopian world which prioritises cost savings over human lives and incentivises public services to encourage the vulnerable to end their lives prematurely?

Evidence cited in the Equality Impact Assessment shows that elderly people, who are by far the main recipients of assisted dying in the jurisdictions analysed, are often highly dependent on those who care for them, putting them at increased risk of elder abuse, as attested by data from the Crime Survey for England and Wales, which estimated that, for the year ending March 2025, 5.3 per cent of adults aged between 60 and 74 years, and 3.4 per cent of those aged 75 and over experienced domestic abuse. This is before we contemplate introducing legislation that would incentivise unscrupulous families to encourage and potentially coerce dependent relatives to seek a state-facilitated early death.

Similar evidence is cited in regard to disabled people: “disabled people may feel subtle pressure due to attitudinal barriers or a lack of alternative appropriate services and support (for example, when accessing palliative care). This could also include structural pressures such as neglect, poverty and difficult living conditions. Disabled people are also twice as likely (compared with non-disabled people) to be victims of domestic abuse which includes coercive behaviour.”

The NHS, hospice care and conscientious opt-out

The Bill also represents a profound change in the role and purpose of the NHS, which would move from an institution founded to protect and promote life to one that becomes complicit in intentionally ending it. For generations, preventing suicide has been a shared moral and public-health commitment. Parliament should think very carefully before asking the NHS to move from preventing suicide to facilitating it.

Once assisted death is folded into “end-of-life care,” the distinction Dame Cicely Saunders drew between palliative care and physician-assisted death begins to erode, as the experience of Canada attests.  On this note, MPs should be exceptionally mindful of attempts by the Bill’s sponsors to muddy the waters on this issue. Baroness Murphy, for example, has claimed that assisted dying “usually happens as part of a palliative care service,” while Lord Falconer has insisted that they are “exactly the same thing”. This is not true of course: palliative care is focused on easing suffering by treating the symptoms of the terminally ill, not terminating the suffering by killing the patient.

There must be a real opt-out, not only for individual doctors and nurses, but for hospices and care homes as institutions. When the Delta Hospice Society in British Columbia, Canada, refused to provide medical assistance in dying, the health authority cut its funding, cancelled the lease and gave dying patients six weeks to move. A hospice built on the British tradition of not abandoning the dying was closed because it refused to provide death-on-demand as one of its services.

If MPs vote ‘aye’ on 11 September, they will effectively be complicit in the slow death of the hospice movement, which, despite burgeoning demand, is already being forced to cut beds and ration access to its end-of-life care services due to wholly inadequate central government funding. To listen to the Conservative MP Kit Malthouse, a key sponsor of the Bill, one could be forgiven for concluding that the destruction of hospice care is mere collateral damage. During the Public Bill Committee on the Leadbeater Bill on 19 March 2025, he asked whether hospices “should still be able to deny what is a legal service, if they are in receipt of public funds.”

Why no health or social care body supports the Bill as drafted

While the Royal Colleges and other representative bodies of health and social care professionals remain neutral on the principle of assisted dying, none has endorsed the Terminally Ill Adults Bill as currently drafted. These are the organisations that would be tasked with facilitating state-facilitated death services, and the concerns they have expressed are grave. The Royal College of Physicians has raised concerns about equitable access to care. The Royal College of Pathologists has raised the absence of coronial scrutiny. The Association for Palliative Medicine, the British Geriatrics Society and the British Association of Social Workers have all restated that they are not confident the safeguards on the face of the Bill can protect the people they serve.

While the BMA remains officially neutral on whether the law should change, that neutrality is not an endorsement of this Bill. Indeed, members have made it clear they do not accept any suggestion that the Association supports it. At its Annual Representative Meeting on 22 June 2026, they reaffirmed that any assisted dying service must be separately commissioned and separately resourced, that participation must be on an opt-in basis and fall outside standard NHS contractual duties, and that those who decline to take part must be protected from discrimination or professional detriment. They also insisted that such a service must not result in any reduction of funding for core general practice, mental health or palliative care. In essence, not a single medical royal college will attest to the safety of this Bill, echoing the safeguarding concerns of every disability group and every elderly advocacy organisation.

Democratic legitimacy

The Bill on which you and your parliamentary colleagues will cast your vote on 11 September is not a Government Bill; it is a Private Member’s Bill. It did not feature in the 2024 Labour manifesto and hence has no democratic mandate. Public polling consistently shows that initial support falls away once people understand how the Bill would work and whom it would put at risk. The largest recent survey, by Whitestone Insight for The Other Half, found that around 60 per cent of the public agreed politicians should prioritise fixing the NHS and improving palliative, social and end-of-life care before considering assisted dying.

Fearful that the new Bill brought by Lauren Edwards might face a similar fate to the Leadbeater Bill, those promoting the Bill are calling on you and your parliamentary colleagues to support it without amendment in the Commons.  The Bill’s sponsor, Lauren Edwards has said that “it is important it goes through the Commons unamended as only then is the Parliament Act in play.”

There is also talk of a potential procedure motion to curtail or dispense with Committee and Report stages in the Commons, on the basis that that work had already been undertaken in the Commons for the Leadbeater Bill. Although the Bill would still proceed to the Lords, the effect of passing it unamended is that the Parliament Acts, which have never been used on a Private Member’s Bill, could then be invoked to place this deeply flawed and inherently dangerous Bill on the statute book without further meaningful scrutiny and essential safeguarding amendments.

Lessons to be learned from the Leadbeater Bill

I do not believe that the House of Lords failed to complete its consideration of the previous Bill due to deliberate stalling by peers opposed to it, but rather on account of the complexity of the issues it raised, the time needed to scrutinize the text, identify its flaws and inherent risks, research and draft workable amendments to strengthen the safeguards, close the evident loopholes, and render the Bill sufficiently safe to protect the public from potential harm.

The previous Bill’s failure in the Lords should give MPs pause. It essentially ran out of time because the Lords took their constitutional duty seriously. Peers scrutinised the proposals, identified potential harms, and sought to strengthen the Bill by suggesting amendments. Sadly, only three amendments of the hundreds peers proposed were accepted. This means that the same safeguarding flaws and fundamental deficiencies remain on the face of the Bill currently before Parliament.

The role and duty of the Commons

MPs cannot rely on the Lords to remedy these flaws a second time around. There is no reason to assume that Peers will now be able to repair what the Commons itself has been asked not to amend, and no reason to treat the upper House as the place in which the fate of this unsafe legislation should be decided. That decision rests with MPs, and must be taken in the Commons, at Second Reading. It is the duty of Members of Parliament to determine whether this legislation should proceed at all. To use procedural tactics, and potentially the Parliament Acts, to drive through legislation the public did not vote for, did not ask for, and which many now fear, would compound the democratic deficit already inherent in proceeding without a manifesto commitment.

While I do not support a change in the law at this current time, it is incumbent on Parliament to ensure that if the Bill does pass, the law that reaches the statute book is the safest legislation possible and provides watertight protections for our sick, elderly and disabled. If passed, the Bill would not take effect until 2031, and it is quite likely that implementation would fall to a future Government that does not share the present commitment to expand palliative care, invest in the NHS, reform social care and protect welfare. A four-year delay cannot be treated as a safeguard when the statute itself would already have been enacted, leaving its operation to whoever holds office then.

What I hope you will reflect upon in the coming days is not only whether the Bill is safe as currently drafted, but whether there is potentially a better way to meet the needs of your terminally ill constituents. Would their needs not be better served by investment in palliative care, in ensuring more accessible social care provision, and in research and development into better, more effective pain-control drugs? The measure of a truly compassionate society rests in the sacrifices it is willing to make to care for and support the dying, not to terminate those lives.

I urge you to reflect deeply on what is at stake, on the dangers inherent in the Bill, and on the potential impacts on palliative and end-of-life care, and to exercise your conscience in the concrete contexts in which this legislation would operate, rather than allow your vote to be swayed by abstract appeals to the principle of assisted dying.

I hope you will listen to the voices of the vulnerable and vote against the Bill at Second Reading.

Thank you.

Yours sincerely,
[Name]
[Address / postcode]
[Email / telephone]