The RCPsych cannot support the Terminally Ill Adults (End of Life) Bill for England and Wales in its current form

Press release
13 May 2025

The Royal College of Psychiatrists (RCPsych) is calling on MPs to consider serious concerns about the Terminally Ill Adults (End of Life) Bill for England and Wales, ahead of the pivotal Commons Report stage debate and Third Reading.  

With too many unanswered questions about the safeguarding of people with mental illness, the College has concluded that it cannot support the Bill in its current form. 

RCPsych is once again sharing its expert clinical insight to support MPs in making informed decisions ahead of the debate in Westminster on Friday 16 May 2025.  

During the Committee stage of the parliamentary process, the College raised questions about the assessments of the coordinating doctor and independent doctor, and is now raising further questions about the multidisciplinary panel (which would include a psychiatrist) being proposed by the Bill. 

The RCPsych wants MPs to consider the following ahead of the debate and Third Reading: 

  1. Terminal illness is a risk factor for suicide: Should the Bill become law in England and Wales, it needs to set out clearly how and at what point a clinician would be deemed to have discharged their duty of care to those who are at risk of self-harm or suicide under existing legislation and codes of practice.
  2. There should be a requirement for a holistic assessment of unmet need: Treatable needs such as intolerable pain, financial hardship and inadequate care or housing can make a person want to die. Yet the Bill makes no provision to assess unmet needs at any stage, nor consult others involved in the person’s care or life.
  3. Assisted dying/assisted suicide (AD/AS) is not a treatment: AD/AS does not aim to improve a person’s health and its intended consequence is death. The Bill does not specify whether AD/AS is considered a treatment option and this ambiguity has major implications in law in England and Wales. Should this Bill proceed, it should be explicit that AD/AS is not a treatment option.
  4. The Mental Capacity Act does not provide a framework for assessing decisions about ending one’s own life: The Mental Capacity Act was created to safeguard and support people who do not have the capacity to make decisions about their care or treatment or matters like finances. Should the Bill become law in England and Wales, implications for both the Mental Capacity Act and Mental Health Act need to be considered. How would clinicians assess the new kind of capacity to decide to end one’s life that is framed in the Bill? How would clinicians protect and empower people with terminal illness to decide whether or not to end their own life, while at the same time detain those who are at risk of suicide so that they can be urgently treated?
  5. It is not clear what a psychiatrist’s role on a multidisciplinary panel would be: If this Bill proceeds in England and Wales, any role a psychiatrist plays in an AD/AS process should be consistent with the core duties of the profession, including determining whether a person’s wish to die can be remedied or treated.
  6. There are not enough consultant psychiatrists to do what the Bill asks: As things currently stand, mental health services simply do not have the resource required to meet a new range of demands.
  7. Professionals must be able to conscientiously object to involvement in any part of the process: We are pleased to see that the Bill no longer requires medical professionals who do not wish to be involved to refer a person to another clinician, but they are still required to signpost patients to information on AD/AS. For some psychiatrists who wish to conscientiously object, this would constitute being involved in the AD/AS process.
  8. Robust professional standards and oversight would need to be in place: Any professional involved in assessments for AD/AS would need to be adequately experienced, trained, and independently overseen.
  9. Physical effects of a mental disorder shouldn’t make a person eligible for assisted dying/assisted suicide: If the Bill proceeds in England and Wales, it must exclude the physical effects of mental disorder, such as anorexia or dementia, as the basis for eligibility for AD/AS. 

Dr Lade Smith CBE, President of the Royal College of Psychiatrists, said: 

"After extensive engagement with our members, and with the expertise of our assisted dying/assisted suicide working group, the RCPsych has reached the conclusion that we are not confident in the Terminally Ill Adults Bill in its current form, and we therefore cannot support the Bill as it stands. 

"It’s integral to a psychiatrist’s role to consider how people’s unmet needs affect their desire to live. The Bill, as proposed, does not honour this role, or require other clinicians involved in the process to consider whether someone’s decision to die might change with better support. 

"We are urging MPs to look again at our concerns for this once-in-a-generation Bill and prevent inadequate assisted dying/assisted suicide proposals from becoming law."

Dr Annabel Price, Lead for the Terminally Ill Adults (End of Life) Bill in England and Wales at the Royal College of Psychiatrists, said: 

"The College has spent decades focused on preventing people from dying by suicide. A significant part of our engagement on this Bill to date has been to point out that people with terminal physical illnesses are more likely to have depression. Terminal illness is a risk factor for suicide, and unmet needs can make a person’s life feel unbearable. But we know that if a person’s situation is improved or their symptoms treated, then their wish to end their life sooner often changes. 

"The Bill does not specify whether assisted dying/assisted suicide is a treatment option – an ambiguity that has major implications in law. It is our view that these proposals should not be considered a treatment as assisted dying/assisted suicide does not aim to improve a person’s health. Furthermore, the Mental Capacity Act in England and Wales offers no framework for assessing such a decision. 

"This Bill proposes that psychiatrists be involved through assessments of mental capacity as part of routine psychiatric practice and in a safeguarding role on a panel. But mental health services do not currently have the resource required to meet a new range of demands. 

"If this Bill proceeds, any role a psychiatrist plays in an assisted dying/ assisted suicide process should be consistent with the core duties of the profession, including determining whether someone’s wish to die can be remedied or treated."

View our full briefing document (PDF)

 

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