As a law student, I’ve always been taught that good legislation must be clear in its language, rigorous in its safeguards and accountable in its implementation. When it comes to a law that permits the deliberate ending of life, those standards should be exceeded, not diluted.
Yet the U.K.’s assisted dying bill, which has just completed its committee stage in Parliament, fails to do just that. The legislation is being rushed through Parliament, meaning essential safeguards are being abandoned and ethical and legal considerations are being ignored — opening the door to a reckless, profit-driven health care system.
The bill, introduced in 2024, seeks to legalize assisted suicide for terminally-ill patients in the U.K. with less than six months to live. It would allow eligible individuals to request euthanasia, carried out by a health care professional, provided the request is voluntary and the individual is mentally competent. After years of public and legal debate, the bill has progressed through Parliament with significant amendments. Yet key concerns about safeguards, oversight and potential profit-driven involvement remain unresolved.
In six weeks, more than 500 amendments were tabled; only 18% of those accepted came from MPs who opposed the bill. Nearly all revisions were shaped by supporters, limiting space for scrutiny and balance. Some of the most serious concerns, those on regulation and delivery, remain unaddressed. The result is a deeply flawed and dangerously vague piece of legislation.
An £1.8 billion market in the making
In March, The Times revealed that the government is prepared to pay private companies to deliver assisted dying services to the terminally ill, with ministers expressing ‘no in-principle objection’ to this. Early estimates put the number of people seeking assisted dying annually at between 5,000 and 17,000, with private providers expected to charge between £3,500 and £10,000 per patient (roughly $4,700 and $13,400 USD, respectively), in line with similar models in other countries.
Instead of investing in a comprehensive NHS-led model that prioritizes patient care, this proposal would create a £1.8 billion industry (about $2.4 billion USD), funded by the state yet operated by profit-driven private companies. This move is clearly driven by financial interests, not health care or ethical considerations, raising serious concerns about the true motivations behind the legislation.
Profit-driven health care is neither novel nor inherently unethical. However, when the outcome is irreversible, as it is in assisted dying, the stakes are fundamentally different.
It is important to note here that profit-driven health care is neither novel nor inherently unethical. However, when the outcome is irreversible, as it is in assisted dying, the stakes are fundamentally different. Financial incentives could create pressures to streamline processes, potentially affecting the thoroughness of assessments or the consistency of care.
While profit-driven models have their place, when it comes to something as serious as ending a life, such a system risks shifting the focus from patient welfare to financial gain, which calls into question whether such an approach is ethically acceptable. This highlights the need for clear regulation, transparency and oversight — elements sorely lacking in the current version of the bill.
Sweeping powers, limited oversight
One of the most concerning elements of the bill is its Henry VIII clause, a provision that allows ministers to decide how assisted dying services will be delivered without needing to return to Parliament for a full debate. This effectively means that the critical details about who will provide the service, under what conditions, and with what specific regulations will not be determined now, but at a later stage through secondary legislation.
In essence, the bill is setting the framework for a law, but many of the specifics will be decided after it is passed, with minimal opportunity for democratic oversight.
To put it simply, we are being asked to approve a law first, and only figure out how it will actually work later. As Conservative MP Danny Kruger put it during committee, the bill contains a “great absence — a blank space” on fundamental issues like who will make the decisions, how those decisions will be made, and who will be held accountable. Labour MP Naz Shah expressed frustration: “We do not have any proposed model before us … this hasn’t been thought through.” Even Liberal Democrat MP Sarah Olney warned that Parliament would have only 90 minutes to debate the final regulations when they eventually appear.
To put it simply, we are being asked to approve a law first, and only figure out how it will actually work later.
These comments reveal just how rushed the process is, leaving little time for MPs or the public to properly examine or challenge the bill’s details. The lack of transparency and the delegation of critical decisions to ministers behind closed doors raises serious concerns about whether the law will be implemented in the best interests of vulnerable patients, or whether it will be driven by political expediency. This is a deeply worrying approach when the stakes are as high as life and death.
The illusion of choice
Supporters of assisted dying often frame it as a matter of individual autonomy and personal choice. Such framing overlooks the significant social, emotional and economic pressures that influence these decisions — particularly for vulnerable elderly, disabled and chronically ill individuals.
Nursing leaders in the U.K. have warned that some people could choose assisted dying because of a lack of adequate palliative care, and that making assisted dying legal would impede the development of palliative services.
As Dr. Rachel Clarke, a palliative care doctor with a decade of experience, told the committee: “The real-world conditions of the NHS today are such that people’s suffering means occasionally they will beg me to end their life, and I know that that begging is coming not from, for example, the cancer per se, but because they’ve actually not been getting any adequate pain relief. And once you start to provide proper palliative care, very often that changes.”
Similarly, in Canada, where assisted dying has been legal since 2016, multiple cases have emerged in which patients cited inadequate access to health care, disability support or suitable housing as reasons for requesting assisted death.
For example, a 51-year-old woman living in Toronto suffered from multiple chemical sensitivities and endured exposure to tobacco smoke and cleaning chemicals in her house. Over two years, Sophia unsuccessfully sought assistance from various levels of government to secure suitable alternative housing. Frustrated and in ill health, she chose to end her life through Canada’s medical assistance in dying program (MAiD) in February 2022. Before her death, Sophia recorded a video expressing her feelings of being seen as “expendable trash” by the government.
This case underscores the potential for assisted dying to be viewed as an alternative to addressing systemic issues like inadequate housing and disability support. It also raises ethical concerns about whether individuals are being offered death as a solution when their basic needs and rights are unmet.
Similarly, a 2019 study published in JAMA Network Open analyzed data from Oregon and Washington, two U.S. states where assisted dying is legal, and found that the most frequently cited reasons for requesting assisted death were not related to pain. Instead, patients most commonly reported a loss of autonomy (87.4%), a decreased ability to engage in enjoyable activities (86.1%), and a sense of being a burden on others (54.3%). Only 27.4% cited inadequate pain control or concern about it.
These findings challenge the assumption that assisted dying is primarily about alleviating physical suffering. In many cases, it is about psychological and existential distress, areas where better palliative and psychosocial support can offer alternative relief. Without adequately addressing these wider pressures through investment in palliative care, mental health services and social support, the notion of ‘choice’ risks becoming extinct.
Safeguards stripped away
Originally, the U.K.’s assisted dying bill included strong safeguards such as judicial oversight and multidisciplinary team assessments. However, during the committee stage, these measures were removed on the grounds that they posed “operational challenges” to an already overstretched NHS.
Moreover, any scrutiny of opposition to the bill is swiftly shut down. Groups representing the disabled and elderly, the two demographics who would be the most affected if assisted dying were legalized, were blocked from giving evidence in the committee formed to scrutinize the bill, adding to concerns that this law was being fast-tracked for profits.
One of the most notable changes is that the bill now permits any doctor to raise the subject of assisted dying with a patient, regardless of whether they have an existing clinical relationship. This shift increases the risk of inappropriate or premature conversations, especially for vulnerable individuals.
Consider a case from Vancouver, Canada. A woman sought psychiatric help for chronic depression and was unexpectedly offered “medical assistance in dying” (MAiD) by a clinician. The clinician’s suggestion was reportedly made to assess her risk of suicide, not as a direct recommendation, but the patient found it deeply distressing. This incident led the hospital to issue an apology for any distress caused.
In legislation that deals with irreversible outcomes, safeguards are not optional. They are fundamental to ensuring that decisions are made carefully, ethically and with full public confidence
Proposals for oversight of the system have also shifted. Rather than assigning supervisory responsibility to an independent authority such as the Chief Medical Officer or the courts, the bill introduces a “Voluntary Assisted Dying Commissioner” tasked with referring cases to Assisted Dying Review Panels and monitoring the operation of the legislation. However, this commissioner will be structurally embedded within the same system they are meant to oversee, raising questions about their independence and whether they can effectively challenge inappropriate decisions.
These are not just technical tweaks. They represent a significant retreat from the principles of transparency, scrutiny and accountability initially intimated by the bill’s proponents. In legislation that deals with irreversible outcomes, safeguards are not optional. They are fundamental to ensuring that decisions are made carefully, ethically and with full public confidence
The U.K. must proceed with extreme caution. Legalizing assisted dying is one of the most ethically complex decisions a society can make, and it is a matter that should never be governed by political or economic expedience. The right to die should never become a duty to die. The legislation in its current form is dangerously vague and risks setting a dangerous precedent where decisions about life and death are made for convenience or profit, rather than respecting the inherent dignity of human life.
