Salus Populi Suprema Lex: A Legal Critique of the Terminally Ill Adults (End of Life) Bill

The Terminally Ill Adults (End of Life) Bill (‘the Bill’) introduced by Kim Leadbeater MP which is currently being considered by the House of Commons possesses purported safeguards which have been previously proposed and subject to sceptical critique by the Divisional Court of the High Court and the Court of Appeal, as well as scholarly jurists such as Sir James Munby, due to their inability to prevent or detect the subjection of vulnerable patients to undue pressure to end their own lives in a system of assisted suicide.

Further, the involvement of a coroner in cases where a patient has died under the auspices of the Bill is completely absent, and leaves the legal position uncertain.

Additional serious questions have been raised as to the workability in particular of the oversight of an authority, whether it be hitherto a High Court Judge and now a three-person ‘Assisted Dying Review Panel’ (‘the Panel’) of a KC / judge, psychiatric specialist and social worker within the Bill’s text. This ranges from the scope and powers of such a body to the procedure by which it would operate and how it might provide any real safeguard for those patients vulnerable enough to be pressured into early death.

Concerns about other elements of the Bill exist, including (amongst others):

• the inability of the family of the patient to appeal decisions by the Panel;
• unstated powers of a proposed ‘Independent Advocate’ for those patients with disabilities;
• the ability of doctors to raise ‘assisted dying’ with their patients, and for them to assume that patients have ‘mental capacity’ even if they suffer from profound psychological problems, lack access to adequate palliative care or are disoriented by malnutrition or drug and alcohol abuse;
• the risk of hospices and care homes being financially penalised for opting out of ‘assisted dying’.

The Bill fails to include any probative safeguards that would prevent abuses of those most easily compromised by virtue of their physical and mental condition. It is a deeply irresponsible piece of legislation which Parliament must reject.

The Terminally Ill Adults (End of Life) Bill (‘the Bill’), proposed by Kim Leadbeater MP, is due to be debated at Report Stage on Friday 16 May 2025, having passed Committee Stage over the last few months. The Bill is seriously flawed in numerous ways that render it a danger to the British public. It must be opposed if it is not to cause serious, and possibly irreparable, harm to our health service.

If the Bill becomes law, then it would become legal for doctors to assist their patients to take their own lives – assisted suicide, which for ease of reference I will refer to throughout this paper by its proponents’ phraseology of ‘assisted dying’ – a practice that is currently not only illegal but also contrary to the most fundamental of medical ethical principles. The ancient ethical prescription for doctors, going back to the times of antiquity, and reproduced in the oath associated with the name of the Greek physician, Hippocrates, was, in the Latin, Primum non nocere – ‘First, do no harm’.

For that reason, doctors have always been forbidden by their ethical codes to take part in executions, save to the extent of certifying that the prisoner is dead and similar. The role of the health-care professional is to preserve life, to cure, to heal and to alleviate suffering and not to cause harm, still less to kill.

In every case of clinical negligence, it is essential to the possible success of the case to show that the health-care professional under scrutiny has caused loss and damage i.e. injury or unlawful death, since the underlying assumption of the law is that the job of such professionals is to heal and not to harm.

The Bill will radically reverse that assumption, as well as the most fundamental principle of medical ethics, and that will radically alter the whole nature, purpose and role of the medical and nursing professions.

The supposed ‘safeguards’ in the Bill are not effective and inevitably can never be so in a Bill of this nature. These, and a range of very serious flaws in the Bill which are set out below in this paper.

The Bill states [1] that:

‘(2) Sections 7 to 27, in particular, require steps to be taken to establish that the person—

(a)  has a clear, settled and informed wish to end their own life, and

(b)  has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it.’

Such criteria will be extremely difficult for any person to determine, including health-care workers or judges in court. In two articles on the blog page of the Transparency Project, specifically addressing these questions, Sir James Munby underscores this in relation to judges being required to make such determinations.

Despite the fact that the proposed judicial role has now been removed from the Bill, and replaced by a proposed ‘Assisted Dying Review Panel’ (‘the Panel’), the self-same difficulties will arise for the Panel just as much, and perhaps even more, than for judges.

Citing the case of R (Conway) v Secretary of State for Justice (Humanists UK and others intervening) [3], Sir James reminds us of the scepticism of both the Divisional Court of the High Court and the Court of Appeal, as regards Mr Conway’s suggested safeguards.

This was in a case in which Mr Conway sought to argue that the prohibition on assisting suicide in s.2 of the Suicide Act 1961 unlawfully breached, under Article 8 (right to respect for privacy and family life) of the European Convention on Human Rights (‘ECHR’), the rights of terminally ill persons with a serious progressive wasting disease who wished to be able to exercise control over the time of their death. The claimant in that case, wished to have the option, when he had a prognosis of 6 months or less to live, of seeking assistance from a medical professional to end his life.

The s.2 prohibition in the 1961 Act had been found, in R (Pretty) v DPP [4] – in which the present author was junior counsel for the interveners – and R (Nicklinson) v Ministry of Justice [5], to interfere with Article 8 rights but not to violate Article 8 because it could be justified under Article 8(2). That is, such interference was ‘in accordance with the law and is necessary in a democratic society in the interests of… public safety… the protection of health or morals, or for the protection of the rights and freedoms of others’. Parliament had debated assisted suicide since the Pretty and Nicklinson decisions and had reaffirmed the prohibition.

Mr Conway proposed an alternative statutory scheme which would supposedly permit assisted suicide while sufficiently protecting the weak and vulnerable, for example by providing that assistance had to be authorised by the High Court; he argued that such a scheme showed that the blanket prohibition was an unnecessary and disproportionate interference with his Article 8 rights. His application was refused, and that decision was affirmed on appeal.

The scheme proposed by Mr Conway has obvious similarities with that proposed by the Bill.

Of it the Divisional Court said this [6]:

‘As part of his case, Mr Conway has put forward the outline of an alternative statutory scheme which he says would safeguard relevant competing legitimate interests and would sufficiently protect the weak and vulnerable in society and which therefore shows that the blanket prohibition in section 2 is an unnecessary and disproportionate interference with his rights under Article 8. The substantive criteria outlined by Mr Conway are that the prohibition on providing assistance for suicide should not apply where the individual is aged 18 or above; has been diagnosed with a terminal illness and given a clinically assessed prognosis of 6 months or less to live; has the mental capacity to decide whether to receive assistance or to die; has made a voluntary, clear, settled and informed decision to receive assistance to die; and retains the ability to undertake the final acts required to bring about his death having been provided with such assistance. In addition, he has outlined these procedural safeguards: the individual makes a written request for assistance to commit suicide, which is witnessed; his treating doctor has consulted with an independent doctor who confirms that the substantive criteria are met, having examined the patient; assistance to commit suicide is provided with due medical care; and the assistance is reported to an appropriate body. As a further safeguard, Mr Conway also proposes that permission for provision of assistance should be authorised by a High Court judge, who should analyse the evidence and decide whether the substantive criteria are met in that individual’s case.’

It is almost a carbon copy of what the Bill  originally proposed and yet the courts, both at first instance and on appeal, were sceptical of his proposed safeguards.

Indeed, the Divisional Court commented that the scheme proposed by Mr Conway was broadly equivalent to that in a Bill introduced in Parliament by Lord Falconer of Thoroton on 5 June 2014 and again, in materially similar terms, on 3 June 2015. Now the Falconer Bill is again before the Upper House [7].

The Divisional Court had this to say [8]:

‘… the involvement of the High Court to check capacity and absence of pressure or duress does not meet the real gravamen of the case regarding protection of the weak and vulnerable. Persons with serious debilitating terminal illnesses may be prone to feelings of despair and low self-esteem and consider themselves a burden to others, which make them wish for death. They may be isolated and lonely, particularly if they are old, and that may reinforce such feelings and undermine their resilience. All this may be true while they retain full legal capacity and are not subjected to improper pressure by others.’

The court went on to quote the dicta of Lord Sumption in the case of Nicklinson [9] thus:

‘The vulnerability to pressure of the old or terminally ill is a… formidable problem. The problem is not that people may decide to kill themselves who are not fully competent mentally. I am prepared to accept that mental competence is capable of objective assessment by health professionals. The real difficulty is that even the mentally competent may have reasons for deciding to kill themselves which reflect either overt pressure upon them by others or their own assumptions about what others may think or expect. The difficulty is particularly acute in the case of what the Commission on Assisted Dying called ‘indirect social pressure’. This refers to the problems arising from the low self-esteem of many old or severely ill and dependent people, combined with the spontaneous and negative perceptions of patients about the views of those around them. The great majority of people contemplating suicide for health-related reasons, are likely to be acutely conscious that their disabilities make them dependent on others. These disabilities may arise from illness or injury, or indeed (a much larger category) from the advancing infirmity of old age. People in this position are vulnerable. They are often afraid that their lives have become a burden to those around them. The fear may be the result of overt pressure but may equally arise from a spontaneous tendency to place a low value on their own lives and assume that others do so too. Their feelings of uselessness are likely to be accentuated in those who were once highly active and engaged with those around them, for whom the contrast between now and then must be particularly painful. These assumptions may be mistaken but are none the less powerful for that. The legalisation of assisted suicide would be followed by its progressive normalisation, at any rate among the very old or very ill. In a world where suicide was regarded as just another optional end-of-life choice, the pressures which I have described are likely to become more powerful. It is one thing to assess some one's mental ability to form a judgment, but another to discover their true reasons for the decision which they have made and to assess the quality of those reasons. I very much doubt whether it is possible in the generality of cases to distinguish between those who have spontaneously formed the desire to kill themselves and those who have done so in response to real or imagined pressure arising from the impact of their disabilities on other people. There is a good deal of evidence that this problem exists, that it is significant, and that it is   aggravated by negative modern attitudes to old age and sickness-related disability. Those who are vulnerable in this sense are not always easy to identify (there seems to be a consensus that the factors that make them vulnerable are variable and personal, and not susceptible to simple categorisation). It may be, as Lord Neuberger of Abbotsbury PSC suggests, that these problems can, to some extent, be alleviated by applying, to cases in which patients wish to be assisted in killing themselves, a procedure for obtaining the sanction of a court, such as is currently available for the withdrawal of treatment from patients in a persistent vegetative state. But as he acknowledges, there has been no investigation of that possibility in these proceedings. It seems equally possible that a proper investigation of this possibility would show that the intervention of a court would simply interpose an expensive and time-consuming forensic procedure without addressing the fundamental difficulty, namely that the wishes expressed by a patient in the course of legal proceedings may be as much influenced by covert social pressures as the same wishes expressed to health professionals or family members.’

The Divisional Court earlier said this [10]:

‘… in relation to external pressure exerted by others on the person concerned, the process of seeking approval from the High Court would not be a complete safeguard. The court would have to proceed on the evidence placed before it. External pressures might be very subtle and not visible to the court. For example, it is not difficult to imagine cases of family discussions about money problems, not necessarily intended to place pressure on an elderly relative, in consequence of which they draw their own conclusions that they are a burden and would be better off dead. In any event, it might be difficult to disentangle factors of external pressure from the individual’s own internal thought processes and difficult to tell when external pressure is illegitimate or such as to invalidate the individual’s own choice to die.’

It need hardly be added that these very same problems will arise even more with the Panel now proposed to replace the involvement of a High Court judge. 

Indeed, the problems may well be exacerbated by the fact that members of the Panel will have much less experience than a High Court judge in such matters and may well be less aware of the likely pitfalls and dangers.

None of these difficulties have been addressed by the authors and promoters of the Bill, nor have they explained why or how the very same schema that has been comprehensively criticised by the courts and which they, more or less, reproduce in the Bill, have now been obviated.

The reason is not far to seek: the reality is that these difficulties simply cannot be resolved and thus the proposers and supporters simply remain silent thereon and do little more than put before Parliament, in almost identical form, the very proposals that the courts have criticised and rejected, and do so without addressing those judicial objections and scepticism.

It is clearly not a responsible way of presenting proposals for legislation, all the more so given the fact that the Bill is dealing with the most serious of all matters, namely human life and fundamental medical ethics.

The Court of Appeal was similarly sceptical of the alleged safeguards proposed by Mr Conway, represented this time by Ms Nathalie Lieven QC, now herself a High Court Judge of the Family Division of the High Court (where she was notable for being the first judge ever to rule as lawful [11] an abortion against the will of a mentally incapacitated mother, a decision later overturned by the Court of Appeal). [12]

Refusing Mr Conway’s appeal, the Court of  Appeal said this [13]:

‘Despite Ms Lieven’s submissions on the evidence, what remains quite clear is that an element of risk will inevitably remain in assessing whether an applicant has met the criteria under Mr Conway’s proposed scheme. The submissions and counter-submissions of counsel on the evidence, limited as it is to the evidence which the parties choose to place before the court, highlight the limitation of the ability of the court to assess with confidence the precise extent of the risk.’

Their Lordships went on [14]:

‘Another concern is whether and how the proposed inquisitorial role of a High Court judge  would work in practice. The judge would only be able to assess such matters as freedom from coercion or direct or indirect undue influence or the medical assessment of the imminence of death if given the evidential material to do so. This would require some independent person or agency to carry out the appropriate evidential  investigation and also, possibly, to play some role in the court hearing. As King LJ observed during the course of the hearing, such an inquisitorial approach would require funding but whether or not such funding would be available is completely unknown.’

Earlier the Divisional Court had echoed [15] the sentiment expressed by Lord Sumption in  Nicklinson, when it raised the concern that:

‘The court would have to proceed on the evidence placed before it. External pressures might be very subtle and not visible to the court.’

Sir James, in his second article [16], recognised that the criticisms he had made in his first article had not gone far enough. Reviewing the dicta of the Court of Appeal in Conway, which said that the proposed process:

‘… would require some independent person or agency to carry out the appropriate evidential investigation…’

Sir James commented that this, in short, meant carrying out the kind of rigorous independent investigation traditionally carried out by the Official Solicitor in wardship cases and more recently in end-of-life cases.

He commented that, in his previous article, he had asked ‘… what procedures are to be adopted for testing and, if need be, challenging the evidence?’, but that he now saw that, in the light of Conway, in putting it this way he did not go far enough:

‘Does there not need to be an independent evidential investigation? If so, is the Official Solicitor to be involved, or if not the Official Solicitor who else? And who is to pay for all this?’

He went on:

‘… even assuming the adoption in every case of the most rigorous procedures, the ultimate question still remains: how confident can we be that even the most rigorous procedures will be adequate to identify and prevent possible abuses and in particular, to use the Divisional Court’s phraseology, be adequate to detect what may be very subtle external pressures?’

Furthermore, he noted that:

‘Both the Divisional Court and the Court of Appeal considered the efficacy of what was being proposed without, so far as I can see, ever considering (not least, I suppose, because the  point had never been raised in argument) the logically prior question of whether this was a proper function for a judge. I suspect that, given the established role of the judges in life and death cases, everyone simply assumed that there was no difference in the case of assisted dying – a lazy and, as I explained in my previous paper, a fundamentally erroneous assumption.’

It need hardly be added that this criticism applies with even greater force to the Panel that is now being proposed in place of a judge.

A further safeguard that has been entirely forgotten and left out is what will be the role of the coroner after an assisted death has occurred.  [17] There is presently no provision for this whatsoever, yet it is an essential protection that there be oversight of assisted deaths by the coroner after the event.

Even at the euthanasia clinic, Dignitas, in Switzerland, every death has to be referred to the state procureur to check that the correct prescription was issued and that consent was properly and fully obtained. There is no such provision in the Bill, nor has the matter even been given any, or any proper, thought by the proposers of the Bill.

In all jurisdictions in the UK, all deaths involving a medicinal product or substance, self-harm, neglect, including self-neglect, a treatment or procedure of a medical or similar nature, whether from adverse reactions or from prescribing errors, must, by law [18], be reported to the coroner and it is by no means clear that this will be the case after an assisted death under the Bill. There is presently no reference or provision in the Bill for the same procedure. That is wholly unsatisfactory.

Why should deliberately-induced deaths be treated with any less scrutiny than other deaths? There is simply no logical reason for such an omission.

A relevant comparison is with legal termination of pregnancy: if a baby shows signs of life after delivery, however briefly, the death must be referred to the coroner [19]. ‘Assisted dying’ similarly involves a deliberate act of termination and yet, it seems, may not be subject to the same scrutiny. Why not? There is simply no rational or logical answer. It is yet another flaw in a Bill containing many flaws.

Sir James Munby goes on to recapitulate the primary questions that are not properly addressed by the Bill and that because they cannot be addressed by any such Bill.

These questions, among many others, remain to be answered:

• What will be the scope of function of the Panel? To what extent will it be expected to exercise a discretion? Or is the Panel’s role only to certify that the decision taken by the patient complies with the stipulated criteria?
• Who can apply to the Panel and who can, and should, be joined as parties?
• Are there to be reporting restrictions? Are the identities of any of the participants, in particular the patient, the witness and the countersigning doctors, to be anonymised?
• What procedures are to be adopted for testing and, if need be, challenging the evidence? Who should exercise that function?
• Is there to be an independent evidential investigation? If so, who is to undertake this and who is to pay for it? What public funding arrangements will there be?
• Should the Panel be required to publish their written reasons?
• How are appeals to be incorporated in the process? Why is there currently only provision for appeal if there is a refusal by the Panel?
• Does the conscience clause apply to Panel members?
• Why should a KC, a psychiatrist and a social worker necessarily be adequate as members of the Panel?
• What are the risks if evidence from the applicant can be (exceptionally) waived, or be pre-recorded?
• How can it be adequate that the Panel need not ask questions, make any further enquiries or notify anyone, at its discretion, and need only hear from one doctor?
• What of ‘open justice’ if the Panel can sit in private?
• Why has the Panel no investigatory powers?
• Why is there no requirement for evidence to be heard on oath?
• Why can the Voluntary Assisted Dying Commissioner (‘the Commissioner’) only consider applications refused by the Panel?

Once again what is proposed is wholly inadequate.

The Bill continues to remain silent as to how the court is to deal with the kind of issue exemplified by the Canadian case of AY v NB [20] where the patient’s partner intervened and obtained an interim injunction because of serious concerns about abuses.

These difficulties are compounded by the Bill’s apparently continued precluding of any appeal save where the Panel refuses a certificate of eligibility.

What if the patient’s partner and relatives, excluded from participation in the Panel process, discover only after the Panel has made the certificate of eligibility, facts of the kind which in AY v NB prompted an eleventh-hour intervention by the Canadian judge? 

What are they to do? They cannot appeal. Can they somehow apply to the Panel? Can they apply to the Family Division and pray in aid the inherent jurisdiction of the High Court? Who knows, and the Bill does not tell us.

There are a whole host of other wholly unsatisfactory issues that the Bill fails to address because, ultimately no Bill could ever satisfactorily address them. These are but a few that spring to mind:

• Provision to ‘reconsider’ a Panel decision is entirely one-sided: it applies only where the Panel refuses a certificate of eligibility and, what is more, the presumption of capacity stipulated by the Mental Capacity Act 2005 is maintained (see s.3);
• The Bill appears to permit, or at least does not forbid, health-care workers proactively suggesting assisted suicide even to vulnerable patients;
• The largely cosmetic, or even ambiguous, provision for an independent advocate in the case of persons with a learning disability or similar (see s.20) is particularly troubling since it clearly envisages the terminating of the life of those with compromised mental capacity, and persons of similar vulnerability, when they are the persons most likely to be most easily influenced by 3rd parties, whether health-care professionals, advocates or otherwise;
• Such advocates are to have a role and powers which are not set out in the Bill but are to be set out in secondary legislation that will be far less scrutinised by Parliament and will consist of later regulations devised by civil servants;
• The whole concept of a ‘death commissioner’ and an ‘assisted dying’ Panel is fraught with even more dangers and pitfalls than was the proposal for the same function to be carried out by a judge, the perils of which have been well scrutinised and criticised by Sir James Munby in considerable detail in his two articles.

Persons may qualify for medically-assisted termination under the Bill even where:

• the doctors concerned presume capacity, meaning that a 51% certainty is sufficient;
• they have learning difficulties or a mental illness;
• are depressed or suicidal;
• feel they are ‘a burden’ to others;
• live in an area where good palliative care is not available;
• refuse treatment and so qualify;
• voluntarily stop eating and drinking and suffer malnutrition as a result;
• drug or alcohol abuse disorientates their thinking.

Under the provisions of the Bill, the person’s family will effectively be excluded from participation, will not necessarily be notified and may not find out that their relative has made a request until after their death. Worse, they will have no recourse to raise any concerns such as of coercion or abuse (in short, the AY v NB [21] situation).

Any doctor will be able to raise the issue of ‘assisted dying’ with his patient but without necessarily having any training so to do, may raise the issue with someone under 18 with a view to their qualifying when they reach the age of 18 and can raise the issue even with patients having Down’s Syndrome or learning disabilities.

If a doctor decides that a patient does not qualify for the assisted death process that patient can freely ‘shop around’ for another doctor who will decide otherwise.

A proxy who may not even know the person seeking ‘assisted dying’, is empowered to sign their application with little more.

Patients will, under the Bill, have a right to request assisted death and to be granted the same but will have no concomitant right to good palliative care, the obvious and necessary corollary.

Under the Bill, the relevant doctors will be obliged to carry out further enquiries only if they think it ‘appropriate’ (see s.11(2)(b)).

There is no requirement for the relevant health-care workers to specify any uncertainties of diagnosis and prognosis in the course of the ‘assisted dying’ process, nor is there any requirement to spell out the risks associated with the use of lethal drugs, e.g. of possible complications that may arise.

An amendment to the Bill which would have clarified that hospices and care homes would be able to opt out of ‘assisted dying’ taking place on their premises was rejected at Committee Stage, and the Bill does not appear to prevent the government from financially penalising hospices if they so refuse.

The Bill does not provide any regulatory regime as to the provision of the lethal drugs to be used.

It seems that the NHS is permitted to outsource the provision of the ‘assisted dying’ service to for-profit companies and the Bill is silent as to how such companies would charge for the service or how they would be regulated.

Chief Medical Officers will no longer be responsible for overseeing the process and the Assisted Dying Commissioner will monitor the system and report on it to the Health Secretary without being held accountable to anyone else or, arguably, at all.

The Bill cannot, and will not, provide the safeguards that are claimed for it by its proposers, not least for the reasons adumbrated by Sir James Munby, former President of the Family Division of the High Court of England and Wales in his criticisms of the Bill, and its predecessors, and for reasons set out in various leading cases. As Sir James quite rightly states in his review of the Bill [22]:

‘... the hard truth, as I previously suggested, is that in contemplating judicial involvement [and the same will apply to a Panel] we face an impossible choice: between an open and transparent process that might deter those for whom the scheme is designed, and a secret process destructive of the integrity of the scheme and corrosive of the judicial function [again the same applies to a Panel]. Despite it being promoted by its supporters as an important and valuable safeguard in which the public can have confidence, the fact is that the architects of the Leadbeater Bill, however much they may protest otherwise, have chosen to promote a profoundly unsatisfactory scheme for judicial involvement [or that of a Panel]: a scheme…which can give us no confidence that it will enable the court [or a Panel] to identify and prevent possible abuses.’

As indicated, his analysis applies mutatis mutandis to an ‘Assisted Dying Review Panel’ as to any Court. For all these reasons, the supposed safeguards are simply not safeguards at all.

Moreover, whether or not a patient is going to live for 6 months, or much longer, and whether or not the patient’s condition is incurable, are imponderables that are notoriously difficult to diagnose and predict and certainly cannot be resolved, or even satisfactorily addressed, by mere legislation.

The whole thrust of the Bill is away from what Parliament should be focusing upon, namely palliative care, and, instead, toward what is but a counsel of despair, that is, to tell the patient that there is nothing that can be done for him and he should simply go and die.

This is not an appropriate way for any responsible, democratic Parliament to legislate. The Bill is simply unworkable, and inevitably so since no bill of this nature could ever provide sufficient safeguards to make it workable or safe. As such, it is impossibly flawed; no amount of tinkering by amendment in committee or, indeed, at Report Stage, or in the Upper House, will be able to rectify those problems.

The only proper course, therefore, is for the Bill to be withdrawn altogether at the first opportunity.

If the issues discussed here affect you or someone close to you, you can call Samaritans on 116 123 (UK and ROI), visit their website https://www.samaritans.org/ or contact them on jo@samaritans.org.

If you are reporting or writing about a case of death by suicide, whether assisted or non-assisted, please consult media guidelines https://www.samaritans.org/about-samaritans/media-guidelines/ on how to do so responsibly.

Cover picture: Adaptation of ‘Artists-impressions-of-Lady-Justice, (statue on the Old Bailey, London)’, by Lonpicman, Wikipedia (used under Creative Commons Attribution-Share Alike 3.0 Unported Licence).

[1] S.1(2) Terminally Ill Adults (End of Life) Bill [212] 2024-5.

[2] Munby, Sir James, Assisted Dying: what role for the judge?, Guest Post on the Transparency Project, 30 October 2024 and 14 November 2024.

[3] [2017] EWHC 2447 (Admin), [2018] 2 WLR 322, [2018] 2 All ER  250; [2018] EWCA Civ 1431, [2020] QB, [2020] QB 1, [2018] 3 WLR 925, [2019] 1 All ER 39.

[4] [2001] UKHL 61, [2002] 1 AC 800.

[5] [2014] UKSC 38, [2015] AC 657.

[6] [2017] EWHC 2447 (Admin), [2018] 2 WLR 322, [2018] 2 All ER  250, para 14.

[7] Assisted Dying for Terminally Ill Adults Bill [HL 7], introduced 26 July 2024, currently at Second Reading.

[8] [2017] EWHC 2447 (Admin), [2018] 2 WLR 322, [2018] 2 All ER  250, para 100.

[9] [2014] UKSC 38, [2015] AC 657, para 228, per Lord Sumption JSC.

[10] [2017] EWHC 2447 (Admin), [2018] 2 WLR 322, [2018] 2 All ER  250, para 104.

[11] Re AB (Termination of Pregnancy) [2019] EWCOP 26, per Lieven J.

[12] Re AB (Termination of Pregnancy) [2019] EWCA Civ 1215, [2019] 1 WLR 5597.

[13] [2018] EWCA Civ 1431, [2020] QB, [2020] QB 1, [2018] 3 WLR 925, [2019] 1 All ER 39, para 171, per Sir Terence Etherton MR, Sir Brian Leveson P and King LJ.

[14] Ibid., para 174.

[15] [2017] EWHC 2447 (Admin), [2018] 2 WLR 322, [2018] 2 All ER  250, para 104.

[16] Op. cit., Munby, Sir James, Assisted Dying: what role for the judge? Some further thoughts, Guest Post on the Transparency Project, 14 November 2024.

[17] I am grateful to Sheila, Baroness Hollins, Emeritus Professor of Psychiatry of Learning Disability at St George’s, University of London, former President of the Royal College of Psychiatrists, former President of the British Medical Association, former President of the Royal College of Occupational Therapists, former President of the Royal Medical Benevolent Fund and cross-bench life peer in the House of Lords,  for pointing out this lacuna and egregious flaw in the Bill.

[18] The Notification of Deaths Regulations 2019 SI 2019/1112, s.3:

‘Circumstances in which the duty to notify arises

3.—(1) The circumstances are—

(a)the registered medical practitioner suspects that that the person’s death was due to—

(i) poisoning, including by an otherwise benign substance;

(ii) exposure to or contact with a toxic substance;

(iii) the use of a medicinal product, controlled drug or psychoactive substance;

(iv) violence;

(v) trauma or injury;

(vi) self-harm;

(vii) neglect, including self-neglect;

(viii) the person undergoing a treatment or procedure of a medical or similar nature; or

(ix) an injury or disease attributable to any employment held by the person during the person’s lifetime;

(b) the registered medical practitioner suspects that the person’s death was unnatural but does not fall within any of the circumstances listed in sub-paragraph (a)…’

[19] If a foetus shows signs of life after a termination of pregnancy, a referral to the coroner is required. This is because a live birth, regardless of gestational age, indicates an independent life and subsequent death necessitates a coroner's investigation. See the Chief Coroner’s Guidance No.45, of HHJ Alexia Durran, Chief Coroner, 2 February 2023, updated 2 February 2024 and 27 June 2024.

[20] 2024 BCSC 2004.

[21] Ibid.

[22] Op. cit., Munby, Sir James, Assisted Dying: what role for the judge? Some further thoughts, Guest Post on the Transparency Project, 14 November 2024.