Laws to allow assisted dying may pass in Scotland, Jersey and the Isle of Man in the next few years, leading to a divergence between different parts of the UK and British Isles, MPs have warned.
The government must consider the repercussions of this, a parliamentary inquiry into assisted dying has said.
Jersey, the Isle of Man and Scotland are all considering the legalisation of assisted dying, although in each case only permanent residents would be eligible.
“It looks increasingly likely that at least one jurisdiction among the UK and crown dependencies will allow [assisted dying] in the near future and ministers should be actively involved in discussions about how to approach the divergence in legislation,” says a report from the health and social care committee.
It also recommends doctors be given clear guidance on how to respond to requests for medical reports from terminally ill patients considering travelling abroad for an assisted death.
Although it is not illegal to provide medical reports to facilitate assisted dying abroad, the British Medical Association (BMA) advises doctors not to do so, while the General Medical Council (GMC) says providing access to a patient’s records should not be considered encouragement or assistance.
“It does not seem to be entirely clear to doctors what they are allowed to do,” the report says, adding that revised guidance from the GMC and BMA is needed.
The report urges the government to commit to increased financial support for hospices and “ensure universal coverage of palliative and end-of-life services”.
The inquiry considered more than 68,000 responses from members of the public and 380 pieces of written evidence during the course of its inquiry into assisted dying.
Its report, published on Thursday, does not come down on one side or the other of what it describes as a “difficult, sensitive and yet crucial subject”. Rather, it is intended to be a resource to inform continued debate, including the possibility of a parliamentary vote in the next few years.
The committee heard from supporters of a change in the law, who argue that too many people have agonising and undignified deaths. Legislation would not offer terminally ill people a choice between life and death but some control over the manner and timing of their death.
Opponents of assisted dying told the committee that legislation was a “slippery slope” and may encourage pressure on old and sick people. Instead of legalising assisted dying, more resources should be allocated to palliative care.
Steve Brine, the committee chair, said the inquiry “raised the most complex issues that we as a committee have faced, with strong feelings and opinions in the evidence we heard. We intend the information and testimony we present in our report today to … be a significant and useful resource for future debates on the issue.” He thanked those who had shared “very difficult personal stories”.
The report was finalised amid growing pressure for change after the broadcaster Esther Rantzen revealed in December that she was considering assisted dying, having been diagnosed with an incurable cancer.
Keir Starmer, the Labour leader, backed a call for a change in the law and the education secretary, Gillian Keegan, said the issue “does need to be debated”. The last parliamentary vote on legalising assisted dying, in 2015, was defeated by 330 to 118, but many more MPs are now thought to be in favour.
Opinion polls have shown that between 73% and 84% of the public support legalisation within strict guidelines. Between 1998 and 2022, 531 Britons travelled to Dignitas in Switzerland for an assisted death, the report says.
It is not illegal for a British citizen to travel abroad for an assisted death but anyone accompanying or helping the person may be subject to investigation and prosecution.
One woman who accompanied her mother to Dignitas said she was investigated by police for two years before the Crown Prosecution Service (CPS) said there was no public interest in proceeding.
“In the meantime they had looked at my bank account, they had taken witness statements from people that we loved, who loved my mum, they had taken equipment from me,” the woman said. “My reputation, I felt, was in serious jeopardy. It drove my sister almost to the brink of suicide … It cost us thousands and thousands of pounds in legal fees to defend ourselves.”
CPS guidance issued in 2014 states that any prosecution must be in the public interest. Starmer, who was the head of the CPS at the time, said he was “unlikely to prosecute those motivated by compassion who help a relative or close friend” with a “clear, settled and informed” wish to die.
Of 182 cases referred to the CPS between April 2009 and March 2023, 125 were not proceeded with and 35 were withdrawn by police, the report says.
The government said it had a “neutral stance on whether to bring in legislation” to allow assisted dying. Helen Whately, the minister for social care, told the committee: “Should the will of parliament change, the government will not stand in its way, but parliament needs to take that step.”
Jersey is expected to move ahead with a draft law after a citizen’s jury overwhelmingly backed assisted dying for adult residents with a terminal illness or who are experiencing unbearable suffering. The process would take 12-18 months, with a further 18 months before the law could come into effect.
The Isle of Man parliament backed a proposal in October to allow terminally ill, mentally competent adult residents to choose an assisted death. The bill is at the committee stage.
In Scotland, a bill proposing the legalisation of assisted dying is expected to be introduced for debate in the devolved parliament this year.
The committee examined the record of 17 jurisdictions around the world where assisted dying is legal for a person who is terminally ill. They include a number of US and Australian states, Canada and several European countries. It found cases of assisted dying “had increased in every jurisdiction” but this “need not be seen as a negative, but could instead be seen as a sign of increased access”.
The report says: “The UK has long been a world leader in palliative and end-of-life care, but access to and provision of palliative and end of life care is patchy. The government must ensure universal coverage of palliative and end-of-life services, including hospice care at home.
“It is important that everyone is able to choose what type of support they need at the end of their life and that their advanced care plan is honoured where possible.”
