Assisted dying: what next, who pays, and what cost?

A historic vote in the House of Commons on Friday 20 June 2025 has passed the Terminally Ill Adults (End of Life) Bill (also known as the Assisted Dying Bill), introduced as a private member’s bill by Labour MP Kim Leadbeater, with a majority of 23 votes. The bill now progresses to the House of Lords for further review and debate.

Amongst MPs backing the bill were Prime Minister Sir Keir Starmer and his predecessor, Rishi Sunak. Deputy Prime Minister Angela Rayner voted against, as did Health Secretary Wes Streeting.

The Guardian on Saturday reported Kim Leadbeater as saying it was, “not a choice between living and dying - it is a choice for terminally people about how they die”.

Process

Those following the debate which has surrounded the bill will know that there have been particular concerns voiced about the potential impact on individuals with mental health conditions and those with anorexia. Before the final vote in the Commons, MPs passed several new amendments. One would bar those who refused food and water from being classified as having a terminal illness although MPs concerned about anorexia said it may not prevent that slipping through the gap. Another amendment would compel the health secretary to report on the state of palliative care.

The fundamental arguments, of course, are all about autonomy and the sanctity of life, the risks of abuse and the safeguards that are in place, and the change in the relationship between doctors and patients, and between the state and each one of as an individual. 

The most significant amendment on the way through the Commons, perhaps, was a very pragmatic change to the safeguards involved.  The original proposal was that each case would be scrutinised by a high court judge, but – it is said – that calculations then suggested that this would take something like 70% of the entire resource of the High Court family division.  Instead, the proposal became that an Assisted Dying Review Panel would review each case, comprising a senior lawyer (a king’s counsel, or a sitting / former high court judge or higher), as well as a psychiatrist and a social worker.  We might still wonder whether there will be enough of those senior lawyers, or the funding to pay them at the rates they expect, to make these panels function in good time. 

The Impact Assessment envisages perhaps 1,750 – 7,600 people might start the process each year, and around 60% of those would complete it.  There might be 1,300 – 5,700 panels per annum, expected to take around 3 hours.  Taking a rough mid-point, that might be say 3,500 panels per annum – or say 1,750 days of a panel sitting.  With say 250 working days per annum for the panels – that would mean 7 panels sitting at any one time, and of course it is unlikely that their panel role will be anyone’s full time job.  There will need to be a large number of people involved, and we suspect that the bottleneck is likely to be the availability of the very senior lawyer. 

Funding and resources

Wes Streeting is reported by The Sunday Times as being deeply concerned about the impact that assisted dying would have on an overstretched NHS. He is also worried about the risks that he believes come with the bill. Writing on Facebook to his constituents he explains why he voted against the Assisted Dying Bill:

“There is no doubt that this is a major and profound social change for our NHS and our country. I can understand why many people who are facing terminal illness, or fear terminal illness, are seeking the right to die at a time and manner of their choosing and I have enormous respect for their position.…
 
But I can’t get past the concerns expressed by the Royal College of Psychiatrists, the Royal College of Physicians, the Association for Palliative Medicine and a wide range of charities representing under-privileged groups in our society about the risks that come with this Bill…..

The truth is that creating those conditions will take time and money. Even with the savings that might come from assisted dying if people take up the service - and it feels uncomfortable talking about savings in this context to be honest - setting up this service will also take time and money that is in short supply.”

Clause 38 of the Bill requires the NHS to make provision for voluntary assisted dying services, and includes a requirement that they must be free of charge.   

There is time, of course, for budget to be allocated to the process, given that the system for assisted dying might well not be in place until 2029, but Wes Streeting is making the point that, as things stand, finding the money for this would mean cuts from other services.  It is hard to see that access to assisted dying services could be rationed (in the same way as IVF is in practice, for example) through local funding decisions (or the so-called “postcode lottery”), or that access could sensibly be managed through waiting lists, as it is with other health conditions, when the patient must already be predicted to be within 6 months of death to even start the process.   

The costs might well be significant.  The Impact Assessment (IA) estimates something like 32 hours of clinicians’ time will be involved in the process for each case (other jurisdictions report the process needing around 60 hours).  And depending on the number of patients taking up the service, the IA puts the total cost in staff time at up to £11.5 million per year. 

We know from experience elsewhere that the costs of a privatised service can be substantial – at Dignitas in Switzerland, costs run from £6,500 to over £15,000.  It will be important to make sure that our NHS system delivers real accessibility in practice if it is to meet its objectives fairly.

No doubt the potential impact on other services, such as palliative care, of moving NHS funding into assisted dying services will feature in the debates to come in the House of Lords. There is no doubt that the bill continues to be a topic of intense debate, controversy and public interest. As it continues its journey to become law there will be wide ranging discussions including ethical considerations, potential safeguards and its impact on our already stretched healthcare system.

We will, of course, keep you informed of its progress through the Lords and – if it happens – into law, to support you with the appropriate preparations to get ready for this.