What the assisted dying bill impact assessment tells us – and what it leaves out
Kim Leadbeater joins campaigners in favour of legalising assisted dying outside Parliament, October 2024 (Credit: Matt Crossick/Empics/Alamy Live News)
4 min read
The long-awaited impact assessment for the Terminally Ill Adults Bill has been published, with a headline finding that legalisation of assisted dying will save up to £90m per year across the NHS, pensions and benefits.
Most of the 149 pages are devoted to calculating these costs and cost savings. Numerous tables and appendices outline the effect of modelling different assumptions, and an acknowledged sparsity of data to guide these calculations means the difference between low and high estimates is large.
Relatively little space is given to broader impacts of this legislation. One potential impact not included is how assisted dying may affect hospice funding and the palliative care workforce. In their evidence to the Terminally Ill Adults Bill Committee, Hospice UK stated that legalisation of assisted dying may lead to hospices losing financial support from donors, and staff and volunteers leaving. This would have knock-on impacts on people dying in the ‘ordinary’ way.
There is almost no consideration of the impact of assisted dying on suicide prevention
The impact assessment rightly acknowledges concerns around palliative care provision, stating that there is “unmet need and variation in quality of provision” of palliative and end-of-life care. Difficulty accessing palliative care poses clear risks when it comes to assisted dying, as some people may choose to have an assisted death because their symptoms are not adequately controlled. This risk is not explored further.
There is also, surprisingly, almost no consideration of the impact of assisted dying on suicide prevention. Professor Louis Appleby, who chairs the National Suicide Prevention Strategy Advisory Group, has said that legalising assisted dying is an “enormous change with far-reaching implications”. In oral evidence given to the committee from leading psychiatrists, concerns were expressed that legalisation of assisted dying would undermine suicide prevention efforts. It is critical to consider how this bill – which amends the Suicide Act of 1961 – may impact on suicide prevention.
There are important opportunity costs of providing assisted dying. For example, if an oncologist spends time delivering assisted dying, who will step in to deliver their oncology clinic? On this, the impact assessment notes “the impact of [assisted dying] on wider resourcing pressures is uncertain”. This, surely, should be explored further. We must understand the knock-on impact on wider services before introducing assisted dying into the health and care system. If we don’t, once again, it will be the ‘ordinary’ people who will suffer.
The equality impact assessment rightly outlines the safeguards in the bill. But it does not explore how robust these safeguards are likely to be. The bill requires doctors to check for coercion, but even with the best possible training coercion can not be reliably detected. The potential impact – a wrongful death – could not be more grave.
The equality impact assessment focuses on ensuring equitable access to assisted dying, rather than on the potential adverse impacts for protected groups. It is of course essential to ensure equitable and safe access for those who want an assisted death. But we also need to acknowledge that some groups may be disproportionately harmed by this legislation.
For example, evidence submitted to the bill committee highlighted that trust in health and care services among marginalised groups is low, and that one in five people from minoritised ethnic groups think palliative care means giving medicines to people to shorten their lives. There is a risk that introduction of assisted dying may reduce public trust in services and professionals further, leading some people to avoid the health and care they need. These indirect risks, outlined in evidence to the committee, must be considered.
After months of waiting, the impact assessment for the Terminally Ill Adults Bill has been published. MPs must carefully consider all the impacts that are outlined – not just the headline figure on cost savings – but they must also pay attention to what has been left out.
Professor Katherine Sleeman is Laing Galazka chair in palliative care at King’s College London and honorary consultant in palliative medicine at King’s College hospital
