The Royal College of Physicians (RCP) has published a new position statement in response to the Terminally Ill Adults (End of Life) Bill currently going through parliament which seeks to legalise assisted dying.
The Terminally Ill Adults (End of Life) Bill passed its Second Reading in the House of Commons in November 2024. Following this the bill was scrutinised and amended by the bill committee which will report on 16 May ahead of third reading. In response, RCP committed to consider, in consultation with its Council, the issues around implementation that the RCP could or should engage with during the parliamentary process.
The RCP adopted a neutral position on assisted dying in 2019 following a survey of its members, reflecting the range of views throughout the 30 plus medical specialties. This means that the RCP neither supports nor opposes a change in the law.
Following discussions at RCP Council about if and how the RCP, given its neutral position, should engage with the bill and any eventual implementation, the RCP set up a short-term clinical reference group on assisted dying. This group was established as a sub-group of Council to consider the implications of the bill for physicians, patients and society. The full membership of the group is listed below.
The RCP submitted evidence to the public bill committee.
The RCP recognises that there is a breadth of views on this issue within its membership and fellowship. The working group examined the legislation recognising this breadth of views, and the neutral position and considered the bill’s implications on physicians and patients were the bill to become law
RCP position statement on the Terminally Ill Adults (End of Life) Bill, 9th May 2025
The following position statement relates to the Bill as published ahead of House of Commons report stage, following public bill committee.
The Royal College of Physicians (RCP) has a neutral position on assisted dying, reflecting the range of views across its membership, which we aim to represent This means that the RCP neither supports nor opposes a change in the law.
While the ultimate decision on assisted dying rests with society through parliament, professional and clinical issues are integral to legislation, regulation, guidance and safe and effective implementation on this matter.
The primary concern of physicians is ensuring the best possible care for our patients, and as clinicians caring for patients as they approach the end of their lives, our members will continue to support and advocate for our patients to receive the very best care.
Some members have expressed the view that the introduction of assisted dying and the requirement to have discussions relating to this with patients would fundamentally change the relationship between the doctor and patient.
Whilst the bill has undergone a number of changes during the public bill committee phase, there currently remain deficiencies that would need addressing to achieve adequate protection of patients and professionals.
The RCP advises that were assisted dying to become legal in England and Wales by way of the Terminally Ill Adults (End of Life) Bill there are key factors that must be protected in the legislation:
- Patients must be enabled to have an equitable choice of services as they approach the end of their lives.
- Doctors must have the option to absent themselves from any aspects of assisted dying.
- Decisions around a patient’s prognosis must be informed by expert clinical professionals including those who know the patient.
- Prognostic uncertainty must be understood and accepted by the patient and professionals involved in decisions and oversight.
- Decisions on capacity, and safeguards around coercion must be informed by face to face assessments of relevant and appropriately skilled health and care professionals including those trained in mental health to assess the patient for any remediable suicidal risk factors.
- Services that may deliver assisted dying must be closely regulated and monitored for assisted dying.
- Medicines prescribed and administered in assisted dying must be regulated for safety and efficacy for this use.
- Assisted dying services must not divert resources from other end of life care which must be available for all patients, or disadvantage provision of end of life and other services.
We share the concerns expressed by the Royal College of Psychiatrists on the limitations of the current Mental Capacity Act and its use in this situation.
We are concerned that patients would not have equitable choice of services because of the inequity of availability, and under-provision of end of life care and palliative care in England and Wales. These inequities of care are particularly present for more disadvantaged populations. There are widespread shortages in health and social care staff who provide these services, alongside increasing demand and very wide variation of where, when and how the services are delivered or available. There is a risk that some patients may chose assisted dying because they fear their needs would not be met, by services that are currently not adequate. There are currently two national reviews of End of Life and Palliative Care that can inform this concern more fully.
If there were to be a large proportion of primary care and hospital doctors who would not be prepared to be involved in assisted dying, this may create inequality of access.
The prognostic uncertainty for people approaching the end of their lives for six months or fewer is very high. This may prevent people who have a deteriorating illness from accessing assisted dying. Equally the bill definition of terminal illness may influence assessing doctors to make this prognosis, despite its inaccuracy.
The current bill describes the coordinating doctor and independent doctors as working alone in making decisions around prognosis, available treatments, mental capacity, and ensuring that patients have not been coerced. These decisions would not be made by doctors alone in any other aspect of clinical practice. Whilst the bill does state that the assessing doctor must “make such enquiries of professionals who are providing or have recently provided health or social care to the person as the assessing doctor considers appropriate, and such other enquiries as the assessing doctor considers appropriate” it does not prescribe a multidisciplinary discussion and decision. Face to face assessments by a clinician trained in mental heath and social worker would be important.
- The legislation makes provisions for a significant number of areas of secondary legislation, guidance and/or regulation to be developed at a later stage by the secretary of state or CMOs after the bill has passed. Many of these elements are crucial to ensure safe, effective and legal service provision. These include:
- Training, qualifications and experience required to be a coordinating doctor
- Regulation of medicines or substances to be prescribed and administered
- Regulation of any provider delivering assisted dying services
- Code of professional practice for those participating
- Operation of the act, and provision of services
The involvement of professional and regulatory bodies including CMC, Royal Colleges, CQC and HMRA will be crucial in their development.
It is essential that the current bill, and decisions that patients may make are considered in the current context of the NHS and healthcare in England and Wales, especially the access, availability and equity of services for people who may be terminally ill. For example, sadly, currently in the NHS most patients requiring medical admission spend a considerable time in temporary care environments including emergency department corridors, and many of these patients are older vulnerable patients who are approaching the end of life. This potential experience could inform their decisions.
This position statement was developed through the RCP short-term clinical reference group on assisted dying, set up as a sub-group of Council. Its content was approved as an RCP position by RCP Council on Wednesday 7 May.
Members of the short-term clinical reference group on assisted dying
- Dr John Dean, clinical vice president – co-chair of the reference group
- Alexis Paton, chair of the committee on ethical issues in medicine – co-chair of the reference group
- Jacob Hayes, Senior Public Affairs and Policy Manager
- Hannah Perlin, Senior Media Manager
- Eileen Burns, Elected Councillor and Trustee
- Angharad Chilton, Resident Doctors Committee representative
- Sarah Cox, Association for Palliative Medicine
- Alan Cribb, Patient and Carer Network
- Dan Furmedge, Censor
- Rowan Harwood, Elected Councillor and Professor of End of Life and Palliative Care
- Suzanne Kite, Association for Palliative Medicine, deputy rep
- Colin Rees, Representing medical specialties
- Ganesh Subramanian, Consultant in Stroke Medicine and RCP Council member
- Laura Waters, Patient Involvement Officer
- Dr Ben Thomas, Consultant Nephrologist, Representative for Wales
- Prof Andrew Wardley, Association of Cancer Physcians
- Dr Kevin Talbot, Association of British Neurologists