Will NHS resource constraints undermine the proposed legal safeguards for assisted dying?

The amended Terminally Ill Adults (End of Life) Bill (published 28 March 2025) proposes a new law allowing assisted dying in England and Wales. It acknowledges the need for safeguards to ensure that assisted dying is only available to terminally ill adults and that decisions are fully informed and free of external pressure and coercion. The Bill proposes three tiers of safeguards. The first two involve information provision and assessments by medical practitioners. The third tier requires confirmation of eligibility by a multidisciplinary Assisted Dying Review Panel, a process which will incorporate evidence given by the assessing doctors. This article suggests three distinct routes by which scarcity of National Health Service (NHS) resources may undermine the proposed safeguards. First, through the direct effect of limited clinical time and resources to enable a thorough assessment and discussion with the patient. Second, through the influence of implicit considerations of resource distribution. Third, by obscuring these safeguards within clinical care, which increases the risk that unconscious bias will influence the process, reduces the opportunity for careful scrutiny by the Panel and creates a potential area of contention between doctors and their patients. Weakened safeguards present risks to patients and doctors alike. The Bill proposes new criminal sanctions for doctors providing false or misleading opinion in connection with the assisted dying procedure. It is suggested that empowering an organisation, outside of the NHS, with responsibility for the first two tiers of safeguards may allow for more robust protection for both patients and doctors by distancing the process from the influence of resource constraints within the health service.