Terminally Ill Adults (End of Life) Bill: how should lawful assisted dying provision be established in England and Wales, and at what cost?

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Abstract
One crucial issue that has historically received little attention within the assisted dying (AD) debate in the UK is what model of state involvement and provision should be implemented if AD becomes lawful. Limited attention has been paid to the question of whether AD should be positioned within existing end-of-life care provision, or whether it should occupy a separate space, with distinct provision. The question of the impact on the National Health Service (NHS) became an important point of concern in debates about the Terminally Ill Adults (End of Life) Bill 2024–2025. These debates raised questions concerning how lawful AD ought to be established, the financial cost of provision for the service which the Bill states must be free, and how best to safeguard the interests of both patients and healthcare professionals. We consider the Government’s impact assessment, possible resource implications and ethical concerns over establishing a lawful AD service in England and Wales. The implications of a model of AD situated either within or alongside existing end-of-life NHS provision or, alternatively, established as a separate service outside existing end-of-life treatment provision are explored. We examine the key issues, including how AD should be funded, drawing on international experiences of different AD models. Our examination reveals that a clear volume/time/cost paradigm emerges, which must be recognised in planning a lawful AD service that avoids encouraging people towards AD. Whatever model of AD is implemented, maximising choice, safety, sustainability and equity of access are key concerns. Given the current NHS funding crisis, a variety of funding options to supplement state funding should be considered.

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