As Parliament passes the Terminally Ill Adults (End of Life) Bill, which would allow terminally ill individuals with fewer than six months to live to request an assisted death, public debate is intensifying. Polling shows widespread public support—but from inside the NHS, the picture is far more nuanced, says a Retired Practice Manager.

In a free vote it was interesting to see the current Health Secretary voting against the bill and further asking the question as to where the money is going to come from, as it is expected to cost in the region of £15,000 per case.

Of course there is a long way to go as the House of Lords may not pass the bill, or will seek further amendments

The Case for Choice and Clarity  

Supporters of the bill speak of autonomy—the ability for patients to take control of their final days, sparing themselves avoidable pain or loss of dignity. For some healthcare professionals, it also brings a sense of relief: the option to respond compassionately when medicine’s curative powers have run their course.
With careful safeguards—two doctors' approval, capacity assessments, and panel oversight—the legislation aims to balance individual rights with public protection.

Six Months: Long Enough?

Yet for all its intent, the six-month window raises significant concerns. In a legal and administrative context, six months is not a long time. The process of requesting assisted dying—medical evaluations, capacity assessments, and possible legal reviews—could consume much of that period. These risk creating a scenario where a patient “times out” of the process while waiting for the system to respond.

Moreover, subtle forms of coercion or emotional burden are not easy to detect. Patients may feel pressure, not from direct manipulation, but from internalised guilt or complex family dynamics. In rarer instances, there may be financial incentives for relatives that cloud a patient’s free will.

As one nurse reflected: “You can't always see it on a form, but sometimes you sense it. That unspoken pressure.”

Inside the NHS: A System Under Pressure

Primary care teams are already overwhelmed. Introducing emotionally demanding and legally sensitive processes—such as evaluating the right to die—adds to their load. These are not quick consultations. They require time, confidence, and support.

Although clinicians can opt out on grounds of conscience, this could create pressures around staffing, service continuity, and patient access. And those who choose to participate may need significant psychological support and robust ethical guidance to manage the emotional toll.

Beyond Legislation: Building a Framework of Humanity

If assisted dying becomes legal, it must not stand alone. It needs an ecosystem of support: comprehensive training, clear guidance for both clinical and managerial staff, and access to counselling and ethics consultation.

This isn’t simply a legal or clinical issue—it is a human one. The goal is compassion, and that must include those who care, not just those being cared for.

As a former manager, I know that systems are only as strong as the people who keep them running. If we are to honour the dignity of patients seeking this choice, we must equally honour the dignity of the professionals asked to help them carry it out.