UK governments must learn from other countries to prepare for assisted dying if legalised, or face a service people can’t access, says Nuffield Trust
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In countries where assisted dying is legal, policymakers often
underestimate the extra capacity needed in the health and care
system to get the service up and running and the ongoing funding
needed to deliver it. MPs and MSPs should heed the warnings from
international evidence, or the UK faces assisted dying becoming yet
another service people struggle to access. That's according to a
new report published today by the Nuffield Trust, which is neutral
on the question of...Request free trial
In countries where assisted dying is legal, policymakers often underestimate the extra capacity needed in the health and care system to get the service up and running and the ongoing funding needed to deliver it. MPs and MSPs should heed the warnings from international evidence, or the UK faces assisted dying becoming yet another service people struggle to access. That's according to a new report published today by the Nuffield Trust, which is neutral on the question of legalising assisted dying. Exploring 15 jurisdictions across Australia, Austria, Belgium, Canada, the Netherlands, New Zealand, Spain, Switzerland and the US, the report takes the most detailed look to date at what the UK can learn from other countries as it takes steps to legalise and set up assisted dying services. The report warns that safe and effective implementation will require substantial planning, infrastructure and funding - all scarce in today's NHS, amid staff cuts, reorganisation, tight finances, and patchy access to end-of-life care. Drawing on data, statistics and over 250 evidence sources, the report establishes, for the first time, a picture of the characteristics of people who access assisted dying. The analysis reveals that even in countries where having a terminal diagnosis is not a requirement, a large majority are terminally ill – 79% in Belgium and 96% in Canada. Between 55% and 80% of those seeking an assisted death had a cancer diagnosis and the majority (75%) were receiving palliative care. The median age for people who had an assisted death was between 69 and 80. Key lessons and recommendations from international evidence include: - Many countries are concerned about inequalities in access to and barriers to assisted dying across different groups. With access to end-of-life care in England already varying by factors such as deprivation and ethnicity, similar challenges are likely here. Recommendation: Policymakers should develop local strategies that reflect population needs, and consider innovations like assisted dying care navigators used in parts of Canada and Australia - Costs wider than delivering individual assisted deaths need to be considered, to cover new services required: for example, in Australia pharmacy services were extended and in Belgium a public information service was established. Yet the UK government's impact assessment limits funding estimates to direct costs (for example for staff directly involved). Recommendation: Officials will need to make funding available that goes beyond the direct costs, to include resources for regulation, data infrastructure, service redesign, workforce training, and oversight bodies. - Most countries had to establish entirely new systems, specialist staff, training, oversight bodies, public guidance and data reporting. In Australia, for example, states relied on intensive 18-month implementation periods. In Belgium, underfunding of the oversight mechanism created problems with capacity to deliver assisted dying. Recommendation: The Voluntary Assisted Dying Commissioner for England and Wales will need to be given the funding it needs for a secretariat, data access, and expert support. Policymakers should set adequate funding and resourcing for review panels too. - Across all jurisdictions that have legalised assisted dying, the number of cases has increased over time, even when eligibility criteria have not changed – for example in Oregon the proportion of deaths which were assisted has risen from 0.2% in 2010 to 0.86% in 2023. In Australia around half of requests do not end in an assisted death, but every request still needs to be processed and the individual and family supported. Recommendation: Officials will need to plan for ongoing investment and increasing demand rather than treating infrastructure development as a one-time implementation cost and funding levels as static. - Staff involved in end-of-life care are often those most likely to be delivering assisted dying services, with general practitioners most often directly involved and pharmacists playing a large role in several countries, including Belgium and the Netherlands. Yet a relatively small number of clinicians are directly involved in delivering assisted dying. In 2023/24 in Victoria, Australia, 10 doctors either coordinated or consulted on 55% of all cases. Recommendation: National contracts for general practice and pharmacy may need to be amended to take account of reimbursement for assisted dying. The report also finds that countries with devolved or regional implementation - Canada and Spain - have needed to develop processes to ensure consistency across different provinces and to share best practice. The authors argue that, with assisted dying laws being debated separately in Scotland, the UK should carefully consider Canada and Spain's experiences and establish which aspects of the service should be locally tailored in devolved regions, and which parts must be standardised. Nuffield Trust Deputy Director of Research, Sarah Scobie said: “With assisted dying remaining a contested issue, and our health and care systems struggling under immense pressure, implementing a new service won't be straightforward. However, other countries provide valuable lessons which can help policy makers to make good choices as the Bills legalising assisted dying continue their parliamentary journeys. “Much of the UK debate around assisted dying so far has focused on avoiding a ‘slippery slope' towards misuse of the service, but many people in other countries face barriers to accessing assisted dying. If parliamentarians choose to legalise it, they will need to get the balance right and worry not just about people who have an assisted death when they shouldn't, but also about people who can't when they are meant to be eligible.” Ends. Notes to Editors
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