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24 June 2025 | Country Update
Assisted dying likely to become law in England, Scotland and Wales
5.10. Palliative care
Palliative care aims to ensure the best possible quality of life for people in advanced illness and at end of life, and for their families by actively managing pain and other symptoms and providing psychological, social and spiritual support. Palliative care may be delivered by specially trained, multidisciplinary specialist teams or by generalist providers such as GPs, district nurses, hospital doctors and nurses, allied health professionals, care home staff, social care staff, social workers, chaplains and others (Dixon et al., 2015). Palliative care is provided in NHS hospitals, hospices or at home. Hospital care is predominantly provided by specialist liaison teams comprised of specialist hospital consultants and palliative care nurses. Residential palliative care is mostly provided in voluntary sector hospices, although a limited number of NHS facilities do exist. Non-residential palliative care includes hospice-at-home services and day-care centres. Day-care centres are often contained within hospices and transfer can be arranged to admit patients for residential care if necessary. In addition to trained medical staff, volunteers provide invaluable support in hospices.
The funding for palliative care is a combination of NHS resources and charitable donations. One survey in 2017, for example, found that charitable donations accounted for 71.2% of funding for hospice-at-home services (Rees-Roberts et al., 2019). This mixed economy has led to patchy, fragmented and poor-quality care towards the end of life for many individuals (Dixon et al., 2015). A systematic review of the cost of palliative care in the United Kingdom undertaken in 2017 was unable to produce reliable estimates and has argued for improved data collection to understand and monitor the costs and resources involved in the provision of palliative care in the United Kingdom (Gardiner, Ryan & Gott, 2018).
The Terminally Ill Adults (End of Life) Bill passed its third reading in the House of Commons on 20 June 2025 and is likely to pass into law for England and Wales during the next 12 months, after debate and amendment in the upper House of Lords [1]. An analogous law (the Assisted Dying for Terminally Ill Adults (Scotland) Bill) is also currently going through the Scottish Parliament [2]. The Bills would legalize physician-assisted suicide, limited to adults judged to be suffering from terminal illnesses.
Neither specifies in detail how assisted dying would be provided alongside or as part of state-provided healthcare services. They were proposed independently by parliamentarians, and governments in England and Scotland are neutral. Following their passage, governments would have latitude to decide when provisions come into effect and how to design services.
These changes will require extensive policy formulation as to what assisted dying services would be implemented, who would deliver them, and how they could work alongside end-of-life care services. It will take time to train staff and put clear processes in place for monitoring and compliance. The Secretary of State for Health has said there is no extra funding available for the launch of a new service at this time; an earlier impact assessment estimated savings from assisted dying, though with a wide margin of uncertainty [3].
Authors
References
[1] The Terminally Ill Adults (End of Life) Bill (June 2025): https://bills.parliament.uk/bills/3774
[2] The Assisted Dying for Terminally Ill Adults (Scotland) Bill: https://www.parliament.scot/bills-and-laws/bills/s6/assisted-dying-for-terminally-ill-adults-scotland-bill
[3] Impact Assessment: https://assets.publishing.service.gov.uk/media/68247bfdb9226dd8e81ab849/terminally-ill-adults-end-of-life-bill-impact-assessment-updated.pdf