Social workers are to be allowed to opt out of the proposed assisted dying process, the legislation’s sponsor has pledged.

Labour’s Kim Leadbeater has promised to work with fellow MPs to amend her Terminally Ill Adults (End of Life) Bill to ensure practitioners other than health professionals are allowed not to participate.

While social workers were originally not part of the bill’s process for assisted dying, they have been added to it through amendments made by Leadbeater during its recently-concluded committee stage.

Social workers to be involved in assisted dying panels

Under this, a panel comprising a senior lawyer, a psychiatrist and a social worker would consider requests for an assisted death that had been already signed off by two doctors, to check whether the statutory requirements had been met. These include that the person:

• has an inevitably progressive illness and is expected not to live beyond a further six months;
• has capacity to make the decision to end their life;
• has a clear, settled and informed wish to end their life;
• made the initial declaration that they wanted to end their life voluntarily and was not coerced or pressured into making it.

However, as the bill stands, only doctors and other health professionals have the right to not participate in helping a person to die and protection from detriment from their employer should they decide to opt out.

Lobbying from BASW

The British Association of Social Workers (BASW) had lobbied for social workers to be similarly covered and welcomed Leadbeater’s pledge, given last week, to introduce an amendment to that effect.

In a debate at the committee stage on 18 March, Conservative MP and prominent bill critic Danny Kruger put forward an amendment that would have extended the so-called opt-out provision to anyone potentially involved and in relation to any part of the assisted dying process.

He highlighted social workers’ current omission and quoted written evidence from BASW.

In response, Leadbeater said: “I would like to get it on the record that I agree with him: there should be no duty on any person to take part in the Bill’s provisions if they choose not to, for whatever reason. I will struggle to support his amendment because there are other issues with it, but on that principle I wholeheartedly agree, and I would be happy to work with him in sorting it out, before report, to that effect.”

This means she will devise an amendment to extend the so-called “conscience clause” more broadly to be considered at the next stage of the bill’s passage through the House of Commons, the so-called report stage.

‘A vital step towards parity between social workers and health professionals’

In response, a BASW spokesperson said: “BASW has engaged significantly with MPs on the assisted dying proposals since they were introduced to parliament, ensuring that social work’s role and voice is understood and represented throughout the process.

“Social workers not being included in the conscience clause in the initial drafting of the legislation was a serious omission that we have been raising with policy-makers since day one. It is paramount that all professionals potentially involved should be able to opt out of work relating to assisted dying without detriment.

“We were therefore pleased that MPs on the committee listened to our calls and gave their assurance that an amendment to this effect will now be brought forward. It is a vital step toward ensuring parity of legal protections between social workers, other non-healthcare professionals, and medical practitioners.”

Social workers would sit on three-person panels set up to review adults’ requests for assisted dying under a proposed amendment to the bill to legalise the practice.

Labour MP Kim Leadbeater, sponsor of the Terminally Ill Adults (End of Life) Bill, has proposed that the panels – which would also comprise a psychiatrist and a senior lawyer – should consider requests for an assisted death that had been already signed off by two doctors.

Role of panels including social workers

The panels’ role would be assess whether the statutory requirements for an assisted death had been met, including that the person:

• has an inevitably progressive illness and is expected not to live beyond a further six months;
• has capacity to make the decision to end their life;
• has a clear, settled and informed wish to end their own life;
• made the initial declaration that they wanted to end their life voluntarily and was not coerced or pressured into making it.

The panels would have to take evidence from at least one of the two doctors and may also hear from the person themselves or any other person.

Replacing court role

Under the bill as currently stands, this role would be carried out by the High Court. However, concerns have been raised about the impact this function would have on court capacity, at a time when the judicial system is already under significant pressure.

Under Leadbeater’s proposal, the social worker member would need to be a registrant on either Social Work England’s or Social Care Wales’s register.

The panels would be appointed by a Voluntary Assisted Dying Commissioner, a new role appointed by the prime minister that would be held by a senior judge. This would be provided for by another of Leadbeater’s proposed amendments to her bill.

The amendments will be discussed by the committee scrutinising the bill after Parliament returns from its current recess next week.

Argument over level of safeguards

In a committee debate last week, bill opponent Danny Kruger raised concerns that replacing the High Court with a panel would weaken provisions in the bill protecting people from being coerced into ending their lives.

In response, Leadbeater cited the evidence of the Association of Palliative Care Social Workers (APCSW) to the committee in arguing that the panels would consist of practitioners with expertise in tackling coercion.

Though neutral on the question of assisted dying, the APCSW and the British Association of Social Workers (BASW) welcomed Leadbeater’s plan.

Social workers ‘uniquely qualified’ for role

The APCSW said: “The inclusion of social workers as core members of these panels shows that Kim Leadbeater and her colleagues have taken on board our arguments that social workers are uniquely qualified and equipped to undertake the complex and sensitive tasks of assessing mental capacity and safeguarding individuals who may be subject to any form of undue influence or coercion.”

It added: “The choices that people make as they approach the end of their lives are strongly influenced by their relationships with others and by the practical circumstances of their lives. This holistic perspective is our native ground as social workers.”

BASW issued a similar message, saying: “Individuals considering assisted dying, and their families, need holistic advice and support. The multi-disciplinary panel also potentially provides the framework to resolve issues of mental capacity and adult safeguarding, both issues which sit with social workers.”

Panels ‘would need to be backed by resource and training’

However, it added that the panels would require sufficient resource to ensure they were adequately staffed, while practitioners serving on them would need appropriate training and supervision to fulfil their roles.

There is a majority in favour of assisted dying on the committee, suggesting that the amendments will be agreed.

The bill will then return to the House of Commons for further debate and a final vote. Though MPs backed the bill in principle previously, the changes proposed by Leadbeater may lead to a weakening of support.

Celebrate those who’ve inspired you

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Do you have a colleague, mentor, or social work figure you can’t help but gush about?

Our My Brilliant Colleague series invites you to celebrate anyone within social work who has inspired you – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a few paragraphs (100-250 words) explaining how and why the person has inspired you.

*Please note that, despite the need to provide your name and role, you or the nominee can be anonymous in the published entry*

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

Almost half of social workers believe they should have a role in any future assisted dying process, though others fear the sector would struggle to take on such a role, a poll has found.

This follows the Terminally Ill Adults (End of Life) Bill passing its second reading in the House of Commons in November 2024.

Under the legislation, a terminally ill person with no more than six months to live could choose to receive assistance to die, so long as they had the mental capacity to make the decision.

To be approved, they would need to be assessed by two separate doctors, and a High Court judge would need to confirm that the legislation’s requirements were met.

However, in light of concerns about people being or feeling coerced into an assisted death, the Association of Palliative Care Social Workers (APCSW) has proposed the establishment of a social work role to safeguard those going through the process.

But do social workers agree?

A Community Care poll with 700 votes found that almost half of practitioners (46%) believed they should be involved in future assisted dying processes. However, over one-third (37%) expressed concerns about the sector’s capacity to accommodate the additional work.

Proposed social work role

The approved palliative care professional position proposed by the APCSW would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or by concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

What do you think about the proposed safeguarding role?

Celebrate those who’ve inspired you

Photo by Daniel Laflor/peopleimages.com/ AdobeStock

We’re expanding our My Brilliant Colleague series to include anyone who has inspired you in your career – whether current or former colleagues, managers, students, lecturers, mentors or prominent past or present sector figures whom you have admired from afar.

Nominate your colleague or social work inspiration by filling in our nominations form with a letter or a few paragraphs (100-250 words) explaining how and why the person has inspired you.

If you have any questions, email our community journalist, Anastasia Koutsounia, at anastasia.koutsounia@markallengroup.com

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Legislation to permit assisted dying has cleared its first parliamentary hurdle after MPs voted in favour of it today.

The Terminally Ill Adults (End of Life) Bill passed its second reading in the House of Commons by 330 votes to 275.

Most Labour and Liberal Democrat MPs voted in favour, with the majority of Conservatives, and a sizeable minority from the governing party, voting against.

The bill will now be considered in detail by a committee of MPs, where it may be amended, before being reconsidered by the whole House of Commons at the report stage and third reading, where the whole legislation will be voted on again.

It is not certain that MPs will back the bill again at this point, given the narrowness of today’s vote and the contentiousness of the legislation.

Should they do so, the House of Lords would be highly likely to approve it, meaning it would become law.

Process for an assisted death

Under the legislation, a terminally ill person assessed as having no more than six months to live would be able to choose to receive assistance to die so long as they had the mental capacity to make the decision.

Before going ahead, they would have to be assessed independently by two doctors and a High Court judge would need to confirm that the requirements of the legislation were met.

Social workers are broadly in favour of the bill, according to a Community Care poll.

However, significant concerns have been raised by critics, including health and social care secretary Wes Streeting, that people would be, or feel, coerced into an assisted death or would choose this option because of the inadequacy of palliative care services.

To address such concerns, the Association of Palliative Care Social Workers (APCSW) – which is neutral on the bill – has proposed the establishment of a social work role to act as a safeguard for those potentially going through an assisted death.

Proposed social work role

The approved palliative care professional position proposed by the APCSW would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or by concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

The committee of MPs established to scrutinise the bill will consider evidence, including by bodies such as the APCSW, which may lead to an amendment to the legislation being drawn up to introduce such a role.

Following today’s vote, think-tank the Nuffield Trust said critical questions remained around how the legislation would be resourced, in the face of the funding challenges facing palliative and social care.

Funding concerns

Chief executive Thea Stein said: “In particular, it is still unclear whether or not assisted dying would be fully publicly funded. If it is, it will sit alongside services like social care and hospice care which are not.

“Both of these services are financially on the brink and MPs will need to understand how current threadbare provision will interact with this new service, what implications this may have for people paying for social care, and how to fund assisted dying from a health budget that is already overstretched.

“If assisted dying is not publicly funded then it will be difficult for the bill to achieve its aim of improving choice for all patients. These are crucial questions to address in the next stage.”

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Most social workers support the legalisation of assisted dying, a Community Care poll has found.

The Terminally Ill Adults (End of Life) Bill, which was approved in principle by the House of Commons this week, would enable adults to receive assistance to end their lives.

Social workers back assisted dying

A Community Care poll, which received almost 1,300 votes, found that most respondents (64%) would support the bill, with 36% against. 

Maharg, who works at a continuing healthcare service, said older people and cancer patients they have worked with have broached this subject, with four to six people having expressed interest in receiving support to die.

“The guidelines are clear, people have to fulfil the criteria and only they can promote their choice,” they added.

“So I agree with this being an option for those who want it.”

Court delays could hinder process

Stuart said: “We are a society predicated on the principle of autonomous choice, which is enshrined in medical ethics. The law supports these principles.

“To deny someone the choice when death is a greater attraction than life is a denial of these principles.”

However, patients would need to seek court approval to be eligible for assisted dying, which might mean that it would not be granted at an appropriate timeframe, said Carol.

“With judges involved and court delays, I can’t see anybody ever being granted this in an appropriate timeframe to ‘self administer’ anything,” she added.

“I find it fascinating that it is okay for health professionals to administer the four core drugs [morphine, midazolam, haloperidol, and an antimuscarinic] which hasten death when they consider it the ‘right time’, but individuals can’t choose themselves.”

‘We need to first expand palliative care to all’

Laura Morris criticised the bill, however, calling it “utterly irresponsible”.

“As social workers, we must first address the unmet needs of any individual who has a life-limiting condition by expanding palliative care to all,” she said.

“First it starts with the wealthy who can afford this legal process but then what? It’s a slippery slope. Why is there no palliative care for all? This country invented palliative care social work.”

What are your thoughts on assisted dying?

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Specialist social workers should be involved in safeguarding people going through an assisted death should legislation on the issue become law.

That was the message from the Association of Palliative Care Social Workers (APCSW) in a position statement on the issue, which was published before the second reading of the Terminally Ill (Adults) End of Life Bill in the House of Commons on 29 November 2024.

MPs voted to back the bill in principle, meaning it will now be considered in detail by a committee of membersbefore returning to the full House of Commons for a further vote.

The APCSW did not set out a position on whether the bill should become law or on the legalisation of assisted dying more broadly. Instead, it made a series of recommendations on what should happen were the bill to be approved.

These included amending the legislation to create the position of approved palliative care professional, to assess and support people seeking an assisted death, with the role initially being carried out by specialist social workers.

What assisted dying bill involves

Under Labour MP Kim Leadbeater’s private member’s bill, adults who are terminally ill and assessed as having no more than six months to live would be able to lawfully be given assistance to end their lives.

They would need to be assessed by two doctors, who would need to confirm that they met the eligibility criteria, including that they had the mental capacity to make the decision.

A High Court judge would then need to declare that the legislation’s requirements had been met, and then the person would have to make a further declaration that they wanted assistance to end their life before this could go ahead.

The bill has proved controversial, with critics, including health and social care secretary Wes Streeting, raising concerns about people feeling coerced into making the decision and not having a free choice because of the alleged inadequacy of palliative care.

Proposed specialist role

The proposed approved palliative care professional role appears designed to tackle some of these criticisms.

The association said it would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or as a result of concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

Palliative social work skills

The association said the functions were particularly suited to the skills of social workers, particularly the specialist palliative care practitioners that it represents.

These included carrying out holistic assessments of people’s physical, social, psychological and spiritual needs, assessing mental capacity, supporting people to exercise choice and autonomy in challenging circumstances and safeguarding.

“We are trained in assessing and managing risk, including the use of statutory powers and legal proceedings where no other options are adequate,” it said.

For its recommendation to be implemented, the bill would need to be voted through on Friday and then be amended to include the approved practitioner role at a subsequent stage, most likely the committee stage that follows the second reading.

Ensuring adequate skills

The APCSW said the role, were it to be implemented, should initially be developed with and held by palliative care social workers before being rolled out to other social workers and relevant practitioners.

However, it said having assisted dying legislation on the statute books would require adequate workforce skills, knowledge and resilience across health and social care more generally.

It said palliative care should be a required element on all qualifying courses for doctors, nurses, allied health professionals and social workers, but also stressed that staff needed adequate psychological support were the bill to become law.

Workforce ‘already stretched to capacity’

“The issue is sensitive, personal and emotive and professionals involved will require relevant training and high quality, structured supervision and opportunity for reflective practice.

“In a workforce that is already stretched to capacity and experiencing unprecedented burn out, the introduction of assisted dying would need careful preparation.”

Any assisted dying policy would also need to respect the views of practitioners who were ethically opposed to it without obstructing those who chose an assisted death.

Concerns over state of palliative care

In an echo of Streeting’s concerns, the APCSW warned that the current state of palliative care risked leading people to choose an assisted death as “the only way to escape from unbearable suffering”.

It said that the majority of palliative care was delivered by charitable hospices, whose already limited funding from the NHS and councils had declined in recent years as donations had also dried up, leading to cuts and redundancies in some areas.

Introducing an assisted dying law in this context could “lead to a vicious and tragic downward spiral by reducing the number of people seeking or being referred to palliative care services”, cutting investment still further.

The association stressed that the legalisation of assisted dying would have to be accompanied by “sufficient funding to provide equitable access to high quality palliative care for everyone”.

Service improvements should be informed by a population-wide assessment of the need for palliative care, it added.

By Tim Spencer-Lane

On 11 November 2024, the Terminally Ill Adults (End of Life) Bill was published. This bill makes provision for a person who is terminally ill and meets the eligibility criteria to choose to request and lawfully be provided with assistance to end their own life.

This will be of particular interest for social workers who work with people who have a terminal illness or practise in specialist palliative care settings.

This is a private member’s bill, introduced by the Labour MP Kim Leadbetter. The government has confirmed it will “remain neutral on the passage of the bill and on the matter of assisted dying”. MPs, including government ministers, will therefore have a free vote on whether to support the bill at its second reading, which involves a debate on its principles.

The House of Commons has not voted on the issue since September 2015.

The legal framework for assisted dying

The Suicide Act 1961 makes it an offence for a person to do an act capable of encouraging or assisting the suicide or attempted suicide of another person. A person guilty of this offence is liable to imprisonment for a term of up to 14 years.

The European Court of Human Rights recognises that states have a “wide margin of appreciation” when it comes to the lawfulness of assisted dying. For example, since 1942, assisted suicide has been lawful in Switzerland, which is also a signatory to the European Convention on Human Rights (ECHR).

But to be compatible with the ECHR, assisted dying must be accompanied by suitable and sufficient safeguards to prevent abuse and ensure that the person’s decision to end their life fully reflects their free will.

Who would be eligible for assisted dying?

Under the bill, there are four criteria that must be met before a terminally ill person can be assisted to end their own life. The person must:

• have capacity “to make a decision to end their own life” (with capacity to be determined in accordance with the Mental Capacity Act 2005);
• be aged 18 or over;
• be ordinarily resident in England and Wales, and have been ordinarily resident there for at least 12 months, and
• be registered as a patient with a GP practice in England or Wales.

A person is “terminally ill” if they have an inevitably progressive illness, disease or medical condition that cannot be reversed by treatment. The person must also reasonably be expected to die within six months.

A person must not be regarded as terminally ill merely by reason of them having a mental disorder, under the Mental Health Act 1983, or a disability, within the meaning of the Equality Act 2010.

The bill also requires that steps to be taken to ensure that the person has a clear, settled and informed wish to end their own life. They must also have made the decision voluntarily and have not been coerced or pressured by any other person in making that decision.

What will the process be?

The process of seeking assisted dying consists of three stages:

• The person makes a “first declaration” (and two medical statements are provided).
• The approval of the court.
• The person makes a “second declaration” (and a medical statement is provided).

The first declaration

At the first stage, the person must make a declaration confirming a number of specified matters, including that they are “eligible” for assisted dying and understand they can cancel the declaration at any time.

This is known as the “first declaration” and must be signed by the person themselves and witnessed by the “co-ordinating doctor” and another independent person. The “co-ordinating doctor” is a registered medical practitioner who meets certain requirements and is willing to carry out the functions under the bill in relation to the person.

The co-ordinating doctor is also required to assess the person and confirm a number of matters, including that the person has the requisite capacity and has not been subject to coercion or third-party pressure.

They must also refer the person for a second assessment by another registered medical practitioner (referred to in the bill as “the independent doctor”). There is a period of at least seven days (“the first period of reflection”) between the first and second assessments.

Approval of the court

At the second stage (ie once the person has made a first declaration and the two medical statements have been made), the person may apply to the High Court for approval of assisted dying. This would require the court to make a declaration that the requirements of the bill have been met in relation to the first declaration.

If the High Court refuses to make the declaration, the person can appeal to the Court of the Appeal. The Court of Appeal can confirm the decision of the High Court or make the declaration. There is no appeal against a decision of the High Court to make the declaration.

The second declaration

At the third stage, if the person still wishes to be provided with assistance to end their own life, they must then make a further declaration (referred to as “the second declaration”).

There must be a period of at least 14 days (“the second period for reflection”) between the court declaration and the person making the second declaration (or if the person is expected to die within one month of the court declaration, a period of at least 48 hours).

The second declaration must be witnessed by the co-ordinating doctor and by an independent witness. The co-ordinating doctor must sign a statement confirming certain matters and that must be witnessed by the same independent witness as witnessed the second declaration.

How would assisted dying be provided?

The bill sets out that in order to administer assisted dying, an “approved substance” must be provided directly, and in person, by the co-ordinating doctor. Approved substances are not defined in the bill but will be specified in regulations.

The co-ordinating doctor may prepare that substance for self-administration by that person, prepare a medical device that will enable that person to self-administer the substance, and assist that person to ingest or otherwise self-administer the substance.

The bill sets out that the decision to self-administer the approved substance and the final act of doing so must be taken by the person themselves, not by the co-ordinating doctor.

The co-ordinating doctor may authorise another named registered medical practitioner to exercise the co-ordinating doctor’s functions in connection with the provision of assistance to a person.

What about healthcare professionals who don’t want to offer assisted dying?

The bill sets out that no doctor is under a duty to raise the subject of the provision of assistance under the bill with a patient. Where a patient indicates to a doctor that they wish to seek assistance to end their own life in accordance with the bill, the doctor may (but is not required to) discuss the matter with the patient.

Clause 23 explains that no registered medical practitioner or other health professional is required to participate in the provision of assistance under the bill. Also, an employee cannot be discriminated against because they choose not to participate in the provision of assistance under the bill or because they choose not to participate in the provision of that assistance.

What are the protections against legal liability for providing assistance?

The bill sets out that a person is not guilty of an offence by virtue of providing assistance in accordance with the bill.

The Suicide Act 1961 is, accordingly, amended to ensure that the provision of assistance to a person in accordance with the bill is not an act which constitutes an offence under section 2 of that act (criminal liability for complicity in another person’s suicide).

The offence under section 2 of the Suicide Act 1961 will continue to operate for other cases where assistance is provided. But the amendment to that act also provides a defence to a charge under section 2 of the Suicide Act 1961 where the person proves that they:

• reasonably believed they were acting in accordance with the bill, and
• took all reasonable precautions and exercised all due diligence to avoid the commission of the offence.

The bill also sets out that providing assistance to a person to end their own life in accordance with the bill does not give rise to any civil liability.

What new criminal offences are created?

The bill creates a number of new criminal offences, including the following:

• where dishonesty, coercion or pressure is used to induce a person to make (or not to cancel) a first or second declaration, or self-administer an approved substance;
• to make or knowingly use a false first or second declaration, or willingly destroy one;
• to knowingly or recklessly provide a medical or other professional opinion which is false or misleading;
• to wilfully ignore or otherwise conceal knowledge of a cancellation of a first or second declaration.

Other matters

The bill provides that the duty to investigate a death under the Coroners and Justice Act 2009 does not arise just because the person died as a consequence of the provision of assistance in accordance with the bill.

The secretary of state is required to issue codes of practice in relation to the bill, such as on the assessment of whether a person has a clear and settled intention to end their own life and the assistance which a person may be given to ingest or self-administer an approved substance.

The chief medical officers for England and Wales are required to, separately, provide guidance relating to the operation of the bill. In particular, they must have regard to the need to provide practical and accessible information, advice and guidance to persons considering requesting assistance under the bill, their families, and the general public.

The secretary of state is also given powers to secure that arrangements are in place for assistance to be provided in accordance with the bill, including arrangements for the funding of any provision made. This would enable the secretary of state to provide for services to be provided through the health service or by a separate service.

The secretary of state is also required to review the operation of the bill. The review must take place at least five, but not more than six, years after the passing of the bill. The report of the review must be laid before Parliament.

Tim Spencer-Lane is a lawyer specialising in adult social care, mental capacity and mental health and legal editor of Community Care Inform.