Ahead of the third reading vote on the Terminally Ill Adults (End of Life) Bill for 萝莉视频 and Wales, expected in the House of Commons this Friday (20 June 2025), the 萝莉视频 (RCPsych) reminds MPs that terminal illness is a risk factor for suicide and warns that a treatable mental illness could be a cause for a person wanting to end their life.
The RCPsych does not take a position on the principle of assisted dying/assisted suicide, however we remain concerned about the practicalities of the Bill. The College’s stance on this Bill is informed by the expertise of psychiatrists who work closely with patients at the most vulnerable stages of life.
With too many unanswered questions about the safeguarding of people with mental illness, the RCPsych shares its expert clinical insight to support MPs in making informed decisions about the Bill.
Dr Annabel Price, the College’s Lead on assisted dying for 萝莉视频 and Wales and a consultant psychiatrist specialising in the care of medically unwell older adults and in palliative care, shares her experience and outlines why the proposed legislation does not provide adequate safeguards to protect vulnerable people.
Dr Annabel Price, RCPsych Lead on assisted dying for 萝莉视频 and Wales, said:
“I’ve been a psychiatrist for nearly 20 years. I spend much of my time with older people who are seriously ill, sometimes dying, often in pain, frightened, and sometimes feeling like they have reached the end.
“Those of us working in psychiatry, especially with patients nearing the end of life, understand how layered and complex a wish to die can be. When someone is struggling physically and mentally, that desire is not always what it seems on the surface.
“We know that around one in every ten patients nearing the end of life experience a wish for their life to end. Many of them are struggling with hopelessness, social isolation and disability, including frailty, which is common in those facing terminal conditions. But I see what happens when we treat depression and address other physical and social factors causing distress and despair. Many of those same individuals often change their minds and feel in a better place and cope when given the right support.
“This is why we believe any legislation must be built on a foundation of robust mental health assessment and support. Without this, we risk making irreversible decisions based on treatable suffering.
“As it stands, this bill would not give us, as psychiatrists, enough space or time to carry out proper, holistic assessments. The idea that we could be involved on a panel only to check decisions made by others, rather than to conduct the full evaluations we are trained to do, is deeply troubling. A psychiatrist’s role should be to ascertain whether a mental disorder is influencing a person’s wish to die, and to offer treatment when this is the case.
“Physical characteristics and symptoms are key features of some mental disorders, such as eating disorders, dementia, and alcohol and substance dependence. We are particularly concerned about the possible inclusion of people whose mental disorders have physical impacts that can lead to death, such as kidney failure from anorexia. We have seen people with eating disorders be considered terminally ill and therefore eligible for assisted dying/assisted suicide in other countries.
“We also have concerns about what this legislation could mean for people with intellectual disabilities, who are more vulnerable to coercion and can find it difficult to fully understand the concept of death. Any assessment in this context would need to be carried out by those trained in this field, but we do not currently have enough consultant psychiatrists to do this.
“There is a practical issue of not having enough psychiatrists to meet current and escalating demand. Even now, we simply do not have the resource to be able to give each person the careful attention they deserve. As things currently stand, less than than one in five hospices have access to dedicated support from a psychiatrist.
“We do not want to see instances where people are given the means to end their life, knowing that, with time, care, and access to proper treatment, they might have chosen differently.
“If the law does change, we psychiatrists will continue to treat people who are mentally unwell and to do all we can to prevent suicide. We will continue to take care of people at the most vulnerable times in their lives. But better access to mental health care must be a priority as it would not only save lives but also improve the quality of life of those who are nearing the end.”