By Rebecca Houghton (fourth year medical student, Newcastle University) and Dr Lily Lamb FRCGP MBBS MMedEd(GP, medical education researcher and undergraduate educator, Newcastle University)

Introduction:

Last month the Terminally Ill Adults: End of Life Bill passed its third reading in the UK House of Commons. In the next four years it is likely that the duties of a doctor will include providing eligible patients with the means to end their life; a momentous change which we believe will challenge the values of our profession.

As a medical student and medical educator, we observed the parliamentary proceedings with keen interest. Our concerns about the potential consequences of the legislation led us both to write open letters to Members of Parliament which were signed by over 1000 doctors and over 300 medical students from all regions of the UK (1) (2). We are particularly concerned about the risk to vulnerable patients, to the medical workforce and to palliative care. Our fundamental duty as doctors is first to do no harm; we do this by making the care of patients our first concern, by practicing evidence-based medicine, and by taking action when we see potential for risk to the delivery of high-quality care.

Medical student perspective:

Before starting medical school, I believed the role of a doctor was to treat patients with compassion and dignity, to relieve suffering and wherever possible preserve life. This belief has only strengthened during my training. This legislation challenges the very foundation that the medical profession is built upon, asking doctors to participate in an act that ends a life rather than preserving one. The impact assessment attached to the Bill (3) suggests that resident doctors will be involved in the process of delivering assisted deaths, and that training will be limited for most to either a few hours online, or one day in person. I wonder if this will really prepare doctors for that duty?

Furthermore, during my training I have witnessed how challenging it is to predict life expectancy. Prognostic uncertainty seems to be a constant in medicine, and patients expected to live only for months often seem to live far longer. The Bill proposes irreversible decisions – such as ending a patient’s life – based on criteria doctors appear to frequently get wrong. I have also experienced how vulnerable people are when they have a terminal illness, and I have seen how challenging it can be to secure palliative care input for those who need it most. I fear the introduction of assisted dying as a treatment option may serve to deepen existing health inequalities, as patients choose this for financial and social reasons, or because they have no access to the clinicians who can help reduce their suffering.

As a future doctor, I am not yet a voice of the medical profession, but I will be, and I will be entering an already overstretched and underfunded workforce. I fear the introduction of assisted dying will signal a radical shift in my future role, from providing patient-centred, compassionate care to facilitating a premature end to life. That’s not what I signed up for.

Medical educator perspective:

I vividly recall being introduced to our duty as doctors during my first week at medical school, the lecturer repeated a quote often attributed to Osler, that we should aim to ‘cure sometimes, relieve often and comfort always’ (4). I value this wisdom to this day, and it provides a guide to me as a GP through the most challenging times, including approaching end of life care. The introduction of assisted dying to NHS care will provide a new duty for the doctor, one which lies outside of this definition, and which will challenge the foundation of protecting and preserving life on which the profession is built.

Doctors in the Netherlands struggle to refuse their patient’s requests for an assisted death, and experience emotional blackmail from patients and relatives including patients threatening suicide if the doctor does not assist them (5). I fear this will also happen within NHS care, as patients have a new legal right to control over the end of their life, there is risk that doctors will put their own discomfort to one side in putting their patients first. This may have detrimental consequences to the mental health of the medical workforce as evidence from other jurisdictions suggests that 15-20% of doctors who participate in assisted deaths experience ongoing adverse emotional impact (6). I fear this risk will be magnified by the proposed legislation which requires that the doctor provides a lethal concoction of oral medication then remains with the patient until death. These deaths may be lengthy and complicated (reports from Oregon detail deaths of up to 137 hours and a complication rate of around 7% including vomiting and seizures) (7).

The impact assessment associated with the bill contains costings which suggest doctors in training will deliver the service, the only requirement being that they are registered medical practitioners and have undertaken the required training either online or in person. Will any training prepare young doctors for delivering someone’s death? Will there be any provision to support them following an event some will find traumatic?

The medical students I teach are typically enthusiastic, compassionate individuals who have committed their lives to a career in medicine because they align with the identity and values of a doctor. They want to ‘cure sometimes, relieve often and comfort always’. As a society we must not assume that they will be comfortable with this radical change in their future role, and we must make provision to evaluate the impact on our medical workforce, particularly on recruitment, mental health consequences and retention in those professions tasked with delivering assisted deaths.

References:

1. Holl-Allen G. Hundreds of student doctors oppose assisted dying bill. The Telegraph. 2025.
2. Megan Harwood-Baynes AJaMT. More than 1,000 doctors urge MPs to vote against assisted dying bill. Sky News2025.
3. Department of Health and Social Care. Terminally Ill Adults (End of Life) Bill Impact Assessment. In: DHSC, editor. 2025.
4. Armstrong DJ. Cure sometimes, care always. Ulster Med J. 2024;93(1):1-2.
5. de Boer ME, Depla M, den Breejen M, Slottje P, Onwuteaka-Philipsen BD, Hertogh C. Pressure in dealing with requests for euthanasia or assisted suicide. Experiences of general practitioners. J Med Ethics. 2019;45(7):425-9.
6. Kelly B, Handley T, Kissane D, Vamos M, Attia J. “An indelible mark” the response to participation in euthanasia and physician-assisted suicide among doctors: A review of research findings. Palliative and Supportive Care. 2020;18(1):82-8.
7. Oregon Health Authority. Oregon Death with Dignity Act. ; 2024.

Declaration of interests
We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: Lily is funded as an National Institute of Health Research Doctoral Fellow, and sits on the Council of the Royal College of GPs.