Authors:
Professor David Albert Jones [MA, MA, MSt, DPhil FHEA], Professor of Bioethics, St Mary’s University, Twickenham. [ORCID ID: 0000-0001-7268-6353]
Dr Theresa Howe [MBBCh, BMedSci, MRCP (UK), FRCR], Consultant Clinical Oncologist, Velindre University NHS Trust, Cardiff
Prof David Jones and Dr Teresa Howe discuss how a probing amendment on pregnancy in progressive illness has started an interesting debate in the context of the proposed Terminally Ill Adults Bill for England and Wales
Introduction
The Terminally Ill Adults (End of Life) Bill, currently under scrutiny in the House of Lords, is controversial not only in principle, but also for the way it has been drafted.[1]
Supporters of the Bill have nevertheless criticised the sheer number of amendments tabled in the House of Lords. They have alleged that many are ‘frivolous’[2] or ‘deliberate time-wasting’,[3] aiming to sabotage the Bill rather than to improve it.
One example that has been much cited in the media is an amendment by Baroness Tanni Grey Thompson that mandates a negative pregnancy test before accessing assisted dying. As currently worded ‘that the person has provided a negative pregnancy test’, this requirement technically could apply even to those not of childbearing potential. Nevertheless, it is important to recognise that what makes this amendment potentially open to ridicule, is principally the way it has been worded. There is nothing frivolous or nonsensical about mandating that women who may be pregnant have a pregnancy test before being offered assisted dying.
Elective procedures and consent
As framed in the Bill, assisted dying is a response to a voluntary request by a patient, notwithstanding that the possibility may be raised initially by a doctor. It is clearly construed as an elective procedure. In general, with elective procedures that involve risk to pregnancy or risk to a child if born, National Patient Safety guidance requires that a pregnancy test be offered and advise that ‘elective surgery should be avoided during pregnancy’.[4] Similarly, according to the RCOG guidance on obtaining valid consent, ‘All reasonable steps should be taken to exclude pregnancy before embarking upon any surgical procedure. If a pregnancy is discovered at the start of a hysterectomy, including one for cancer, the operation should be rescheduled’.[5]
Pregnancy and terminal illness- common or rare?
The amendment of Baroness Grey Thompson thus calls attention to the serious issue of how to support women who are terminally ill during pregnancy if they seek assisted dying. Terminal illness during pregnancy is more common than many people realise. A recent paper on the epidemiology of cancer in pregnancy noted that it occurred in approximately 1 in 1000 pregnancies,[6] which would be around 500 cases a year in England. Of course, not all of these cancers would be terminal- though if terminal illness includes treatable illness where treatment is refused, then a larger proportion would be.
Considerations when a patient with a progressive illness is pregnant
A potential dilemma in the case of cancer during pregnancy is how to balance optimum outcomes for cancer treatment with a desire for the child to be delivered alive if this is possible. Such decisions will involve not only multi-disciplinary clinical judgement, but also the wishes and judgement of the pregnant woman. It will depend on the circumstances and on a realistic estimate of the risks and the level of uncertainty- this is likely to need multiple consultations for effective communication and decision making. Shared expertise and peer support is crucial for the health professionals involved.
In an analogous way, if assisted dying is legalised, there may be tension between the wish of a woman to end her own life using the means provided under the law, and the wish to delay this until a child could be delivered. In any case, the fact that the procedure would not only end her life but also would end the pregnancy is clearly relevant for valid and informed consent.
Suicide, mental health and pregnancy
It may be assumed that assisted dying is not relevant to the case of terminal illness during pregnancy, as women in this situation may be assumed to be more likely to want to live as long as they can. Indeed, a change in circumstances can bring about a change in a previously firmly held conviction. However, in a similar way, it is often stated that pregnancy is protective against suicide, but recent research indicates that the extent of its protection may have been overstated.[7] Suicide remains a leading cause of death during pregnancy and the risks may be much higher when combined with other factors such as a history of mental illness, drug use, or intimate partner abuse. Pregnancy may be the occasion for the onset or the exacerbation of intimate partner abuse.
It is recognised that mothers who are at risk of serious mental health complications associated with pregnancy are at risk of deliberate self-harm and suicide. It is an extraordinary scenario to envisage a pathway for a terminally ill pregnant woman to access an assisted death within a health service which currently frequently lacks provision of equitable, timely specialist perinatal mental healthcare.
Conclusion
The situation of women who are pregnant while terminally ill raises specific issues both clinically and in relation to safeguarding and valid informed consent. It is imperative when assessing how assisted dying may be implemented in practice, to consider what specific safeguards may be needed for those who seek to end their life under this law while they are pregnant. Such safeguards could theoretically be provided in future guidance or regulation, but the Bill has been criticised for leaving too much of its implementation to delegated powers rather than making it clear on the face of the Bill.[1]
The topic of this amendment is by no means frivolous nor a waste of time, but concerns a situation that is serious, indeed tragic. This amendment is an example of the importance of necessary scrutiny in the second chamber. Indeed, in contrast to the cursory way the issue was raised in the media as a sound-bite, when it came for debate in the Lords, peers on both sides of the debate acknowledged the complexity of the issue.[8] Whether or not the Bill passes into law, it is important to recognise the reality that faces women who are pregnant and who have a terminal or life-threatening illness. If it does pass into law, then some thought will be needed as to the specific needs and concerns of this group of patients, the first of which is the need for information. During the debate Baroness Grey Thompson acknowledged that this as a ‘probing amendment’ and that it could have been worded better but was clear that the intention behind the amendment is serious,
‘I am serious about my amendments, although I could have worded them better. I did not intend for men to have a pregnancy test, and I did not intend to get into a debate about age and the pregnancy test. The reason why I tabled the amendment on a pregnancy test was to allow women to understand all the implications of what they are getting into and to be able to make a choice. They may or may not choose to do something differently with that information.’[8]
References:
[1] Constitution Committee. Terminally Ill Adults (End of Life) Bill (12th Report, Session 2024-26, HL Paper 177) https://publications.parliament.uk/pa/ld5901/ldselect/ldconst/177/17703.htm
[2] Dimbleby J. Assisted dying’s disgraceful delay. New Statesman 3 December 2025 https://www.newstatesman.com/politics/uk-politics/2025/12/assisted-dyings-disgraceful-delay
[3] Wootton S. Press statement, Dignity in Dying 14 November 2025. https://www.dignityindying.org.uk/news/terminally-ill-people-urge-peers-keep-our-voices-at-the-centre-as-lords-return-to-debate-assisted-dying-bill/
[4] NHS England. Pregnancy tests not performed before anaesthesia
[5] Royal College of Obstetricians and Gynaecologists. Obtaining Valid Consent: Clinical Governance Advice No. 6. January 2015 https://www.rcog.org.uk/media/pndfv5qf/cga6.pdf para 3.3.
[6] Javitt MC. Cancer in pregnancy: overview and epidemiology. Abdom Radiol 48, 1559–1563 (2023). https://doi.org/10.1007/s00261-022-03633-y
[7] Chin K, Wendt A, Bennett IM, Bhat A. Suicide and Maternal Mortality. Curr Psychiatry Rep. 2022 Apr;24(4):239-275. doi: 10.1007/s11920-022-01334-3. Epub 2022 Apr 2. PMID: 35366195; PMCID: PMC8976222. https://link.springer.com/article/10.1007/s11920-022-01334-3
[8] Hansard. Terminally Ill Adults (End of Life) Bill Volume 851: debated on Friday 12 December 2025. https://hansard.parliament.uk/lords/2025-12-12/debates/F835F8E6-164F-42AA-B693-71C31CEFD046/TerminallyIllAdults(EndOfLife)Bill (col 508)
The authors have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none