Four different things get called assisted dying
Most candidates lose marks here in the first thirty seconds, before any argument has started, because they treat four separate practices as one. Interviewers listen for the distinctions specifically, and blurring them makes everything that follows sound uninformed however humane it is.
- Assisted suicide
- A clinician prescribes lethal medication and the person takes it themselves. The final act is the patient’s.
- Voluntary euthanasia
- A clinician administers the lethal medication at the competent person’s request. The final act is the doctor’s.
- Withdrawing or withholding treatment
- Stopping or not starting life-sustaining treatment. Lawful, common, and grounded in the right to refuse treatment — not assisted dying.
- Doctrine of double effect
- Giving proportionate symptom relief that may foreseeably shorten life is lawful, because the intention is relief and not death.
- Non-voluntary euthanasia
- Ending life where the person cannot express a wish. Not part of any current UK proposal, and worth naming so you are not accused of meaning it.
The third is the one candidates most often mislabel. A competent adult may refuse any treatment, including treatment keeping them alive, and continuing against that refusal would be unlawful. Where a patient lacks capacity, treatment no longer in their best interests may lawfully be stopped: Airedale NHS Trust v Bland (1993) held that withdrawing clinically assisted nutrition and hydration from a patient in a persistent vegetative state was lawful, partly on the reasoning that withdrawal is an omission rather than an act. That reasoning has never been comfortable: the judges in Bland themselves urged Parliament to examine the area, and philosophers have long argued that the moral gap between killing and letting die is thinner than the law assumes. You can say so — but say it as a criticism of the distinction, not as a claim that it does not exist. Extubating a patient for whom ventilation has become futile is not euthanasia, and calling it "passive euthanasia" signals that you have missed the distinction being tested.
Double effect is the other one worth stating precisely. English law has long accepted that a doctor may give treatment intended to relieve suffering even where a foreseeable side effect is to shorten life, provided the dose is proportionate to the symptom. The intention must genuinely be relief. It is also worth knowing that properly titrated opioids and sedation rarely shorten life to any measurable degree, so the doctrine is invoked far less often in practice than candidates assume.
Two of the four are already settled law
Withdrawal of treatment and proportionate symptom relief are lawful, daily, uncontroversial practice. The live debate is only about assisted suicide and voluntary euthanasia. If you can say that sentence in the room, you have already separated yourself from most of the field.
Blurring the categories to sound compassionate
Saying "we already do this every day when we turn off ventilators" sounds worldly and is wrong as a statement of what the law permits. It collapses the act-and-omission distinction the law rests on, and it hands the interviewer an easy follow-up you will not be able to answer. Name each practice separately, then say which one the question is actually about.
Where UK law stands, and how quickly it moves
Suicide itself ceased to be a crime under section 1 of the Suicide Act 1961. Section 2 of the same Act creates a separate offence of encouraging or assisting the suicide of another, carrying a maximum of fourteen years’ imprisonment, and no prosecution may be brought without the consent of the Director of Public Prosecutions. That statutory offence covers England and Wales. Northern Ireland has its own equivalent provision. Scotland has no matching statutory offence, though assisting a death can still be prosecuted under the common law depending on the facts.
That consent requirement is why prosecution policy matters as much as the statute. After R (Purdy) v DPP (2009), in which a woman with multiple sclerosis sought clarity about whether her husband would be prosecuted for accompanying her abroad, the DPP was required to publish an offence-specific policy. Published in 2010 and later updated, it sets out factors for and against prosecution: compassionate motivation and a clear, settled, voluntary decision by the person who died weigh against, while acting for gain, or being a healthcare professional in a professional relationship with the person, weighs towards. The practical result is that prosecutions of compassionate relatives are rare and clinicians are far more exposed than family members.
The courts have been asked repeatedly and have given a consistent answer. Pretty, brought by a woman with motor neurone disease, failed in the House of Lords in 2001 and then at the European Court of Human Rights in 2002. In R (Nicklinson) v Ministry of Justice (2014), brought on behalf of a man with locked-in syndrome who had died before the appeal reached the Supreme Court, the court dismissed the appeals, the majority holding that this was pre-eminently a question for Parliament — though the justices divided on whether a court could ever properly rule on it at all. If you are asked why the law has not changed despite public support, the answer is not that judges disagree with the public — it is that they have declined to make the change themselves.
Parliament has considered it several times, most recently in the current attempt. The Terminally Ill Adults (End of Life) Bill, a private member’s bill introduced by Kim Leadbeater MP, passed its second reading in the House of Commons in November 2024 on a free vote, passed its Commons third reading in June 2025, and went to the House of Lords for further stages. As introduced, it proposed a narrow model: an adult of 18 or over, resident in England and Wales, with capacity, who has a terminal illness and is reasonably expected to die within six months, making a settled and informed voluntary decision free from coercion, assessed independently by two doctors with a further approval step, and taking the medication themselves. That is assisted suicide, not euthanasia, and the difference is deliberate. The safeguards, including the approval mechanism, were debated and amended as the bill progressed, so describe the model as proposed rather than as settled.
Quoting a legal position that has since moved
Everything in the paragraph above is the position at the time of writing. A bill in progress can be amended, passed, defeated or run out of parliamentary time, and implementation would follow years later even if it became law. Check the current status the week before your interview, and say "as things stand" rather than asserting a fixed state of the world. An interviewer who knows the topic has moved will notice.
The picture is not uniform across these islands. Scotland legislates separately: the Assisted Dying for Terminally Ill Adults (Scotland) Bill, introduced by Liam McArthur MSP, has been going through the Scottish Parliament on its own timetable. The Isle of Man and Jersey are Crown Dependencies with their own legislatures, and both have progressed their own proposals ahead of Westminster. Assisted dying may well be lawful in one part of the British Isles and not another.
The countries that already allow it do it very differently
"It is legal in other countries" is not an argument until you say which country and which model, because the models diverge sharply on eligibility. That divergence is the whole substance of the slippery-slope debate.
- Oregon has operated its Death with Dignity Act since 1997. Eligibility is terminal illness with a prognosis of six months or less, and the person must self-administer, so euthanasia is not permitted. A substantial minority of those who obtain the prescription never take it.
- Switzerland is the outlier. Assisting a suicide is not an offence there unless done for selfish motives, the practical assistance generally comes from non-medical right-to-die organisations rather than from the health system — though a doctor must still prescribe the medication — and there is no residency requirement, which is why British citizens travel there.
- The Netherlands and Belgium both brought euthanasia laws into force in 2002 and permit euthanasia as well as assisted suicide. The threshold is not terminal illness but unbearable suffering with no prospect of improvement, assessed with a second independent opinion and reviewed after death. That criterion has been applied, in a small number of cases each year, to psychiatric illness and to dementia with an advance directive.
- Canada legalised medical assistance in dying in 2016 following the Supreme Court decision in Carter. Legislation in 2021 removed the requirement that death be reasonably foreseeable, opening a second track for people with grievous and irremediable conditions who are not dying. Extending eligibility to those whose sole condition is mental illness has been postponed more than once.
Hold two facts together when the slippery slope comes up, because both are true and each side quotes only one. Canada’s eligibility widened within five years, by legislation following litigation, and the proportion of all deaths there attributed to assistance has risen year on year, reaching somewhere in the region of one in twenty in the most recent federal reporting available at the time of writing. Oregon’s core eligibility criteria, by contrast — terminal illness, a six-month prognosis, capacity and self-administration — have stayed essentially as they were for more than a quarter of a century, the notable changes being procedural and the removal of its residency requirement in 2023. Whether a narrow law stays narrow appears to depend on how it is drafted and on the constitutional route by which it can be challenged — expansion is neither inevitable nor unheard of.
The argument, at full strength on both sides
What follows is not a list of talking points to recite. It is a check that you can build the opposing case as convincingly as your own, which is exactly what the station is scored on.
Should assisted dying be lawful in the UK?
The case for a change in the law
- Autonomy is already recognised at the end of life: a competent adult may refuse ventilation, dialysis or feeding and die as a result. Authority over your own dying should not evaporate at the point where you need help to exercise it.
- Not all suffering is relievable. Palliative medicine achieves a great deal, but specialists accept that some breathlessness, agitated delirium and existential distress cannot be fully controlled without sedating a person into unconsciousness.
- The option itself has value. Where a significant proportion of those who obtain a prescription never use it, knowing there is a way out appears to relieve the fear of the dying process.
- The current position is not "no assisted dying" but assisted dying for the wealthy: those who travel to Switzerland need money, mobility and family able to go with them, and must go earlier than they would choose, while still well enough to travel.
- Relatives who accompany them face police investigation while grieving — a burden imposed by legal ambiguity rather than by principle.
- A regulated process with eligibility criteria, independent assessment and mandatory reporting is more transparent than an arrangement in which these decisions happen without external scrutiny at all.
- Public opinion has favoured a change consistently and by a wide margin across decades of polling, raising a legitimacy question about a prohibition Parliament keeps declining to revisit.
The case against
- Coercion need not be explicit. The people most likely to feel they ought not to be a burden are frail, dependent and often isolated, and a short assessment is a weak instrument for detecting family pressure or internalised obligation.
- Capacity assessment is genuinely hard where depression is present. Depression is common in terminal illness, treatable, and capable of distorting how someone weighs the future — yet an unwise decision is not evidence of incapacity, so a great deal rests on one difficult judgement.
- Prognosis is unreliable. Six-month estimates are frequently wrong in both directions, so eligibility criteria built on them are less precise than they appear.
- The doctor-patient relationship changes if the profession also holds this power. Patients who already distrust services may wonder whether a doctor is weighing whether their life is worth continuing.
- Canada is read as showing that a law justified for the dying was extended within five years to people who were not dying, and the Dutch criteria have reached psychiatric illness and dementia.
- The real answer may be funding. Assisted dying is inexpensive and good palliative care is not; most UK hospice funding comes from charity rather than the NHS, so a choice is offered in a system that never properly funded the alternative — a point tied to NHS resourcing and workforce.
- Disability rights organisations have been among the most consistent opponents, arguing that a law available specifically to people with terminal or disabling conditions carries a message about which lives are held to be not worth living.
Notice that both columns appeal to the same principles. Autonomy and non-maleficence appear on both sides, and so does justice — the inequity of the flight to Zurich against the inequity of a poorly resourced alternative. Saying that out loud shows you understand that the four pillars are a way of organising a disagreement rather than a machine for resolving one.
Do you think assisted dying should be legalised in the UK?
Do not answer in the first sentence. Open by defining what you are being asked about — assisted suicide and voluntary euthanasia, as distinct from withdrawal of treatment and double effect, which are already lawful. State the current legal position and date it. Then give the strongest case each way, using the same principles on both sides so the interviewer can see you reasoning rather than reciting. Only then say where you land, and land somewhere honest: a qualified position with named conditions is stronger than a confident one. Finish with what would change your mind — robust evidence on how reliably coercion can be detected, for instance. A candidate who says "I support it, provided the coercion problem is answered, and here is what answering it would look like" scores far above one who is simply certain.
Capacity, coercion and the conversation you might have to hold
The technical heart of this debate is capacity, which is why the topic sits after consent and capacity on this reading path. Any assisted dying law depends on distinguishing a settled, autonomous wish to die from a symptom of treatable illness, in a person who is frightened, exhausted and often on medication that affects cognition.
Both halves of that are hard. A person with depression does not automatically lack capacity, and the law is explicit that an unwise decision is not incapacity, so a clinician cannot simply refuse on the basis that wanting to die is irrational. Equally, depression can impair the ability to weigh information, particularly the ability to imagine that things might improve. Psychiatrists have pressed hardest on exactly this point: whether the assessment can reliably be made, by whom, and in how much time.
Coercion is subtler still. In Oregon’s own annual reporting, being a burden on family and carers appears among the end-of-life concerns commonly reported by people using the law. Opponents read that as pressure operating exactly as predicted. Supporters read it as a legitimate part of how people weigh their own dying, noting that we do not disqualify other end-of-life decisions for being made with the family in mind. Both readings are defensible, and a strong answer names both rather than the convenient one.
A patient with advanced motor neurone disease tells you she has had enough and asks you to help her die. What do you say?
Do not lead with the law, and do not lecture. Start by finding out what is behind the request: why now, what specifically she is frightened of — choking, breathlessness, losing the ability to communicate, being a burden — and whether something has changed. Much of what sounds like a request to die is a request for something to stop. Acknowledge it without flinching or reassuring her out of it. Be honest and kind about what you cannot do: you cannot help her end her life, and assisting is currently a criminal offence. Then be specific about what you can do, because that is where the marks are — symptom control and specialist palliative input, advance care planning, an advance decision to refuse treatment, her right to decline ventilation now or later, screening for treatable depression, and support for her family. Do not offer to arrange travel abroad. Say you will come back and talk about it again, and mean it.
Where the profession stands, and how to answer in the room
The professional bodies have moved, and getting the direction of travel right is worth a mark. The BMA moved from opposition to neutrality in 2021, following a vote of its representative body. The Royal College of Physicians moved to neutrality in 2019, after polling its members and finding that no option reached the threshold it had set for adopting a stance. Other royal colleges have surveyed members and reached different conclusions, and some have shifted since — check where the relevant body stands rather than assuming.
Be precise about what neutrality means. It is not endorsement. It is a decision by an organisation whose membership is genuinely divided not to lobby on either side, and it tells you nothing about what individual doctors think: surveys consistently find palliative medicine specialists markedly less supportive than doctors generally, and doctors less supportive than the public. That gap is itself part of the argument, since the people who would have to carry the law out are not the people most in favour of it.
Conscientious objection is the point candidates forget. Legislative proposals here have provided that no one would be obliged to take part, and the general professional standard is that you may decline a lawful intervention that conflicts with your beliefs, provided you do not obstruct the patient, do not express those beliefs in a way that distresses or exploits them, and ensure they can see someone else without delay. A live secondary question is whether institutions such as hospices should be able to object as institutions, not just individuals.
You may hold a view. You must be able to argue the other side.
No interviewer is marking whether you are for or against. They are marking whether you knew the distinctions, stated the law accurately, built both cases at full strength, and reasoned to a position instead of arriving with one. A well-argued view either way scores well; an unexamined view either way does not.
- Define the terms — say which of the four practices the question is about, and note that two are already lawful.
- State the legal position and date it, including that a bill has been before Parliament and may have moved.
- Argue both sides at their strongest, using the same principles on each, and name where they collide.
- Land somewhere, with conditions attached, and say what evidence would change your mind.
That sequence is the general dilemma structure applied to a specific case, so practise it alongside answering a dilemma live rather than as a separate script, and take longer worked scenarios from the ethics guide. Rehearse this one aloud at least twice, once arguing the side you do not hold. The first time you try it you will find your own case is far better developed than the other, and an interviewer will hear that immediately.