Impact assessment

Terminally Ill Adults (End of Life) Bill: equality impact assessment - summary

Published 2 May 2025

Applies to England and Wales

Introduction

The Terminally Ill Adults (End of Life) Bill (‘the bill’) would allow someone who is terminally ill to ask a medical professional for help, and receive this help, to end their own life. In the bill, a terminally ill person is someone who is expected to die within 6 months from an illness or disease that cannot be cured. The person would need to be:

• aged over 18
• living in England or Wales
• registered with a general practitioner (GP)

They would need to be able - that is, have the capacity - to make this decision. There are several steps that must be taken to make sure the person:

• is sure that they want to end their own life
• has made this decision voluntarily
• has not been pressured into making it

The bill has a number of safety measures to help ensure that the person is sure that they want to end their own life.

The bill is a private member’s bill. This means it is being led by a Member of Parliament - in this case Kim Leadbeater MP. The government does not have a position on assisted dying. The bill was debated by a group of MPs called a committee. This document sets out how an assisted dying service may affect different groups of people if this bill becomes law.

Analysis of impacts

The bill would mostly affect eligible, terminally ill adults who will be able to ask for help to end their own life. It could also affect professionals involved in this service, such as doctors. This equality impact assessment (EQIA) looks at how the bill might affect people who share one or more of the 9 ‘protected characteristics’, as defined in section 4 of the Equality Act 2010. The assessment shows that people with the following protected characteristics could likely be impacted by the bill:

• disability
• race
• age
• religion or belief

The assessment also shows potential impacts due to these other factors:

• socioeconomic background
• geography
• mental health

We do not expect major equality impacts on people who share the protected characteristics of:

• pregnancy and maternity
• sex
• gender reassignment
• sexual orientation
• marriage and civil partnership

Protected characteristics

Disability

Disabled people may have problems accessing the service. For example, some disabled people may have problems understanding the language or information used to explain the service (see reference 2). Some disabled people may also have problems speaking (known as dysarthria) or writing, including dysgraphia and dyslexia (see reference 11).

Some disabilities can cause problems with swallowing - some people with this problem may not be able to swallow the medication prescribed to them to end their own life. This may therefore limit their options to other alternatives. Some disabled people with a long-term health condition or disability that reduces their quality of life, such as motor neurone disease, would not qualify as ‘terminally ill’ under the bill. Those people could feel disadvantaged. Disabled people may be more likely to feel as though they are a burden on their family and friends. They are also twice as likely to be victims of domestic abuse compared to non-disabled people.

The bill contains measures to reduce the potential difficulties faced by disabled people.

Doctors involved in the process would have to be trained on what particular arrangements might be put in place for disabled people and autistic people. They would also need training on how to recognise whether someone had been pressured to decide to ask for assistance to end their own life. 

A disability advisory board would be set up to advise on the rollout and impact of the bill on disabled people.

Some people (those with mental disorders, autism or other ‘substantial difficulties’ in understanding processes or information) will be given access to an independent advocate. An advocate is a person who can provide support to help the person understand options on end of life care, including the option of assisted dying.

These measures would aim to help prevent disabled people being treated differently compared to non-disabled people. They would help give eligible disabled people equal opportunity to access this service. Further adjustments may need to be considered during the rollout phase if this bill becomes law.

Race - ethnic minorities, nationalities, Gypsy, Roma, Travellers and language barriers

People from ethnic minority backgrounds experience differences in health outcomes (see reference 4). This may lead to difficulties accessing this service. Some people from ethnic minority backgrounds are less likely to have 2 valid proof of identity documents such as a passport. English may not be someone’s first language (see reference 5). 

The NHS is already addressing differences in health outcomes for people from ethnic minority backgrounds, for example, through the NHS Race and Health Observatory. In addition, this bill includes measures to help with language, speaking, reading and writing barriers.

Age

The bill would only allow adults (over 18) to access assisted dying. Older people may feel slightly more pressure to end their lives compared to younger people (see reference 1). This is because they are often reliant on other people caring for them (see reference 8). The bill includes measures that would reduce the risk of pressure on any person in the context of assisted dying.

Religion or belief

The bill applies equally to people of all religions and beliefs. Medical professionals, such as doctors, who do not wish to participate in the assisted dying service can decide not to. There are also measures to protect medical professionals who refuse to or do not want to participate. These measures may reduce the risk of someone being treated differently because they decide to not be involved in delivering assisted dying services.

Other identified groups (not covered by the Equality Act 2010)

Socioeconomic background

People living in poverty or disadvantaged areas are experiencing differences in health outcomes (see reference 6).  People living in poverty often have other protected characteristics such as disability and race.

Assisted dying is currently not legal in England and Wales. Some people travel abroad to use this service (see reference 9). This can be expensive. If assisted dying becomes law in England and Wales, this would remove the costs of accessing assisted dying abroad for eligible people.

People requesting assisted dying must provide 2 forms of identification. The types of identity documents are yet to be decided. This may have a financial impact on some people living in poverty. It may also be difficult for those who are homeless or rough sleeping as they are less likely to have identification, such as a passport.

The bill may improve access to assisted dying for those from lower socioeconomic backgrounds by making the service available without the costs linked to travelling to another country.

Geography

Primary care services (such as GPs) are under pressure across England and Wales (see reference 3). Patients in rural areas might find it difficult to speak to healthcare professionals on time. Some may have limited access to the right care at the end of their life. This regional difference has been pointed to by some as a reason for some patients to consider assisted dying when they may not have done so if appropriate end of life care was available to them (see reference 1).

There are measures in the bill that would reduce this risk. For example, doctors must discuss all appropriate care options with the person who is requesting assisted dying. If this bill becomes law, work would be needed during the rollout phase to give people equal access to this service across England and Wales.

Mental health

The bill does not consider ‘mental illness’ on its own to be a terminal illness. Mental ill-health often overlaps with protected characteristics such as disability, gender reassignment and sexual orientation (see reference 7). Some groups of people who are eligible for assisted dying, such as patients with certain types of cancer, might be more likely to take their own lives (see reference 10). Sometimes a mental illness can impact someone’s ability to make and understand decisions.

There are several measures in the bill that would make sure that a person has mental capacity before they can access assisted dying. This would be assessed by a medical professional. People with mental disorders can also access an independent advocate to provide support.

The bill does not treat those with a mental illness differently. It provides equal access to assisted dying if the person is eligible, terminally ill and has the mental capacity to make the decision to end their own life.

Conclusion

If this bill becomes law, the government will take steps to help ensure that potential equality issues are identified and addressed. The government would work out what needs to be done to help reduce risks of unlawful equality impacts.

References

All references were viewed in March 2025.

Parliamentary briefing, House of Commons Library and government or ALB publications and research

1. Equality and Human Rights Commission. Terminally Ill Adults (End of Life) Bill - House of Commons Second Reading.

2. GOV.UK. Learning disability - applying All Our Health.

3. Older People’s Commissioner for Wales. Access to GP Practices in Wales: older people’s experiences.

4. NHS Race and Health Observatory. Ethnic Health Inequalities and the NHS.

Research from the voluntary sector, non-governmental bodies, professional bodies and think tanks

5. The Migration Observatory at the University of Oxford. English language use and proficiency if migrants in the UK.

6. The King’s Fund. Illustrating the relationship between poverty and NHS services.

7. Stonewall. LGBT in Britain - Health (2018).

Academic research

8. Jahn DR and others. Perceived Burdensomeness in Older Adults and Perceptions of Burden on Spouses and Children. Clinical Gerontology 2013, volume 36, number 5.

9. Knights M and others. Accessing an assisted death from the UK: Navigating the legal ‘grey’ area. Death Studies 2024: pages 1 to 10.

Official statistics from England and Wales

10. ONS. Suicides among people diagnosed with severe health conditions, England: 2017 to 2020.

Information on specific health conditions, disabilities and mental capacity

11. Dyslexia UK. Dysgraphia and dyslexia.