This editorial highlights the UK’s drug regulatory double standards. Drugs for assisted suicide would bypass standard regulation despite limited evidence, while psychedelics face significant barriers despite promising evidence internationally. I argue that drugs for assisted suicide should meet the same regulatory standards, and psychedelics should be rescheduled to enable further clinical research.

High mortality rates and poor outcomes from eating disorders, especially anorexia nervosa, are largely preventable and require urgent action. A national strategy to address this should include prevention; early detection; timely access to integrated physical and psychological treatments; safe management of emergencies; suicide prevention; and investment in training, services and research.

Proposed assisted dying legislation does not adequately consider comorbid mental illness, such as depression, which variably compromises decision-making capacity. Current tests of capacity are limited in their ability to assess any such compromise, and therefore we highlight these concerns and put forward suggestions as to how this may be rectified.

Assisted dying debates overlook the powerful unconscious forces that shape end-of-life decision-making. These dynamics influence personal, clinical and societal judgements and may be contributing to the rapid international expansion of assisted dying practices. Strengthening safeguards requires acknowledging these forces and integrating structured psychological assessment, clinician support and reflective practice to reduce unconscious bias and enhance the reliability, transparency and ethical integrity of decisions.

With assisted dying becoming increasingly available to people suffering from somatic diseases, the question arises whether those suffering from mental illnesses should also have access. At the heart of this difficult and complex matter are values such as equality and parity of esteem. These issues require humane deliberation.

Medical assistance in dying for mental illness as a sole underlying medical condition (MAiD MI-SUMC) is a controversial and complex policy in terms of psychosocial and ethical medical practice implications. We discuss the status of MAiD MI-SUMC in Canada and argue for the use of the UK Medical Research Council's framework on complex interventions in programme evaluations of MAiD MI-SUMC. It is imperative to carefully and rigorously evaluate the implementation of MAiD MI-SUMC to ensure an understanding of the multiple facets of implementation in contexts permeated by unique social, economic, cultural and historical influences, with a correspondingly diverse array of outcomes. This requires a complexity-informed programme evaluation focused on context-dependent mechanisms and stakeholder experiences, including patients, service providers and other people affected by the policy. It is also important to consider the economic impact on health and social welfare systems. Such evaluations can provide the data needed to guide evidence-informed decision-making that can contribute to safer implementation and refinement of MAiD MI-SUMC.

The treatment of longstanding severe eating disorders is a public concern amid rising service pressures and legal cases. These cases raise complex issues about the interface between legislative schemes, restrictive practices, best interests, treatment refusal and potential interaction with assisted dying legislation, when patients lack capacity yet clearly express wishes.

In this editorial, I examine the parallels between conventional and assisted suicide. Psychedelic therapy has been shown to alleviate end-of-life distress and reduce suicidality. I advocate for rescheduling psychedelics to enable research into their effectiveness as an adjunct to palliative care, prior to institutionalising assisted suicide in the UK.

As assisted dying moves towards legalisation, it is imperative that research be undertaken to inform eligibility and ensure that proper safeguards are instituted. To achieve a meaningful understanding of physician-assisted suicide, such research must draw on professionals with a wide range of expertise and include people with lived experience.