Published in 2024 before the recent parliamentary votes made assisted dying a closer reality, this important collection of 34 essays remains significant as the legislation continues to be debated. The editors Julian Hughes and Illora Finlay are to be commended for bringing together up-to-date data, evidence, reflection, and careful argument on assisted dying and euthanasia from international experts. Some of these experts support the legislative change to permit assisted dying in the UK, others do not, and some write from their experience of the practice of assisted dying in other countries. The aim of the book is to clarify and inform the debate by highlighting the realities of assisted dying and the implications for legislation. This careful approach counteracts the usual approach to the debate that tends to rely on anecdotal evidence, hard cases, and highly charged emotional stories of bad deaths. As Baroness Butler-Sloss points out in the Foreword, ‘if we are to cross the Rubicon and allow assisted suicide or euthanasia, we must do so with our eyes open’. The essays are expertly collated, and Finlay and Hughes offer a helpful guide by outlining concerns and issues, indicating the chapters where discussion of these concerns can be found (pp. 3–4). This collection comes together successfully as a coherent whole, yet the essays can also stand alone as commentary on particular issues.

The book is divided into seven parts, reflecting the aim of the editors to cover the issue of assisted dying as comprehensively as possible. In this relatively slim volume of some 200 pages, this has been quite a feat. Part 1 sets the context for the debate, including an analysis of the terminology used, the concerns for legislators and the public, the difficulty of formulating accurate polls, and the weaknesses in prominent arguments in favour of the legalization of euthanasia and assisted dying. The chapter by Andrew Hawkins on the misuse of public opinion in polls is particularly revealing. Given that public debates often reference the practice of assisted dying in other countries, Part 2 offers an important global perspective by investigating the evidence from abroad where legislation is already in place. The data indicate that there are serious practical concerns. Evidence from Canada illustrates the ease with which legislation can be relaxed by court challenges. Practice from the Netherlands shows that doctor–patient relationships of trust have been reframed and that the acceptance of non-voluntary and involuntary euthanasia has grown. Further evidence from the Dutch experience highlights that implicit negative value judgements are made on the lives of people with disabilities. Notably, in Australia there are tensions between the provision of palliative care and assisted dying, where assisted dying is simply another end-of-life treatment option.

Part 3 explores the existing prosecution policy on assisted suicide in England and Wales, and the complexities of changing the law especially when it comes to apparent safeguards and questions of capacity. The essays in this part are particularly relevant to the current debates on legislative change. Part 4 looks at assisted suicide in the context of medicine and palliative care, including the argument for de-medicalizing assisted dying and promoting autonomy. Claud Regnard’s essay on the lack of evidence and proper scrutiny of lethal drugs used in assisted dying and euthanasia raises important questions including those around the role of pharmacists and the possibility of conscientious objection. Part 5 considers safety and vulnerable groups, from the very young to people with disabilities, elderly people, and those living with dementia. Since the experience from other countries such as Canada indicates that extension to legislation has been made on the grounds of equality and discrimination by people with long-term chronic illnesses who often refuse to be treated as disabled, this section of the book takes on an added importance. In highlighting discriminatory attitudes and negative value judgements on the lives of disabled people, the essays demonstrate how implicit and explicit coercion can take place at all levels. Notably, people with learning disabilities and autism are particularly at risk of being influenced by others. The problem of coercion figures prominently in all the debates surrounding the legislation of assisted dying. The essays in this section of the book should be required reading for those assessing the impact of legislation on vulnerable people.

Part 6 examines the philosophical and ethical concepts of autonomy, dignity, suicide prevention, and eligibility criteria. A nuanced understanding distinguishes autonomy from mere choice and notes the very many ways in which individual autonomy is already limited. A deeper understanding of dignity reminds us that intrinsic dignity does not depend on an assessment of the quality of a person’s life. A closer examination of suicide prevention indicates that a culture of permitting assistance in suicide encourages suicide itself. A critical analysis of eligibility demonstrates that appeals to equality result in ever-expanding criteria for eligibility for assisted death. Finally, Part 7 reflects on the place of faith and humanism in the debates. Given that in the recent debates arguments against assisted dying were often dismissed as being based on irrational religious beliefs, this section of the book is a reminder that questions such as the permissibility of killing do not lend themselves to simple medical or empirical answers.

In contrast to the relentless drive for change in the legislation, almost all the contributors to this book urge caution. In keeping with the appeal of Butler-Sloss to advance with ‘eyes open’, the authors point to the inevitable and dangerous consequences of changing the legislation; they advise taking seriously the mistakes made by other legislatures over the implementation of safeguards and the expansion of eligibility criteria. There is undoubted compassion in the book with the clear recognition that good people struggle with the issue of assisted suicide and that there are problems and challenges as people face grave illness, especially when it comes to accessing appropriate palliative care. Nevertheless, the editors avoid oversimplification of the issues relating to assisted suicide, and they encourage hard and careful thinking about the implications of changing the law by providing clear evidence-based arguments. As a detailed and thoughtful consideration of the real problems that changes in the legislation to permit assisted dying may encounter, this book must be required reading. Notably, the editors of this important collection of essays dedicate their book to all those who work in palliative care and do so much to ensure that death is ‘as peaceful, pain-free and dignified as possible’. This is a salutary reminder that in seeking to understand the reality of assisted dying, palliative care must not be left behind.