The Mental Capacity Act 2005 was not designed to, and is not fit to, provide safeguards for assisted dying. The impairment requirement puts interpersonal pressure beyond the scope of the Act. The criteria included in the Act struggle to deal with the effects of affect and motivation on decision-making even for its intended purposes and within its intended scope. The use of the Act in the Terminally Ill Adults (End of Life) Bill presents an opportunity for reform.

What is euthanasia? Basically, killing someone for their own good. The aim here is first to clarify this and second to explore the relationship between this killing and that envisaged under the proposed assisted dying scheme. There are important differences. With euthanasia the focus is on the patient’s best interests, doing what is good for her, while with assisted dying the emphasis is on autonomy, and doing what she wants. A suggestion is that the former concern is the one to prioritize.

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.

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.

The article “Is Assisted Dying Really a Matter for Medical Regulation” provides four arguments for the demedicalization of Assisted Dying (AD). Giwa, Myers, and Teaster counter, arguing that demedicalization will increase regulatory complexities if “non-medics” are at the helm and that AD will not be any less susceptible to healthcare economics.

This paper considers whether assisted suicide and euthanasia (AS/E) is an area for medical regulation or whether there is a better alternative regulatory mechanism to govern it. Drawing from empirical evidence across a range of jurisdictions where it is legalized, the paper argues that there are at least four good reasons to consider demedicalizing AS/E: (1) pragmatic ethical issues of infrastructural weakness in AS/E service provision in already overstretched healthcare systems globally; (2) challenges of medicalization; (3) regulatory complexities concerning medical law (including pharmaceutical law) and criminal law; (4) the risk that AS/E becomes more easily susceptible to healthcare economics. The paper suggests several recommendations concerning a possible “demedicalized model.”

An exploration of the ethical issues surrounding assisted dying, in the form of a dialogue.

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.

The UK is currently considering making assisted dying available to patients who are terminally ill. We discuss ethical and practical aspects of this complex issue and outline the potential role of psychiatry. We set out the challenges of implementation of legislation, and potential unintended consequences including the impact on health inequalities.