Right to Die - Intention and Implementation

First a bit of history. I was at secondary school when the 1967 Abortion Act was passed; it amended the law on abortion in Great Britain.  Prior to 1967 many abortions were both illegal and unsafe, and the 1861 Offences against the Person Act made it a crime to procure a miscarriage, or to assist in doing so.

The Abortion Bill was not introduced by the Government but as a Private Members Bill by Liberal MP David Steele. Steele was a practicing Christian and son of the manse. The Bill followed a long campaign by the Abortion Law Reform Association and several previous unsuccessful attempts to change the law.

The Intentions of the bill were:

• To protect women from the dangers of illegal, unsafe abortions.

• To provide clear legal grounds under which abortion could be performed, and by whom.

• To prevent the birth of children with severe physical or mental abnormalities.

Safeguards in the Abortion Act

Abortion was controversial in 1967. Consequently the Act did not legalise all abortions. Unless the provisions of the 1967 Abortion act are explicity followed, abortion remains an offence under the 1861 Offences against the Person Act. Hence the safeguards in the Abortion act were both necessary and a safeguard against a more liberal Abortion policy.

• The Abortion Act stated that abortions can only be performed by registered medical practitioners.

• Apart from in extreme life saving circumstances, two registered medical practitioners had to agree independently that at least one of the legal grounds for abortion was met. 

• Abortions were permitted up to 24 weeks of pregnancy (originally 28 weeks, later reduced by amendment).

• All abortions performed under the Act had to be notified to the Chief Medical Officer (CMO), ensuring that the provisions of the Act had been followed and enabling data collection.

These safeguards enabled access to abortion under medical oversight, balanced with ethical considerations to ensure that abortions were not carried out lightly or without proper justification. They were also designed to reassure the public that abortion was only provided to those women with the grounds specified in the act.

Consequences of the 1967 Act

The Act indicated the at a Doctor performing an abortion ‘would not be guilty of an offence in the following circumstances’:

(a)   that to the continuance of the pregnancy would involve risk to the life of the pregnant woman or of injury to the physical or mental health of the pregnant woman or any existing children of her family greater than if the pregnancy were terminated or

(b)  that there is a substantial risk that if the child were born it would suffer from such physical or mental abnormalities as to be seriously handicapped

In practice, termination for fetuses with severe or non-viable abnormalities was generally welcomed, and in turn the diagnostic tests for these abnormalities were significantly improved. This led to detection of many more congenital abnormalities, allowing pregnancies with affected children to be terminated. Families at risk of conceiving children with serious abnormalities were given the opportunity to have healthy children.

However, the emphasis on a ‘risk of injury to the physical or mental health of the woman’ rapidly became interpreted differently. Pregnancy of itself carries significant risks, including miscarriage, ectopic pregnancy, maternal health events and severe pregnancy related conditions including haemorrhage, pulmonary embolism, hypertension, sepsis and even maternal death. Early termination before 12 weeks also carries some risks but in general, it is safer that carrying a pregnancy to term.

Despite the intent of the 1967 Act, its precise wording meant that at least in the first 12 weeks, abortion could be legally approved for virtually any woman provided the other safeguards were met. The current interpretation of the 1967 Act, which is to permit Abortion on request especially in early pregnancy, is largely supported by the Public and the Medical profession.

The current position of abortion

In 2022 over 250,000 Abortions were legally performed in England and Wales and the numbers appear to be rising. So although the intention of the 1967 act was to restrict Abortion to women at great risk of detriment to their physical or mental health, abortion is virtually unrestricted by the 1967 Act in the first 12 weeks of pregnancy.  In practice the 1867 Act led to a liberalisation of Abortion beyond what Parliament had originally intended.

Many groups including the RCOG argue that the 1967 Act is far from perfect, and campaign for further reform to encompass Abortion as a fundamental right. Meanwhile the safeguards in the 1967 Act are still in place. Abortion is still performed by Doctors, the need for 2 independent signatures remains, as does the mandatory reporting of abortions to the CMO.

Right to Die legislation in 2025

Parliament is now considering the equally challenging issue of assisted dying in England and Wales, in the Terminally Ill Adults (End of Life) Bill . This Bill is also a Private Members Bill introduced by Kim Leadbeater, MP for Spen Valley. It successfully passed its first reading in October 2024  and completed the Committee stage in March 2025. The Report stage is the next step on its journey before it returns for debate in the Houses of Commons and Lords and passing into law. A separate bill with similar provisions, the Assisted Dying for Terminally Ill Adults (Scotland) Bill, is also proceeding through the Scottish Parliament.

As was the case in the 1967 Abortion Act, the Terminally Ill Adults (End of Life) Bill, includes significant safeguards:

·       It limits eligibility to terminally ill adults, with capacity, and with a prognosis of six months or less.

·       It requires multiple assessments, and oversight by a multi-disciplinary panel.

·       It exclude those with solely mental illness or disability as qualifying conditions.

·       It mandates a voluntary, informed, and self-administered process

International Experience of Assisted Dying:

In countries and jurisdictions where assisted dying has been legalised - such as the Netherlands, Belgium, Canada, and several US states - the initial legislation has typically included similar strict eligibility criteria safeguards. Over time, many of these jurisdictions have seen their laws liberalised, either through legislative amendment or judicial interpretation.

In particular:

·      Eligibility expanded to include non-terminal chronic conditions that cause unbearable suffering (Netherlands, Belgium)

·      Age restrictions lowered or removed (e.g. Belgium)

·      Assisted dying made accessible to people with a sole underlying Mental Health disorder or physical disability

·      Waiting periods reduced

·      Physician administration of drugs (Assisted Suicide) legalised

·      Streamlining and shortening of the approval process.

During the Committee stage of the Assisted Dying bill, amendments have focused on strengthening, rather than weakening oversight and safeguarding, or liberalising access (e.g., replacing a single High Court judge with a multi-disciplinary panel, extending implementation timelines, and adding independent advocates for vulnerable applicants).

However, International experience is that where assisted dying has been legalised it commences with stringent safeguards and limited eligibility, but over time, moves towards more liberal provision, expanding access and reducing procedural barriers. The UK’s current legislative process is at the stringent, highly safeguarded stage. The Law in England and Wales may buck the trend but international precedent suggests this will change in future. Indeed some groups are already campaigning for change, arguing that the bill does not go far enough, and excludes many people suffering unbearably from chronic or degenerative conditions that are not immediately terminal.

Disability and assisted dying 

Disabled people’s organisation have raised concerns regarding the Terminally Ill Adults (End of Life) Bill, even though disability is currently excluded in the legislation.

They argue that the bill poses grave risks to their safety, autonomy, and equality, especially in a context of systemic discrimination and a lack of meaningful consultation. The bill could further devalue disabled lives, increase vulnerability to coercion, and undermine hard-won rights. Disabled people may be pressured into seeking assisted dying due to inadequate care or support. The decision to seek assisted dying may be influenced by unmet needs and inequalities. The availability of Assisted dying could have a potential negative impact on provision and services.

These organisations fear ‘legislative creep’ - once legalised for terminally ill people, the criteria for assisted dying could be gradually widened to include other groups, including disabled people who are not terminally ill. They note that this “slippery slope” has been observed in other jurisdictions, and fear a similar expansion in the UK.

Although there appears to be considerable public support for assisted dying, many agree that disabled people could be at greater risk of pressure to end their lives, especially if the person feels a burden to their families. The need for strong safeguards is supported.

Intention vs implementation

The intent of any Act of Parliament is not always reflected in its words, and we have some bad laws as a result. Laws that are intended to be proscriptive can often be interpreted liberally. The current act suggests between 273 and 1,078 applicants for assisted dying in the first half-year, rising to between 1,737 and 7,598 in year ten. I suspect similar numbers were anticipated in 1967, when the Abortion Act was passed, rather than the 250,000 procedures that were performed in 2022.

I have not expressed my personal view on the Terminally Ill Adults (End of Life) Bill.  As an Executive Coach I do not offer my opinion for or against Assisted Dying. My challenge is for us to understand that despite the safeguards contained in the current bill, the process of liberalisation is almost inevitable, whatever form of legislation is passed.

The bill will legalise Assisted Dying in specific safeguarded circumstances but, if the experience of other countries is followed, will inevitably lead to a more liberal availability to people with chronic illness and disability without terminal prognoses, the degradation of services for those people and probably to the legalisation of physician-assisted suicide.   

Post script

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