Lessons from 15 International Jurisdictions
The study analysed evidence from Australia, Austria, Belgium, Canada, the Netherlands, New Zealand, Spain, Switzerland, and the US, offering the most comprehensive insight yet into how other nations have implemented assisted dying services.
Key findings reveal that:
- Safe and effective implementation requires substantial planning, infrastructure, and funding, all of which are already under strain within the NHS.
- The majority of people who access assisted dying internationally are terminally ill: 79% in Belgium and 96% in Canada.
- Between 55% and 80% of individuals seeking assisted death had a cancer diagnosis, with 75% already receiving palliative care.
- The median age of those accessing assisted dying ranges between 69 and 80 years old.
Key Challenges for the UK
The report warns that introducing assisted dying without addressing existing NHS pressures, such as staffing shortages, financial constraints, and uneven access to end-of-life care, could deepen inequalities.
1. Funding Beyond Direct Costs
Countries like Australia and Belgium have expanded services, including pharmacy provisions and public information campaigns. Experts stress that the UK must also fund:
- Workforce training
- Oversight bodies
- Data infrastructure
- Service redesign
2. Developing New Systems
Other nations required specialist staff, regulatory frameworks, and training programmes. For example, Australian states relied on 18-month preparation periods, while Belgium has faced challenges due to underfunded oversight mechanisms.
3. Rising Demand Over Time
Data shows that assisted dying cases tend to increase steadily after legalisation. In Oregon, the proportion of assisted deaths rose from 0.2% in 2010 to 0.86% in 2023. Experts urge UK policymakers to plan for growing demand and allocate sustainable funding.
4. Role of Clinicians and Pharmacists
General practitioners and pharmacists play a central role in countries where assisted dying is legal. However, the report highlights that only a small number of clinicians currently deliver these services, meaning the UK will need to consider reimbursement structures and specialised contracts.
5. Devolved Implementation Challenges
In countries like Canada and Spain, regional variations have created inconsistencies in access. With separate assisted dying debates underway in Scotland, the report recommends a clear UK-wide framework while allowing for locally tailored solutions.
Expert Warning
Sarah Scobie, Deputy Director of Research at the Nuffield Trust, said:
“Implementing assisted dying will not be straightforward given the immense pressure on the health system. Lessons from other countries show we must plan carefully to avoid creating barriers for people who should be eligible.”
She added that policymakers must balance two concerns: preventing misuse while ensuring that eligible individuals are not denied access.
