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Assisted dying legislation and end of life conversations

This guidance is for CSP members who may have conversations with patients about end of life care. 

Assisted dying is currently not legal in the UK or Crown Dependencies.

An older woman having a conversation with a healthcare professional

The CSP holds a neutral position on the ethical question of legalising assisted dying in the UK. It is appreciated that members may have diverse and polarised views on the implementation of this legislation for cultural, religious, moral, personal or professional reasons.

While the parliamentary and public debate and related processes move forward, this paper primarily aims to inform and support members in considering the relevant context of the assisted dying agenda and to provide a framework for safely and appropriately managing conversations with patients and their families.

Whilst the assisted dying bill is a new development, the conversation around assisted dying is not new. Physiotherapists may already have been drawn into those conversations as trusted professionals to patients with terminal conditions.

This guidance aims to provide a framework for considering a physiotherapy response to this conversation, regardless of the Bill's outcome.

The guidance explains:

  • The current legal position across the UK and Crown Dependencies (it is therefore only relevant to members working in these countries or regions).
  • How physiotherapists should respond if a patient talks about assisted dying
  • How to stay within the law, professional standards, and workplace policies

The guidance is not intended to cover lasting power of attorney or decisions around withdrawal of treatment and do not resuscitate (DNR/ DNCPR).

It was drafted with input from members and professional networks and is designed to help all members understand the proposed legislation.

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Assisted dying is currently not legal in the UK or Crown Dependencies. However, assisted dying legislation is progressing through parliaments across the UK:

  • England and Wales the Terminally Ill Adults (End of Life) Bill was passed in the House of Commons for England and Wales (2024) but failed to pass in the House of Lords (2026).
  • Scotland's parliament recently rejected the Assisted Dying for Terminally Ill Adults (Scotland) bill. (17/3/2026).
  • The Isle of Man has established new legislation that is now awaiting Royal Assent before becoming law.
  • Jersey States assembly approved draft legislation February 2026 which will come into effect after a minimum 18 month implementation period (Summer 2027)

There is currently no legislation  being developed for Northern Ireland or Guernsey.

Whilst legislation is still being scrutinised or developed across the UK and Crown Dependencies, this guidance will be updated. More information will follow as laws are passed or amended.

Currently, there is no indication or content in the proposed legislation across the UK or Crown Dependencies, naming physiotherapists as health professionals who will be expected to be part of the assisted dying legislation process. 

The proposed legislation, as it stands, is clear that health professionals can opt out of involvement where a patient expresses a wish to be assisted to die. For more details, please check the guidance for your area.

Previously Proposed legislation for England and Wales

  • Age 18+
  • Must have full mental capacity able to express a clear, settled wish and be free from coercion or pressure.
  • The person has a terminal illness (defined as an inevitably progressive illness or disease that cannot be reversed by treatment) and is reasonably expected to die within 6 months
  • Resident in England or Wales for at least 12 months
  • Registered with a GP in England or Wales
  • Able to make 2 declarations witnessed and signed about their wish to die
  • 2 independent doctors would need to be satisfied that the person meets these requirements and is legally eligible
  • The patient could self-administer the substance or be assisted to ingest or self-administer the substance by the coordinating doctor. The decision to self-administer and the final act must be taken by the person to whom the substance has been provided.
  • Allows a person to opt out of participating in the provision of assistance in accordance with the Act.
  • Allows a health professional or social care professional not to respond when consulted by the assessing doctor.

Amendments to the bill were made in January to March this year by public committee, see page 4 of the document below.

The bill failed in the House of Lords 2026

Previously Proposed legislation in Scotland

  • Age 16 and over
  • The legislation is for terminally ill, mentally competent adults only.
  • Resident in Scotland for 12 months
  • Registered with a medical practice in Scotland
  • Must have mental capacity
  • Waiting period to give dying people time to reflect on their decision.
  • Requires assessment by two doctors.
  • Requires that a person is aware of all their other options, including palliative care.
  • Allows doctors to conscientiously object to being involved in the process.
  • Substance is provided to the terminally ill adult by the registered professional or an authorised health professional*.
  • Requires the dying person to take the life-ending medication themselves and does not permit another person to do it for them.
  • Introduces a new offence, explicitly making it a crime to coerce someone into an assisted death.

*authorised health professional means a registered medical practitioner or registered nurse authorised by the coordinating registered medical practitioner for the purposes of this section.

The Assisted Dying for Terminally Ill Adults (Scotland) Bill was rejected on the 17th March 2026 after a majority MSP vote against the bill.

Proposed legislation in the Isle of Man

  • Assisted dying conversations are not to be initiated by a health care professional
  • 18 years of age
  • 12 months left to live
  • Must have mental capacity
  • 2 doctors verify the decision
  • Resident in the Isle of Man for 5 years
  • A registered nurse could provide the eligible person with the approved substance to end their life, but it is prescribed by the attending doctor
  • Allows a person to opt out of participating in anything authorised by this Act to which that person has a conscientious objection.
  • Self-administered (an assisting health professional* may assist that person to ingest or otherwise self-administer the medicine)
  • Medication can only be delivered to the person for whom it is prescribed-
  • by the attending doctor; or by (i) another registered medical practitioner; (ii) a registered nurse; (iii) a registered pharmacist.

*Authorised health professional” means a registered medical practitioner or registered nurse authorised by the coordinating registered medical practitioner for the purposes of this section.

The Assisted Dying Bill 2023 was passed by the House of Keys and Legislative Council in March 2025 it now needs to pass Royal Assent in the Tynwald

Proposed legislation in Jersey

  • 18 years of age
  • Has a terminal diagnosis that is expected to cause death within 6 months or a neurodegenerative condition which is causing or is expected to cause unbearable suffering that cannot be alleviated in a manner the person deems tolerable.
  • Must have decision-making capacity
  • Must have a voluntary, settled and informed wish to end their own life
  • Resident in Jersey for at least 12 months
  • Provision will be through the Jersey Assisted Dying Service
  • A Pharmacist or pharmacy technician registered with the Assisted Dying service will prepare and dispense the substance, working within the Hospital Pharmacy.
  • Administering practitioner- (Doctor or Nurse) would administer the substance or support the person to self–administer.
  • Physiotherapists could be part of the MDT supporting the assessment process if they opted to register with the service.
  • Professionals have the right to refuse to directly participate in assisted dying on any grounds. This extends to professionals providing supporting opinions/assessments and premises operators.
  • Professionals are neither compelled to raise the subject of assisted dying nor prohibited from doing so - guidance will clarify where a professional might raise the issue.

Draft legislation has been approved (February 2026) by the States Assembly. A minimum 18 month period will now commence, before the law comes into full effect at the earliest Summer 2027. 

Taken directly from the bill: 

'Training is proposed for all health and care staff on the island. Covering: an introduction to the legislation, overview of the assisted dying process and the Jersey Assisted Dying Service, discussing assisted dying with persons, reference to relevant information and professional guidance, including appropriate conversation guidance and referring persons to the services.'

Cornerstones of practice and end of life care

This guidance is intended to support you in having compassionate conversations with patients and families while following the law and maintaining CSP and HCPC regulatory and professional standards.

Considering the progression of legislation, and the reality that patients do, and will, engage healthcare staff in conversations about end of life care, any member, student, associate or physiotherapist must consider the framework on which to base any response or contribution to this conversation. 

You need to consider the following cornerstones that support your practice when entering conversations around end of life care and palliative care with patients:

Legislation

Currently, assisted dying is not legal within the UK and Crown dependencies. You must not discuss assisted dying with your patients.

You may explore end of life care where it is within your scope and role to do so, and optimise patients' access to services and palliative care.

You can also discuss your patient's wishes around advanced decisions. 

Regulatory

Consider the HCPC standards and how they impact your practice.

Using the HCPC standards, consider particularly how you work as part of an MDT when discussing complex areas or those areas outside the scope of physiotherapy.  

Professional

Consider the context in which you work and use guidance that applies to your team and your clinical area. What clinical and other national guidance exists? This might be condition-specific.

Local/workplace

Ensure you know your organisation’s policies, procedures and guidance around palliative care, end of life care and services available locally. Consider what training might be available locally for yourself or your team. 

Conduct a skills gap analysis among the team or review learning needs during supervision. Within this, consider what local support there is for the team's mental health and wellbeing. 

Keep up to date with legislative changes and how they may impact your workplace or practice, or affect local policies and procedures. 

Safeguarding

If you believe a patient is being pressured or coerced into requesting assisted dying, contact your safeguarding team immediately. Do not wait. Familiarise yourself with your local safeguarding policies and procedures so you know who to contact and how should the need arise. 

Talking to patients about their end of life concerns or worries  

If a patient feels comfortable approaching you to discuss this subject, please consider the trust and confidence they are demonstrating in you and the relationship you have built with them.  

It is important that the topic of end of life care is explored in a sensitive and compassionate manner with an open approach to the discussion, irrespective of a clinician's personal beliefs or feelings.

There is an opportunity to explore the underlying reasons why a patient might consider assisted dying.

  • Are they worried about the effect on their family?
  • Are they depressed or anxious?
  • Are they worried about pain control?
  • Do they feel under pressure? 

You may reassure the patient by considering the following:

  • Has a referral to palliative care been made?
  • Does the patient need counselling, onward referral for assessment of mental health issues, symptom management, or safeguarding? 

If you really feel unable to have the discussion for personal or professional reasons with the patient, ask them if they are happy to carry on the conversation with a trusted colleague.

Please do not give them the impression that they cannot have the conversation or make them feel embarrassed or uncomfortable about asking. It is important to ensure that a patient's care is optimised and their concerns are addressed. 

Practical tips and considerations

  • Keep up to date with what treatment and services are available to patients locally, such as palliative care services, hospices, charities, pastoral care and mental health support.
  • Document all conversations clearly, objectively and in a timely manner.
  • Patients have a right to access their notes through a Subject Access Request, and you cannot refuse except in extreme circumstances.
  • Explain that assisted dying is illegal and cannot be discussed. Explain that lawfully supportive options such as palliative care are available.
  • Offer timely support, such as access to palliative care or referrals, if the patient consents.
  • Healthcare professionals should consider whether the patient has any unmet palliative care needs, including pain, mental health issues and symptom management. If additional care can be provided to make the patient more comfortable, this should be discussed with the patient, implemented and clearly documented.
  • There is, of course, no obligation to prolong life. Where a patient has capacity, they can refuse to consent to medical treatment even if that decision leads to their death (withdrawal of treatment). 

What you must not do;

Remember that you would be currently breaking the law and professional standards if you:   

  • Suggest suicide abroad
  • Start a conversation about assisted dying or suicide
  • Write medical reports that help someone access assisted dying abroad
  • Provide information or signpost to organisations or media that promote assisted dying
  • Help a patient or their family plan an assisted death

Always consider the perspective of the person who has started the conversation and sensitively manage the situation, engaging other members of the team as needed.  

Useful phrases for those who feel unable to continue the conversation

If you are unsure of how you would respond to a patient sharing their thoughts or feelings, consider the following suggested responses. 

  • I hear/understand that you have been considering this, you might get more clarity or understanding of your options if you spoke to XXX
  • I hear how difficult you have been finding living with your diagnosis/condition/symptoms/prognosis.  Would it be helpful to speak with XXX about this?
  • Thank you for sharing that with me, I appreciate it might have been difficult to voice what you are feeling just now.  I think that XXX might be better placed to help you with this, would you like me to refer you/speak to them/ask them to come and see you?
  • I can see this is an important concern for you and want to make sure you can speak to the best people to discuss this with – do you mind if I ask xxx to come and talk to you about it? (Maybe offer to be present for this conversation if the patient has developed trust in you). 

For those able to continue the conversation but needing some useful phrases

  • Can you tell me more about that worry?
  • Is there something you are particularly concerned about (the use of 'something' rather than 'anything' creates a more open space for a patient to lead a conversation).
  • What matters most to you about this now?   

Repeat back to the patient what they have said to confirm you have understood & give the patient space to deepen what they have shared.  

Remember the value of silence – often just pausing and waiting will allow the person time and space to think and fill in the silence themselves. 

Frequently asked questions on assisted dying

Is it currently illegal to discuss assisted dying with a patient?

Yes, it is illegal to discuss assisted dying with a patient.

You may discuss a patient’s fears about dying, and this is an important part of providing patient-centred care and ensuring patient needs are met.

You must not, as part of any discussion, encourage, facilitate or promote assisted dying. Ensure you maintain professional standards and stay within the law.

Do I need to offer assisted dying as a treatment option?

No, assisted dying is not considered part of physiotherapy practice or a treatment option.

What should I document when a patient expresses a desire for assisted dying?

It is important to document a summary of the conversation. Include what the patient said, how you responded, any concerns, and any referrals made.

Ensure notes are factual and objective and are written in a timely manner in accordance with record-keeping guidance.

Can I share my views on assisted dying with patients and families?

No, your role as a physiotherapist is to support the patients' health and well-being needs whilst remaining neutral and professional.

Expressing your personal opinions may influence or distress patients, which would breach professional standards.

How can I develop skills in handling end of life conversations?

Communication skills are essential. You can:

  • Check if your organisation/employer or area offers courses in Palliative care and communication skills
  • View our information on having difficult conversations
  • Online training is available from eLearning for Health, such as end of life Care for All, and hospices offer online courses too.
  • Discuss reflections and development in supervision or mentoring sessions
  • Access resources from the NHS, Hospice UK, Marie Curie and NICE guidelines as a starting point. Some charitable organisations offer condition-specific training.

How can we support our team with these conversations?

Consider setting up mechanisms to de-brief formally or informally as a team huddle

  • Reach out to your local Hospice physiotherapist – they may be able to arrange an IST for your team.
  • One-to-one supervisions around complex conversations
  • Peer-to-peer supervision
  • Build a culture of not carrying the weight of conversations yourself, draw on team support
  • Discuss with the team and gather support if you think a patient may bring up the conversation ahead of time.
  • Develop resilience-based clinical supervision groups

What support is there for members to support their mental health and wellbeing when having these conversations?

Check in with your team if you are expecting the conversation to arise with a patient and prepare for it. Seek support from your team either formally through supervision and debriefs or informally.

  • Take time after a conversation to take stock of your own emotional well-being
  • Signpost to employee assistance programmes
  • Seek support through line management
  • Undertake training in resilience and be able to self-assess the need for further support

I work in private practice as a lone practitioner. Where can I seek peer support?

Seek support from our professional networks and iCSP forums or reach out to local hospices for peer support.

Glossary of terms

DNAR stands for do not attempt cardiopulmonary resuscitation. A DNAR form is completed by you and/or your doctor and healthcare team. If your heart or breathing stops, your healthcare team will not try to restart it. They can be part of a ReSPECT process (recommended summary plan for emergency care and treatment).

Lasting power of attorney – this is a legal document that appoints someone to make decisions on your behalf when you are no longer able to communicate your own decisions. This can cover health and well-being and/ or financial. LPAs can only be set up whilst the individual has mental capacity.

Assisted dying happens when someone who is terminally ill asks for, and is provided with, assistance to end their life. In some countries where assisted dying is legal, this is extended to those experiencing unbearable suffering.

Terminal Illness is a disease that cannot be cured or adequately treated and is expected to result in the death of the patient.

Palliative care is a holistic approach to managing serious life-threatening illnesses, providing relief from the symptoms and stress of the illness.

Withdrawal of treatment – a patient opts not to have treatment that might prolong their life. This is legal, and patients can currently choose to withdraw treatment. This is referred to as an advanced decision plan.

Euthanasia is the act of deliberately ending a person's life to relieve suffering. For example, if a doctor deliberately gave a patient with a terminal illness a drug they do not otherwise need, such as an overdose of sedatives or muscle relaxants, with the sole aim of ending their life.

Advance Directive or Living Will is a document that determines the specific medical care you wish to receive if you are no longer able to make these decisions yourself.

Further information

These resources can help you have conversations with patients.

CSP resources

HCPC resources

Other professional bodies

Other sources of information

Videos on communication

Thank you

Thanks, and appreciation to those who gave up their time to support the development of this guidance paper, including the professional networks ACPIN, ACPOPC, and PPA, and the many individual members.

Last reviewed: