News13th November 2024

Project to explore public attitudes towards assisted dying in England reveals some of the key factors that can influence someone’s view on the topic

New evidence, published by the Nuffield Council on Bioethics (NCOB) suggests a person’s view on assisted dying is shaped by the level of confidence they have in effective safeguarding being possible, and the imminence to which they have been confronted with their own or a loved one’s death.  

Assisted dying

Since October 2023, we have been working with Hopkins Van Mil (HVM), M·E·L Research and the Sortition Foundation to explore public attitudes towards assisted dying in England. Our project is unique in that we commissioned England’s first Citizens’ Jury on the topic and ran this alongside two nationally representative surveys. This robust methodology has enabled us to ascertain not only what the public think, but why they think it. 

Public views on eligibility criteria 

Our analysis suggests the majority of the public supports the legalisation of assisted dying in England. And that the most likely favoured circumstance for this would be if the service was limited to adults who have a terminal diagnosis with an estimated six-months of life left.  

We found less public support for a terminal diagnosis of 12-months and lesser still for the inclusion of intolerable suffering due to concern that there is no agreed definition, and some fearing that it would make the service too easy to access.  

Delving into the reasons that could underpin a difference in these views, our data suggests people who have been confronted with their own or a loved one’s imminent death, tend to express stronger support for assisted dying. Through our survey, there is some evidence to suggest that when people are presented with assisted dying scenarios and asked to form a view, rather than simply asked a binary question on the topic, people who currently have a family member or friend with a terminal illness may tend to support wider eligibility criteria whereas people who have lost someone in the last five years may tend to support a narrower one. 

Requirement for effective safeguarding 

Our analysis shows effective safeguarding controls are of upmost importance to the public. Indeed, a key difference between those who want to see a change in the law and those who do not is their confidence in whether legislation will be able to protect people. People who want England to legalise assisted dying say that legislation can provide effective safeguards to ensure choice without coercion. Whereas one of the main reasons, besides religious beliefs, expressed by people who are against a change in the law, is a concern that any safeguards put in place cannot be strong enough to protect vulnerable people from societal- and self-pressure.  

The consideration of safeguards also extended to healthcare professionals who could be asked to provide an assisted dying service. Many expressed a concern for medical professionals, saying they will need to be given significant mental health support and assured that they’ll be protected from action by those who do not wish a change in the law. However, there are mixed views when considering whether medical professionals should be able to opt-in or out as some fear this could create an inequity of provision across the country. 

Supporting a good death 

Our analysis shows the public are united in their want for England’s palliative care and social care services to be improved, and they say this needs to happen irrespective of whether assisted dying is legalised or not.  

There is also a public desire for national conversations on assisted dying and death more generally – working to remove any existing barriers or taboos so that society can discuss what a good death looks like.  

And if current political interest in assisted dying does not lead to its legalisation, the public would like to see a stopping of the criminalisation of people who have no choice but to travel abroad with loved ones who seek the service. 

Under 18s and overseas access 

Our project has also exposed where there is currently a lack of public consensus. The inclusion of under 18s and whether the service needs to be limited to people who are a resident of England were two areas where we observed the highest diversity of views.  

With regards to under 18s, some felt that if they had a terminal illness and parental support, they should be able to access an assisted death. Others expressed concern over establishing capacity of a child / young person and said it would be unfair for parents to be put in this situation. Considering residency, some said people should be living in England in order to access assisted dying here. But others could see benefit in it being offered to people coming from other countries, as their payment might support the NHS.   

The steadfast commitment of the Jury to discuss this ethically charged topic at a societal level, rather than as individuals, and through a public benefit lens, has seen them step outside of their personal views and consider if a change in the law would bring benefits to wider society. It has been incredible to observe. 

“The Hopkins Van Mil team has thoroughly enjoyed working with the Nuffield Council on Bioethics on this significant and timely project. Their establishment of an independent Advisory Board and Content Group provided us all with the impartial and informed advice and challenge to ensure the project was robust, rigorous, and of the highest integrity. We hope it will provide policymakers with the evidence they need.“

Henrietta Hopkins, Director of Hopkins van Mil

Using discussions and recommendations from the Citizens’ Jury as a starting point, we were able to develop scenarios in our second survey that tested the acceptability of assisted dying in specific circumstances, alongside support for a change in the law in principle.  I hope that the resulting evidence base gives the public a voice in the forthcoming debates.” 

Steve Handley, Quantitative Research Director at M·E·L Research

The responses to our two nationally representative surveys and findings from an ‘Initial qualitative analysis of the Citizens’ Jury’ have been published in response to increased parliamentary interest in assisted dying. The main project report, which will expand on these initial insights further will be published in early 2025.  

These findings reveal where there is public consensus on how a legalised assisted dying service in England should operate, were it to become a reality – having effective and robust safeguarding controls that will enable a strict eligibility criteria of terminally ill adults to be applied is clearly of upmost importance to the public.  

“As the political debate on assisted dying gathers pace, we hope these timely insights will help to ensure those making the decision have the robust and trustworthy evidence they need to participate in a well-informed and nuanced conversation.

Professor Anne Kerr, Chair of the Nuffield Council on Bioethics’ Assisted Dying Advisory Board

If you like to hear more about the Jury members’ experience, please read a blog written by Ashok, Daniel and Helen. Or watch a video of them in action. 

If you would like to receive updates on our assisted dying project, which is funded by the AB Charitable Trust you can sign up for the mailing list.