SPICe previously published a blog examining the differences between the Scottish and UK assisted dying bills. At this point in time, the Scottish Bill was in the middle of stage 1 scrutiny and the UK Bill had just had its second reading in the Commons.
Since this time, the Scottish Bill has passed stage 1 and will begin its first amending stage on Tuesday 4 November. Meanwhile, the UK Bill has completed part of its journey through the Commons and begins its Committee stage in the House of Lords on 14 November 2025. Please note that the UK Bill only applies to England and Wales.
In advance of stage 2 of the Scottish Bill, this blog provides an updated look at how the Scottish Bill (as introduced) compares to the UK Bill (as amended), as well as highlighting notable amendments that have been lodged at stage 2 on the Scottish Bill.
This blog covers the main changes and is not intended to be an exhaustive account of changes to the UK Bill or the amendments proposed in Scotland. For more detailed information on the progress of the UK Bill please see the House of Commons Library briefing on Terminally Ill Adults (End of Life) Bill 2024-25: Progress of the bill and the House of Lords Library briefing Terminally Adults (End-of-Life) Bill: HL Bill 112 of 2024-25.
Amendments for stage 2 of the Scottish Bill lodged so far can be viewed at: Assisted Dying for Terminally Ill Adults (Scotland) Bill: Stage 2.
Eligibility
Table 1: An overview of eligibility in the Scottish and UK assisted dying bills
Scottish Bill (as introduced) | UK Bill (as amended) |
Assisted dying would be available only to terminally ill adults aged 16 or over with capacity. The Bill defines someone as terminally ill if they: “[…]have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.” To be eligible a person would also need to be registered with a GP practice and have been ordinarily resident in Scotland for at least 12 months. | Assisted dying would be available to terminally ill adults aged 18 or over with capacity. The Bill defines someone as terminally ill if: “[…](a) the person has an inevitably progressive illness or disease which cannot be reversed by treatment, and (b) the person’s death in consequence of that illness or disease can reasonably be expected within 6 months.” The person would also need to be registered with a GP practice and have been ordinarily resident in England or Wales for at least 12 months. They must also be present in England or Wales when seeking assistance under the Bill. Specifies that a treatment which only temporarily relieves the symptoms of a disease is not to be regarded as a treatment for the purposes of the definition. The UK Bill also explicitly provides that a person is not to be regarded as terminally ill by virtue of only having a mental disorder, a disability or both. An amendment to the Bill also specifically excludes people as terminally ill solely as a result of voluntarily stopping eating and drinking. |
The eligibility criteria in the UK Bill have remained largely the same and so too have the key differences with the Scottish Bill. These include:
- The age of eligibility is set at 16 in Scotland and 18 in England and Wales.
- The Scottish Bill does not contain a prognostic timescale but the UK Bill includes a 6-month prognosis.
- The UK Bill applies to conditions that are untreatable while the Scottish Bill refers to conditions that are unrecoverable.
- The UK Bill explicitly excludes mental illness, disability or both as the sole qualifying criteria for assisted dying.
A new criterion was added to the UK Bill which would specifically exclude people who are dying solely as a result of voluntarily stopping eating and/or drinking.
The UK Bill also removed reference to ‘medical condition’ from the definition of terminal illness. This was on the grounds that “some medical conditions are likely to also amount to a disability” and therefore the amendment was intended to add stronger safeguards for people with disabilities.
In addition, people seeking assistance under the UK Bill must be physically located in England or Wales, as well as ordinarily resident. This is intended to prevent ‘medical tourism’.
Notable amendments lodged on the Scottish Bill in relation to eligibility are shown below.
| Proposed Stage 2 amendments on eligibility (amendment numbers are in brackets): The addition of a 3-month (143) or 6-month prognostic timescale to the definition of terminal illness (4, 83, 97, 119 and 144). Proposals to raise the age of eligibility to 18 years (1,2 and 3) or 25 years (152 and 168). Exclude people from the definition of terminal illness solely as a result of having a mental disorder, disability or both (24, 73 and 144). Requirement for the adult to have appropriate palliative and social care plans and/or packages in place before being eligible (25, 145 and 219). Exclude people whose illness is a consequence of voluntarily stopping eating or drinking (144). |
Process
Table 2: An overview of the processes in the Scottish and UK assisted dying bills
Scottish Bill (as introduced) | UK Bill (as amended) |
The process in the Scottish Bill includes the following steps: 1. First declaration 2. Coordinating doctor assessment 3. Coordinating doctor statement 3. Referral to independent doctor 4. Independent doctor’s assessment 5. Independent doctor statement 6. Second declaration 7. Request for assistance 8. Provision of assistance The process aims to ascertain the person who made the declaration(s) is: – a terminally ill adult – is eligible to be lawfully provided with assistance to end their life, and – made the declaration voluntarily and has not been coerced or pressured by any other person into making it. There would be a 14-day reflection period in between making the first and second declarations. This can be shortened to between 2-13 days if both doctors agree death is likely to occur in less than 14 days. The person can withdraw from the process at any point. | The process in the UK Bill includes the following steps: 1. Preliminary discussion (optional) 2. First declaration 3. Coordinating doctor assessment 4. Coordinating doctor statement 5. Referral to independent doctor 6. Independent doctor assessment 7. Independent doctor statement 8. Referral to assisted dying review panel 9. Certificate of eligibility issued (if panel satisfied) 9. Second declaration 10. Provision of assistance The process aims to establish: – the person is terminally ill – is eligible to be provided with assistance, has a clear, settled and informed wish to end their own life, and – has made the decision voluntarily and in the absence of coercion or pressure from another person. There would be two periods for reflection; one 7-day reflection period in between the coordinating doctor statement and referral to an independent doctor, then a second 14-day reflection period in between the panel issuing an eligibility certificate and a second declaration. The second period of reflection can be shortened to 48 hours in cases where it is believed the person has less than one month to live. The person can withdraw from the process at any point. Both doctors must discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance. |
The processes in both Bills contain many similarities but the obvious area of divergence is the inclusion of a decision-making panel in the UK Bill.
The process in the Scottish Bill is entirely doctor-led. Initially, the process in the UK Bill was largely the same but with a key exception that applicants required approval from the High Court.
This provision in the UK Bill was criticised by some as adding a bureaucratic barrier and adding strain to the judicial system. The UK Bill has subsequently been amended to remove this requirement and has been replaced by a requirement for applications to be reviewed by a panel appointed by a ‘Voluntary Assisted Dying Commissioner’.
This panel would be made up of a senior lawyer, a psychiatrist and a social worker and its role would be to grant a ‘certificate of eligibility’ once satisfied that all the eligibility criteria had been met. If the panel refuses to grant the certificate, the person could ask for their case to be reconsidered on the grounds that the first decision contained an error in law, was irrational or procedurally unfair.
The Voluntary Assisted Dying Commissioner would be a judge or former judge of the Supreme Court and would be appointed by the Prime Minister. The role of the Commissioner would be to oversee the assisted dying process in England and Wales. This means the initial plan for Chief Medical Officers to monitor the operation of the legislation has moved to the Commissioner.
There is no equivalent oversight or decision-making body in the Scottish Bill (as introduced).
Other notable amendments to the process in the UK Bill include:
- Removing the requirement for a doctor who is unwilling to take part in the process to refer the person to a willing doctor. This was replaced with an obligation to direct the person to where they can access information and have the preliminary discussion.
- A regulation making power to appoint independent advocates who will support people seeking assistance to end their own life.
- Health professionals cannot have a preliminary discussion about assisted dying with anyone under the age of 18.
- Doctors are explicitly prevented from discussing assisted dying in isolation from other options, for example, palliative care, symptom management and psychological support.
- A new duty on the Secretary of State to make regulations detailing the required training, qualifications and experience of the coordinating and independent doctor. This should include training in domestic abuse, including coercive control and financial abuse.
- A requirement for doctors to make enquiries (as the doctor considers appropriate) of professionals who are providing, or have recently provided, health or social care to the person.
- A request for a second opinion would now apply when the second doctor’s statement had reported they were not satisfied the person met the eligibility criteria, as opposed to a simple refusal by a doctor to make the statement.
Notable amendments lodged in this area in the Scottish Bill are shown below.
| Proposed Stage 2 amendments related to the assisted dying process (amendment numbers are in brackets): Creation of an Assisted Dying Review Panel which would determine eligibility (239 and 240). Prohibiting doctors and health professionals from initiating a discussion about assisted dying (220). Prohibiting health professionals from raising the topic of assisted dying with under 18s (53). Creating a right to independent advocacy for those seeking an assisted death (242). Requiring an independent assessment of whether the person has been coerced (161). Extending the period of reflection from 14 to 28 days (7,8 and 9). Encouraging doctors to consult with professionals who are providing, or have recently provided, health or social care to the person (13 and 28). Requirement to refer the person for a palliative care assessment (116). Requesting information on whether the adult is vulnerable or at risk (226 and 100). Requiring a doctor who is unwilling to participate in the process to direct the person to someone who may be willing, or direct them to further information about the process (27). A proxy who signs a declaration on behalf of the person must have known them for at least 2 years (32). Amend the requirement for the doctor to remain with the person until death to ‘once the adult has used the approved substance’ (33). The creation of a body (independent of the NHS) responsible for the administration of the functions in the Bill (148). Various amendments seeking to detail the training and qualifications required by professionals involved in assisted dying, including training in assessing under 25s, the provision of assistance, the assessment of capacity, as well as the creation of an assisted dying training authority. A requirement to enquire what advice and support the adult has received to enable them to live independently in line with article 19 of the UN Convention of the Rights of Persons with Disabilities (231). A requirement for the doctor to inform the person about potential side-effects of the approved substances and any complications that may arise from using them (158). Enhanced assessment of under 25s seeking assisted dying (51). Prohibition on someone seeking a further assessment for assisted dying earlier than 6 months since their last assessment (117A) |
Capacity
Table 3: An overview of the approach to capacity in the Scottish and UK assisted dying bills
Scottish Bill (as introduced) | UK Bill (as amended) |
Describes a person as having capacity if they are not suffering from a mental disorder which might affect the making of the request, and they are capable of: 1. Understanding information and advice about making the request 2. Making a decision to make the request 3. Communicating the decision 4. Understanding the decision, and 5. Retaining the memory of the decision ‘Mental disorder’ is defined in accordance with the Mental Health (Care and Treatment)(Scotland) Act 2003. | The UK Bill says references to a person having capacity are to be read in accordance with the Mental Capacity Act 2005. The 2005 act sets out a two-stage test for assessing capacity: S2(1) – a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain. S3 – defines for the purposes of s2 the circumstances in which a person would be considered unable to make a decision for themselves. |
Both Bills require the person to have capacity at every stage of the process. The UK Bill references the existing law on capacity, while the Scottish Bill takes the approach of describing what capacity entails.
It has been argued that the Scottish Bill reverses the typical approach in law, whereby people are assumed to have capacity unless shown otherwise. This was raised in evidence to the Scottish Parliament’s Health, Social Care and Sport Committee:
The bill reverses the usual presumption. Under the [Adults with Incapacity (Scotland)] 2000 act, it is presumed that we all have capacity to make all decisions until somebody—a relevant professional—proves, on the balance of probabilities, that we do not. I do not fully understand the reasons for reversing that in the bill, requiring that capacity rather than incapacity is proved. Dr Stephen Potts
However, others have suggested this reversal may be appropriate for assisted dying decisions.
The Scottish definition of capacity would also exclude people who have a mental disorder which ‘might affect the making of the request’. Mental disorder includes people with a mental illness, learning disability or personality disorder.
Amendments to the UK Bill in relation to capacity were limited but include:
- A regulation making power requiring the coordinating and independent doctors to have had training in assessing capacity, domestic abuse, assessing whether someone is being coerced and making reasonable adjustments and safeguards for people who are autistic or have learning disabilities.
- A requirement for the Secretary of State to issue a code of practice in connection with assessment of whether a person has a clear and settled intention to end their own life. This would include an assessment of a person’s capacity to make such a decision and the consideration of mental disorders that may impair a person’s decision making.
Key amendments lodged in relation to capacity in the Scottish Bill are shown below.
| Proposed Stage 2 amendments related to capacity (amendment numbers are in brackets): People seeking assistance to die are presumed not to have capacity unless it is established by evidence beyond a reasonable doubt that they have capacity to do so (146). A presumption that people do not have capacity if their primary motivation for seeking an assisted death is one of a list of prescribed conditions. These conditions include eating disorders, intellectual disabilities and mood disorders (147). Training for doctors in the assessment of capacity (255) as well as regulations to specify training in identifying coercion, pressure or undue influence (225). |
Assistance
Table 4: An overview of assistance in the Scottish and UK assisted dying bills
Scottish Bill (as introduced) | UK Bill (as amended) |
Describes assistance as; – providing the terminally ill adult with the substance with which the adult may end their own life, – staying with the adult until they have decided they wish to use the substance or, – removing the substance if they decide they do not wish to use it. The policy memorandum and explanatory notes to the Bill stress that the substance must be ‘self-administered’. | The approved substance must be provided directly and in person by the coordinating doctor to that person. The coordinating doctor may— – prepare a device which will enable that person to self-administer the substance, and provide that person with the device. – prepare an approved substance for self-administration by that person, and assist that person to ingest or otherwise self-administer the substance. The final act must be taken by the person to whom the substance has been provided. The Bill specifically rules out the option of the doctor administering the substance. |
Both Bills have an intent that the substance will be self-administered but the drafting is different and may have a different effect.
The term ‘self-administration’ does not appear on the face of the Scottish Bill but is emphasised in the policy memorandum and explanatory notes published alongside the Bill. The Bill also emphasises self-administration with several references to providing assistance and a substance for the person to ‘end their own life’.
The UK Bill specifically describes methods of assistance, including some which would allow people with physical impairments to access assisted dying. Whether the Scottish Bill would permit these methods is unclear and questions on types of assistance and administration were raised in the Health, Social Care and Sport Committee’s call for views on the Bill.
Both Bills permit a proxy to sign declarations for those physically unable to do so, but the Scottish Bill does not specifically say whether any third-party assistance is allowed to help overcome physical impairments that prevent self-administration.
The Scottish Bill also does not specifically rule out doctor administration, unlike the UK Bill, but the UK provisions seem to be for the avoidance of doubt.
The main amendments to the UK Bill in relation to assistance included:
- that the doctor may be accompanied by health professionals and such other persons as they may see fit when providing the substance, and
- that when providing the substance, the doctor must explain that the person does not have to go ahead and may still cancel their declaration.
Key amendments lodged on the Scottish Bill in relation to assistance are shown below.
| Proposed Stage 2 amendments on assistance (amendment numbers are in brackets): Allowing the doctor to prepare a medical device to let the person administer the substance themselves or allow the doctor to assist the person to ingest or otherwise use the substance. The provisions would not allow the doctor to administer the substance (10). Requiring a doctor to intervene and take all reasonable steps to preserve life in situations where the substance has not had the intended effect (181). Requiring Scottish Ministers to prepare and publish guidance for doctors and health professionals on the provision of assistance, including what to do in the event of complications (268). |
Conscientious objection and protection for professionals
Table 5: An overview of conscientious objection and professional protections in the Scottish and UK assisted dying Bills
Scottish Bill (as introduced) | UK Bill (as amended) |
Sets out that no one is under any duty to participate in anything authorised under the Bill if they have a conscientious objection. States the burden of proof with regards to conscientious objection lies with the person claiming to rely on it. The coordinating doctor must also be willing to carry out the functions provided for by the Bill. | Sets out that no person, doctor or other health professional is under any duty to provide assistance under the Bill. It also includes a specific clause stipulating that an employer must not subject an employee to any detriment for not participating. |
The UK Bill has a broad ‘no duty to participate’ clause whereas the Scottish Bill allows objection for conscience reasons. This has been described as an ‘opt-in’ approach versus an ‘opt-out’.
The Scottish Bill does also require the coordinating doctor to be ‘willing’ to carry out the functions of the Act so it could be argued that the Scottish Bill also requires an element of opting in.
The Scottish Bill also does not specify which professionals can conscientiously object whereas the UK Bill specifies ‘no person’ is under any duty to participate. Other provisions within this part of the UK Bill are also directly aimed at healthcare professionals, social care professionals and pharmacists rather than just doctors.
The Scottish approach has been criticised by some as lacking clarity, although the broader drafting is viewed by some as potentially more inclusive of ancillary staff such as social workers and care home staff. However, court decisions in relation to the, almost identical, provision in the Abortion Act 1967 suggest it will only apply to staff who are directly involved in assisted dying.
The Scottish Bill also does not contain a ‘no detriment’ clause, unlike the UK Bill. The inclusion of such a clause in the UK Bill is intended to address concerns about staff being pressured to participate.
There were no amendments made to this part of the UK Bill. In relation to the Scottish Bill, notable amendments are shown below.
| Proposed Stage 2 amendments on conscientious objection and protection for professionals (amendment numbers are in brackets): Removal of the requirement for not participating in assisted dying to be on the grounds of conscientious objection (40). A ‘no detriment’ clause for any individual or organisation not participating in the process due to conscientious objection (11 and 248). The inclusion of an ‘organisational objection’ for care homes and hospices, alongside an accompanying ‘no detriment’ clause (16, 20, 52, 153, 249). Clarification that ‘no duty to participate’ applies to direct participation (39). Greater clarification on what ‘participation’ entails (190). Inclusion of a duty for non-participating doctors to direct a person to another doctor willing to participate, or to direct them to information on the provision of assisted dying (27). Creation of a register of doctors willing to participate in assisted dying (151). Creation of a register of psychiatrists eligible to undertake further psychiatric assessments (80). |
Other key differences
Some other differences of note include:
- The UK Bill specifies that a doctor is under no duty to raise the topic of assisted dying but can use their professional judgement as to when it might be appropriate. The Scottish Bill is currently silent on whether a doctor has an obligation or not to raise assisted dying but an amendment has been lodged which mirrors the UK provision (amendment 195).
- The UK Bill has a specific provision to record assisted death alongside the underlying terminal illness on the death certificate, whereas the Scottish Bill would record the underlying terminal illness as the cause of death. Amendments have been lodged which would mean the cause of death recorded on the death certificate would change from the underlying terminal illness to the ‘direct cause of death’ (amendments 37 and 247). Another amendment would require the approved substance to also be recorded as ‘other relevant medical information’ (amendment 38).
- The UK Bill requires the Secretary of State to create a regulatory regime for approved substances. The Scottish Bill does not have comparable provisions but note that medicines is an area reserved to Westminster.
- The UK Bill has offences not covered by the Scottish Bill, including: inducing someone to self-administer the substance, inducement by means of dishonesty, and an offence for falsifying or destroying records with the intention of causing the death of another person. An amendment has been lodged on the Scottish Bill which would create a new offence of coercing someone into taking the approved substance (amendment 42).
- The UK Bill would require a 5-year review report to contain an assessment of the impact on the provision of palliative and end-of-life care services, as well as an assessment on the impact of people with learning disabilities. There is a similar 5-year review provision in the Scottish Bill but currently there is no requirement to include similar assessments. Amendments have been lodged which would require Scottish Ministers to review the availability, quality, and distribution of palliative care services and the implications of the Act on palliative care (amendments 23 and 54).
- The UK Bill’s provisions for England must be implemented within 4 years of the Bill becoming law (up from 2 years previously). Commencement in Wales would be up to Welsh Ministers. The Scottish Bill does not specify a time period in which the legislation should be implemented and this would be specified in regulations by Scottish Ministers.
Other notable stage 2 amendments proposed on the Scottish Bill
Almost 300 amendments have been lodged for stage 2 of the Scottish Bill, many of which are detailed above. Other notable amendments are shown below.
| Other notable proposed stage 2 amendments (amendment numbers are in brackets): The inclusion of a sunset clause (14, 218, 271 and 272). A sunset clause is a provision that sets an automatic expiration date, meaning the law will end at that point unless it is renewed or extended. Requirement for Scottish Ministers to hold a referendum on the provisions of the act no later than 7 November 2028 (259). The creation of a Scottish Commission on Assisted Dying to monitor and review the operation of the act and report to the Scottish Parliament (18 and 19). The creation of an Assisted Dying Review Panel to review whether each assisted death was provided in compliance with the law (200). Creation of an Assisted Dying Safeguards and Oversight Body to review the operation of the legislation, maintain a register of authorised health professionals and investigate concerns (199). A requirement for reports to include information on the health and social care services (including pain management, symptom control and psychological support) discussed with individuals who made a first declaration and whether and to what extent those services were actually provided (21 and 22). A requirement for Scottish Ministers to review the capacity of social care services (258). Creation of a code of practice on the interaction of assisted dying with palliative and end-of-life care services (55). A duty on Ministers to provide information on assisted dying to: terminally ill adults wishing to have an assisted death, health and social care professionals, as well as the general public (44). A requirement for the regulation of assisted dying services provided outwith the NHS (62 and 168). A requirement for each health board to set up a specialist assisted dying service for its area (257). Regulations around the approved substance(s) and reporting when such substances do not have the desired effect (125 and 187). Various proposals for specifying what should be reported in relation to assisted deaths, including complications (e.g. 126 and 188). Giving Ministers powers to establish safe access zones around premises where assistance is provided (127). A right for relatives to request a review of an assisted death where there is concern the person was not eligible (189). Creation of an offence to advertise assisted dying (252). Creation of an offence to disseminate information on the substances used in assisted dying (253). Requirement for Scottish Ministers to review the financial impact of the legislation (260). Creation of an independent information service (197). |
Kathleen Robson, Senior Researcher, Health and Social Care