Assisted Dying: What It Could Mean for the NHS Workforce

The debate over assisted dying in the UK has reached another pivotal moment. Legislation is currently before Westminster and Holyrood, with campaigners arguing it’s time to align the law with public opinion. Yet a new report from the Nuffield Trust serves as a sober reminder that, if legalised, assisted dying would present not just ethical dilemmas but also practical and logistical challenges for the NHS and wider care system.

The think tank’s analysis of nine countries where assisted dying has already been introduced highlights a recurring theme: policymakers tend to underestimate the infrastructure, funding, and workforce requirements needed to deliver such a service safely. For the UK—where even core NHS functions are straining under record demand—the warning could not be clearer.

Beyond Ethics: The Practical Realities

Public debate around assisted dying has largely been framed by morality, autonomy, and fears of a “slippery slope”. These questions matter. But as the Nuffield Trust stresses, the harder problem may prove to be much more mundane: how to make it work in practice.

Countries that have legalised assisted dying have often struggled with delays, inequities in access, and inadequate regulation. The report warns that the UK could face the same pitfalls unless policymakers prepare with significant lead-in time, robust regulation, and, critically, dedicated funding. Without this, assisted dying risks becoming “yet another service people struggle to access”—a grim irony given that the reform is meant to provide choice and dignity.

The NHS Capacity Problem

The central challenge is capacity. Assisted dying is not simply a matter of passing a law. It requires trained professionals, clear processes, and reliable oversight. All of this would place further pressure on the NHS, hospices, and social care services—sectors already stretched to breaking point.

Palliative care remains underfunded and patchy across the UK, with hospices often reliant on charitable donations to keep their doors open. Social care is chronically understaffed, with vacancy rates persistently high. Asking these services to take on the additional burden of assisted dying, without substantial investment, risks creating a two-tier system where access depends on geography, resources, or workforce availability.

Training, Regulation, and Opt-Outs

The report makes a series of pragmatic recommendations. Healthcare professionals would need dedicated training—not just doctors, but nurses and social care staff too. Regulation must be watertight, both to prevent misuse and to ensure those eligible can actually access the service.

Equally important is the right for staff to opt out. Assisted dying raises profound personal and professional questions. The system must allow clinicians to conscientiously object without fear of penalty, while still ensuring patients’ choices are respected. Balancing these rights will not be simple.

Devolution and Inequalities

The UK has a devolved system of government, where Scotland, Wales, and Northern Ireland have their own legislatures with powers over health policy. This allows them to make different decisions on funding, service structure, and the approval of medicines than those made in England. This divergence can lead to differences in the availability of treatments. For instance, the drug Orkambi for cystic fibrosis was available on the NHS in Scotland before it was approved in England.

The Canadian healthcare system operates under a similar model, where provinces manage healthcare delivery. This has resulted in measurable variations in coverage for pharmaceuticals and other services between provinces.

The independent health policy think tank, the Nuffield Trust, has published analyses highlighting the potential for such divergence to create inequalities in the UK and has recommended coordinated planning to address it.

Furthermore, the recommendation to collect data on ethnicity, gender, and regional variation is vital. Health inequalities already pervade the NHS, and assisted dying must not exacerbate them. Evidence from other countries suggests that marginalised groups may face disproportionate barriers in accessing end-of-life care. The UK must learn from those mistakes.

Voices for and Against

Reactions to the report highlight the polarised nature of the debate. Advocates such as Dignity in Dying point to strong public support—three-quarters of the population back reform, according to recent polling. For them, the priority is ensuring a safe, compassionate law that gives terminally ill people more control.

Opponents, such as Care Not Killing, argue that the very existence of such a law is dangerous, and that attention should instead be focused on fixing palliative and social care. Their concern is that legalising assisted dying risks undermining the moral and financial case for investing in end-of-life services.

What This Means for the NHS

The NHS is already dealing with unprecedented pressures: long waiting lists, workforce shortages, and a social care system in perpetual crisis. Introducing assisted dying will not be simple. It is not just about offering a new choice at the end of life; it is about embedding that choice into a health system struggling with the basics.

If parliament does legalise assisted dying, it cannot be done on the cheap. Dedicated funding, workforce planning, regulation, and equity must be non-negotiable. Otherwise, the promise of a compassionate option risks being undermined by the very system meant to deliver it.

Conclusion

The UK is closer than ever to a historic change in how society approaches death and dying. But the Nuffield Trust’s warning is timely. Assisted dying cannot be treated as a bolt-on policy. It will demand serious planning, political honesty, and sustained investment.

Without this groundwork, the NHS risks stumbling into a reform that could deepen inequalities, strain already fragile services, and fail the very people it is meant to help.