Assisted dying and the difficulties of predicting end of life

The private member’s bill on assisted dying for terminally ill adults in England and Wales is now in committee stage, being scrutinised and amended by MPs.1 The fact that this bill applies only to people “reasonably expected to die within six months,” is proposed as a central safeguard. A similar six month prognostic criterion is included in legislation in Australia, New Zealand, and several US states, extended to 12 months for neurodegenerative diseases in some jurisdictions. However, the challenges of prognostication in relation to eligibility for assisted dying remain underexplored. Prognostic eligibility criteria are limited by the fact that prognosis is inherently uncertain and there are no valid tools, tests, or clinical examinations that can reliably and safely identify that a person is expected to die within six months.2

Clarity about what is meant by “reasonably be expected to die within six months” is vital so that clinicians can understand the intended beneficiaries of the bill. It could mean that on the balance of probabilities the patient is expected to die within six months, but the word …