In depth: Assisted dying and therapy
Thresholds, January 2026

Thresholds January 2026

From an organisational perspective: Â鶹ԭ´´â€™s Third Sector Lead Jeremy Bacon has been following the Bill closely since it was first introduced in Parliament in October 2024. He shares insights he has gained from engaging with parliamentary debate, consulting with members and studying international examples.

As the Terminally Ill Adults (End of Life) Bill progresses through Parliament, the issue of assisted dying is brought into sharp focus for the public, politicians and healthcare professionals. The proposed legislation, introduced to the UK Parliament by Labour MP Kim Leadbeater in October 2024, seeks to allow terminally ill adults in England and Wales, subject to strict safeguards, to request medical assistance to end their own lives. Following a successful second reading and extensive committee scrutiny, the Bill passed its third reading in the House of Commons in June 2025 and progressed to the House of Lords. At the time of writing, the Lords have decided that the Bill should receive further scrutiny by a dedicated select committee before being debated, supporting a motion proposed by Baroness Luciana Berger. 

The Â鶹ԭ´´ Policy team has been keeping a close watch on the Bill and the discussions and debates that have accompanied its progress, as well as the Member’s Bill proposing assisted dying legislation in Scotland, being progressed by Liam McArthur MSP. Â鶹ԭ´´ takes a neutral position on whether there should be a legal right to assisted dying for terminally ill people in the nations of the UK, but recognises that any change to the law is likely to have an impact on the counselling professions. We have spoken to counsellors working in hospice settings about their work and how they expect any changes in law to affect them, and about their interest in improving access to high-quality palliative care, whether or not the law changes. Issues raised in these conversations included: 

• Recognition and treatment of the psychological needs of the person considering assisted dying, and the importance of access to therapy as they consider their choice
• The potential for socioeconomic circumstances to influence a terminally ill person’s choice.
• Additional training and supervision requirements for therapists working with clients who have chosen assisted dying.
• Changes in the support needs of family and friends of people opting for assisted dying. 

Â鶹ԭ´´ is committed to working with its members and expert partners to identify and respond to training and support needs for therapists. We welcome the views and suggestions of members as our internal working group considers the impact of potential law change on counselling and psychotherapy. 

Public opinion polling suggests support for a change in the law to allow assisted dying for terminally ill, competent adults.¹ The national campaigning organisation Dignity in Dying (formerly the Voluntary Euthanasia Society) has long campaigned for a change to the law, calling for legal recognition of the right to a good death for terminally ill, mentally competent adults. It argues that the lack of legal access to assisted dying puts terminally ill people at risk of painful, unsafe and lonely deaths, and highlights the expense and risk of prosecution of relatives and friends of those choosing to travel to Dignitas in Switzerland to end their lives. 

Opposition to law change has come from people whose religious beliefs and faith place the sanctity of life beyond the rule of law; and most stringently from disability rights groups, citing concerns about potential coercion, lack of adequate safeguards and the devaluation of disabled lives. 

Between January and March 2025, the Public Bill Committee held over 30 sittings to scrutinise the Bill, during which more than 500 amendments were considered. A wide range of stakeholders gave evidence, including medical bodies, legal experts, faith groups, patient advocacy organisations and representatives of the palliative care sector. 

A key theme emerging from committee hearings was the inadequacy and inequality of access to palliative and end-of-life care across England and Wales. Several health and hospice organisations emphasised that while assisted dying may offer choice to some, it must not become a substitute for investment in high-quality palliative care for all. 

Among the organisations providing evidence were: 

• Hospice UK who cited workforce shortages, uneven funding and a lack of integrated services as persistent barriers to consistent, quality care at the end of life. They stressed that any legislative change must be accompanied by commitments to improve palliative care infrastructure.
• The Royal College of Physicians (RCP) who noted that many people face unmanaged pain and distress due to delayed referrals or limited availability of palliative care teams. They also called for clearer care pathways and more training for healthcare professionals.
• The British Medical Association (BMA) who pointed out that while the Bill’s focus is on patient autonomy, broader systemic failings – particularly for those with non-cancer diagnoses or complex conditions – must not be overlooked. 

Additionally, submissions from regional hospice providers and community nursing organisations drew attention to significant disparities in care access depending on geography, ethnicity and socioeconomic status. 

In its 2024 report, Marie Curie described access to palliative care as a ‘postcode lottery’.² The same report found that fewer than 30% of people who died in England and Wales in 2022 had contact in the last three months of their life with a palliative care doctor, nurse or ‘hospice at home’ team, and that only approximately 2% had contact with a psychologist or counsellor. 

Early access to palliative care services can improve survival, as well as symptom control and quality of life.³ Â鶹ԭ´´ believes that fully commissioned statutory access to high-quality, culturally relevant palliative care that includes psychological support is an essential safeguard that must precede any enactment of a change in the law. The need for this change is demonstrated by the inequalities in access to hospice care with patients without cancer, the oldest old, ethnic minorities and those living in rural or deprived areas being under-represented in hospice populations.^4Ìý

Although the Bill includes a four-year implementation period to ensure readiness, many witnesses to the committee scrutinising the Bill urged that assisted dying legislation should not proceed without parallel investment in palliative care. Some MPs on the committee expressed concern that legalising assisted dying could shift attention and resources away from essential end-of-life care improvements – a claim strongly refuted by supporters of the Bill, who argued that both can and must progress in tandem. 

This debate has sharpened the spotlight on the broader state of end-of-life care in the UK. While assisted dying continues its path through Parliament, these hearings have reinforced the message that meaningful choice at the end of life is only possible if robust and equitable palliative care is universally accessible. 

From a therapist’s perspective 

Psychotherapist Kamalyn Kaur has worked with clients who are at the end of their life and have explored their position on assisted dying in therapy. Here she answers some of the main questions that may arise when working in this area. 

What does this mean for me in my work as a practitioner? 

It means the therapy space could now include conversations that touch the very edge of life. As a therapist, particularly one trained in CBT, I might find myself moving beyond cognitive restructuring or behavioural activation into territory that feels deeply existential – grappling with questions of dignity, control, meaning and suffering. 

This work asks me to be more than a technician of tools; it asks me to be a steady presence when someone is considering death not as a symptom, but as a choice. That can feel heavy. It might stir my own discomfort with mortality or with the limits of what therapy can ‘solve’. However, it also invites me to be truly human with someone in their most vulnerable, honest state. 

What ethical, moral or spiritual questions might emerge out of this? 

I might start to ask myself: What do I believe about life and death? Is it ever OK to want to die? What if I believe every life has value, even in suffering, but my client sees it differently? 

As a therapist, I may feel caught between my ethical duty to support client autonomy and a deep, internal sense of moral conflict – especially if I hold spiritual or religious beliefs. Then, this work may surface profound tensions. I might worry: Am I enabling death, or bearing witness to someone’s agency? These will no longer be abstract philosophical questions. Instead, they will be in the room, in real time. I’ll need to explore them, not suppress them.

How might this change the dynamics of a therapy session? 

For me, I may notice a shift in both the physical and therapeutic dynamic. Suddenly, the air in the room may feel different – more emotionally charged. Time slows. Words feel more loaded. There’s a gravity that demands presence – not fixing, not quick interventions, but a capacity to sit with what’s raw and unresolvable. 

As a CBT therapist, I might feel momentarily out of my depth – so used to guiding clients towards coping and change, I may now find the ‘solution’ to be letting go. This might challenge my own sense of usefulness or control in the therapy process. Sessions could become slower and require deeper attunement rather than problem-solving. 

As a practitioner, what do I need to be equipped to work with this in the future? 

I need more than professional knowledge – I need emotional resilience and reflective capacity. Of course, I’ll need to understand the legal framework and my ethical responsibilities, but I’ll also need support for myself. Supervision, peer spaces and time for personal reflection will be crucial. 

Working in this area means I may carry a different kind of emotional weight. I might feel sadness, uncertainty or grief – even fear. I’ll need spaces where I can unpack those responses, without shame. I may also need to deepen my skills in grief work, existential therapy or palliative care, to feel truly equipped for these moments. 

How do I explore my own perspectives and subconscious biases around this? 

I can start by asking: What messages did I grow up with about death, control and suffering? Maybe I was raised to see death as failure, suffering or something to be endured. Maybe I carry a subconscious belief that wanting to die means something is broken. Or perhaps I internalised the idea that agency over your own death is the ultimate expression of autonomy – that choosing to die with dignity is inherently brave or enlightened. I might carry a subconscious belief that wanting to die is always a rational, empowered choice. 

In any case, if I don’t examine these internal narratives – whether they lean towards resistance or support – I risk projecting them onto my client, subtly guiding the conversation based on my values instead of holding space for theirs. 

This reflection might bring up guilt, discomfort or even resistance – and that’s OK. The goal isn’t to erase my biases, but to name them, hold them gently and understand how they might affect my work. This is where personal therapy, self-exploration or deep supervision becomes essential. 

What happens if I don’t want to work with clients facing this dilemma? 

That’s a valid and human response. Not all of us are equipped, emotionally or ethically, to hold space for this kind of conversation. However, a point to consider is that if I choose to avoid this work altogether out of fear or discomfort, I risk abandoning clients in one of their most profound times of need. 

Bearing that in mind, I have to ask myself: Is this a hard ‘no’ based on a clear boundary – or a growth edge I can lean into with support? If it’s the former, I have an ethical duty to refer responsibly. If it’s the latter, I owe it to myself – and my clients – to seek the support I need to expand my capacity. 

What happens if this goes against my personal spiritual or religious beliefs or worldview? 

This is where things can get tender. If my personal faith or worldview sees assisted dying as wrong or morally unacceptable, that doesn’t just stay outside the therapy room. It lives in my body, my tone, my hesitations. Clients will feel it even if I don’t say it outright. 

In this instance, the work becomes: Can I separate my beliefs from my professional role? Can I offer unconditional positive regard to someone making a choice I wouldn’t – or can’t – make? And if not, how do I name that limitation without judgment and refer ethically, rather than subtly withdrawing my empathy or presence? 

How do I know what the ‘right’ thing to say is? What if what I say gets misinterpreted? 

The truth is there might not be a ‘right’ thing to say. There’s just what feels most grounded in compassion, respect and care in that moment. I might second-guess myself. I might worry that a supportive comment could be taken as permission – or that curiosity could be seen as judgment. 

This uncertainty can be unnerving. It brings up fears of saying the wrong thing, or of not being enough. In those moments, I can remind myself that showing up with humility and openness matters more than getting it perfectly right. I can always repair. I can always ask, ‘How did that land for you?’ or ‘How do you feel about this?’ 

How do I deal with the responsibility of supporting someone given the absolute nature of this? 

This is one of the hardest parts. Knowing that this choice, once acted on, cannot be reversed can feel like an enormous emotional weight. I might fear saying too much – or not enough. I might feel a sense of helplessness or a deep wish to protect; yet this isn’t about me controlling the outcome. It’s about me staying present while someone else decides what peace looks like for them. 

This level of emotional exposure requires deep support. I might grieve with and for my clients. I might carry stories that don’t leave when the session ends. I need to make space for my own emotional processing; otherwise, the burden of bearing witness can become overwhelming. 

How do I work in the context of the client’s wider family and community systems? 

It’s rarely just about the individual. There may be complex dynamics at play – family members who disagree, communities who hold strong moral positions, relational wounds that resurface in the face of death. As a therapist, I may be asked to help clients prepare for difficult conversations or hold the emotional fallout of estrangement or guilt. 

I might carry some of that too – wondering how families will cope or whether I should have done more to repair those bonds. However, my role is to support the client in navigating those systems on their own terms, not to fix or mediate. Still, I can hold space for the relational grief that so often comes when endings arrive before repair or resolution – when apologies aren’t spoken, forgiveness isn’t reached or connections feel unfinished. Death rarely ties everything up neatly and part of my work may be to help clients (and sometimes families) acknowledge that reality with compassion, rather than trying to erase it.