Experts are divided over six-month safeguard for assisted dying
Some healthcare professionals question the ‘six-month rule’ for proposed assisted dying laws (Alamy)
4 min read
As assisted dying legislation continues to be debated in Parliament, palliative care experts are divided on whether limiting it to those with a prognosis of six months or fewer would be an effective safeguard.
As debates continue around the Terminally Ill Adults (End of Life) Bill, with Report Stage scheduled for 16 May 2025, safeguarding remains central. If passed, the Bill would allow doctors to provide terminally ill patients with lethal substances to self-administer.
Recent evidence from the Nuffield Council on Bioethics (NCOB) shows that public support for legalising assisted dying in England increases when there is confidence that sufficient safeguards are in place.
A key safeguard proposed is the ‘six-month rule’, limiting access to those with terminal illness and a prognosis of six months or fewer. The NCOB found 70 per cent of people support this time frame, compared to 64 per cent who support access for those with up to 12 months to live.
Yet, many healthcare professionals question this rule. This article explores the views on both sides.
A law built on shaky foundations is more likely to slip
Professor Katherine Sleeman, Laing Galazka Chair in Palliative Care at King’s College London and Honorary Consultant in Palliative Medicine
As a doctor who looks after terminally ill people, I am unconvinced that this so-called safeguard actually makes the proposed law safer.
First, prognosis is highly uncertain. Data from around 6,500 prognosis estimations found doctors were accurate about someone dying within six or twelve months only 46 per cent of the time. That’s toss-a-coin territory.
Second, the six-month timeframe is arbitrary. There’s nothing especially meaningful about six months—it could easily be four or eight. A law built on shaky foundations is more likely to slip.
Most concerning, though, is that the rule is inherently discriminatory. It excludes people who may suffer longer simply because they are expected to live longer.
So why include it? The NCOB’s surveys suggest people are less comfortable with assisted dying for those with longer prognoses. If so, the rule may be more of a campaigning tactic than a genuine safeguard.
Calling it a safeguard may feel reassuring. But it implies that those with shorter prognoses are less vulnerable—and require less protection—than people expected to live longer. Clinically, that doesn’t hold true.
Even now, some campaigners are calling for assisted dying to be available to anyone, regardless of prognosis. This is, arguably, a more honest stance. After all, if assisted dying is a good thing, why restrict it based on arbitrary timeframes?
In my view, the six-month rule makes the law more palatable—it doesn’t make it more safe.
Reliable prognosis already underpins practice and policy
Professor Sam Ahmedzai, Emeritus Professor at the University of Sheffield and retired consultant in palliative medicine
Prognosis in terminal illness isn’t like setting a due date in maternity care. Terminally ill patients don’t expect precision — they want a guide.
Some professionals say prognosis is too imprecise to rely on, but this doesn’t reflect how clinical decisions are made. From drug access to palliative care referrals, prognosis underpins practice and policy.
Cancer, the most common condition in assisted dying cases, is also the one with the most robust data. Thousands of studies have produced survival tables, algorithms and scores. While these can’t give a specific date, they can say if someone is more or less likely to live three, six, or twelve months. The shorter the estimate, the more reliable.
Could the prognosis be shorter? In theory, yes — but in practice, it might come too late for the patient to organise a peaceful death. Delay can mean unnecessary suffering, loss of dignity and independence.
If this Bill becomes law, we must take advice from researchers and clinicians on which prognostic tools to use. Being both, I’d expect two doctors to give their prognosis independently—and show their reasoning.
Should someone outlive their prognosis, no one will force them to take the medication. But the prognosis should be reviewed every two to three months—standard clinical practice.
