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Beyond the ‘Licence to Kill’ Headlines: Assisted Dying and MSK Practice
When was the last time you held a conversation with a colleague or patient about assisted dying? Never? You’re not alone — and that’s precisely why I’m writing this article. If a patient were to bring it up tomorrow, would you know how to respond, or even what the law currently says?
As I write this, on 23rd September 2025, the Terminally Ill Adults (End of Life) Bill has just completed its second reading in the House of Lords. It is now one step closer to becoming law in England and Wales.
If passed, this legislation would permit terminally ill adults — those with a prognosis of less than six months to live — to seek medical assistance to end their life.
For many, this represents a compassionate choice and an act of autonomy at the end of life. For others, it is deeply troubling. One newspaper branded it a ‘licence to kill’. Another commentator countered, “Let’s be clear — people who choose assisted dying are not suicidal. They are dying, and they want to regain some control.”
This isn’t an article for or against the Bill. Rather, it’s an invitation for MSK clinicians to understand what this legislation means, and why it might soon become part of the conversations we have with our patients.
It’s also worth noting that assisted dying will only become law if both the House of Commons and the House of Lords agree on the final text. If that happens, the government will have four years to design and implement the service.
What the Bill Proposes
In its current form, the Bill would allow adults aged 18 and over, who are mentally competent and terminally ill (with a life expectancy of six months or less), to request medical assistance to end their life.
Built into the Bill are several safeguards:
* Two independent doctors must confirm the person’s diagnosis, prognosis, and decision-making capacity.
* The person must make two written declarations of intent, witnessed and signed.
* A minimum reflection period (typically 14 days) must elapse between the declarations.
* Healthcare professionals retain the right to conscientiously object.
* All cases would be subject to oversight and review, ensuring decisions are free from coercion or abuse.
At present, the Bill is at the discussion stage but its momentum in Parliament and the intensity of public debate make it something clinicians can’t ignore. [1,2]
Why MSK Clinicians Should Care
You might be wondering why this has anything to do with musculoskeletal practice.After all, we don’t manage terminal diagnoses or prescribe medication. But our patients live within broader stories than the pain that brings them to us. Many will be living with, or alongside someone living with, terminal illness.
Crucially, MSK clinicians often occupy a trusted space in a patient’s healthcare journey. People may disclose feelings or questions about assisted dying during treatment, perhaps before ever voicing them to their GP or palliative care team.
Being able to listen without judgement, respond appropriately, and know where your professional boundaries lie will be vital if this Bill becomes law.
Conversations You Don’t Expect
A patient raising assisted dying might catch you completely off guard. It’s not part of typical clinical education. But how you handle it matters.
The correct response isn’t to advise or to share your personal view, it’s to acknowledge, listen, and signpost. Let the patient know you’ve heard them, avoid making assumptions, and refer back to their GP or specialist team who are equipped to explore such discussions safely and legally.
You will have hopefully realised that this is not so different from our everyday person-centred care: recognising the person behind the condition, holding space for them to be heard, air their thoughts, and knowing when to seek support from others in the multidisciplinary team.
Recognising Vulnerability
Much of the opposition to the Bill revolves around coercion - the fear that vulnerable individuals might feel pressured into choosing assisted dying. As someone who specialises in supporting people with lifelong disabilities, this point has been high on people’s agenda.
That pressure need not be overt, it can be subtle: a sense of being a burden, financial worry, or emotional exhaustion. Because MSK clinicians often see patients regularly, sometimes over months, we are well placed to notice changes in psychological state, behaviour, or motivation.
If assisted dying becomes legal, these observations take on new significance. Recognising and acting on vulnerability will become even more central to safeguarding practice. [3]
Understanding Your Limits
It’s also crucial to be clear about what isn’t our role. The Bill hinges on a six-month prognosis, something notoriously hard to predict even for experienced physicians.MSK clinicians are not responsible for making or validating such judgements.
Our remit remains focused on function, comfort, and communication, ensuring our interventions and observations support the broader healthcare picture while staying firmly within our scope of practice.
If a patient raises assisted dying, record the interaction factually and without interpretation.Note what was said, how you responded, and what onward referrals or signposting were made. Avoid including your own opinions or assumptions.
Clear documentation protects both the patient and you as a professional, and it provides continuity of care for other members of the healthcare team.
The Ethical Divide
The arguments surrounding assisted dying are emotionally and ethically charged.
Supporters view it as an issue of autonomy, a right to choose the timing and manner of one’s death, especially in cases of uncontrollable suffering. They argue it restores dignity, reduces prolonged distress, and provides clarity for families and clinicians.
Some opponents are vehemently against assisted dying in all forms. Others worry about slippery slopes; that what begins as a choice for the terminally ill could expand to include those with chronic illness, disability, or psychological distress. Others highlight the difficulty of accurate prognoses and the potential emotional burden on healthcare professionals involved. [4–6]
Neither stance is ours to champion as clinicians. But both shape the environment in which we practice, one where patients’ questions, fears, and choices may soon take new forms.
Preparing for Change
If the Bill passes, change will come gradually but inevitably.While MSK clinicians are unlikely to play a direct role in assisted dying procedures, we will increasingly encounter patients and colleagues grappling with its ethical and emotional implications.
Some ways to prepare include:
* Keeping up to date with guidance from your professional body.
* Reflecting on your own boundaries, beliefs, and comfort levels.
* Building strong links with palliative care and primary care teams.
* Seeking supervision or peer support when facing difficult conversations.
This isn’t about advocacy; it’s about readiness. Our role, as ever, is to support patients with respect, clarity, and compassion, wherever their journey takes them.
Conclusion
Assisted dying is one of the most profound questions modern healthcare faces.As MSK clinicians, we may not sign the forms or certify the diagnoses, but we are part of the healthcare web that surrounds each individual confronting the end of life.
Being informed and not indifferent is how we continue to uphold professional integrity, compassion, and patient trust in the years ahead.
References
* Parliament UK. Terminally Ill Adults (End of Life) Bill. Available at: https://bills.parliament.uk/bills/3774 (Accessed September 2025).
* CMS LawNow. A licence to kill? The Assisted Dying Bill passes its second reading in the House of Lords. 2025.
* Academic OUP. Safeguarding and Assisted Dying: Protecting Autonomy and Preventing Coercion. 2024.
* Brabners. Legal Implications of the Assisted Dying Bill for Healthcare Professionals Explained. 2025.
* British Medical Association. Physician Assisted Dying: Guidance for Clinicians. 2024.
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit mskmag.substack.com/subscribe
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By Physio MattersWhen was the last time you held a conversation with a colleague or patient about assisted dying? Never? You’re not alone — and that’s precisely why I’m writing this article. If a patient were to bring it up tomorrow, would you know how to respond, or even what the law currently says?
As I write this, on 23rd September 2025, the Terminally Ill Adults (End of Life) Bill has just completed its second reading in the House of Lords. It is now one step closer to becoming law in England and Wales.
If passed, this legislation would permit terminally ill adults — those with a prognosis of less than six months to live — to seek medical assistance to end their life.
For many, this represents a compassionate choice and an act of autonomy at the end of life. For others, it is deeply troubling. One newspaper branded it a ‘licence to kill’. Another commentator countered, “Let’s be clear — people who choose assisted dying are not suicidal. They are dying, and they want to regain some control.”
This isn’t an article for or against the Bill. Rather, it’s an invitation for MSK clinicians to understand what this legislation means, and why it might soon become part of the conversations we have with our patients.
It’s also worth noting that assisted dying will only become law if both the House of Commons and the House of Lords agree on the final text. If that happens, the government will have four years to design and implement the service.
What the Bill Proposes
In its current form, the Bill would allow adults aged 18 and over, who are mentally competent and terminally ill (with a life expectancy of six months or less), to request medical assistance to end their life.
Built into the Bill are several safeguards:
* Two independent doctors must confirm the person’s diagnosis, prognosis, and decision-making capacity.
* The person must make two written declarations of intent, witnessed and signed.
* A minimum reflection period (typically 14 days) must elapse between the declarations.
* Healthcare professionals retain the right to conscientiously object.
* All cases would be subject to oversight and review, ensuring decisions are free from coercion or abuse.
At present, the Bill is at the discussion stage but its momentum in Parliament and the intensity of public debate make it something clinicians can’t ignore. [1,2]
Why MSK Clinicians Should Care
You might be wondering why this has anything to do with musculoskeletal practice.After all, we don’t manage terminal diagnoses or prescribe medication. But our patients live within broader stories than the pain that brings them to us. Many will be living with, or alongside someone living with, terminal illness.
Crucially, MSK clinicians often occupy a trusted space in a patient’s healthcare journey. People may disclose feelings or questions about assisted dying during treatment, perhaps before ever voicing them to their GP or palliative care team.
Being able to listen without judgement, respond appropriately, and know where your professional boundaries lie will be vital if this Bill becomes law.
Conversations You Don’t Expect
A patient raising assisted dying might catch you completely off guard. It’s not part of typical clinical education. But how you handle it matters.
The correct response isn’t to advise or to share your personal view, it’s to acknowledge, listen, and signpost. Let the patient know you’ve heard them, avoid making assumptions, and refer back to their GP or specialist team who are equipped to explore such discussions safely and legally.
You will have hopefully realised that this is not so different from our everyday person-centred care: recognising the person behind the condition, holding space for them to be heard, air their thoughts, and knowing when to seek support from others in the multidisciplinary team.
Recognising Vulnerability
Much of the opposition to the Bill revolves around coercion - the fear that vulnerable individuals might feel pressured into choosing assisted dying. As someone who specialises in supporting people with lifelong disabilities, this point has been high on people’s agenda.
That pressure need not be overt, it can be subtle: a sense of being a burden, financial worry, or emotional exhaustion. Because MSK clinicians often see patients regularly, sometimes over months, we are well placed to notice changes in psychological state, behaviour, or motivation.
If assisted dying becomes legal, these observations take on new significance. Recognising and acting on vulnerability will become even more central to safeguarding practice. [3]
Understanding Your Limits
It’s also crucial to be clear about what isn’t our role. The Bill hinges on a six-month prognosis, something notoriously hard to predict even for experienced physicians.MSK clinicians are not responsible for making or validating such judgements.
Our remit remains focused on function, comfort, and communication, ensuring our interventions and observations support the broader healthcare picture while staying firmly within our scope of practice.
If a patient raises assisted dying, record the interaction factually and without interpretation.Note what was said, how you responded, and what onward referrals or signposting were made. Avoid including your own opinions or assumptions.
Clear documentation protects both the patient and you as a professional, and it provides continuity of care for other members of the healthcare team.
The Ethical Divide
The arguments surrounding assisted dying are emotionally and ethically charged.
Supporters view it as an issue of autonomy, a right to choose the timing and manner of one’s death, especially in cases of uncontrollable suffering. They argue it restores dignity, reduces prolonged distress, and provides clarity for families and clinicians.
Some opponents are vehemently against assisted dying in all forms. Others worry about slippery slopes; that what begins as a choice for the terminally ill could expand to include those with chronic illness, disability, or psychological distress. Others highlight the difficulty of accurate prognoses and the potential emotional burden on healthcare professionals involved. [4–6]
Neither stance is ours to champion as clinicians. But both shape the environment in which we practice, one where patients’ questions, fears, and choices may soon take new forms.
Preparing for Change
If the Bill passes, change will come gradually but inevitably.While MSK clinicians are unlikely to play a direct role in assisted dying procedures, we will increasingly encounter patients and colleagues grappling with its ethical and emotional implications.
Some ways to prepare include:
* Keeping up to date with guidance from your professional body.
* Reflecting on your own boundaries, beliefs, and comfort levels.
* Building strong links with palliative care and primary care teams.
* Seeking supervision or peer support when facing difficult conversations.
This isn’t about advocacy; it’s about readiness. Our role, as ever, is to support patients with respect, clarity, and compassion, wherever their journey takes them.
Conclusion
Assisted dying is one of the most profound questions modern healthcare faces.As MSK clinicians, we may not sign the forms or certify the diagnoses, but we are part of the healthcare web that surrounds each individual confronting the end of life.
Being informed and not indifferent is how we continue to uphold professional integrity, compassion, and patient trust in the years ahead.
References
* Parliament UK. Terminally Ill Adults (End of Life) Bill. Available at: https://bills.parliament.uk/bills/3774 (Accessed September 2025).
* CMS LawNow. A licence to kill? The Assisted Dying Bill passes its second reading in the House of Lords. 2025.
* Academic OUP. Safeguarding and Assisted Dying: Protecting Autonomy and Preventing Coercion. 2024.
* Brabners. Legal Implications of the Assisted Dying Bill for Healthcare Professionals Explained. 2025.
* British Medical Association. Physician Assisted Dying: Guidance for Clinicians. 2024.
This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit mskmag.substack.com/subscribe