Assisted Dying and a role for the Coroner?

There is a risk in the Parliamentary debate over the Leadbeater Bill, that some voices are heard more loudly in the media than others. There has been a huge debate with respect to anorexia nervosa repeatedly, yet limited discussion on, say, the role of the coroner.

The latest in the Times prior to tomorrows Parliamentary debate.

There have been repeated concerns from the eating disorders community that the Leadbeater Bill has an ‘anorexia loophole’, and as currently drafted, the Bill could allow people with eating disorders- not because of a psychiatric diagnosis, but because of the physical deterioration caused by illness.

Well- meaning though these interventions are, they appear to be based both on a misunderstanding of the Bill and the Court of Protection. In addition, there is a huge controversy in the eating disorders community over a label by some of ‘terminal anorexia’ which was used in one academic journal (indeed, some, correctly are trying to have this paper withdrawn).

I am not an eating disorders psychiatrist, I am a neurologist who is written previously on the ethics of hunger- striking, but there is a real danger by repeating this debate over a highly controversial area, we end up missing the ‘big picture’ over the Leadbeater Bill.

The proposed legislation is ONLY for those who have mental capacity. The natural history of starvation, certainly in a hunger striking context, is to lead to a condition called Wernickes’ encephalopathy- a form of dementia sometimes seen in alcoholics. There absolutely is a loss of mental capacity, so the Leadbeater Bill will not be relevant.

However, one the voices that has not been heard so well is that of pathologists.

This week, the Royal College of Pathologists issued what I feel is a very helpful statement, which I quote in full, as it is short and also I think their voice is one that has perhaps not been heard as loudly as it should (and there has been a incredible tendency for media spin on some Royal College statements)

How the Daily Telegraph initially ran the story- when what the RCPath actually said was no such thing!

The full statement from the RCPath:

10 JUNE 2025

The Royal College of Pathologists has no position on the ethical issues relating to assisted dying. It recognises that members hold a range of views.

The College does, however, have an opinion on the Bill as currently proposed. In particular, the College cannot support clause 35 as drafted in the current version of the Bill. This states that death following assisted dying will not require notification to the coroner, purely because death was assisted. By default, this means that all assisted dying deaths would be scrutinised by a medical examiner, as all non-coronial deaths in England and Wales must be. The opinion of the Royal College of Pathologists – the lead college for medical examiners – is that deaths following assisted dying should be notified to the coroner, just as other deaths following the administration of drugs, prescribed or not, must be.

The College’s concerns relate only to the involvement of medical examiners after an assisted death has taken place. As part of their scrutiny, medical examiners would need to review the process leading up to the decision to authorise an assisted death and the circumstances of the assisted death, which they are not qualified to do. They would also be required to speak to the bereaved family, who may not have been aware of the application for an assisted death until after the individual’s death.

Notification to the coroner following an assisted death would ensure independent judicial review, which is particularly important given the concerns raised by many individuals, organisations and medical royal colleges about the lack of adequate safeguards in the Bill for vulnerable people. Lawyers, not doctors, are the most appropriate professionals to review these deaths. The medical examiner system was implemented to detect problems with medical care, not to identify discrepancies or malintent in the legal process required for assisted deaths. The training and resourcing for medical examiners to take on this new role would be significant, potentially taking medical examiners away from their current important role. Coronial referral for assisted deaths would be in line with current regulations, with all deaths due to a medical intervention or medicinal product being notified.

Dr Suzy Lishman CBE

Senior Advisor on Medical Examiners

I think this is a helpful intervention, and I agree with it. Previously when I have had questions regarding a suspicious death, I have found coroners extremely helpful especially in legally contentious situations.

Lets consider a hypothetical situation.

A rogue psychiatrist diagnoses Patient X with ‘terminal anorexia’, the patient manages to convince the assisted dying panel (which includes a doctor and social worker) that they have mental capacity. They do not tell their family and they pursue an assisted death. I accept that each of these aspects are questionable, but we need to consider this as a possibility.

After Patient X’s death, her family are appalled. A coroner’s inquest would enable independent judicial review precisely along the lines that Dr Lishman has stated, increase public confidence, and also assist on identifying any rogue medical opinions and deficiencies in the assisted dying process.

I hope that Parliamentarians will consider the RCPath view seriously on clause 35 as this would improve the legislation.

Likewise I hope Parliamentarians will consider Tom Gordon’s amendment on Motor Neurone Disease (MND)- as Ive written previously- a 6 month time limit for neurological conditions like MND is just too restrictive, 12 months is more realistic. Given that around 15% of assisted deaths in Australia are from MND or related disorders this seems a not unreasonable request.