“I’ve got a terminal diagnosis and I want help to end my life when the time comes — will you help me, doctor?”

A direct request for assisted dying from a terminally ill patient is a profound ethics/palliative consultation. Respond with COMPASSION and without judgement or alarm — a brisk refusal or moralising shuts the patient down. The heart of the consultation is EXPLORING what lies behind the request, which is often a cry for help or driven by treatable factors: fear of future suffering/pain, loss of dignity/control, fear of being a burden, current uncontrolled symptoms, depression/hopelessness, and existential/spiritual distress. Be HONEST and clear that in England and Wales encouraging or assisting suicide remains a criminal offence under section 2 of the Suicide Act 1961 (DPP policy 2010, updated 2014: acting as a doctor with the person in your care favours prosecution); the Terminally Ill Adults (End of Life) Bill 2026–27 was defeated at Commons second reading on 11 September 2026 by 286 votes to 270 (Politics.co.uk, 11 September 2026), so as of October 2026 the law is unchanged — check the current legal position, and a doctor cannot lawfully assist a patient to end their life and must not act on, assist or encourage it (GMC: listen, discuss the reasons, limit information to explaining that it is an offence) — delivered gently and factually, framed within continuing care rather than as a rejection of the person. Crucially, do NOT abandon the patient: reassure that you will keep caring for him and make the explicit promise that you will do everything to keep him comfortable and not leave him to suffer, which directly addresses the fear driving many such requests. Address the modifiable drivers — optimise symptom control and involve palliative/specialist care, screen and treat depression, offer psychological/spiritual support, undertake advance care planning (wishes about future treatment, ceiling of care, DNACPR/ReSPECT, preferred place of care/death) — explain the lawful choices (refusing any treatment, an advance decision to refuse treatment under the Mental Capacity Act 2005, proportionate symptom relief), and assess risk (suicidality/immediate plans, means including stockpiled medicines, without risk scores per NICE NG225), capacity and coercion, discussing with the palliative team or a senior colleague and keeping his disclosure confidential within the care team with his agreement. The skill is compassionate exploration, an honest legal position, non-abandonment, and addressing the underlying distress — not a moralising refusal or a false promise. Legal position, as of October 2026: encouraging or assisting suicide remains a criminal offence in England and Wales (Suicide Act 1961, s2) and in Northern Ireland (Criminal Justice Act (Northern Ireland) 1966, s13). The Terminally Ill Adults (End of Life) Bill 2026–27 was defeated at Commons second reading on 11 September 2026 by 286 votes to 270 (Politics.co.uk, 11 September 2026: https://www.politics.co.uk/news/2026/09/11/how-every-mp-voted-on-the-assisted-dying-bill-in-commons-return/). The law differs elsewhere: in Scotland there is no specific statutory offence of assisting suicide, but assisting can be prosecuted under the common law, and the Scottish Parliament rejected the Assisted Dying for Terminally Ill Adults (Scotland) Bill on 17 March 2026 (ITV News, 17 March 2026: https://www.itv.com/news/2026-03-17/scottish-parliament-rejects-assisted-dying-bill); Jersey’s assisted dying law was reported to have received Royal Assent in July 2026, and the Isle of Man’s Assisted Dying Bill, passed by Tynwald, was still awaiting Royal Assent in mid-2026 — neither applies to a patient living in England. Always check the current legal position before discussing it with a patient.