16th June 2025

We, the undersigned ethnic minority healthcare organisations representing thousands of members collectively, wish to express our united concerns regarding the Terminally Ill Adults (End of Life) Bill and its potential to disproportionately disadvantage racially and ethnically minoritised communities. We urge that this Bill be reconsidered with greater scrutiny, consultation, and cultural sensitivity to ensure it does not exacerbate existing health inequalities.

Signatory Organisations:

• Dr. Nadeem Raja, President, Association of Pakistani Physicians of Northern Europe
• Dr. Sahira Dar, President, British Islamic Medical Association
• Dr. Shahid Latif, Chair, British Pakistani Psychiatrist Association
• Elizabeth Pearson, Lead, Diaspora Uganda Nurses & Midwives Society
• Dr. Hina J Shahid, Chairperson, Muslim Doctor Association & Allied Health Professionals
• Dr. Emaad Alauddin, President, Muslim Doctors Cymru
• Yusra Choury, Fatma Habib, Naveed Sharif, Co-chairs National NHS Muslim Network
• Sabina Hafesji, Chair and co-founder, NHS Muslim Women’s Network
• Dr. Nasim Mahmoud, UK & Ireland Paediatric Professionals of Pakistani Origin 
• Dr. Jastinder Pal Singh, President, UK Sikh Doctors and Dentists Association

Key Concerns

1. An Inadequate Impact Assessment

The current impact assessment underpinning the Bill has failed to meaningfully consider the perspectives or needs of ethnic minority communities. It lacks any comprehensive evaluation of how structural racism, language barriers, cultural values, or spiritual beliefs may influence access to—or coercion into—assisted dying. This omission renders the proposed framework unfit to protect vulnerable populations and unresponsive to community concerns.

2. Cultural Misalignment and Lack of Safeguards

The discretion given to clinicians to initiate assisted dying conversations does not account for cultural norms that prioritise life preservation or family consultation. Without required cultural competence standards, patients from ethnic minorities risk being misrepresented, misinformed, or subtly pressured in ways that violate their values.

3. Risk of Coercion and Family Dynamics

The Bill allows proxy signing and does not offer strong safeguards against coercion within complex family structures. In collectivist cultures, this raises the risk that decisions could be influenced by financial, social, or emotional pressures—without adequate legal or ethical oversight.

4. Communication Barriers

No mandated access to interpreters or translated materials further entrenches inequality. Patients unable to fully understand their rights, options, or medical condition in their own language may not be in a position to provide informed consent.

5. Historical Mistrust and Systemic Bias

The Bill overlooks the documented mistrust that many ethnic minority communities have toward the healthcare system, particularly where they have experienced lower-quality care, diagnostic delay, or discriminatory treatment. Introducing assisted dying without first addressing these systemic inequities will only serve to reinforce fears that some lives are less valued than others. We have noted Bill proponents putting forward data from another jurisdiction suggesting minoritised ethnic communities not accessing assisted dying/euthanasia more- our deep concern is that in an effort to protect their loved ones from assisted dying and the fear that this may shape interactions and presented care options, ethnic minority communities will stop accessing health and palliative/end of life care with the consequence of increased needless suffering and poorer outcomes. This dynamic was very concerningly observed during the COVID-19 pandemic, where areas with larger ethnic minority populations experienced greater reductions in emergency admissions during the first ten months of the Covid-19 pandemic, an elevated rate of home deaths, lower levels of non-COVID hospital usage and poorer experiences reported by minority groups, as per findings by the Institute for Fiscal Studies and the Care Quality Commission.

6. No Organisational Opt-Out for Hospices and Care Homes

The Bill, as currently drafted, does not provide institutions—such as faith-based or culturally aligned hospices and care homes—with a legal opt-out. This would place healthcare professionals who hold conscientious or faith-based objections, many of whom are from ethnic minority backgrounds, in an ethically untenable position. This threatens to displace these professionals from the palliative care sector and care homes, exacerbating staff shortages and reducing cultural representation in end-of-life care.

7. Risk to Workforce Diversity and Patient Outcomes

There is substantial evidence that a diverse palliative care workforce improves trust, communication, and outcomes for minoritised patients, , . By making hospice work ethically or culturally inaccessible to many professionals from minoritised ethnic backgrounds, the Bill may reduce diversity in palliative care—undermining quality and equity at the end of life.

8. Absence of Data Monitoring

The Bill does not require ethnicity-based monitoring of who is referred to, consents to, or receives assisted dying. Without this data, systemic patterns of inequality cannot be identified or addressed, posing significant ethical and clinical risks.

9. Increased Risk of Two-Tier End-of-Life Care

Assisted dying may well be offered before equitable palliative care access is achieved. This risks turning assisted death into the only accessible ‘option’ for some patients—especially those already facing health inequities—rather than a decision made from a position of autonomous choice.

We call on Parliament and policy-makers to put equity, dignity, and community protection at the heart of end-of-life legislation, and safeguard the vulnerable and unheard within their constituencies. The current Bill seriously risks worsening disparities, undermining already eroded trust, and weakening the diverse workforce essential for delivering compassionate palliative care.

References:

1. Institute of Fiscal Studies. Ethnicity inequalities in Covid disruption to hospital admissions https://ifs.org.uk/articles/ethnicity-inequalities-covid-disruption-hospital-admissions

2. Care Quality Commission. The Unequal Impact of COVID-19. https://www.cqc.org.uk/publications/major-report/soc201920_2d_unequal-impact-of-covid

3. Burke C, Doody O, Lloyd B. Healthcare practitioners’ perspectives of providing palliative care to patients from culturally diverse backgrounds: a qualitative systematic review. BMC Palliat Care. 2023 Nov 17;22(1):182

4. Sítima G, Galhardo-Branco C, Reis-Pina P. Equity of access to palliative care: a scoping review. Int J Equity Health. 2024 Nov 25;23(1):248

5. Abel J, Kellehear A, Mills J, Patel M. Access to palliative care reimagined. Future Healthc J. 2021 Nov;8(3):e699-e702