Suicide prevention is understood as a multi-agency public health endeavour aimed at reducing suicide deaths through a combination of individual and population-level interventions. National policy, set out in the Suicide Prevention Strategy for England, emphasises a whole-system approach, including reduced access to means, improved data and surveillance, timely and effective mental health care, and targeted support to high-risk groups (one of which is people with severe physical health conditions). The statutory obligations underpinning suicide prevention – above all, the duty on the United Kingdom to secure the right to life of those within its borders – are fulfilled through several legal and regulatory frameworks which position suicide prevention as a shared responsibility across health, social care, and public health systems, extending beyond mental disorder alone to encompass those with significant physical illness and broader social risk factors.
It may be obvious, but it is necessary to emphasise, that current law and good clinical practice in England & Wales does not differentiate between those who are, and are not, terminally ill when it comes to suicide prevention. Indeed, it is difficult to see how it could be because it would be impossible to pinpoint the point in the trajectory of a terminal illness that the state ceases to have a concern to secure the person’s life – is it at diagnosis, at 9 months prognosis, at 6 months, or 6 days?
It is into this complex terrain that the proposal is made in England & Wales that the State should – in some circumstances – not just seek to prevent death, but actively to facilitate it. We are therefore in the zone squarely identified by the International Association for Suicide Prevention (‘IASP’) which has recently (December 2025), in the context of a position statement expressly highlighting “the significant potential for overlap between assisted dying and what is traditionally understood as suicide,” emphasised that:
All people and organisations who work in suicide prevention must do their utmost to provide the same level of quality help and interventions to all people who express a wish to die, regardless of the means chosen to end their life and the nature of their circumstances. In our work, we should never take the position that there is a category apart of people who may be “better off dead,” and encourage them to seek death as a solution to their problems.
The IASP also emphasised that:
Jurisdictions considering legalising and/or expanding the availability of assisted suicide and euthanasia should engage meaningfully with suicide prevention experts and/or organisations to carefully weigh concerns about overlap between what is being contemplated and what we usually consider to be suicide. Any such concerns should have a prominent impact on decision-making.
(For these purposes, the IASP defines “suicide” as “the act of intentionally carrying out an action to kill oneself”).
In an article (a pre-print version of which can be found here), members of the CLADD group and collaborators explain how statements such as ‘terminally ill people are definitely not suicidal’ are clinically incorrect, how the tools that we use to identify ‘conventional’ suicidal ideation are essentially identical to those which we use to identify ‘wish to hasten death’ cases, and how the first-line responses to those expressing such ideation or such wishes will be same. In the circumstances, we suggest that the starting point must be that any move made to legalise assisted death must recognise that it will always sit in tension with suicide prevention policies. No amount of finessing or policing of language can get around this issue; it will therefore always be a question of managing the tension, requiring – when it comes to legislating – a full systems response, not just ‘getting the job done.’
