Pregnancy as a Barrier: Assisted Dying and Amendment 458

The Terminally Ill Adults (End of Life) Bill has been described by many as one of the most significant shifts in the legal landscape of England and Wales in our generation. Whether this claim overstates the matter is open to debate. What is not in dispute, however, is that the Bill raises profound questions about the relationship between the state and those it governs. Unsurprisingly, its existence, proposals, and suggested amendments have generated extensive discussion and controversy. In this blog series, leading voices in the field of assisted dying reflect on the Bill, what it means for the state to sanction the deliberate and knowing ending of an individual’s life, and how we might tread a path forward.

Richard B. Gibson, Aston University

Keywords: Assisted dying, Pregnancy, Vulnerability, Autonomy, Safeguards

To say that the Terminally Ill Adults (End of Life) Bill has proven a source of debate is, if nothing else, an understatement. Since Kim Leadbeater MP first expressed her intention to introduce an assisted dying Bill to the House of Commons via the private member’s bill mechanism,  discussion has ranged across what the Bill means for those seeking to end their lives, what it reveals about how we, as a society, understand vulnerability, and what role, if any, the state should play in ending the lives of those over whom it exercises power and towards whom it bears a protective responsibility. For those concerned with the socio-ethical implications of law, this has been a particularly fertile period of debate.

Yet while the Bill has generated controversy across its breadth, specific provisions have been particularly contentious. Some sections, paragraphs, and clauses seem relatively innocuous: matters of procedure or definition that appear unlikely to attract sustained objection like §12(1) which defines the term ‘assessing doctor.’ Others, however, are so far-reaching or normatively charged that they were always likely to prove stumbling blocks to the Bill’s passage before the end of the current session. Perhaps the clearest example of this is the question of oversight: who, precisely, should be responsible for authorising an assisted death once two doctors have completed their assessments? Is the involvement of a single judge sufficient and appropriate, or was it inevitable that a broader decision-making panel would be required?

Controversy has not been confined to the Bill in its original form, however. A significant number of amendments proposed by members of both the House of Commons and the House of Lords have themselves prompted concern and debate. In this post, I highlight one such proposal: Amendment 458, tabled by Baroness Tanni Grey-Thompson.

Amendment 458 is one of 131 amendments put forward by Baroness Grey-Thompson, within a total of 1,227 amendments to the Bill. It is notable not merely because of its content, but because of what it reveals about the boundaries of assisted dying as presently imagined. The amendment proposes the insertion of additional text at the end of Clause 17, page 14, line 26; a clause concerning the requirements that must be satisfied before an expert panel may approve a request for assisted dying. The proposed addition reads: “(j) that the person has provided a negative pregnancy test.” In effect, the amendment would restrict access to assisted dying to those who can demonstrate that they are not pregnant.

Even setting aside the introduction of an additional barrier to accessing assisted dying (a point to which I return shortly), a more immediately obvious problem arises: a pregnancy test would be irrelevant for a significant number of individuals. This includes those who cannot become pregnant at all, such as cis men, individuals beyond reproductive age, and those for whom, for medical or other reasons, pregnancy has never been a possibility. Requiring a negative pregnancy test from an applicant for whom pregnancy is biologically implausible is, at best, conceptually incoherent. Were the amendment to be adopted, it would itself require further refinement to specify the circumstances in which it would apply. Indeed, Baroness Grey-Thompson has acknowledged this during proceedings in the House of Lords on December 12^th, 2025. If we give the amendment the benefit of the doubt, then its scope might be narrowed from the pointless to the pointed. The more significant question, however, is why such a requirement is thought necessary, desirable or indeed defensible in the first place.

According to Baroness Grey-Thompson, the amendment is not frivolous but crucial. She notes that the issue has not been discussed in the other place and therefore must be addressed in the Lords. I do not find the act of discussion itself problematic. Ensuring that individuals have access to relevant information when making healthcare decisions is generally welcomed. The more informed a decision, the more meaningful it can be. Nevertheless, the prospect raised by this amendment remains difficult to digest.

The difficulty lies in the differential treatment it would introduce. Treating an individual differently from the general cohort of those eligible for assisted dying solely based on their potential gestational status is troubling. If an individual presents to the assisted dying panel, satisfies all other statutory criteria, and is nonetheless denied access to a service designed—at least in part—to reduce suffering and uphold individual autonomy because they fail a pregnancy test, the justification for that denial demands scrutiny. Why should a potentially pregnant person be required to clear additional hurdles that others are not?

This is not to suggest that pregnancy testing should never be offered to those seeking assisted dying. It is entirely plausible that someone might reconsider their decision if they discovered they were pregnant, and facilitating access to information that could inform such a decision may be appropriate. However, there is a crucial distinction between offering a pregnancy test as part of an informational process and requiring a negative result as a condition of eligibility. The former respects decisional autonomy; the latter risks transforming pregnancy into a categorical exclusion. In that sense, the amendment appears less concerned with informed choice than with filtering certain bodies out of the assisted dying process altogether.

A further concern follows from this. What, precisely, happens if a person seeking assisted dying tests positive? Would they be barred from accessing assisted dying until they have given birth? If so, the amendment would impose not merely an additional procedural requirement, but a temporal one: individuals would be compelled either to carry a pregnancy to term or to terminate it before regaining access to assisted dying. This places the state in an especially intrusive position, conditioning access to end-of-life care on reproductive outcomes.

Seen in this light, Amendment 458 does more than raise a technical or evidentiary issue. It reveals a more profound anxiety about whose suffering is recognised as warranting relief, and whose autonomy is deemed defensible in the name of protection (of a foetus). In a Bill already preoccupied with vulnerability, safeguards, and oversight, the amendment exposes the risk that protection can slide into paternalism. That concern for potential life can eclipse concern for existing lives. Whether or not Amendment 458 survives the legislative process, it serves as a telling illustration of the ethical fault lines that continue to shape debates over assisted dying in England and Wales.