On Friday, MPs will have a chance to debate a bill which could legalise assisted dying in the UK for the first time.
The proposals, put forward by Labour MP Kim Leadbeater, would allow terminally ill people with less than six months to live to seek medical assistance to end their life, provided they get approval from two doctors and a judge.
MPs will have a free vote, meaning they can vote based on their conscience rather than along party lines, and there are reported to be more than 130 requests by MPs to speak in the debate.
As MPs consider the proposals, here are six things you should know about the debate around assisted dying before forming an opinion.
Cost implications for the NHS
One of the principal issues raised throughout the debate on assisted dying has been what impact it will have on NHS services and end-of-life care.
Health Secretary Wes Streeting raised this issue publicly in November, telling Times Radio that legalising assisted dying would have “resource implications” for the NHS that would “come at the expense of other choices”.
Asked whether he would have to find extra money in the NHS budget for assisted dying, Streeting continued: “Yes. To govern is to choose. If Parliament decides to go ahead with assisted dying, it is making a choice that this is an area to prioritise for investment. And we’d have to work through those implications.”
He has instructed his department to do an impact assessment on the proposals, which have not yet been published.
But Labour grandee Harriet Harman has criticised the interventions from Streeting on costs, claiming that the issue of assisted dying should not be reduced to “pounds and pence”. She told The Observer: “By commissioning work to assess the cost of facilitating assisted dying – which he will have to publish – he will then, of necessity, have to balance that against the cost of the person staying alive.
“That leads you to the awful prospect that the research could find that it is cheaper for people to be doing assisted dying rather than staying alive, and that would really contaminate the argument.”
“It has to be an argument about individual choice and moral principle. It cannot be an argument about money.”
These criticisms on costing were echoed by Tory MP Kit Malthouse, a leading supporter of the bill, who told The i Paper: “There are lots of times in somebody’s life when we put a price on whether we help, but when they’re dying in agony is not one of them.”
“Yes, we have to make decisions about drugs and whether they’re worth the money, but if somebody is actually in front of you, writhing in agony, telling them we can’t help them because it’s too expensive crosses a moral threshold for me.”
Supporting palliative care
The debate around assisted dying has also shone a fresh light on the state of the UK’s palliative and end-of-life care provisions, with some arguing these services need more funding before the law can be considered.
Writing in The Guardian last week, former Labour prime minister Gordon Brown reflected on how the death of his newborn daughter in 2002 had convinced him of the “value and imperative of good end-of-life care”.
He joined calls for a Royal Commission to be set up to establish a “fully funded, 10-year strategy for improved and comprehensive palliative care” before assisted dying could be considered.
Labour MP Rachael Maskell has also directly called for a greater exploration of this issue, claiming that she did not think legislation could be passed “when we know that there needs to be significant funding and delivery improvements to palliative care services”.
“Good palliative care can remove the concerns that people will have a difficult death, instead providing people with the pain relief, care and support necessary to have a ‘good death’,” she continued.
Charlie King, deputy director of external affairs at Hospice UK, told Sky News in October that thought needed to be given to how such a “fundamental change” would impact the sector while it was “already under really significant stress”.
“We’ve got hospices who are cutting back their services already, making frontline staff redundant, because they’re no longer able to fund those services.
“Whether or not assisted dying is introduced by this government, we must fix the end-of-life care system in the UK,” he said.
Earlier this year, Hospice UK – which has remained neutral on the issue of assisted dying – warned that hospices across the UK were facing a £77m funding deficit, which was forcing many to close or cut back staff.
A report published in January by the group and the APPG for hospice and end-of-life care also warned that the current funding model for the sector was “not fit for purpose.”
Need for strong safeguards
Many MPs supportive of the legislation have stated that their vote is conditional on the process of assisted dying having strong safeguards to protect against coercion and misuse.
Leadbeater has repeatedly insisted that her proposals are “the strongest, most robust piece of legislation on this issue in the world.”
She cites the fact that no other jurisdiction requires an individual to seek the approval of a judge and two doctors before they can access assisted dying. Her bill also creates a new offence, which makes it illegal to encourage somebody into assisted dying against their will.
Anyone found guilty of encouraging someone to either apply for assisted dying or administer the lethal medication through “dishonesty, coercion or pressure” could face up to 14 years in prison.
Some fear, however, that this may not be enough to prevent coercion. Labour MP John Grady is among those who have cited this as a reason for voting against the bill.
“I believe the safeguards against pressure, coercion and dishonesty are flawed, and I do not believe they will work,” he said.
“Assessing whether someone has been put under pressure or coerced is difficult. It will be difficult for both the two doctors involved in the process, especially if one or both do not know a patient well. It will also be difficult for the judge to assess this.”
Actor and disability rights activist Liz Carr said the legislation amounted to coercion “almost on a state level”, arguing that people may feel pressured into ending their life.
“While we have such low expectations and a low value of certain groups of people – and I say that as a disabled woman, but equally ill people and older people – we just don’t see their value and their worth… There could be somebody who just feels like they’re a burden, somebody who doesn’t want to use all of their savings or sell their house for home care.”
However, Sally Talbot, an MP in the Parliament of Western Australia, where assisted dying has been legal since 2021, told reporters that they had seen little evidence of coercion of this kind.
She said: “We did receive evidence about coercion in jurisdictions that already had assisted dying. It was exactly the opposite of the way that opponents of this bill were presented. It was coercion from families on their loved ones not to access assisted dying because they would say, ‘Can’t we have one more week with you?’”
‘Slippery slope’ concerns
One phrase that has come up frequently in criticisms of assisted dying is the so-called “slippery slope” – fears that any law on the matter could later be expanded far beyond its original remit.
The most commonly cited example is Canada, where assisted dying has been legal for those with a terminal illness since 2016.
However, in 2021, a new law was brought forward to relax some of the restrictions. The changes allowed people to seek assisted dying if their death was “reasonably foreseeable” and required the approval of only one doctor. It also has plans to allow individuals with severe mental illness to end their life – but this has been delayed repeatedly.
Belgium legalised assisted dying for terminally ill adults in 2002 but has since expanded its laws to cover under-18s in exceptional circumstances.
The Netherlands has also extended who can access assisted dying, with the country’s Supreme Court ruling in 2020 that patients with advanced dementia who have made a written advance request for euthanasia can receive it.
However, in a briefing document sent to all MPs, Leadbeater insisted that this “cannot happen here”.
“Only another detailed piece of primary legislation could alter what this Parliament votes upon. Once both Houses reach a settled view that will be, and remain, the law of the land,” the document read.
It also pointed to the findings of the 14-month inquiry into assisted dying by the health and social care select committee, which concluded that fears of a slippery slope are “unsubstantiated by evidence”.
“Jurisdictions which have introduced assisted dying on the basis of terminal illness have not changed the law to include eligibility on the basis of ‘unbearable suffering’,” the report stated.
The briefing document also argued that several legal challenges to the blanket ban on assisted dying have been brought to the UK courts, and none have succeeded, which Leadbeater suggested was proof that the courts could not intervene in the UK to expand the scope of assisted dying.
Parliamentary process criticisms
One area of concern around proposals to legalise assisted dying in the UK is whether it should be proposed by a private members’ bill (PMB) rather than by the Government.
Under this process, an individual MP – in this case, Leadbeater – drafts and proposes the bill. The first debate on the bill will be limited to five hours, and future parliamentary stages may have less scrutiny time than other legislation.
Darren Jones, the chief secretary to the Treasury, has stated he will abstain or vote against the bill because it is being delivered via a PMB, arguing that this is not the right way to change the law on “such a complex issue”.
He warned that such bills “don’t get anywhere near the same level of scrutiny and debate as the bills put forward by the Government – and legalising assisted dying is far from a straightforward issue”.
A cross-party group of MPs – including Conservative MP Ben Spencer, Lib Dem MP Munira Wilson, and Labour’s Anna Dixon – has even announced plans to table a so-called “wrecking motion” during the assisted dying debate on Friday. This motion would prevent the bill from being voted on if it received enough support.
The amendment states that “the House’s procedures for the consideration of private members’ bills do not allow for sufficient debate on and scrutiny of a bill on a matter of this importance”.
Nikka da Costa, a former director of legislative affairs at No 10, has also warned that PMBs are usually reserved for shorter bills, claiming that the process is “limited by a very insisted clock” and that the “entire pre-legislative stage” given to other bills has been skipped.
However, former Clerk of Commons Sir David Natzler has written to Leadbeater to say that he believes PMBs undergo “the same legislative scrutiny as Government bills.”
“At second reading, the first bill down for second reading can be debated for as long as could be expected on a Government bill, with at least the same opportunities for many backbenchers to participate. The public bill committee can scrutinise a bill for as many sittings as it wishes on days of its own choosing,” he said.
Shortcomings in the current law
Many of the proponents of assisted dying argue that, regardless of reservations about the bill going before parliament, the current state of the law on the matter in the UK is not fit for purpose.
Speaking at a briefing event for MPs, former director of public prosecutions Sir Max Hill, claimed that he decided not to prosecute 26 cases of encouraging suicide during his tenure as there was “public interest” in prosecuting grieving families.
He argued that current investigations into assisting suicide “only commences after the death has occurred” when it is “too late to save the victim because that person is already dead”.
“That’s surely the wrong way round. Where we do have offending behaviour, which we still will under this bill that passes all scrutiny, then we need that upfront to ensure that offenders are brought up to account and victims are protected,” he continued.
A briefing document from barristers Alex Goodman, Stephanie Harrison and Chris Butler also claimed that it was “far from clear that the current state of the law offers much, or better, protection to vulnerable people.”
It argued that a terminally ill person wishing to end their life had three options: they could travel alone to a country where assisted dying is legal, they could commit suicide, or they could ask someone for assistance.
“In any of these courses, there is no system available to allow the person to make a fully informed decision with the help of professionals. Currently, the only realistic safeguard for those who are vulnerable and might be under pressure or coercion to end their life is that of retrospective criminal investigation,” the lawyers stated.
The briefing went on to claim that the proposed law would ensure that a terminally ill person’s decision-making would “not be clandestine, but out in the open”.
Liz Truss needs to take her own advice, and cease and desist