Away from the high-profile public interventions that have defined the debate over assisted dying, MPs have been quietly wrangling over what part they want to play in this historic piece of legislation.
High on many of their minds as they consider their vote is the state of the NHS. Questions remain about what impact the legislation could have both on other services and the well-being of doctors.
These concerns are said to have “spooked” many MPs who are still grappling with how they will vote on the bill on Friday.
Reflecting on his choice, one Liberal Democrat MP said: “In hustings at the general election, I was saying I’d vote for it, but after hearing from [Wes Streeting], I’m not so sure.”
He is referring to Health Secretary Wes Streeting who, despite being the man who would be responsible for implementing assisted dying if Kim Leadbeater’s bill passes into law, has come out strongly against the proposals, citing the inability of the NHS to cope.
The Lib Dem MP continued: “The biggest problem is it should have been done in government time because you need the army of the civil service to look at this. I’ve had hospices writing to me, saying they don’t know how this will impact them. We need the impact assessments,” he continued.
The MP initially told i that he was planning to support the bill because “maybe some of my concerns about the NHS can be answered,” but he has since confirmed publicly that he intends to vote against it on Friday, citing concerns over the NHS impact in his letter to constituents.
Although Cabinet Secretary Simon Case warned senior ministers that they should “exercise discretion and should not take part in the public debate,” Streeting told Times Radio earlier this month that the proposed bill 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.”
Former Labour prime minister Gordon Brown has joined Streeting in raising concerns over the NHS’s ability to cope. Writing last week, he 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.
Health service concerns
The concerns MPs have are also shared by some senior figures in the health service.
Consultant neurosurgeon Helen Fernandes, chair of the grassroots lobbying group Doctors’ Association UK (DAUK), echoed MPs’ concerns. She told i: “It doesn’t sound like the wider medical profession has been consulted. I’m an active member of the BMA [British Medical Association] and haven’t seen anything through the union.
“Nobody has come to DAUK for soundings, so I would agree with that sentiment, given it’s such a fundamental change in what doctors are trained in and promise to do. It’s quite scary, really.”
The Royal College of GPs (RCGP) has set up a working group to look at the “practical implications” of any potential change in the law on assisted dying. However, the body remains officially opposed to the law change after a 2020 survey found 47 per cent of members supported this stance.
Other doctor organisations, including the BMA and DAUK, hold a neutral stance on the issue of assisted dying. Though many of their members are in favour, others still have questions about how the legislation could be implemented.
Fernandes told i the practicalities of the potential new legislation are “hugely important”, adding: “It is such a change from everything you’re taught as a doctor in terms of medical care, which is to keep people alive. To switch that around and how that works on a day-to-day basis is going to be phenomenally difficult to sort out.”
Free vote
The first assisted dying vote will be a free vote, unlike most other Commons votes, meaning MPs can vote according to their conscience. This, however, has made the decision much harder for many as must consider the competing forces of their constituents’ views, the calls of campaigners on all sides, and their own morality.
Some MPs have opted to hold events on the issue in their constituency to hear voters’ views and help them make their choice. Many have seen hundreds of local people attend, with MPs taking to social media to praise their constituents for sharing their views. But, as one Tory MP admitted, a few of these meetings may be simply for show.
“I held an event, but I’ve always known I’d vote against it. The event was just to make sure my constituents felt listened to. Nothing they could have said would have changed my mind,” he said.
The MP, who has already decided he will support the bill, said that “surveys and meetings are redundant on this issue”, adding: “Lots of people are going to be able to hold contradictory views on this, and then, depending on the details and the prefix for the question, they’ll come up with completely different answers.”
Should MPs support assisted dying and the bill is passed, Ms Fernandes called for a “proper and open engagement” not just with doctors, but nurses and all othe other allied health professionals and their organisations who may be involved in the process – as well as the public.
“Not so much on the concept of assisted dying, which I don’t think many people have a problem with as it gives people that control many want, but it’s more how it actually happens, because we’re different from Switzerland where the private clinics deal with assisted dying,” she said.
“This will come through the National Health Service and suddenly it’s becoming the National Death Service. Well, that’s a root and branch change which has to be considered really very carefully.
“Even if it happens in a non-hospital environment, a home or hospice, assisted dying will still be a NHS service. It doesn’t matter about the location as it will be provided by NHS staff, which is a fundamental change.”
Streeting has ordered his department to carry out a review of the costs of potentially changing the law to legalise assisted dying, and i understands ministers are expected to seek to amend the legislation if it passes to ensure it is workable.
Medics, however, have little hope that any impact assessment will provide accurate figures. Fernandes said that while the cost of drugs and bed space for assisted dying will be “relatively small”, costs could add up elsewhere.
“It will be all of the training, protocols, and processes that are put into place, which will be quite costly and time-consuming and take up a lot of staff time. There’ll be many hours of time spent on that which, cynically, will detract from time looking after those that want to live,” she continued.
Medic objections
A hint of what is to come if the bill is passed was seen on X this week when Matthew Dore, a Palliative Care Consultant at the Royal Victoria Hospital Belfast and Northern Ireland Hospice, asked Kim Leadbetter and the GMC: “If this bill is legalised, as a doctor, I will not refer people onwards for lethal medications – this act of refusal to refer is illegal under this bill. Please could you tell me what will be my penalty? Will it effect my GMC [registration]? #trueconscientiousobjection.”
Dr Calum Miller, who describes himself as a medical doctor, ethicist and philospoher, said: “I will not refer a patient for assisted suicide, whatever law or regulation compels me to do so. I urge other doctors to take the same stand!”
Mr Dore said the sentiment reflected “rising numbers” of doctors who say they will not refer patients for an assisted death. He described the safeguards in the bill as “not safeguards [but] a vague eligibility criteria inevitable to expand”.
Fernandes is also concerned about what happens to NHS staff who have “religious or moral objections” to assisted dying and the protections they will be offered from prosecution.
Proponents of the bill, however, argue that the legislation will offer better protections for medical staff than is currently the case. Dr David Nicholl, a consultant neurologist at City Hospital and Queen Elizabeth Hospital in Birmingham, told reporters last month that the current law leaves many doctors fearing prosecution.
He recounted how, in 2022, a patient of his with heart disease informed him they were travelling to the Dignitas clinic in Switzerland to end their life, which meant he had to seek legal advice. In a separate case, a colleague of his who ran a motor-neuron diseases clinic faced “aggressive questioning” in court after one of his patients also chose to visit Dignitas.
“The current law does not protect patients. It doesn’t protect doctors, and, actually, I don’t think it protects society”, he said.
“If I were a doctor involved in this, I wouldn’t raise [assisted dying], but if the patient raised it with me, at least we can have a conversation, whereas at the moment, if that conversation arises, I’m speaking to my medical defence organisation,” Nicholl continued, referring to the legal support groups for doctors.
‘Intolerable suffering’
Speaking to a briefing event for MPs last week, Rebecca Gillanders, a barrister who watched her mother go through “intolerable suffering” at the end of her life due to brain cancer, also shared how doctors amended her mother’s care due to fears of prosecution.
“We found ourselves with our one family GP on her knees, holding my mum’s hand in the kitchen of our family home, with the GP in tears because she could not help my mum in the way that my mum was begging her,” she recounted.
“Another who’d been called to the home to discuss the management of her symptoms stated that he wasn’t comfortable offering her a higher dose of sedative to allow her to get some rest overnight because she had been so clear on her wish to die that he was concerned not to do anything which might appear inappropriate. In this context, as a result, Mum became increasingly despairing.”
Gillanders’s testimony at the event was enough to change minds. Labour MP Warinder Juss told the panel their stories had convinced him to vote in favour despite having already “wrestled” with the issue due to his faith. A second MP was also said to have had their mind changed that evening.
Addressing the other MPs in the room, Juss said: “It would be wrong to do nothing. Nothing in life is perfect.
“We’re not saying that we’re going to get an act of parliament. We’re not saying that the bill is perfect, but I have to say to damn sight better than what we have at the moment. And so I just want to acknowledge my fellow MPs that we should be supporting this bill.”
Like the Lib Dem MP, many in the Commons and beyond have expressed alarm that the assisted dying bill is being proposed as a private members’ bill (PMB) rather than government 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 (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”.
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