This is Prospect’s rolling coverage of the assisted dying debate. This page will be updated with the latest from our correspondent, Mark Mardell. Read the rest of our coverage here
19th June
If Kim Leadbeater’s bill passes on Friday it will offer no escape route from a dreadful death to me, or people like me. Still, I want it to pass for the sake of others.
Why won’t it help me? Because I have Parkinson’s, a complex, currently incurable neurodegenerative condition which can end with you in a pretty awful state: unable to speak, perhaps bed-bound, doubly incontinent. Not everyone of course, and I desperately hope not me.
But it is not a terminal condition. A few doctors might be willing to describe it as such, but most won’t. And the bill is quite clear about who it is for. Read its very deliberate, very carefully constructed title: Terminally Ill Adults (End of Life) Bill. It is only for grown-ups who a doctor has decided are suffering from an illness that will kill them within six months.
You have to put that at the front of your mind when MPs demand rules to ensure that the depressed or disabled aren’t allowed to use it to commit suicide, or fret that young women will starve themselves to the point of death so they can win the right to have an assisted death, or when red herrings are waved in your face about doctors discussing assisted dying with children.
It is not a bill for children. Not for the disabled. Not for the poor. Only for those few people who have been told they will die within six months and want the right to leave this world at a time of their choosing, not when the disease has delivered its full payload. It is not some nice thing we are discussing, not a treat to be denied the unworthy who may only be pretending to be terminally ill.
I’m not sure that I would wish to have an assisted death, even it was available to me. Frankly, the whole business, so reminiscent of an execution, gives me the creeps. I am not sure I could put myself or my family through that.
But I am sure I want the possibility. And so if I was an MP I would certainly vote for it.
This is a bill that would allow people with cancer or any one of scores of other painful, unpleasant conditions to die with dignity. To deny them that, simply because it doesn’t go far enough for me, would be obviously wrong. The perfect must never become the enemy of the good.
Therefore it is equally wrong, and equally selfish, of the enemies of this bill to hide behind the argument that until palliative care is perfect, no one must be allowed to end their existence a few weeks earlier than they would otherwise die from “natural” causes.
I have huge admiration for Gordon Brown. But his recent jeremiad against the bill is the work of Brown the master tactician not Brown the towering intellect. He warns against creating a law with a “focus on the few who wish for assisted dying and do too little to support the majority of those facing their final days who want—and deserve—access to the best of palliative care”.
Which is fine, and perhaps it would have been better if increased funding for end-of-life care had been linked to assisted dying, as they were originally in the French bill. But the attempt to elevate palliative care, particularly that provided by hospices, above any other NHS service is wrong-headed. Not wrong in itself but because it hijacks a critical debate for an ideological purpose.
The most recent headline to ramp this argument up was generated by Siobhain McDonagh, a Labour MP opposed to the bill, who claimed an assisted dying service could “rob our stretched NHS of much needed resources”.
She said: “When asked today in the House of Commons the Secretary of State for Health made clear to MPs that there is no money allocated to the NHS to fund the assisted dying bill.
“It’s now clear that the assisted dying bill will rob our stretched NHS of much-needed resources and could become the trojan horse that breaks the NHS, the proudest institution and the proudest measure in our Labour party’s history.”
It is simply foolish to pretend that the problems of the NHS are due to the assisted dying bill. Labour’s “proudest measure” was conceived as providing a decent start in life for Britain’s children. But as more and more of us live long beyond three score and 10, but often with chronic conditions, the system is close to collapse.
Despite the recent boost in funding, it’s clear to anyone who encounters the National Health Service that it is still very much strapped for cash. Witness yesterday’s decision to not fund new drugs which would help thousands of elderly people have a happier future. And there’s an elephant in the room, a key question that most MPs are ignoring: what to do about social care?
Until that is sorted out the health service will remain in a permanent state of crisis. And we probably need a full-scale debate before enshrining end-of-life care as more important than neonatal care or oncology.
The bill is tight enough to quell much mention of the “slippery slope” argument. But it will be there.
For some of the bill’s opponents see the very existence of people like me as a threat. They worry that, in the future, we could turn into campaigners to expand the bill to include provisions like “intolerable suffering”. They are right, some will, but I think—don’t promise, don’t swear, but think—that I will respect the restrictions as the democratic wish of parliament. Many will feel that a long period of time is going to pass before it seems right to have another bash at this.
The bill is so tightly drawn, I think it would be impossible to prise it open and force in radically new wording. Of course, a future parliament could pass an entirely new bill with looser definitions, but that’s true of any law.
So while warnings about a slippery slope are worth considering, I believe they’re largely misplaced.
Rather than a slippery slope, I prefer to think of a ratchet—a ratchet that only moves one way. Not because of how the law is written, or how cautious its safeguards are, but because no country that has legalised assisted dying has ever chosen to make it more restrictive afterwards.
The direction of travel is always in one direction. Because in practice most of the predictions of dire harm have not come to pass, the vast majority don’t want it to be reversed. No government that has nervously introduced these measures goes on to want more restrictions.
And no, that is not because the state is greedy to grab the power to kill patients who might be judged to be a burden on the NHS.
I’m rather dismayed to see Labour MPs lining up to make the same argument as Sarah Palin when she attacked Barack Obama’s proposal for socialised medicine in the United States—because it would mean rationing of resources and thus the introduction of death panels. It’s laughable when it comes from an extreme right-wing populist. It’s pitiful when it comes from Labour MPs.
What will happen on Friday? Of course, it is set to be a great parliamentary occasion. As we are constantly reminded, it is the most important vote many MPs make in their lives.
There will be lots of attempts on both sides to create drama and emotion, outside the chamber as well as inside. But the tone of the debate may be set in the first few moments. For it will begin with a vote. And what MPs decide to do with Conservative MP Rebecca Paul’s new clause 16 will probably foreshadow the outcome of the final vote. The clause states that no one would be allowed to:
seek assistance to end their own life if they are substantially motivated by:
(a) not wanting to be a burden on others or on public services,
(b) a mental disorder (including depression),
(c) a disability (other than the terminal illness),
(d) financial considerations, including lack of adequate housing,
(e) lack of access, or delayed access, to treatment or other service which a public authority is required (or can reasonably be expected to) provide, or
(f) suicidal ideation.
Pity the poor panel given the task of peering inside the head of a dying patient and quizzing them about whether they are worried about money or being a burden, and then determining whether their worries are the motivation for them seeking to die before that terminal illness kills them, and whether or not that is a “substantial” motivation.
This amendment does not appear to be “substantially motivated” by compassion for the terminally ill person.
Indeed, this looks like a catch-all wrecking amendment which would destroy the whole purpose of the bill if it were passed. It would set an impossible test for each and every individual who requests an assisted death. Only the hale and happy rich would qualify.
So those who want the bill to pass will vote against while those who want to stop the bill dead in its tracks will vote for. It should tell us very early on whether we are heading for a nail-biting climax, a comfortable victory for Kim Leadbeater or a shock defeat.
I suspect many of the amendments—and much of the debate to come—will be made on the assumption the bill will pass and therefore go next to the Lords. So I see a lot of these amendments as pitch-rolling for that process—preparing for various amendments to be brought back, either because they genuinely, in the minds of those proposing them, would be greater safeguards for those they believe are vulnerable… or simply because it would destroy the bill.
But the details of that are for another day. Probably Monday.
18th June
Recently, the London Review of Books published a trenchant, erudite and intriguing piece by Stephen Sedley about his diagnosis with Parkinson’s 14 years ago and his attitude to the assisted dying bill, which this week has reached a critical stage.
Stephen is a former judge of the High Court and the Court of Appeal, celebrated for his rulings on privacy, human rights and freedom of speech. One of his highly regarded judgments involved a street preacher:
“Free speech includes not only the inoffensive but the irritating, the contentious, the eccentric, the heretical, the unwelcome and the provocative, provided it does not tend to provoke violence. Freedom only to speak inoffensively is not worth having.”
Impressed with the article, I quickly arranged an interview over Zoom one Sunday morning— but it didn’t go too well. Not because of any fundamental problem, but because of our mutual problem—the condition we share, through no fault of our own.
Stephen had had a bad night and I could only make out every fifth word he was saying. My weak voice didn’t help; he couldn’t quite make out what I was saying either. So we decided instead to have an exchange of emails over the course of a few days.
This is it.
First of all, I asked him what lay behind his use of certain striking phrases in the article:
“Indeterminacy and durability”:
Stephen Sedley: What I had in mind was that PD [Parkinson’s] can go on for years without ending or even shortening life.
“A season in hell”:
SS: Once with you, PD never leaves you. It kids you that you’ve reached a plateau, then tips you off it.
Mark Mardell: From what you’ve heard of the debate so far, what do you make of the quality of the arguments?
SS: The overarching problem is that, as a society, we are unable to approach assisted dying objectively. We are forced to approach it through centuries-old thickets of religious anathemas and interdictions. One could regard it as an achievement that we have at least decriminalised suicide itself. But we now face the equally great hurdle of decriminalising assistance, however humane and disinterested.
The arguments about safeguarding the vulnerable are real and necessary, but they are distorted by the unspoken premises of objectors—principally a doctrinal hostility to the entire project. In such a context reasoned debate is hard to come by.
Suppose we start not from where we are but from where we ought to be—that is to say in a humane society which respects and maximises human autonomy, and in particular allows individuals such help as they need to terminate their own life safely and peacefully. Such a society would still have important debates about motive, coercion and guilt. These would take place in a context of respect, not of anathema or sin or criminality.
The promoters of the debate, by voluntarily introducing a terminal illness test, have consciously ceded some of the central ground to the opposition. There is in reality no compromise with such people. The result has been that the promoters of assisted dying have been on the back foot from day one.
MM: In what way do you think introducing the terminal illness test put the promoters of the bill on the back foot? I felt, listening to the second reading debate, that unless they did that they had no chance of passing the Commons whatsoever. It also begs the question, how loosely would you have drawn it? Would you have merely liked something like “intolerable suffering” in its place, or would you have just said it’s up to any individual who wants assisted dying to apply for it?
SS: It may be that we would have ended up with the terminal illness compromise; and some level of safeguarding will always be needed. But to start with it, as [Charles] Falconer, [Rob] Marris and [Kim] Leadbeater have all done, is to offer maximum scope to the bill’s opponents. Instead of working to dilute the system (eg by excessive and unnecessary safeguarding) they are now hoping to defeat it.
Perhaps more important, the price of the compromise has been exclusion of the hardest cases of all—those of intolerable and indefinite suffering. It may be thought both a strategic and a moral error to have sacrificed the relief of indefinite suffering on the altar of terminal illness.
MM: I wanted to run through a few of the things that brought me up short. The first thing that really shocked me was the attitude of some disabled campaigners, who feel they will be under pressure to make a choice about dying even though they’re not terminally ill.
They cite things like Do Not Resuscitate orders being placed on disabled people during Covid—against their wishes, and sometimes without their knowledge.
As one campaigner put it—and I’m quoting from memory, not verbatim—“If you live in a high-rise block, the lift doesn’t work so you can’t get out of the small flat in your wheelchair, your benefits have been taken away, and every moment of your life is a struggle—why would you not want to die?”
I’ve little doubt that some people genuinely feel this and don’t think the safeguards are strong enough and that disabled people will be candidates for assisted dying and will effectively be killed by the state. What do you make of this?
SS: I agree safeguarding requires close attention. The need for it is not an argument against assisted dying but an argument for scrupulous care in administering it.
Few systems, medical, financial or commercial, are proof against abuse. True, there can come a point at which the risks and consequences of abuse make the system itself unviable. But the answer, as a general rule, is to improve and monitor the system. This is what Kim Leadbeater is attempting to do, but against unusually implacable opposition.
There are endless forms of human misery, from some of which suicide seems (and sometimes is) the only escape. We do nothing to alleviate these by making suicide harder. Our task as a society is to prevent such cases from ever arising or (if they arise) going unresolved. But until we have resolved the untreatability of diseases like Parkinson’s, we owe it to those sufferers who rationally choose a peaceful and dignified death in place of indefinite suffering to allow them the assistance they need in exercising the choice.
MM: Some MPs claim they see replacing a High Court judge with a panel as a weakening of safeguards and thus a reason to change their vote—what do you make of the proposal?
SS: Experience in other jurisdictions suggests that justiciable disputes about sanctioning an assisted death are uncommon. More commonly, the need is to be sure of the state of mind of the applicant. A three-expert panel, with an individual veto and recourse to a judge in the event of a deadlock, is more appropriate. Judges are not a sensible part of a monitoring system. Judges are experts at resolving disputes.
MM: What would you consider a good death?
SS: Perhaps it’s a universal wish, but for most (me included) it signifies a painless death at a time and in circumstances of our choosing. GK Chesterton has a phrase, “the decent inn of death”. It suggests a good rest after a long hike. That’s all most of us want.
True, I sometimes find myself—like Keats besotted with his nightingale—half in love with easeful death. But not for long. Death, for me at least, is a last refuge from distress, not a passage to paradise.
16th June
The political temperature is likely to soar this week as the days tick by towards Friday, when MPs will cast what many consider the most important votes of their careers—on the Terminally Ill Adults (End of Life) Bill.
This Friday will be make-or-break for assisted dying in England and Wales when Kim Leadbeater’s bill reaches its third reading. MPs will either kill the bill or allow it to continue to the House of Lords.
Opponents were given a major symbolic boost last Friday when, for the first time, its sponsor, Kim Leadbeater, suffered an important defeat in the House of Commons. MPs voted for an amendment from Labour MP Meg Hillier to prevent doctors from discussing assisted dying with those under the age of 18.
Shortly after the vote I asked one key opponent of the bill, Rachael Maskell, the MP for York Central, what she made of it. She told me: “I do believe that the MPs who were in the debate today engaged with the evidence, and are starting to see the cracks emerge in the bill. This is even more so now that so many Royal Colleges and professional bodies are withdrawing their support. No matter people’s view on the principle of assisted dying, it is so evident that this bill is so unsafe. While I talked about the drugs, the issues of coercion, scrutiny, the quasi-judicial role and someone’s own mental health are recurrent themes which are exposing just how vulnerable people will die unnecessarily.”
This is the chink in Leadbetter’s armour that her opponents have been seeking for some time—and now 50 of them from the Labour benches have written to the leader of the House, Lucy Powell, demanding more time for scrutiny of the bill.
How significant is this?
Whether or not you accept the Independent’s argument that this is a “major challenge” to Keir Starmer or see it as I do—as a clever tactical move that is bound to fail—it piles on the pressure and will make those who want the bill to pass nervous.
Shortly after breaking the news of the letter on X, Paul Brand, ITV’s home editor, wrote: “Having double-checked the names on the list, all but a handful voted against the bill at 2nd reading” and the rest had already said they had changed their minds.
He added: “The letter does not signify a new wave of switches—yet”. That is a very important qualification. But Friday’s debate does show the volatility of MPs’ moods, and what happens when the whips aren’t herding people into the “right” lobby and instead MPs are allowed to examine the issues one by one.
What of their argument? In the letter, the MPs argue: “The fact that such fundamental changes are being made to this Bill at the eleventh hour is not a badge of honour, it is a warning. The private member’s bill process has shown itself to be a woefully inadequate vehicle for the introduction of such a foundational change to our NHS and the relationship between doctor and patient.
“New Clause 2 was added to the Bill last Friday with a sizeable majority. Such a profound alteration to this Bill at the last minute reflects the discomfort uniting the House about the current format of this Bill and the desire to further amend it to protect vulnerable people.”
The Hansard Society has published what amounts to a detailed rebuttal of the “not enough time” argument—while conceding that the government could have done more, and that things should have been done differently.
Here is part of what it says. “Some critics point to the limited number of amendments accepted from opponents. But in the world of legislative process, this is far from unusual. That the committee agreed 41 amendments tabled by MPs other than the sponsor (32 of them from MPs who voted against the bill at Second Reading), of which two were against the sponsor’s wishes, actually makes the assisted dying bill a rarity. Almost all non-government amendments to government bills—often thousands per session—fail. During scrutiny of the 1967 Abortion Bill, another PMB, the only amendments accepted were those backed by its sponsor, David Steel.”
Of course, the argument that it’s had a lot of time compared to other bills is not an argument to say it shouldn’t have even more time, because it’s so significant.
The tone and the development of the debate on Friday was interesting. The proponents of the bill hardly spoke at all and the opponents’ arguments were largely repetitious until late in the day. For understandable reasons there has been little humour in this debate—until, that is, Labour’s Blair McDougall spoke. “Many honourable Members will be guided by their religion when they vote on these issues. Although I deeply respect that, I am not a person of faith. If there is a booming baritone voice appealing to my conscience, it is not that of God, but that of Nye Bevan, who was concerned about the commodification of care. In his time, the worry was about the role of the market in extending life. Today, my concern is about the potential role of the market in ending it.”
Many of the opponents’ arguments against this bill are easy for me to dismiss. But I think one they raise would worry me if I were an MP: it’s the widespread leeway given to ministers to change the bill without parliamentary debate—what’s known as the Henry VIII powers.
For me, the debate came to a crescendo with what one former veteran MP later described as one of the best speeches he’s ever heard in the Commons. It came from Dame Siobhain McDonagh, proposing that Henry VIII powers be removed from this bill, which again began with Bevan’s promise that the NHS should “relieve suffering”, “keep very many people alive who might otherwise be dead” and “make a great contribution towards the wellbeing of the common people”: “We have a duty in this place to defend that promise. We cannot allow the promise to be reworded without the full voice of parliament. We owe it to the public, to patients and to the NHS staff who dedicate their lives to this service, to stand firm and protect what is sacred.
“The amendment is simple but its impact is profound. It would ensure that any future changes to the core principles of the NHS must be debated openly, transparently and with the full consent of every Member—no short cuts, no sidestepping, no ministerial overreach. I urge colleagues across the House to support amendment 12, to stand with our NHS and with the people it serves. I urge my side—the Labour side—not to allow the assisted dying bill to be the Trojan Horse that breaks the NHS, the proudest institution and the proudest measure introduced by our party in 120 years.”
Leadbeater has not yet responded to any of this, but we have an interesting few days ahead.
