Dignity in death? The assisted dying debate

Tomorrow marks the most significant vote on social reform in the UK since the legalisation of same-sex marriage. Unlike that decision, which was included in the 2010 Conservative Party manifesto, the Assisted Dying Bill was not included in Labour 2024 manifesto and is being voted on in the form of a Private Members Bill, introduced by Labour MP, Kim Leadbeater. 

A Private Members Bill is a vehicle to backbench MPs to influence legislation outside the normal programme of government. Private Members Bills have, in the past, introduced seismic social reform in the UK. Leading examples include the temporary abolition of the death penalty in Great Britain in 1965, the legalisation of abortion in Great Britain in 1967 and the decriminalisation of homosexuality in England and Wales in 1967. With power more centralised within the Cabinet, and to a greater extent the Prime Minister, the ability of backbenchers to influence legislation has been curtailed. The vast majority have – and will – fail. Most bills introduced by backbenchers that are successful are ‘government hand out bills’, essentially dictated to the backbenchers and then given to the successful MPs to adopt as their own. 

The level of diversity in views in the debate on assisted dying is notable. The Health Secretary, Wes Streeting MP and the Justice Secretary, Shabana Mahmood MP, are both opposed to the Bill; while Ed Miliband, Yvette Cooper and Louise Haigh are among several high-profile cabinet members in support. The Prime Minister, Sir Keir Starmer, has previously spoken out in support of assisted dying, but has not commented publicly on his position vis-à-vis this iteration. Our first indication will be when he walks through the voting lobby tomorrow. Gordon Brown has also come out against the Bill, citing the experience of the death of his 11-year-old daughter as reinforcing his belief in the importance of end-of-life care.  

On the Conservative side, former Prime Ministers Theresa May, Boris Johnson and Liz Truss have all spoken publicly against the legislation. Lord Cameron, however, has stated, “It is not about ending life, it is about shortening death”. He added further, “When we know that there’s no cure, when we know death is imminent, when patients enter a final and acute period of agony, then surely, if they can prevent it and – crucially – want to prevent it, we should let them make that choice.”

Those in support of the legislation believe that it will allow family members to give loved ones “dignity in death”, and a right for the terminally ill to choose when to die. Assisted dying is legal in ten US states, Canada, the Netherlands, Belgium and Switzerland, their belief being it can end the suffering with those with just months or weeks to live. Supporters and critics have used numerous examples of how assisted dying operates in those countries to advance their respective arguments. 

Leadbeater’s Bill defines a terminal illness as one “which cannot be reversed by treatment” as an adequate safeguard. Critics have countered that this definition does not take into account that there are incurable illnesses that can be managed. Their arguments highlight potential issues with coercion, the erosion of safeguards over time and whether the protections included in the Bill go far enough. Assisted dying has been framed as a fundamental reimagining of society’s view of death - Chief Rabbi Ephraim Mirvis has cautioned that the Bill could turn “life into a commodity like any other”. Former Defence Secretary and veteran MP Liam Fox has said that it would make the NHS a “National Death Service” and questioned whether the NHS is fit to administer assisted dying. 

A final group of MPs have criticised the level of scrutiny afforded to the Bill and called for proper time to be set aside to debate it. The nature of a Private Members Bill means that it is debated on the less well attended Fridays, when MPs are usually in their constituencies and given less time for scrutiny than legislation introduced by the government. 

Whatever the result – this vote will have a profound impact on our interpretation of end-of-life care – and ultimately whether it is appropriate for an individual to intervene in the death of another. As a free vote, MPs can vote according to their conscience and the result is impossible to discern. If the Bill fails, the government will no doubt feel pressured to introduce a Bill as part of its own legislative agenda.