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
3rd December
If you agree with whoever it was who said “laws are like sausages; it is better not to see them being made”, look away now. Because I’m odd. I’d quite like to watch as a bit of prime pork, maybe with some fennel seeds and sage, is turned into premium bangers. It’s interesting. And I’m pretty excited about seeing what goes in making a law out of the assisted dying bill: what will cause ructions and rows, and who will threaten to change their vote if they don’t get their way.
Some campaigners against the bill are pinning their hopes on what happens when MPs meet in a committee to go through it line by line. Phil Friend, from Not Dead Yet, is one of them. He was outside the Commons protesting as MPs voted.
“I was at the demo freezing my nuts off for my pains, you know, being in a wheelchair and stuff, and disability doesn't equate very well with the British winters, that's for sure,” he tells me. “I think we just felt incredibly disappointed at the time when the result came through, there were quite a few people in tears, some very emotional scenes from one or two people. Personally, I wasn't surprised. I thought that this might happen. The question now is: do we still try to stop this bill going through? Or do we make sure that it’s at least better than it was on Friday?”
That’s the opponents’ dilemma. In victory, Kim Leadbeater strikes a careful balance of humility and resolve. She’s keen to counter the scepticism voiced during the debate—particularly claims that the bill would lack effective scrutiny. This means accepting the possibility of really substantive amendments. She’s telling colleagues that she is very open to those that would make the safeguards stronger, and that she is very aware that MPs have legitimate questions and concerns that would clarify exactly how assisted dying would be offered as a choice to the terminally ill.
She is telling colleagues some of those questions can only be answered by the government, so it is a good thing that a minister will be on the committee. We don’t know who yet—but they will have to answer the huge question: how do we pay for all this?
So what are the other likely flashpoints?
Palliative care. There is near universal agreement among MPs who spoke in the debate that palliative care needs to be improved, whether as an alternative to assisted dying or in order to deliver it. But there’s likely to be disagreement over how much that should be part of the bill.
Royal Commission. Many opponents of the current bill suggest there should be a full investigation before the bill returns to the Commons. As that would take years, this would be seen as a wrecking amendment and it would be fought fiercely if anyone did try to introduce it.
I ask Phil about Not Dead Yet’s plan and he says they haven’t discussed it yet, but my question has made him ponder the possibilities.
“I think what we’re thinking about is pushing for a government stance with a Royal Commission and a proper look at this. Then developing something where the safeguards would be safer and where resources are part of the game, because that’s the issue here. This has been made in the middle of a budget which is telling us that we’re broke. We haven’t got any money. The country's broke, and then you’re suddenly increasing the workload.”
Who initiates the conversation? This is one of the most controversial details of the bill. Currently, it says doctors should be allowed to raise the subject of assisted dying with a person with a terminal diagnosis, raising fears this could put pressure on the patient. Three MPs who supported the bill have told the BBC they want this changed. One, Mike Tapp, the Labour MP for Dover and Deal, said it must “be specifically stated in the bill that medical practitioners are not to raise assisted dying with any patient. It should only be discussed if it is raised by the patient. This helps mitigate the risk of accidental coercion, or the perception of a hint, at a time of immense emotional distress and vulnerability.” But the British Medical Association does not want this to be forbidden by law.
Conscientious objectors. It is quite clear from the bill that doctors, nurses and others who might be involved, such as pharmacists, can opt out of taking part in assisted dying. Some will want this provision to be watertight, with more explicit detail about which organisations can also opt out—private care homes obviously, but a hospital trust perhaps not. But there is a model: the 1967 Abortion Act.
Role of judges. The bill is unique in the world in that it appoints a High Court judge to approve the request from the patient and two doctors. But the exact role will have to be clarified. Do they merely rubber stamp it (in which case what is the point?) or do they act like a trial judge or an investigating magistrate? On what grounds could they deny a request? And how would the overburdened and under-resourced courts system cope with a new workload? Lots of work for lawyers here!
Six-month terminal diagnosis. Why six months, not four or eight? We all know of cases where doctors have given someone a short time to live and they have survived for years. It seems unlikely that anyone will change their vote over this issue, but doctors will be pressed to explain. And how do we define which diseases count as “terminal” What about Parkinson’s, for instance?
Now this is getting personal. It will also take us to the core question—how to protect the vulnerable from coercion.
Which is why I will leave the rest of the sausage-making until tomorrow. To be continued.
2nd December
The world changed for everyone on Friday afternoon, when the assisted dying bill passed its second reading by 55 votes. Some campaigners were horrified. Bishop Philip Egan of Portsmouth said: “Britain has now crossed a line: things will not be the same again. May God help us.”
The world certainly shifted for the government, which now faces the perennial question: “yes, but who’s going to pay for it all?”
On Friday the Commons was at its best—a rarity in itself. The mood was sombre, quietly emotional but undramatic, MPs thoughtful and respectful of each other’s point of view. But now lurid headlines are back. Veteran Labour MP Diane Abbott told the BBC’s Sunday with Laura Kuenssberg: “We’re moving to a situation where it will be cheaper for a GP to get a very ill person to sign on the dotted line for assisted suicide than to find them a place in a hospice.” She urged the government to spend more on palliative care.
Indeed, if one point of unity has emerged from this debate it is this: MPs on both sides agree there must be stronger, more coherent palliative care available. Inevitably, this translates into demands for more funding from an already overstretched government and a “broken” NHS. The Guardian reports that a commission on palliative care is being set up by the Labour MP Rachael Maskell, who fiercely opposed the bill, and organisations and medics that currently deliver end-of-life care—Hospice UK, Marie Curie, Sue Ryder, and the Association for Palliative Medicine. I’m planning to investigate the whole subject more by the end of the week.
Finding the hard cash is not the only headache for the government. For many Labour politicos it is an unwelcome distraction from their priorities and will eat up government time and ministerial energy. Immediately after the vote the Cabinet Office issued a bland, non-committal “hands off” statement: “We understand this is a deeply emotive issue, with strongly held views on all sides. That is why it was a free vote for MPs, allowing parliament to decide independently of government.
“As the bill progresses through parliament, MPs will further debate and scrutinise the legislation and we will respect its will.
“This continues to be a matter for parliament.”
Up to a point, Lord Copper. Buried in notes at the bottom of this news release was the fact that work would now start on assessing the impact of the bill—usually that isn’t just the cost, but a wide range of topics including the regulatory burden, health and wellbeing, human rights and justice, and equality legislation. It will eventually make very interesting reading, but what I’d really like is to be a fly on the wall while it is being discussed and written.
It will take a good deal of political judgement, as the impact assessment could have an outsized impact on the debate. It is just one of the factors which may still sway those 330 MPs who voted for the bill as well as the 31 who abstained.
Campaigners against the bill believe many of those MPs are only tentative in their support and that by the time that it comes back to the Commons, probably next spring, they may be ready to chuck it out. While opponents acknowledge Friday’s vote as a significant setback, they will carry on fighting. They have lost an important battle but the war is far from over.
The next skirmishes will probably unfold in the new year or whenever the committee to examine the bill meets for the first time. Because this is a private members’ bill it is a bit of a strange beast. Kim Leadbeater gets to choose the committee members, and she has promised to include critics as well as supporters—but the choice itself gives her some power to flatter and persuade.
She has also said that the committee will have the power to hear witnesses and call for written evidence—and that is a first for a private members’ committee. As I understand it she won’t be the chair because for private members’ bills there are two chairs, who cannot vote and must be neutral. They are chosen from the delightfully named panel of chairs by the Commons Speaker.
The line-by-line scrutiny will take place every Wednesday when the House is sitting. I’ll be looking at potential flashpoints. Opponents view this as a prime opportunity to derail the legislation, exploiting any perceived weaknesses and winning the propaganda battle during the committee’s deliberations.
Their strategy hinges on sowing doubt among MPs who supported the bill with reservations. They hope these MPs won’t find the proposed safeguards convincing once subjected to post-Christmas scrutiny. The committee, scheduled to meet every Wednesday, is expected to deliberate until at least April before reporting back to the Commons, where another vote will follow.
For the bill’s critics, this prolonged process is not just a chance to pick apart the legislation but also to chip away at the fragile support it currently enjoys. I’ll follow every twist and turn.
