A good death

Who will pay for assisted dying?

The bill passed its second reading on Friday. Now come the hard questions

December 02, 2024
Rachael Maskell is setting up a commission on palliative care. Image: AN Davidson / Alamy Stock Photo
Rachael Maskell is setting up a commission on palliative care. Image: AN Davidson / Alamy Stock Photo

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

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.