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
5:30pm
After another week of detailed scrutiny of the bill we thought it would be good to hear from a pro-bill MP who sits on the committee, so here is Lewis Atkinson MP for Sunderland Central with a view from the hot seat. You can read an earlier take from an opponent of the bill here.
7th March
5pm
We had a very interesting panel discussion on end-of-life care at the Nuffield Trust Summit yesterday (you can watch highlights here). One of my fellow panellists was Dr Libby Sallnow, who is an associate professor and head of the Marie Curie Palliative Care Research Department at UCL. Perhaps as, or more, importantly, she is also a palliative care doctor working in a community in north London, seeing people at home, in prisons and in nursing homes when they are at the end of life or have a life-limiting illness. I spoke to her afterwards and hope you find our conversation as fascinating as I did.
Mark Mardell: What do you think makes for a good death?
Libby Sallnow: That’s a very good question and something I’ve thought a great deal about. One of the problems is that when we think about what makes a good death, we often take on the norms and ideas that society sets, rather than considering what it really means for us as individuals. And that’s the crucial part—what does a good death mean for you?
In palliative care, we often describe a “good death” as one that happens at home, in the community, with a hospital bed, injectable medications, a care package and district nurses coming in. These are the transactional aspects—the systems we can put in place. But what’s often missing, both in palliative care and more broadly in end-of-life discussions, is everything beyond those logistics: the relational aspects, the sense of connection and meaning.
Have we made sense of our own mortality? Are the right people there? Has there been space to process the finality of it all? These are enormous questions to grapple with. Yet, so often, the focus is on the practicalities—the hospital bed, the medication. Those are crucial, but they’re just the platform. The real work of dying well happens on top of that.
MM: How do you grapple with that? Because I’m grappling with it, and I find it difficult.
LS: Hopefully, your death is a long way off, but I see what you mean. I’ve grappled with it alongside many people, and I’ve thought about it personally as well, with my family.
I think it’s important to reflect on who we are in our community, in our family. What does it mean to say goodbye? What does it mean to look back on our lives, however long or short they’ve been? What does it mean to make sense of it all?
Beyond the transactional aspects, there’s the deeper work of coming to terms with our mortality. And I don’t think society allows much space for that.
Within hospitals and healthcare—where I spend a lot of my time—death is treated as if it’s not inevitable. It’s not seen as something that bookends our lives, something that’s part of the human condition. Instead, it’s presented as something infinitely deferrable, something we don’t have to confront.
So when it does become immediate—through a terminal illness, either our own or that of someone we love—there’s an enormous amount of emotional and existential work to do, often with very little preparation.
MM: It’s extraordinary because it is the absolute inevitability.
LS: Yes, exactly. Death is the one certainty, yet we push it to the margins. It is a population-level event—every single person will be affected by death and dying, and many will be caregivers and, later, bereaved. And yet it isn’t the focus of any major societal intervention.
Palliative care is a clinical intervention, and it’s valuable, but we need a broader response because these are societal events. Unless we create a place for death in society—not to dwell on it constantly, not to celebrate it, but to acknowledge it—we will continue to be unprepared when it comes.
If we ignore it until it confronts us, people are often left unable to cope. They struggle not just with the practicalities of caring for someone who is dying but also with the deeper questions of loss and mortality.
MM: Is that because, for good reasons, we are less familiar with death?
LS: Yes, exactly. Public health interventions and medical advancements have increased life expectancy. Fewer people die of avoidable causes, which means that unavoidable mortality is rising. But we’re not having a conversation about what that looks like.
In hospitals, death is still treated as something to be avoided at all costs, even though, by definition, it cannot be.
MM: I was just thinking about this—I recently said in an interview that I’d rather have a heart attack or be hit by a bus than face what I might otherwise go through.
LS: Yes, and that’s a common sentiment. People often say they’d prefer a sudden death to a prolonged decline. And yet, we are surviving cancer, we are surviving heart disease, and so more people are dying of old age. We have to die of something.
The problem is that so much of medical research is focused on “beating” conditions—beating cancer, beating dementia. But we cannot beat death.
There are Silicon Valley futurists looking at ways to extend life indefinitely—uploading our consciousness, cryopreserving bodies—but our physical bodies have a timeline. Even if we can extend it, we will always have a finite lifespan.
We need to integrate that reality into medicine, research and public discourse. At the moment, death is not recognised as a fundamental part of life. That has to change.
MM: We need a big conversation about this.
LS: Yes, and that’s what I’m working to build—both in the UK and globally.
But the conversation needs to go beyond healthcare. Healthcare has a vital role, but these are population-level, societal, deeply intimate, yet also deeply public experiences. We need to ask people what they want at the end of life, how healthcare can support that, and how the rest of society can, too.
MM: And in terms of what you do day to day?
LS: One of the big challenges is crisis management—particularly for people at home. Crises don’t follow working hours; they often happen at night or on weekends.
In Cambridge and Peterborough, Arthur Rank Hospice has developed a system where, if you call 111 (the urgent medical helpline), you can select option three for end-of-life care. This puts you straight through to someone who can give an appropriate response.
Without that, 111 operates on a standard protocol—“Are you breathing?” “Do you need an ambulance?”—which often results in unnecessary hospital admissions. With option three people can access specialist advice, making high-level decisions under pressure: Should I go to hospital? Should I stay at home?
MM: Because most people would rather die at home?
LS: Exactly. Studies show most people want to die at home, but that’s not the reality.
That said, it’s important not to say, “Dying in hospital is bad, dying at home is good.” A bad home death can be worse than a well-supported hospital death.
Hospitals are good at treating reversible conditions, but if a person’s priority is to be at home, surrounded by loved ones, then home is where they should be. The challenge is that most resources are hospital-focused, and community-based care is fragmented.
There’s no single point of responsibility, just a mosaic of services with different phone numbers, different working hours and no clear coordination. That makes it incredibly difficult for families to navigate.
That’s why something like option three on 111 is so important—it streamlines access to specialist care when it’s needed most.
MM: What do you make of the assisted dying debate?
LS: It’s a crucial debate, and I see its place in healthcare. But we have to address equity.
In jurisdictions where assisted dying is legal, it’s mostly taken up by people with good healthcare access, strong health literacy and trust in the system—people who feel empowered to say, “I’ve had enough.”
But for those with poor healthcare access, limited health literacy and little trust in the system, the conversation is different. They aren’t asking for assisted dying; they’re asking for more care.
So while I believe assisted dying should be an option, we must also ensure that people who are struggling to access basic care are not forgotten. The debate must include both groups.
MM: Thank you.
Next week you can read my conversation with another fascinating expert on death and dying, Professor Vic Rayner, CEO of the National Care Forum.
6th March
I’ll be at the Nuffield Trust’s big health summit today, on a panel about “end of life care”—including but not focusing on assisted dying. I hope to report back afterwards, but you can watch here. I’m up at 4pm but there’s lots of good stuff before then.
1pm
Did Leadbeater’s more emollient approach work with her critics on the committee? Up to a point. The anti-bill Labour MP Naz Shah welcomed the change but worried it didn’t go far enough protecting women in abusive relationships.
This is just a part of her lengthy speech: “Multiple people have raised concerns about the importance of… identifying coercion. Currently, nothing in the bill requires the two independent doctors to have met the patient before assessing them. Coercion can develop over years, and we have repeatedly heard from experts that it is extremely difficult to identify. This is because coercion involves trust: for a victim to admit to being controlled, or even to recognise it themselves, is not easy.
“If domestic violence is involved, the difficulty increases. I have spent years campaigning against domestic abuse. Research shows that, on average, it takes women 40 attempts before they are able to leave an abusive relationship. I know this from personal experience—it took me a long time to escape my own abusive post-marriage relationship when I was very young. Repeated coercion makes it even harder for victims to recognise their situation. For a professional, even one who suspects coercion, getting a victim to acknowledge it is a significant challenge.
“Again, multiple people have emphasised the importance of the doctor-patient relationship. Yet nothing in the bill guarantees that doctors assessing a patient for assisted dying will have had a longstanding relationship with them. It is reasonable to assume that someone who has experienced coercive control over many years would be reluctant to disclose their true circumstances, even to a doctor they do not know well.
“Research also suggests that a significant proportion of UK medical staff do not feel adequately trained to recognise domestic abuse. A YouGov study commissioned by Save Lives in 2018-19 found that half of UK healthcare professionals had not received training to identify domestic abuse. Given that many patients may not have an established relationship with their doctors, it is even more vital that doctors are properly trained to recognise coercive control.
“Like many other MPs, I was elected on a manifesto pledge to tackle violence against women and girls within the next decade. We must not lose sight of this commitment as we scrutinise this legislation. This bill will have particularly grave consequences for women, since we know domestic abuse disproportionately affects them. The Crime Survey for England and Wales estimated that in the year ending March 2024, 2.3m people aged 16 or over experienced domestic abuse—1.6m of them women. In the same period, only 51 domestic abuse-related homicides resulted in prosecution. This is a shockingly small number compared to the scale of abuse.”
12.30pm
Kim Leadbeater is offering an olive branch to critics who suggest she too willingly rejects any attempts to tighten the safeguards on the bill.
It is true that, watching the committee rattle through its business, there are frequently votes where those who support assisted dying reject proposals from those who oppose it, by 13 votes to eight. However, many of these amendments seem intended to wreck the bill, slow it down in committee, or are otherwise hostile.
She has judged that isn’t the case with amendments put forward by two Labour MPs who voted against her bill. Jess Asato’s amendment would require the training of doctors to include identifying domestic abuse, coercive control, and financial control. She’d previously been critical of the committee’s approach, arguing it felt “chaotic”.
Leadbeater has signalled she will support this, explaining: “This bill brings long-overdue scrutiny and regulation to decisions that are already happening behind closed doors, where potential coercion is hardest to detect. By requiring doctors involved in assisted dying assessments to undergo specialist training in recognising domestic abuse and coercive control, we are embedding world-leading safeguarding standards into law.
Leadbeater also backed another amendment, proposed by Labour MP Polly Billington, which would require doctors to refer patients to a palliative care specialist. “I am also pleased to support the amendment that ensures those exploring assisted dying are made aware of specialist palliative and hospice care options,” she said. It’s important that people know what their choices are, the support is available to them and that, for those who still wish to pursue an assisted death, that there are clear, accountable, and protective steps in place.” The amendment passed yesterday afternoon.
Will this mollify Leadbeater’s critics? Not the diehards certainly, but perhaps others—if only those two who proposed the changes. When the bill comes back to the Commons every vote will count.
5th March
12pm
The committee resumed its deliberations at 9.25 this morning. Yesterday, Conservative MP Kit Malthouse was clearly frustrated by the way opponents have been using the process to create headlines.
He asked the chair: “If anybody, if any member or indeed anybody externally, were for example to attempt to misrepresent part of the debate on those amendments, what possibly could we do?”
He suggested that an opponent of the bill could imply that the committee had refused to look at accommodations for people with Down’s syndrome, and was disregarding their welfare, because one amendment had been voted down.
“That you will be aware would be a serious misrepresentation of both the debate and the intention if anybody did that, either a member of the House generally or somebody externally. What measures could we take to correct that?”
The chair said it wasn’t up to him but for the House authorities. But I wonder if Malthouse was watching when Dr Gordon Macdonald, chief executive of Care Not Killing, spoke outside parliament and accused the committee of “ideological” rejection of safeguards.
“Today’s vote against an amendment, which merely tried to give greater protection to those people with Down’s syndrome and mitigate the negative impact of the draft legislation, is chilling,” he said.
“Every amendment put forward to strengthen this draft legislation, including protecting those with diabetes, eating disorders such as anorexia and now Down’s syndrome, has been voted down. A reasonable person might well conclude that those rejecting these measured changes are doing so for ideological reasons, while the centrepiece of the draft bill’s safeguards, as sold to MPs and members of the public alike—independent scrutiny of each application by a High Court judge in a formal judicial hearing, with all the power that confers—has been ditched.
“Day by day, the truth of this legislation becomes clearer. Safeguards are illusionary, doctors will be forced to talk to all their patients with a six-month prognosis about assisted dying even when they don’t think it’s appropriate, and essential details are being left to regulation at some later stage—including the role of the medic at point of death and even what method of suicide will be legal.”
Fair comment or serious misrepresentation? And even if it is the latter, isn’t it also the former?
12pm
There’s a lot of worry in the committee about embroidery, and it is a big dividing line. Not about the MPs’ attitude to sequins or back stitches. It’s their jargon for over-ladening a bill with unnecessarily protection that actually makes it worse in practice. Labour, pro-bill MP Dr Simon Opher put the argument very clearly.
“As the bill is drafted, it’s simple but very, very effective,” he began. “I would also say something about ending treatment and its effects. These are the discussions we have with patients. We say, for example, ‘You can go for further chemotherapy, but it may cause you to lose your hair, it has other side effects, and it might only give you another couple of months.’ These are the sorts of discussions we have as medical practitioners.
“What guides us as doctors is the General Medical Council (GMC), which sets standards for the profession. If we are hemmed in by legal parameters, we risk breaking the law without realising it. If we set too many legal constraints around medical consultations, patient care will suffer because doctors won’t have the freedom to offer the best advice.”
He added: “I think that if we add too much embroidery to this, it will not be a safe bill. That has been the case throughout its drafting.
“Good medical care is based on explaining treatment availability, its likely effects, prognosis and the chance that it may be either longer or shorter than expected. All of this is based on good clinical care.”
11.30am
There has already been a series of rapid-fire votes on various amendments—all of which went the expected way: eight for tighter guidelines to 13 against stricter rules. One MP, Conservative Kit Malthouse, asked if there was any way of stopping people misrepresenting what the committee had decided, for instance if they said the committee had rejected the views of those representing people with Down’s syndrome.
Leading bill opponent Danny Kruger, and the probable target of the remarks, replied: “We must accurately reflect the debates that take place in this House. For my part, I will not be commenting externally that the House has disregarded people with Down’s syndrome, and I respect the point made by the minister and the honourable lady that there will be an effort to engage with the Down’s syndrome community in the drafting of further consultation and guidance. I appreciate that point.
“Nevertheless, the committee did choose to exclude an amendment that would have required the government to put specific protections for the Down’s syndrome community into the bill, as my right honourable friend, the member for Hampshire, has specified. I will be making that point, but I also understand the importance of accurately and fairly reflecting the amendments in this group.”
No gagging clause for MPs then.
11am
This morning the committee is looking at various plans to impose gagging clauses on doctors, limiting how they raise the subject of assisted dying with patients, and with which patients. The minister for social care Stephen Kinnock opened up, setting out the government’s basic provision that existing rules and regulations worked well and should be tinkered with as little as possible.
Conservative MP Rebecca Paul began to make a broad point: “During these proceedings, there has been a tendency among some speakers to describe assisted dying as another type of treatment or healthcare option offered by medical practitioners rather than as a completely separate and distinct matter. I have grave concerns about this. The legal norm and guidance are that patients should be offered all reasonable medical treatments. A medical treatment is defined as something that combats disease or disorder. It is fundamentally about healing, symptom relief, recovery and cure. Straight away, we have a conflict. Assisted dying ends the life of the person; it is not a treatment in the usual sense of the word.”
But the chair interrupted, saying she had to talk about the specific amendments rather than make general points. Looking somewhat frustrated and bewildered she sat down.
Kim Leadbeater quoted the British Medical Association (BMA) at length. “Doctors and healthcare professionals, like any other group of people, hold a range of views on assisted dying. We only have to reflect on the oral and written evidence presented to the committee to see that. The BMA holds a neutral position on assisted dying, and in their oral evidence to the committee they made it clear that they wanted an opt-in model for doctors, allowing them the right to decline participation in assisted dying for any reason. These requests have been incorporated into the bill.
“It is also worth noting that in their submission the BMA are very clear in opposing amendments, including 342, which we will come to later. They argue that adding prohibitions or limitations in the bill would create uncertainty and legal risks for doctors, potentially inhibiting effective doctor-patient communication. The BMA welcomes the bill’s provision that a doctor is not under a duty to raise assisted dying, which they see as necessary to avoid any suggestion that doctors have a legal obligation to do so. They are concerned that these amendments will remove that provision, leaving doctors in a position of legal uncertainty.”
4th March
10am
The third week of detailed scrutiny of the bill gets underway this morning. The first two weeks were gruelling line-by-line trench warfare, with opponents in a losing battle to amend the bill. Today and tomorrow are unlikely to be any different.
The bill’s sponsor Kim Leadbeater has reacted with this appeal to MPs: “Dying people and their families must be at the heart of this process. It is for them that I and the committee as a whole are putting in so much time and effort into making sure the bill is workable. It is essential we keep in mind the harm inflicted on terminally ill people and bereaved families by the law as it stands, so we can work together to produce a better, safer and more compassionate law than we have at present.”
You can watch proceedings here—but don’t worry, I’ll do it for you and will report back soon.
