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
24th April
I’ve been wanting to talk to Professor Lucy Selman since reading her fascinating and thought-provoking piece for the British Medical Journal at the end of last year. The article argued that “despite a growing interest in death, support for end-of-life care and bereavement remains inadequate. We urgently need a community-centred, public health approach to the social processes of dying and grieving, backed by properly funded palliative care.”
Selman is professor of palliative and end-of-life care at the University of Bristol and also the founding director of the Good Grief Festival. I finally caught up with her earlier this week. I began by asking what her attitude was towards assisted dying and the current debate.
Lucy Selman: I’ve nothing against it in principle, and certainly from an ethical perspective, I can fully appreciate the arguments for assisted dying. Before I started doing palliative care research at the beginning of my academic career, I studied philosophy. I did an MPhil in the philosophy of science and was very interested in philosophical approaches to these kinds of issues.
And before I did that, I think I was very much in the camp of, you know, we should legalise cannabis and definitely legalise assisted dying—it all seemed very straightforward. But the more I’ve thought about it, especially through the lens of my work, the more I’ve realised that you can’t see this as a purely ethical question.
So for me, it’s very much about looking at the system into which we’re considering introducing it—the social context, the healthcare system, the NHS, end-of-life care. From that perspective—the contextual and systemic perspective—I have real worries and concerns about introducing assisted dying.
And obviously I’ve followed the recent debates quite closely. My concerns weren't alleviated by what I saw in those debates.
Mark Mardell: What were your concerns, if they weren’t ethical?
LS: I think the way the debate often hinges on very emotive, personal, individual cases is quite worrying and problematic. We need to take a population-level view of these things. And we need to, as I said, consider the whole system—the specifics of the bill being proposed, not just the abstract idea.
I was particularly concerned by what felt like a very simplistic portrayal: that assisted dying is a positive choice—you have a terminal illness, you receive excellent palliative care, but you have intractable suffering that can’t be relieved, and therefore assisted dying is a logical, autonomous decision.
But that’s just not the reality for many people. We know there’s underfunding in palliative and end-of-life care. There’s a lack of funding for social care. There’s discrimination and marginalisation in society. Coercion and control are real—they influence decision-making. Ableism and ageism exist. And more broadly we see poor housing, poverty, lack of access to care. All of these can influence someone’s experience and their choices.
So I worry that assisted dying could become the only choice for some people—not necessarily because they want to die, but because they feel a real pressure, not just through overt coercion but from society itself.
As I said, I think it will be implemented at some point—maybe not now, but within my lifetime—and I don’t think that’s wholly a bad thing. I can appreciate that palliative care isn’t always enough. But I do really worry about the societal ramifications of introducing it now, especially as that bill outlines.
MM: And do you worry about the medicalisation of death? Does assisted dying further that—or does it perform something useful, by concentrating people’s attention on death?
LS: I think it does medicalise death and dying—partly because the nature of the conversation has evolved that way. It’s become a medical issue. The debate is about whether it should happen within the NHS, or whether private providers should be allowed to do it. Somehow it feels like the discourse is missing the point.
It’s not really addressing the wider issues I tried to outline in that BMJ article. We need to look in depth at what currently happens, and at the problems with what currently happens. I think sometimes assisted dying is seen as a kind of shortcut—a way to leap over the inequities and gaps we already know exist in the system.
MM: So what are your basic concerns about the way we approach this debate? You mentioned poverty and those wider issues in society. But what about our attitude to death?
LS: First, there’s a lack of public understanding around end-of-life care—what’s currently available, what’s already permitted. The jargon around things like advanced care planning can put people off. It’s hard for people to talk about their wishes when they’re not sure what the system offers.
There’s also a lot of mistrust—especially in minoritised groups—towards healthcare providers. And more broadly, we have poor death and grief literacy. There’s a discomfort in talking about death and dying—and in how we respond to bereavement.
I think sometimes that’s easier to understand when you look at personal experiences. If someone’s experienced a disenfranchised grief—say, they’ve lost someone to substance use, or they’re in a same-sex relationship and their partner’s death isn’t recognised by the family, or they’ve had a stillbirth—it becomes really clear how uncomfortable society is. People will literally cross the road to avoid you.
If your grandmother dies at 95 after a long illness, that’s easier for people to handle. But those other experiences show how far we still have to go to build a compassionate society for people facing illness or bereavement.
That’s what we’ve tried to tackle through things like the Good Grief Festival—creating opportunities for people to come together, to think, talk, reflect and learn.
Then there’s the issue of funding. It’s frankly scandalous how little NHS funding goes to formal end-of-life care—hospice care, palliative care. It’s been deprioritised.
And finally, the deep-rooted inequities in access. People who most need support often can’t access it. In wealthier areas, you’re more likely to get good end-of-life care. And the barriers are real—we have to tackle them.
People say, “Well, compared to other countries we’re doing well,” but if you look at the data, I don’t think that’s true. The system is complex and unequal.
MM: Have we lost touch with death? We don’t see it—literally see it—so often now.
LS: I do think the point about losing touch with death, with dying and with grief—that’s significant. Our language around grief has diminished too.
That distance affects our social attitudes and behaviours. And those behaviours can either support someone going through grief—or make it much harder.
If people were more comfortable with death and dying as part of life, I think they’d be better placed to meet those harder losses—the ones we find more difficult—with real compassion.
I’d really recommend the chapter in Dying, Death and Bereavement by David Clark on laying out the dead. I’m not an expert myself, but it’s a fascinating insight into the historical practices around the dead.
It’s not so much the family, but the community that would play a role. He writes: “In parts of the UK, it was common until the mid-20th century for families to manage death at home. In Yorkshire villages, for example, women took great pride in laying out the dead, and family members took it in turns to sit by the body through the night. One woman—the ‘bidder’—was employed to knock at every household to bid or invite people to the funeral.”
So, in the article I was talking about how, at a community level, that knowledge and those rituals have been lost. There’s a really interesting piece I can send you—it’s on the Wellcome Collection website, by the historian Claire Cock-Starkey. She wrote about historical changes in practices around keeping the dead at home. It’s fascinating.
In the UK today, some people just don’t realise what is allowed after someone dies. The folk at the Good Funeral Guide are doing excellent work, and others too...
MM: What do you mean—what is allowed?
LS: Well, because of the medicalisation of death and the distance many of us now have from it, people often think that the first thing you must do when someone dies is phone the doctor, and then you have to call a funeral director to take the body away. But actually, that’s not the case. You can keep a body at home. There are lots of aspects of a funeral—or after-death care—that you can do yourself, as a family, if you want to.
But we’ve internalised this very Victorian model—even down to the funeral directors’ outfits, with their top hats and black coats. That era has really shaped our expectations. More recently, I think people are becoming aware of the alternatives—the personal touches you can add, how much more involved you can be.
This morning I was looking at the Good Funeral Guide’s page on how to care for the body of a person who’s died. And there’s a radical undertaker—Ru Callender—who’s written a book called What Remains, which I really recommend. He writes vividly about supporting families who want to keep the body at home, and about rituals that involve family and community.
I do think we’re starting to come out of this long period of detachment—but for years we’ve been so far removed from death and grief. We’ve handed it all over to professionals.
MM: I find that all quite fascinating—historically, but also, frankly, a bit revolting. Personally, I’ve never understood the desire to visit a funeral home to see a dead body—although I did sit for a while with my father’s body when he died at home in his armchair, and I saw my mother’s body in hospital. Very moving in a way. but it isn’t how I want to—or do—remember them. I think there’s something fundamentally wrong about allowing the final moment to overshadow the memory of a life. I remember as a boy seeing a film about a child forced to kiss his dead grandmother. It haunted him, and I can imagine that happening. Indeed the film itself rather haunted me, for years. Isn’t it sometimes right to keep death out of sight—to protect people?
LS: Yeah, I get what you’re saying. It’s tricky. So often when we talk about these issues—whether it’s assisted dying or broader attitudes to death—we focus on individual choices. But we also need to zoom out and look at the bigger picture: what norms we’ve created as a society.
It’s not about saying, “This is good” or “That is bad.” I wouldn’t romanticise the pre-palliative-care world, or a time before funeral services. But I think it’s important to ask: what have we lost by medicalising everything?
Medical science has been a wonderful thing—but it has consequences. Our healthcare system has become fragmented. Care is divided by organ: cardiology, nephrology, etc. That often means the person gets lost. Ironically, it’s only when someone is dying—when palliative care steps in—that we start seeing holistic care.
And of course, in gerontology, for example, there’s more of that whole-person approach. But if you speak to patients, they’ll often tell you how exhausting it is to juggle appointments across multiple specialties. Most older people have several conditions. It’s complex.
I think the medicalisation piece is crucial. It's not about throwing the baby out with the bathwater. It’s about understanding the unintended consequences.
I remember sociologist Tony Walter talking about the Dying Matters campaign years ago. He said, “Everyone says we must talk about death—but why must we? What’s the benefit?”
That’s a fair challenge. But on the flip-side: if no one’s talking about death, end-of-life care, or bereavement… what then? At the Good Grief Festival, we’ve seen people come with questions they’ve carried for 20, 30 years—about the deaths of their parents or grandparents.
MM: What sort of questions?
LS: Questions like: “Did the doctors starve my loved one?” or “Why weren’t they given anything to drink?” People carry guilt, fear, and confusion about what happened—and no one has explained the dying process to them.
When they learn that it's natural to stop eating and drinking at the end of life, that it’s not about neglect, it can be a huge relief. They realise they were witnessing the body shutting down—not cruelty or failure.
Grief is another big one. People who haven’t been bereaved often think grief is just sadness. But then they experience it—and realise it’s not. It can be anger, identity loss, confusion. It can shake your world. Sadness doesn’t begin to cover it.
So yes—we need more open conversations. Not to impose anything, but to make sure people are prepared, and have the scaffolding to handle it when it comes.
MM: Do you think we need a secular ritual for dying? Funerals have become more personalised—favourite rock anthems, horse-drawn carriages. But when it comes to dying itself, the only formal ritual I can think of is the Catholic Church’s Last Rites—and that can be pretty strange if you’re not religious.
LS: I think that’s one of those areas where there’s no single answer. You can’t create a ritual that works for everyone. But maybe the key is talking about it more—giving people choices and helping them understand what’s permitted.
During Covid we saw how when you take away the traditional funeral format, people found new ways to create meaning—online rituals, art, poetry. Maybe we’ll see more of that: creative, personal ways of memorialising.
We know from psychology that ritual can be helpful. But knowing that doesn’t mean everyone wants to do it. It’s like religion—there’s research linking religious belief to better health outcomes, but you can’t just decide to be religious for the benefit. It doesn’t work like that.
So yes, rituals can help—but it’s about making space for personal ones, not imposing anything.
MM: Has all this work changed the way you think about your own death—or the deaths of those close to you?
LS: That’s a tough one. I remember when I was just starting out, I worked at Help the Hospices—now Hospice UK—and then at the Cicely Saunders Institute. I met Cicely Saunders herself. She was an extraordinary woman—the founder of the modern hospice movement.
Before she died, a colleague told me that she was almost excited about it. She was religious and saw it as a transition, the start of something new. She was curious about what came next.
For most of us, especially if we’re agnostic or atheist, it’s not like that. We know death is the end of what we have, but we still wonder: is there anything more? What happens to consciousness?
I don’t know the answers. I don’t think anyone really does.
But yes, studying this field for 20 years has shaped how I think. It makes you value conversations—the chance to talk to those you love while you still can. To think about legacy. To make sure things don’t go unsaid.
I don’t know how I’d feel facing my own death. I imagine I’d fear pain, the process. I’d want to know I was getting good care. But I’m sure this work has shaped the way I think about it—even if I couldn’t say exactly how.
22nd April
Many MPs who are in favour of Kim Leadbeater’s assisted dying bill are said to be boiling mad at the possible delay in implementation, which they feel may hole the plan below the water line.
They’ll get their chance to challenge it on 16th May, when the bill returns to the Commons—if they have the courage of their convictions.
What’s making some Labour MPs nervous is that it’s a bit of a mystery why the delay has been introduced, and by whom. Although the amendment was formally moved by Leadbeater herself, it’s pretty clear she’s putting a brave face on it—and swallowing hard, through gritted teeth.
Although she insists that the four years is a backstop, not the actual plan, many MPs worry that the very possibility that it can take four years from the passage of the bill to implementation means it will take four years. The simple pressure of other work may encourage ministers and civil servants progress to proceed at a snail’s pace—after all, we all know the equation where work expands to the maximal deadline. That would scupper the whole thing, because it could put it bang in the centre of the next general election—probably not where the Labour party wants it, as a contentious issue.
Liberal Democrat MP Tom Gordon has put down an amendment that would cut this to three years, and so avoid that trap. Some of the pro-bill organisations such as My Death, My Decision are supporting him and quoting people such as Clare Turner, a mother of two with stage four breast cancer, who is disgusted with the four year move:
“This is outrageous for terminally ill people like me. Every delay means more suffering, more people forced to endure unbearable pain against their will. The government needs to stop dragging its feet and act now because the vast majority of the public supports assisted dying. People across the country want this change—so why push it further down the road? We deserve dignity, not delays!”
But before voting for this amendment if it is selected by the speaker, MPs will be asking themselves: if Leadbeater didn’t really want the change, who did?
It seems to be the health department that pushed for it. Apparently, the health minister on the committee, Stephen Kinnock, isn’t enthusiastic. Was it his boss—Wes Streeting—who is opposed to the bill and originally hinted he’s worried about the cost to the NHS?
Or was it simply civil servants, who may have genuinely worried about the time it will take to organise an assisted dying service within the NHS, and paid no heed to the politics of it all?
One usually reliable source claims although Number 10 did know about the amendment, Keir Starmer wasn’t personally aware of it before it was passed. That might give some hopes that even if the amendment isn’t ditched in next month’s vote, the prime minister is now alive to the dangers of running close to the election and so may push for it to be done more quickly.
But all this confusion means that even if Tom Gordon’s amendment is selected by the Speaker, many MPs will be wary of appearing to oppose the government. If this amendment and others are adopted, the bill could be scuppered anyway through lack of time, some experts believe. More on the timetable soon.
