One step closer: what's next as the Assisted Dying Bill clears Second Reading

England and Wales

In our earlier Law-Now article, Assisted Dying – is the UK ready for assisted dying, we discussed the potential consequences of MP Kim Leadbeater’s Private Member’s Bill, the Terminally Ill Adults (End of Life) Bill (“the Bill”), which was introduced in the House of Commons on 16 October 2024, proposing to legalise assisted dying in the UK. On 29 November 2024, the Bill passed its second reading in the Commons, marking a significant step in the legislative journey towards legalising assisted dying in England and Wales. The Bill garnered the support of 330 MPs, including Prime Minister Keir Starmer and former Prime Minister Rishi Sunak, while 275 MPs voted against it – a majority of 55. However, despite this initial success, the historic debate has highlighted critical issues, and many MPs have emphasised that their future support is contingent upon the Bill’s refinement. 

Overview of the Bill

The Bill aims to provide terminally ill adults with greater autonomy over their end-of-life decisions. Its key provisions for eligibility state that applicants must:

  • be 18 or older;
  • have a terminal illness with less than six months to live;
  • have been a resident of England or Wales for at least 12 months; and
  • be registered with a GP in England or Wales.

As for the process, two independent doctors must confirm the diagnosis and assess the patient’s mental capacity. The applicant must then make two formal declarations, stating their willingness to end their life, with approval from the High Court before proceeding. A 14-day reflection period (or 2 days if death is imminent) must follow court approval to ensure the patient has had time to fully consider their options. Once confirmed, life-ending medication is then prescribed and must be self-administered.


Key themes from the debate

The debate on the Bill highlighted a range of critical issues, reflecting the complexity of assisted dying as a moral, legal, and logistical matter. While the majority of MPs supported the Bill’s progression, concerns regarding its safeguards, implications for vulnerable groups, and its practical implementation led to passionate arguments across party lines.

  1.  Judicial oversight

    One of the central points of contention was the adequacy of judicial oversight in the proposed process. The Bill currently requires the High Court to confirm that the applicant’s request to end their life is informed, voluntary, and free from coercion. Critics argued that this judicial safeguard might be little more than a “rubber-stamping” exercise, as judges are not required to meet applicants in person. Labour MP Catherine Atkison highlighted how “more than two thirds of care proceedings involving the most vulnerable children cannot be completed within six months”. Given this statistic, she argued that “there is a real concern that the safeguard is not deliverable, or risks being the rubber stamp”.   Fellow Labour MP Diane Abbott quoted Sir James Munby, former president of the Family Division of the High Court, “Only those who believe implicitly in judicial omniscience and infallibility – and I do not – can possibly have any confidence in the efficacy of what is proposed.”  Comments made by Sir Gerald Barling, a retired High Court judge, described the proposed judicial oversight as “arbitrary and defective,” asserting that without direct interaction, judges would struggle to evaluate whether a decision to die was “clear, settled, and informed.” Concerns about court resources were also raised, with estimates suggesting that an additional 24,000 hours of court time would be needed annually to manage the expected caseload. This additional burden would place further strain on an already pressured judicial system, raising questions about whether the judicial safeguards could ensure fairness and thoroughness in each case due to constraints on court time, in addition to concerns about their potentially arbitrary function.
     
  2. Palliative care

    Another recurring theme was the relationship between assisted dying and the state of palliative care in England and Wales. Opponents of the Bill stressed that access to high-quality palliative care must be guaranteed before offering assisted dying as an option. They argued that without robust palliative care infrastructure, patients may feel forced to choose assisted dying due to a lack of alternatives. Some MPs called for an explicit clause in the Bill requiring the government to develop a comprehensive palliative care strategy alongside the introduction of assisted dying, ensuring patients are not left feeling as though death is the only viable option.
     
  3. Coercion

    There were also concerns around coercion and the potential for vulnerable individuals to be pressured into choosing assisted dying. Disability rights advocates and some MPs voiced fears that people with disabilities or chronic illnesses might be made to feel like burdens on their families or the healthcare system and are, “at most risk of coercion”. Critics noted that the Bill lacks a clear definition of coercion, leaving it open to interpretation and, therefore, making it difficult to safeguard against. Similarly, the provision allowing doctors to raise the option of assisted dying without the patient requesting it caused alarm. MPs such as Roz Savage, a Liberal Democrat, warned that this could result in unintended coercion, undermining the principle that assisted dying should be “patient-led, not doctor-led”. Advocates of the Bill acknowledged these risks but argued that strong safeguards could mitigate them, ensuring that the process remains rooted in individual choice and agency.
     
  4. Impact on healthcare sector

    Finally, there were significant concerns about the medical and pharmaceutical implications of assisted dying. Some MPs and professional bodies questioned whether the NHS, already under strain, could adequately support assisted dying without compromising other areas of care – the Health Secretary, Wes Streeting, has already made comments in this regard, as we mentioned in our earlier article. Doctors’ unions proposed that assisted dying services should be organised and funded separately to avoid further burdening the system. Additionally, there were calls for stricter regulations around life-ending medications, with proposals for enhanced monitoring and greater transparency to prevent misuse. Critics also argued that clearer medical guidelines are needed to help doctors navigate this ethically challenging process.
     

Barriers to the Progression of the Bill

As previously mentioned, although the Bill has managed to gain enough support to reach the Committee Stage, future support is contingent on whether the concerns raised are addressed. To overcome these potential barriers, proponents of the Bill will need to focus on addressing concerns through amendments. This may involve integrating provisions for enhanced palliative care, tightening safeguards for informed consent, and ensuring clear, transparent oversight of the process.  The wider reach of the Bill also requires consideration, including the potential impact on the pharmaceutical companies who manufacture life-ending medication. 

Both in 2014 in the House of Lords and in 2021 in the Commons, there was majority support for assisted dying bills, but the parliamentary sessions ended before the bills could progress further. The time constraint of the Parliamentary session is a potential barrier to legalising assisted dying, of which Kim Leadbeater is only too aware and on 11 December 2024 announced the membership of the Committee that will scrutinise the Bill. The Bill’s Committee will sit before the Christmas recess to agree the schedule of work for the New Year. The Committee is then expected to begin sitting in late January and with the earliest date for the Report Stage scheduled for 25 April 2025, it is likely that the Committee Stage will last until at least Spring 2025.

The combination of practical, ethical, and procedural barriers means that the Bill's future progression will require careful negotiation and refinement.


Next Steps

While the Bill has taken a significant step forward, its future depends on striking the delicate balance between patient choice and safeguards. With continued debate and amendments likely, it remains to be seen whether the Bill will secure the backing it needs to become law.

We will continue to monitor the progression of the Bill, and our team is on hand to assist with your regulatory queries.

 

[Co-authored by Areesha Qureshi]