MPs have voted to support the assisted dying bill which would allow terminally ill adults to end their lives, following an hours-long debate covering the role and expertise of doctors.
On Friday, 330 MPs voted in favour of progressing the bill through Parliament, while 275 voted against it.
The proposed legislation, which was introduced as a private members bill by Labour MP Kim Leadbeater, requires the participation of two doctors who assess terminally ill adults and sign off on the decision.
However, it makes clear that doctors are not under ‘any duty’ to raise assisted dying with patients or to ‘participate in the provision of assistance’ if they do not wish to.
Only adults whose death from terminal illness ‘can reasonably be expected’ within six months would be eligible to receive assistance to end their life, and doctors must also ensure they have ‘capacity’ to make the decision.
The vote means that the bill has passed its ‘second reading’ in the House of Commons and will move on to further stages with the backing of MPs.
The two GPs who sit in the House of Commons – Labour’s Dr Simon Opher and the Conservatives’ Dr Luke Evans – both voted in favour of the bill.
During the debate, which lasted almost five hours, several MPs raised concerns about potential coercion, a perceived lack of adequate safeguards and the role that doctors will play in the process.
Conservative MP Danny Kruger argued that ‘terminally ill’ is a ‘term of great elasticity, almost to the point of meaninglessness’ and that it is a ‘purely subjective judgment’ made by the assessing doctor.
‘It is well known […] that it is impossible for doctors to predict with any accuracy that somebody will die within six months,’ he said.
Meanwhile, Labour MP Diane Abbott said she does ‘not believe that the safeguards are sufficient’ within the bill.
She continued: ‘They are supposed to be the strongest in the world because of the involvement of a High Court judge, but the divisional courts have said the intervention of a court would simply interpose an expensive and time-consuming forensic procedure.’
Speaking at the outset of the debate last week, the bill’s sponsor Ms Leadbeater said that the using ‘terminally ill’ in its title was a ‘very conscious decision’.
She told the Commons: ‘That title can never be changed, and it ensures it is only adults who are dying that would ever come within its scope.
‘As such, this bill is not about people who are choosing between life and death. It is about giving dying people who have got six months or less to live, autonomy about how they die and the choice to shorten their death.’
Ms Leadbeater also said that having consulted with the medical profession, she is sure ‘they can and will fulfil’ their safeguarding responsibilities, and that they ‘have the expertise to do so’.
‘And let’s be clear, Mr Speaker […] this is not brand new territory for doctors – doctors working in partnership with other clinicians are already required to manage complexity in end-of-life decision making.’
She also supported the BMA’s request that doctors ‘should be under no obligation whatsoever to participate’, but said that if they do, they will ‘receive appropriate training and support’.
‘Doctors should be able to use their professional judgment when and if a conversation takes place, taking their cue from the patient, as they do in many other issues, and I welcome this patient-centred approach,’ Ms Leadbeater added.
In response to the vote, the BMA reiterated its ‘neutral’ position on the issue of assisted dying, saying it does ‘not support or oppose a change in the law’.
However, the union’s medical ethics committee chair Dr Andrew Green said that there were a ‘number of key issues that would need addressing given the impact on doctors, their patients and their working lives if the law were to change’.
He continued: ‘These include the need for an opt-in system so that doctors choose whether or not to participate, the right for doctors to decline to participate in any part of the process, and the protection from abuse and discrimination for healthcare workers.’
The debate showed the importance of considering such details in the Bill, said Dr Green, and the committee would continue to engage with amendments to protect doctors and patients as the bill progressed further.
‘Speakers both for and against this bill during today’s debate called for urgent improvements in funding for, and the provision of, high-quality palliative care. We strongly support those calls,’ he said.
Thea Stein, chief executive of the Nuffield Trust, added: ‘MPs will need to carefully consider how such a change in the law would interact with the NHS and social care. There are large unanswered questions around funding, staffing and equity if this Bill becomes law.
‘In particular, it is still unclear whether or not assisted dying would be fully publicly funded. If it is, it will sit alongside services like social care and hospice care which are not. Both of these services are financially on the brink and MPs will need to understand how current threadbare provision will interact with this new service, what implications this may have for people paying for social care, and how to fund assisted dying from a health budget that is already overstretched.’
She added that if assisted dying was not publicly funded, that it would be difficult to achieve its aim of improving choice for all patients.
‘MPs will also need to scrutinise and debate the staffing and regulatory questions this throws up,’ she said. ‘Will NHS trusts be able or expected to provide this service? Will medical professionals carry out this work privately or as part of their NHS contract? Who will regulate this service? And what changes will be needed to training and education to ensure staff have the skills and knowledge to deliver it?’
Following the introduction of this bill to Parliament last month, the UK’s most senior medical leaders advised that it is ‘entirely reasonable’ for doctors to take part in the public debate around assisted dying.
The bill follows a Health and Social Care Select Committee inquiry looking into the current law and at international examples of assisted dying becoming legal.
A version of this story first appeared on our sister publication Pulse.
