On 12 September the House of Lords began to consider the Terminally Ill Adults (End of Life) Bill. This Private Member’s Bill, proposed by Kim Leadbeater MP, was passed by the House of Commons in July. For this Second Reading debate, when the principles are considered, the House of Lords was packed, with 180 Peers registered to speak – the second largest number ever in a Lords debate. As a result, the discussion has been split across two sessions. The second day will end with a critical vote on Friday 19th.
The Bill
The Bill would provide the choice to those that need and want it, to have medical help to end their lives. This would only apply to mentally competent adults, diagnosed with a terminal condition and expected to die within 6 months. The Bill would introduce measures to assess eligibility, ensure medical and judicial oversight, and monitor each step of the process. For the first time, there would be new criminal offences for coercing someone to seek assistance to die. The Government’s impact assessment has described the framework as the strongest assisted dying law proposed anywhere in the world.
The Commons passed the Bill with a majority of 23, on a free vote, with the Prime Minister and a majority of cabinet ministers voting in support.
The Lords debate
Opening the Lords debate, the former Lord Chancellor and Justice Minister, Lord Falconer, said:
“The current law is confused, causes terrible suffering and lacks compassion and safeguards. People must be at the heart of this debate. The Government’s own estimate is that, if the law was changed to introduce assisted dying, less than 1% of deaths would be assisted after 10 years. However, it is right that we allow assisted dying as an option for those who, despite the best palliative care, still want an assisted death.”
Support in the first Lords session included senior voices from healthcare, policing and the judiciary, including former Director of Public Prosecutions Lord MacDonald, leading KC and constitutional expert Lord Pannick, and former Metropolitan Police Commissioner Lord Hogan-Howe. Two of the three psychiatrists in the House of Lords – Lord Alderdice and Baroness Murphy – said they would vote for the Bill, sharing distressing stories of friends or former patients who would have wanted the choice.
Some peers said they had changed their mind from opposition to support. They included Lord Forsyth – who spoke movingly of his father, who on his deathbed criticised his son for blocking change in the past.
But there was substantial opposition, with the Bishops turning out in force to speak against the Bill, as did the former Prime Minister, Baroness May. Baroness Berger has proposed an amendment which would delay and perhaps block the Bill’s progress. A number of peers warned against any such procedural delay, with Lord Falconer reminding colleagues “our job is not to frustrate, but to scrutinise”.
What happens if the Lords vote against?
The constitutional position is unclear, though the Hansard Society has published a guide to the process, outlining the various ways in which the Bill might be defeated by the Lords. If the Lords insist on wrecking amendments which the Commons reject there will be deadlock. The procedure whereby a Government Bill can become law after two years without the Lords’ consent had never been used for a Private Member’s Bill. So, a lot hangs on whether the Lords vote in favour of the principle in Friday’s vote.
Public opinion
In September, England’s first ever citizens’ jury on assisted dying found overwhelming support for law change. In 2024, in the largest ever opinion poll on this topic, three-quarters of Britons supported it, with majority support in every constituency in Great Britain and across all demographic groups. The latest YouGov poll, in June, confirmed that the British public continues to be strongly in support of legalising assisted dying.
Medical opinion
Medical opinion has been shifting in favour of change. The British Medical Association dropped its official opposition in favour of neutrality in 2021. The Royal College of GPs, The Royal College of Physicians, Royal Society of Medicine, Royal Pharmaceutical Society, Royal College of Surgeons and Royal College of Anaesthetists have all now adopted a neutral stance. The Royal College of Nursing voted to support the principle of assisted dying at its Annual Conference in June 2024.
Legal opinion
Three former Directors of Public Prosecution have criticised the status quo and expressed support for the Bill.
In England and Wales, ‘assisting a suicide’ is a crime with a maximum sentence of 14 years, but the Crown Prosecution Service has issued new guidance in response to changing public attitudes. This aims to distinguish the genuine crime of assisting or encouraging a suicide, from cases where the deceased had a clear and settled wish to hasten their death in the face of significant suffering, and was assisted by a compassionately motived family member.
Change across the UK and beyond
Currently, four Parliaments around the British Isles are considering legalising assisted dying for terminally ill adults. On the Isle of Man, the Assisted Dying Bill has cleared all its stages and is now awaiting Royal Assent, with the law expected to come into force as early as 2027. In Scotland, the Terminally Ill Adults (Scotland) Bill has passed its Stage 1 vote with strong cross-party support. Jersey’s assisted dying bill is expected to be debated later this year, after Assembly Members voted in principle to support changing the law in May 2024.
Internationally, 300 million people have access to assisted dying. Two thirds of these, including people in New Zealand, and ten US states, limit access, like the current Bill, to terminally ill, mentally competent adults. Eleven countries have wider scope. Legislation is being considered in five other countries.
Friday matters
On Friday the Lords will vote on the principle of the Bill, and it will then pass to a Committee of the Whole House to examine the detail. At that stage there will certainly be amendments, some designed to improve it, and others perhaps to delay or obstruct. Then Lords amendments will go back to the Commons for discussion and negotiation. It will be some time before we have a final result, but if it passes it will go down as a landmark piece of social reform, and a tribute to the determination and work of its sponsor, Kim Leadbeater MP.
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