Why is assisted dying so controversial – and where is it already legal?
Assisted dying is inching closer to becoming an option for terminally ill adults in England and Wales as a law moves through parliament – but it has been beset by lengthy delays.
It could mean people in the UK with terminal illnesses can end their lives “on their own terms”, according to Kim Leadbeater, the MP behind the bill.
Ms Leadbeater’s Terminally Ill Adults (End of Life) Bill received 330 ayes compared to 275 noes at its second reading in the House of Commons in November – a majority of 55.
The list of proposed safeguards includes a life expectancy of six months or less, the ability for the patient to take the fatal drugs on their own, and the sign-off of two doctors.
But the bill has been under intense scrutiny since the second reading, with hundreds of changes proposed, and a lengthy delay has thrown its future into doubt.
But why is it such a contentious subject – and where else is assisted dying legal?
Why is assisted dying controversial?
A key concern is the so-called “slippery slope” argument.
Opponents argue a law might initially have strict criteria – for example, restricting it to terminal illness and excluding mental health conditions – but that over time these could be eased.
Ms Leadbeater said this hadn’t happened in countries that have brought in assisted dying laws.
“Where there are countries where the law is broader, that was always how it started,” she told Sky News in October.
“So I think there is a perception around the slippery slope concept, which actually isn’t reality.”
But there is one example of this: Canada has changed its laws.
It no longer requires the presence of a terminal illness – only a chronic physical condition. It had also been due to expand the laws to mentally ill people this March, but the move has been delayed until 2027.
Other frequently cited worries are that people could be pressured to end their life – perhaps by a relative who would benefit financially; that people might act because they don’t want to “burden” others; or that they could make an irrational decision while depressed.
Some opponents also say it’s against their religion or unethical for doctors and that the focus should be on improving palliative care to ease suffering.
However, those who support a law change, such as Dignity in Dying, insist “everybody has the right to a good death” – rather than suffering for months or years with a very poor quality of life.
The group says it should be an option for terminally-ill adults who are mentally competent.
It claims more than eight in 10 people favour changing the law and that currently some people are forced to choose “a lonely and perhaps violent death”.
What is happening with the bill now?
MPs have been considering and proposing changes through a scrutiny committee since the bill’s second reading, with Ms Leadbeater saying 150 amendments have been adopted.
The initial bill stipulated that any assisted death was subject to approval by two doctors and a High Court judge.
But one of its biggest and most controversial amendments saw the requirement for a High Court judge’s involvement scrapped and replaced with a voluntary assisted dying commissioner.
It will comprise a judge or former judge to oversee assisted dying cases, along with expert panels featuring a senior legal figure, a psychiatrist and a social worker.
Ms Leadbeater said such a change would give her bill “additional patient-centred safeguards” by providing a “range of expertise” via the three-member panel, arguing it was “is a strength, not a weakness”.
Opponents of assisted dying disagreed, and said removing the High Court judge requirement “fundamentally weakens protections for the vulnerable and shows just how haphazard this whole process has become”.
In a statement issued after the vote, 26 Labour MPs who previously voted against the bill issued a statement which said: “It does not increase judicial safeguards but instead creates an unaccountable quango and to claim otherwise misrepresents what is being proposed.”
MPs are expected to vote on further amendments to the bill on 25 April, but the rollout of assisted dying is set to be delayed until at least 2029 due to a proposal by Ms Leadbeater.
In late March she announced that an initial two-year “backstop” would increase to four years, saying she was disappointed to propose the extension but adding it was “more important to do this properly than to do it quickly”.
The four-year delay, passed by the committee scrutinising the legislation, now means the law is unlikely to be operational until at least 2029 – the year by which the next general election must take place.
After the vote, Ms Leadbeater said the bill will come back to the Commons in a “safer, fairer, and more workable” form.
Some in favour of the bill have said the lengthy backstop risks the bill being abandoned.
Assisted dying on Isle of Man pushing ahead
The Isle of Man is set to become the first place in the UK where assisted dying is legal, after a bill cleared the last parliamentary hurdle before royal assent.
The legislation would give terminally ill people “autonomy and choice” at the end of their life, according to Dr Alex Allinson, a GP and politician who introduced the private member’s bill in 2022.
Members of what is known as its legislative council approved a final reading of the Assisted Dying Bill on 25 March, meaning it will become law after it receives royal assent.
Dr Allinson is hopeful it can be legalised by later this year and become available by 2027.
The bill is only for adults who have been residing on the island for five years and who have a terminal illness with a life expectancy of no more than 12 months.
They must also have a settled intention to end their life.
Where else is assisted dying legal?
Among places to have a form of assisted dying law is Switzerland, where it’s been legal since 1942 to help someone to die as long as the motive is not “selfish”.
The country’s Dignitas group has become well-known as it allows non-Swiss people to use its clinics.
New Zealand brought in a law for terminally-ill people with fewer than six months to live following a 2020 referendum.
Every state in Australia also has some kind of assisted dying law. Victoria was the first to pass such legislation in 2017.
The Australian laws allow a person to self-administer life-ending drugs, or get a doctor to do it if they aren’t physically able.
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The Netherlands, Spain, Luxembourg and Belgium operate similar laws allowing doctors to prescribe the drugs as well administer them in some cases.
In Austria, two doctors need to sign off a request for life-ending drugs. The patient must have a serious long-term condition and wait 12 weeks to reflect on their choice in case they change their mind.
The law came in in 2022, but minors and people with mental health conditions are excluded.
A handful of US states, including California, Oregon, New Jersey and Colorado, have also taken action on assisted dying.
A doctor can only prescribe the drugs, meaning the patient must be physically able to take the fatal medication themselves.
Canada became the first Commonwealth country to legalise assisted dying. It passed a law in 2016 allowing doctors to both prescribe life-ending drugs and to administer them.
Who’s for and against assisted dying?
MPs were given a free vote on the law in its second reading – meaning they could side with their conscience and not along party lines, with the government staying neutral on the matter.
The vote came after a five-hour debate in the chamber, which drew emotional opinions on both sides.
The division list showed Prime Minister Sir Keir Starmer backed the proposal, as did Chancellor Rachel Reeves.
But other cabinet members including Health Secretary Wes Streeting and Justice Secretary Shabana Mahmood voted against the bill, having previously warned about vulnerable people being coerced and of a “slippery slope of death on demand”.
Liberal Democrat leader Sir Ed Davey has also expressed caution.
He told Sky News he was “sceptical” about the case for assisted dying due to “quite personal” concerns, largely because of his mother’s battle with bone cancer when he was a child.
Sir Ed said that through nursing and palliative care “she was able to enjoy life and be with us”.
The issue has also gained attention recently due to campaigning by Dame Esther Rantzen, perhaps best known for setting up counselling service Childline.
The 84-year-old has stage-four lung cancer and revealed last year that she had joined Dignitas.
Others well-known supporters include Great British Bake Off judge Prue Leith, broadcaster Jonathan Dimbleby – whose brother had motor neurone disease – and actor Sir Patrick Stewart.