Assisted dying bill clears first parliamentary hurdle

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The Terminally Ill Adults (End of Life) Bill passed its second reading in the House of Commons by 330 votes to 275.

Most Labour and Liberal Democrat MPs voted in favour, with the majority of Conservatives, and a sizeable minority from the governing party, voting against.

The bill will now be considered in detail by a committee of MPs, where it may be amended, before being reconsidered by the whole House of Commons at the report stage and third reading, where the whole legislation will be voted on again.

It is not certain that MPs will back the bill again at this point, given the narrowness of today’s vote and the contentiousness of the legislation.

Should they do so, the House of Lords would be highly likely to approve it, meaning it would become law.

Process for an assisted death

Under the legislation, a terminally ill person assessed as having no more than six months to live would be able to choose to receive assistance to die so long as they had the mental capacity to make the decision.

Before going ahead, they would have to be assessed independently by two doctors and a High Court judge would need to confirm that the requirements of the legislation were met.

Social workers are broadly in favour of the bill, according to a Community Care poll.

However, significant concerns have been raised by critics, including health and social care secretary Wes Streeting, that people would be, or feel, coerced into an assisted death or would choose this option because of the inadequacy of palliative care services.

To address such concerns, the Association of Palliative Care Social Workers (APCSW) – which is neutral on the bill – has proposed the establishment of a social work role to act as a safeguard for those potentially going through an assisted death.

Proposed social work role

The approved palliative care professional position proposed by the APCSW would have the following functions:

• Ensuring that the person had the mental capacity to make this decision.
• Having in-depth discussions with the person, those close to them, the multidisciplinary team responsible for their care and any paid carers.
• Ensuring all reasonable care and resources had been provided and that no other forms of care or treatment could be offered which would alter the person’s choice of an assisted death.
• Making an independent assessment of the individual in the context of their wishes, values and relationships, and ensuring that they were making a fully informed decision without undue influence by others or by concerns about the pressure on others of caring for them.
• Taking timely and sensitive action to safeguard anyone who was subject to neglect, abuse or coercion.

The committee of MPs established to scrutinise the bill will consider evidence, including by bodies such as the APCSW, which may lead to an amendment to the legislation being drawn up to introduce such a role.

Following today’s vote, think-tank the Nuffield Trust said critical questions remained around how the legislation would be resourced, in the face of the funding challenges facing palliative and social care.

Funding concerns

Chief executive Thea Stein said: “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.

“If assisted dying is not publicly funded then it will be difficult for the bill to achieve its aim of improving choice for all patients. These are crucial questions to address in the next stage.”