The assisted dying Bill appeared to have unstoppable momentum. Now it's on shaky ground

It was always going to be divisive. For the past nine weeks, MPs have been debating a piece of legislation so significant that it is, quite literally, a matter of life and death. If it becomes law, the Terminally Ill Adults (End of Life) Bill, which reaches the next stage in Parliament this week, will allow adults diagnosed with a terminal illness and a six-month prognosis to be provided with assistance to end their own life.
There are persuasive – and emotionally charged – opinions on both sides of the debate, but at one point it seemed as though the assisted dying bill had unstoppable momentum.
Introduced as a Private Member's Bill by Kim Leadbeater, the Labour MP for Spen Valley, last autumn, it was approved in a historic vote on November 29. The last time Parliament voted on assisted dying was a decade ago, in 2015, when a proposed change to the law was overwhelmingly rejected. This time, it was voted through, albeit by a reasonably narrow margin of 330 MPs in favour to 275 against.
On that wintery afternoon, a crowd of dozens of Dignity in Dying campaigners in Pepto-Bismol pink, the charity's signature colour, cheered, cried and embraced in Parliament Square, hailing a historic victory.
Crucially, Leadbeater's Bill seemed to be building on a solid foundation of public and political support. YouGov polling has suggested that three quarters of Britons support handing the terminally ill the right to end their own lives. While the Government itself has remained neutral on the issue, the Bill has the tacit backing of the prime minister and a series of senior Cabinet ministers, all of whom voted in favour.
However, as the Bill winds its way back to the Commons on May 16 – when all MPs will have the opportunity to propose and vote on further changes – there is a sense that it is on increasingly shaky ground. Critics have raised concerns that key safeguards have been removed from the legislation since the last time it was debated.
A recent poll conducted by Whitestone Insight on behalf of the campaign group Care Not Killing suggested that more parliamentarians now oppose the Bill than support it. Of 100 backbenchers polled in March and April, 42 per cent said they intended to vote against the legislation at the third reading, while 36 per cent said they would back it. Another 13 per cent were undecided, 5 per cent said they intended to abstain, and 8 per cent preferred not to say.
In November, the Bill was passed with a majority of 55, meaning only 28 MPs need to change their minds or abstain from voting for it to fail. A number are said to have decided to do so.
Two Labour MPs and critics of the legislation told The Telegraph they know of several colleagues who have changed course and will vote against the legislation, but none has yet said so publicly. Reports on Wednesday suggested at least five unnamed MPs who had previously abstained will now oppose it. Three others were said to be considering changing their position.
To date, only Reform MP Lee Anderson and Independent Rupert Lowe, who supported the Bill last year, have publicly declared they will reverse course and vote against the Bill.
Adding to the sense of uncertainty over its prospects, research published on Wednesday showed that GPs are deeply divided on the issue. The BBC surveyed 5,000 practitioners, 500 of whom said they were against the law change, calling it 'highly dangerous' and 'cruel'. 'We are doctors, not murderers,' one said. (Four hundred GPs told the BBC they supported the legislation.)
The Bill's second reading, which MPs voted on last November, was in fact only the first major hurdle it had to pass to become law. The next challenge was the committee stage, where the highly emotive debate around this issue would be translated, clause by clause, into the letter of the law.
For a little over two months, the Bill has been painstakingly scrutinised by a representative committee of MPs selected by Leadbeater. It has been a gruelling process, with sittings lasting until 9pm and, on one occasion, past midnight. Leadbeater and her supporters say the Bill's safeguards have been strengthened. But after 90 hours of debate and 150 amendments, opponents argue that what has emerged from the committee meeting is far more dangerous than the Bill that went in.
Unsurprisingly, the atmosphere has been charged. One member describes the mood in the committee meeting room as 'superficially courteous, but in reality quite fractious'. A Labour source close to the proceedings says: 'The 'pro' side have been running this like a campaign, so the legislation is a mess. There's a real sense it hasn't lived up to the promise.'
One of the key critics is Tory MP Danny Kruger, who sat on the committee. He says the process has only solidified his strong opposition to the legislation. 'One Bill was sold at the second reading; another has emerged from the committee,' he tells The Telegraph, citing the removal of the High Court judge's role in overseeing each case, a key safeguard.
Kruger claims a number of his colleagues supported the Bill in November only to see whether it could be strengthened at the committee stage, many of whom could now change their minds. 'I hope there will be a fair few who recognise that hasn't happened,' he says.
Kruger has been strongly opposed to the legalisation of assisted dying from the start. But others, such as Sean Woodcock, the Labour MP for Banbury and a fellow committee member, were 'on the fence' before determining that the current Bill was unworkable.
'It took me a long time to make up my mind on how I would vote,' Woodcock says (he ultimately voted against). 'In principle, I am not opposed to assisted dying, but having worked on the committee, I have come to the conclusion that the Bill that is emerging is deeply flawed. All I've seen is that vital safeguards have been removed, and significant new risks have also emerged.'
The most controversial change to the legislation is the scrapping of its requirement for a High Court judge to approve each assisted dying application, a provision which Leadbeater argued would make her Bill 'the most robust in the world'.
The change was made after senior judges warned that courts would not be able to handle the increased workload. Instead, it is envisaged that a three-personnel panel of experts composed of a legal figure, a psychiatrist and a social worker will review each case.
Meanwhile, plans for a two-year rollout have been extended to four years – reportedly a request from the Department of Health, headed up by one of the Bill's key opponents, Wes Streeting – amid fears that it would put further strain on an already overburdened NHS.
Streeting, who voted to legalise assisted dying in 2015, has said that if the Bill becomes law, he is concerned that people may choose to end their lives prematurely because of the current state of the NHS. He has argued that Britain's palliative care system is unfit to support the change.
Leadbeater has also faced criticism for rejecting amendments designed to put stronger protections in place for people with anorexia, among other vulnerable groups. There is still no process in place for family members to be involved in decision making, and significant questions remain over capacity and coercion.
Equally crucial is the question of how, practically, assisted dying would actually work. It is still unclear whether private firms would be contracted, or all services would be provided by the NHS. The long-awaited impact assessment – published at 4pm on the Friday before the early May bank holiday weekend – states that legalising assisted dying would save the NHS up to £10 million in the first year of its legalisation, rising to up to roughly £60 million in its 10th year. It also predicts how many people would choose to die this way: between 164 and 787 in the first six months, rising to between 1,042 and 4,559 in the 10th year of its legalisation.
Prof Louis Appleby, the Government's adviser on suicide prevention and mental health, described the report as 'stripped of moral values'. Seeing a cost-saving figure put on the plans will do nothing to reassure those who fear that people will be pushed into an assisted death as they feel they are burdening their loved ones or the state.
Kit Malthouse, the Tory MP for North West Hampshire, sat on the committee selected by Leadbeater and is a key supporter of the Bill. 'It's a sensitive, complex issue of humanity and morality, and for some people, spirituality, and so it was never going to be easy,' he says.
As the legislation progresses to the report stage and subsequent third reading, when MPs will have their say on it for the final time, Malthouse hopes those who disagree are able to do so respectfully. 'We just hope that it stays civilised,' he says.
But it seems the gloves may already be off.
Online, the debate swiftly spiralled out of control, with MPs on both sides being subjected to vitriolic abuse on social media. Leadbeater, who is the sister of Jo Cox, the MP who was murdered by a terrorist in 2016, told the BBC that sponsoring this Bill had exposed her to a new level of online hate. 'There are people on the extremes of the debate, people who do not want to see any version of a change in the law, and there are people on the other extreme of the debate who would want a much broader law,' she told the BBC. 'Sadly, that has led to more abuse than I've probably had on anything.'
Meanwhile, some critics have called the integrity of the scrutiny process into question, arguing that their concerns have been dismissed and that the committee's evidence was weighted towards those who are backers of the Bill. (The Royal College of Psychiatrists, which opposes the legislation, was initially excluded from giving evidence because of an alleged shortage of time, before the decision was reversed.)
Allan House, a liaison psychiatrist and emeritus professor at the University of Leeds, was invited to give oral evidence to the committee on January 29. 'You were asked to share whether you were 'for' or 'against' [assisted dying], which I remember thinking was very odd, as I thought people were called because of their expertise, not their opinion,' he says. House claims he was one of only a small number called who were outright opposed to the legislation. Moreover, he says, the Bill, as it stands, 'does not resemble best practice in any other area of health care.'
As events have progressed, the issue has formed unlikely alliances in some corners of Westminster, where MPs who may agree on very little else have stumbled on common ground. Diane Abbott and Edward Leigh, the current mother and father of the House, have united from their opposite benches to write a joint op-ed for The Guardian, warning of the legislation's 'dangerous' unintended consequences. Within the committee itself, Kruger and Naz Shah, the Labour MP for Bradford West, have found themselves on the same side of the debate despite having very different politics.
'I'm very clear that I've spoken to colleagues who voted for it [in November] who are not going to vote for it now,' says Shah, who voted against. 'I am one of those who could have been convinced to vote for it had the Bill's safeguards genuinely been strengthened… I'm not convinced it has the mandate it had. The process has been haphazard at best, it has been rushed.'
Supporters maintain this is not the case. Malthouse, for example, argues that the Bill has been 'very significantly strengthened'. 'MPs are looking again at [it], as they should, and thinking about its implications for a second time, but we haven't seen any significant shift in opinion about the principle,' he says. 'If anything, there are more people who are reassured.' One of them is Marie Tidball, a Labour MP born with a congenital disability, who had tentatively voted in favour but said she would push for considerable amendments to the legislation. Now, she says, her concerns have been allayed.
Leadbeater does not believe that those who backed the Bill in November will rescind their support, despite the growing sense that her Bill is on borrowed time.
'If they look at it in detail, which I really hope they do and believe colleagues will do, they will see the things that have been added that really enhance the safeguards,' she says.

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