The nine reasons why MPs might reject assisted dying bill
On Friday, MPs will vote on whether the controversial assisted dying bill brought by Labour MP Kim Leadbeater should become law.
The outcome is too close to call. The slim 55-vote majority Ms Leadbeater secured at the bill's Second Reading is narrowing by the hour. A growing number of MPs who previously backed it or abstained last November are now coming out against it.
With the clock ticking, The Telegraph sets out nine serious flaws in the legislation that remain unresolved. Critics of Ms Leadbeater's bill hope these unaddressed issues will be enough to persuade wavering MPs to oppose the bill, shifting the balance and stopping the law change in its tracks.
1. People with anorexia could qualify
Doctors and lawyers have warned that the bill leaves the door open for patients with severe eating disorders to access assisted dying. If their condition is deemed terminal and they are judged to have mental capacity, they could qualify.
In a significant intervention on Wednesday, Dr Annabel Price, lead for assisted dying at the Royal College of Psychiatrists, warned: 'We are particularly concerned about the possible inclusion of people whose mental disorders have physical impacts that can lead to death, such as kidney failure from anorexia.
'We have seen people with eating disorders be considered terminally ill and therefore eligible for assisted dying/assisted suicide in other countries.'
2. Financial strain on the NHS
A government impact assessment last month estimated that setting up and running the service could cost up to £13.6 million a year. Critics argue that while some savings may come from reduced treatment and care, these are finite, while the cost of running the scheme is not.
Civil servants were unable to put a total figure on costs because the draft legislation contains no plan for how the service will be run.
On Tuesday, Dame Siobhain McDonagh warned the bill could 'rob our stretched NHS of much-needed resources', urging Labour MPs to vote against it. Wes Streeting, the Health Secretary, also confirmed there was 'no money allocated' for the service.
3. Sign-off inadequate
Final approval by a High Court judge, a key safeguard previously cited by dozens of MPs at the last major Parliamentary vote, has been removed from the bill.
Instead, final approval will be taken by three-member panels of a lawyer, psychiatrist and social worker. Sir James Munby, former head of the Family Division of the High Court, said he remained 'deeply troubled' by the lack of rigour these panels would afford.
Proposals to ensure these panels were independently appointed and had further investigative powers were not selected by the Speaker and cannot now be reinstated before the vote.
4. Not enough psychiatrists
The Royal College of Psychiatrists has warned there are not enough specialists to meet current demand, let alone the new requirement for every sign-off panel to have a psychiatrist on it.
Dr Price said: 'There is a practical issue of not having enough psychiatrists to meet current and escalating demand. Even now, we simply do not have the resource to be able to give each person the careful attention they deserve.'
5. Oversight issues
Ms Leadbeater's bill includes the option for doctors who carry out the initial assessments for an assisted death to refer to a psychiatrist for further review. However, in most cases, the first time that a psychiatrist will be involved in assessing an application, will be when it gets sent to the three-member panel for final sign-off.
Ms Leadbeater claims the inclusion of psychiatrists on panels, which would be expected to process two cases a day, ensures proper oversight. But the royal college disagrees. Dr Price said the bill gives psychiatrists too little time and space for a full assessment and reduces them to rubber-stamping decisions made by others.
She said: 'The idea that we could be involved on a panel only to check decisions made by others, rather than to conduct the full evaluations we are trained to do, is deeply troubling. A psychiatrist's role should be to ascertain whether a mental disorder is influencing a person's wish to die, and to offer treatment when this is the case.'
6. Hospices risk losing funding
While Ms Leadbeater conceded an amendment allowing individual staff from care homes and hospices to opt out from any involvement in administering assisted deaths, a wider amendment protecting hospices and care homes from being forced to participate was not selected for separate decision on Friday.
It comes after MPs have already rejected a proposal by Rachael Maskell that would have meant care homes and hospices were not obligated to participate. As a result, hospices could face pressure to comply or risk losing funding.
7. Private companies could profit
The bill does not prevent private companies from offering assisted dying services or profiting from them.
Danny Kruger MP said this created scope for private providers to run the process from referral to death. In response, Labour's Lewis Atkinson said it would be 'inconceivable' that the Health Secretary would commission services in this way and accused him of 'scaremongering'.
However, an amendment to ban for-profit provision was not selected, meaning MPs must vote on a bill with no restrictions in place.
8. Mental capacity concerns
The bill relies on the Mental Capacity Act test, meaning doctors or panels need only be 'satisfied' on the balance of probabilities that a patient is acting voluntarily and meets the criteria before approving an assisted death request.
Amendments to raise the threshold to 'beyond reasonable doubt' were rejected, despite critics of the bill, including Daniel Francis MP, whose daughter has a learning disability, warning that patients were vulnerable to errors or subtle coercion.
9. Auto-commencement clause
Despite major outstanding concerns over training, infrastructure and NHS readiness, the bill includes an auto-commencement clause forcing it to come into effect in October 2029, four years after it would become law.
This deadline stands regardless of whether the necessary work has been completed or whether the NHS and palliative care sector were prepared, raising the prospect of a legally operational service without proper safeguards.
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