The House of Commons’ backing of the assisted dying bill for England and Wales was a historic moment but just the first step in a long process.
One thing that was clear is that many MPs hope to see significant amendments to the bill that they voted on. That includes some MPs who voted in favour of Kim Leadbeater’s bill but only because they anticipate that lingering concerns they have will be dealt with before it becomes law.
So what are the amendments likely to be proposed and which could be made to the final bill?
Beefing up safeguarding and preventing coercion
One of the key issues for many who voted against the bill is that vulnerable people, particularly those with disabilities, could choose an assisted death to avoid being a burden on their family, including because of the cost of care. There are also concerns about people being coerced into making the choice. Critics believe that the bill’s restriction of assisted dying to mentally competent adults diagnosed with a terminal illness and expected to have six months or less to live, and its requirement for medical and judicial oversight, are insufficient.
One of the suggestions is to amend the bill to state that assisted dying must never be raised initially by medical practitioners and should be patient-led. Another is to introduce a review or reversal process, without which the fear is that victims of coercive control will not have any recourse. Marie Tidball, a Labour MP who was born with a congenital disability that affects all four limbs, called for “dishonesty”, “coercion” and “pressure” to be properly defined in the final bill.
Improving judicial and medical oversight
As the bill stands, a request for assisted dying would have to be signed off by two doctors and a high court judge, but there are concerns at the lack of detail surrounding this. There have been calls for the bill to specify training required for medical practitioners and judges, particularly so they can identify signs of coercion. Additionally, some want doctors who approve the necessary medication to have a special licence.
Addressing the risk of a 'slippery slope'
Another major concern with the bill is the slippery slope argument. This is the theory that once assisted dying is introduced it will become normalised in the eyes of the public and MPs and will inevitably be extended with fewer restrictions. There has been a suggestion that some MPs want some kind of protection within the bill to prevent – or at least create stiff obstacles to – this happening. It is difficult to see how this would be achieved as parliament cannot make laws that would restrict future parliaments.
Investment in palliative care
In Friday’s debate there were calls from MPs on both sides of the debate for the inadequate funding for palliative care and postcode lottery to be addressed. While the way to do this does not rest within the bill, many believe it is an issue that must be addressed in tandem with it, to ensure that if assisted dying is made legal, people will not be choosing it solely because they do not have access to proper palliative care, which could alleviate their suffering.
Could the eligibility criteria actually be extended?
Some have suggested that Leadbeater’s bill is too narrow and have questioned why it should not be extended, for example to people with a terminal illness with more than six months to live or people living unbearable pain but who do not have a terminal illness. However, given how tight the vote was and the concerns raised by opponents, extending the eligibility criteria before it becomes law looks like a non-starter.
