Assisted dying set to become legal in England and Wales after MPs back bill

Assisted dying is set to become legal in England and Wales after MPs gave legislation to bring it about their backing.

The House of Commons voted by 314 to 291 in favour of the Terminally Ill Adults (End of Life) Bill at the final stage of its passage through the House of Commons today.

The bill will now go to the House of Lords, where it will be voted on and face further scrutiny. To become law, the two houses must agree a version of the bill before the end of the current session of Parliament, either later this year or early next.

While peers may amend the legislation - a private member's bill sponsored by Labour backbench MP Kim Leadbeater - they are unlikely to resist the will of the elected chamber, meaning it will very likely become law.

There will then be a period of up to four years before the legislation comes into force.

Who will be eligible for an assisted death?

To be eligible for an assisted death under the legislation, a person must:

• be terminally ill, meaning they have an "inevitably progressive illness or disease which cannot be reversed by treatment" and their death as a result of the illness or disease can be reasonably expected within six months;
• have capacity to make a decision to end their own life  under the Mental Capacity Act 2005;
• be 18 or over;
• be ordinarily resident in England and Wales, and have been ordinarily resident there for at least 12 months, and
• be registered as a patient with a GP practice in England or Wales.

A three-stage process

The bill provides for a three-stage process for an assisted death to be agreed:

1. The first declaration: here, the person must make a declaration confirming a number of specified matters, including that they are “eligible” for an assisted death and understand they can cancel the declaration at any time. This must be witnessed by a doctor ("the co-ordinating doctor), who meets certain requirements, and an independent person. The doctor must assess the person and confirm that they meet the eligibility criteria, have a "clear, settled and informed wish to end their own life" and made the declaration voluntarily and had not been coerced or pressured by anyone else to do it. The person then has a seven-day period of reflection before a second doctor ("the independent doctor") carries out a similar assessment.
2. The multidisciplinary panel: the person's first declaration and the two doctors' reports are then sent to the Voluntary Assisted Dying Commissioner, a senior judge appointed by the prime minister to oversee the process. The commissioner then must refer the case to an assisted dying review panel consisting of a senior lawyer, psychiatrist and a social worker. Their role is to assess whether the person meets the eligibility requirements for an assisted death, including that they have not been coerced. They must hear evidence from at least one of the two doctors and may also hear from the person themselves or any other person. If the panel rejects the request, the person may request the commissioner reconsider it on the grounds that the panel has made an error of law, been procedurally unfair or acted irrationally. If the commissioner agrees, they must refer the case to a second panel.
3. The second declaration: should the first or second panel agree the person is given a certificate of eligibility. There is then a second - 14-day - period of reflection before the person must make a second declaration of their wish to have an assisted death, which must be witnessed by the co-ordinating doctor and an independent witness. The doctor must sign a statement confirming the person meets the eligibility requirements and submit this and notify the commissioner of the second declaration.

The person may cancel either of their declarations, orally or in writing.

Should they wish to continue, the bill provides for the co-ordinating doctor - or another doctor authorised by the co-ordinating doctor - to provide the person with an "approved substance" (one or more drugs specified in regulations), which the person must administer themselves in order to end their lives

The doctor must stay with the person until they die.

Independent advocates

Besides the safeguards provided by the three-stage process, the bill provides for the appointment of an independent advocate to provide support and advocacy to a "qualifying person" who is seeking to understand options around end of life care, including the possibility of requesting assistance to end their own life, to enable them to understand and engage with the law's provisions.

A qualifying person is defined as:

• A person with a learning disability;
• A person with a mental disorder under the Mental Health Act 1983;
• A person with autism;
• Anyone who may experience substantial difficulty in understanding the processes or information relevant to those processes or communicating their views, wishes or feelings;
• Any other person defined by the government in regulations.

Reaction from palliative care social workers

In a statement on the bill's passage through the Commons, the Association of Palliative Care Social Workers (APCSW), which is neutral on the legislation as a whole, said it welcomed the inclusion of social workers on multidisciplinary panels.

However, it said it would continue to advocate for social workers to be involved, alongside doctors, from the earliest stage of discussion with anyone considering an assisted death.

"This reflects the fact that social workers are the lead specialists in making holistic assessments and supporting individuals to make fundamental life choices that profoundly affect both them and those who matter most to them," said the APCSW.

"Social workers are experts in identifying evidence of coercion or other safeguarding concerns. We bring specialist knowledge and strong practice based skills in assessing mental capacity, which is crucial to making sound assessments of risk and vulnerability."

Mixed reception to MPs' approval of bill

MPs' approval of the bill provoked a mixed response.

Sarah Wootton, chief executive of Dignity in Dying, which campaigns for legalisation of assisted dying, said: "Today’s vote is a landmark moment for choice, compassion and dignity at the end of life. MPs have listened to dying people, to bereaved families and to the public, and have voted decisively for the reform that our country needs and deserves."

However, Disability Rights UK said it was "devastated" at the news.

"It is deeply disappointing that the vote was narrowly in favour of the bill and will now go to the House of Lords. Such a monumental change to our health and social care and culture within it should not be rushed through on a private member's bill on such a slim margin. Legislation of this enormity needs far more time and safeguarding."

It said it would continue to work with other disability groups campaigning against the bill, "highlighting ableism and inequality, inadequate protections, unsatisfactory bill process and lack of engagement with disabled people".