During Scrutiny

Even The Times editorialises:

The prime minister said on Wednesday that before there was a wider debate on the principle of assisted dying, “there’s something that needs to happen first and that’s the fixing of the funding of palliative care and social care”. Fixing palliative care and social care is a long-term project. Lauren Edwards, a Labour backbencher, has pledged, in the next parliamentary session, to reintroduce the deeply flawed Terminally Ill Adults (End of Life) Bill that was mercifully timed out in the Lords in April. The message to her from her new boss is: don’t bother.

This is welcome news, for three reasons. First, Andy Burnham is right: whatever your view of the ethics of the state sanctioning doctors to dispense lethal doses of drugs to their patients, the suggestion that before contemplating such a momentous step the government should first radically improve end-of-life care is surely correct. Hospices in the UK are underfunded. The notion that the suffering of the terminally ill can only be alleviated by a fatal injection, rather than by the love, care and medication that befit a member of a wealthy, civilised nation, is a grotesque counsel of despair.

Second, as even many of its proponents admit, the initial bill — introduced by the Labour MP Kim Leadbeater — was poorly drafted, light on precision and due safeguards. It had no business passing on to the statute book. The Lords, performing its constitutional duty to scrutinise legislation, saw fit to table more than 1,300 amendments, over 70 of them proposed by Lord Falconer of Thoroton, the bill’s sponsor in the upper house.

During scrutiny, the risks of such a seismic shift in the relationship between state and citizen were exposed. In Canada, where medically assisted deaths have been allowed for a decade, they now account for 5 per cent of all deaths, having risen from 0.6 per cent ten years ago. Nothing in the failed bill would have prevented a similarly sinister increase in England and Wales. The measure was opposed by all the relevant royal colleges and hundreds of disability charities. It was not included in Labour’s 2024 manifesto. The prospect of the bill being forced through the Lords under the provisions of the Parliament Acts of 1911 and 1949 is arrogant and undemocratic.

Third, Mr Burnham’s smooth and swift euthanising of this zombie proposal showcases his political acumen while demonstrating the absence of any such quality in his predecessor. Sir Keir Starmer, bizarrely citing lobbying by Dame Esther Rantzen as his motivation, said he supported the principle, but then failed to expend any authority to back Ms Leadbeater’s bill. Wes Streeting, then the health secretary, said it was a mistake. Shabana Mahmood, the home secretary, was disgracefully smeared by her own side as a religious zealot for voicing her objection. Sir Keir floundered. The result: a protracted mess.

Mr Burnham knows the concept of assisted dying is currently popular with his backbenchers. But he is clear-sighted enough about the legal and moral morass it entails. He has little personal enthusiasm for the cause and certainly doesn’t want the distraction. So the prime minister has found an elegant way, acceptable to his party, of signalling that this is not a priority. Assisted dying should be retrieved from obscurity only if any party can muster the courage to include it in its next manifesto. Given that many voters, rightly, regard this matter as a thick red line not to be crossed, such courage is unlikely to be summoned.

As Nuala O’Loan, Baroness O'Loan writes:

The Terminally Ill Adults (End of Life) Bill had no democratic mandate. It was a Private Members’ Bill, not a government initiative. There had been no pre-legislative scrutiny, no consultation, no proper impact assessment before the Bill was introduced. The result was widespread concern.

Finally published on 11 November 2024, a little more than two weeks prior to Second Reading, giving MPs virtually no time to assess its provisions, it ultimately limped through the Commons at Third Reading with a majority of just 23 votes — 314 to 291 — on 20 June 2025, with support from fewer than 50 per cent of MPs. In those seven months, it had undergone significant change and lost vital safeguards.

The duty of the House of Lords is to scrutinise, and to approve, amend or reject a bill. We do not have to pass a bill simply because the House of Commons did so.

Very specific and detailed criticisms and concerns arose among stakeholders and the public. Among those raising concerns, the Royal College of Psychiatrists said they could not support it; the Royal College of Physicians said that “it was not in line with good clinical and professional practice”. The Royal Colleges of General Practitioners, Pathologists, and Nursing, and the Royal Pharmaceutical Society, The British Association of Social Workers, The Law Society, the British Geriatrics Society, the Association for Palliative Medicine, Liberty, and the group Standing Together Against Domestic Abuse all made extensive criticism of the bill, as did Disability Rights UK, BEAT and other eating disorder groups, MIND, the National Down Syndrome Policy Group and many others.

The Government’s Suicide Prevention Advisor said it was “very dangerous”. The former President of the Family Division of the High Court said it was “lamentably short of providing adequate safeguards.” Lord Stevens, the former CEO of the NHS, said that there was “evident and substantial risk”.

In fact, for the two days we debated the general principles of the Bill, information provided indicates that 516 Peers attended at least one day, while 327 turned up for both. It was the beginning of a long and very difficult process.

At least 244 peers were directly involved in scrutiny of the Bill in Committee, and the average speech lasted less than 7 minutes, although we were allowed to speak for up to 10 minutes on most occasions.

92 peers tabled or supported amendments. Lord Falconer, the promoter of the Bill, tabled 76 amendments, some of which removed safeguards inserted in the House of Commons.

The Bill’s supporters said that we had only discussed 7 clauses in 14 days in Committee. Actually, we debated over 800 amendments and discussed the content of 46 of the 59 clauses in the Bill and all 3 of the Schedules.

These amendments addressed some of the major problems we identified, including the risk of individual and organisational coercion of the elderly, sick, the disabled, those with learning difficulties, those with mental illnesses, those who might be isolated and struggling with financial difficulties, and many others.

There was a huge risk of people opting to die not because they wanted to, but because they had been subjected to pressure to do so, or because people living with Down Syndrome and learning disabilities often have an “acquiescence bias” and a strong innate desire to please authority figures, so they were more likely to agree to something suggested by a doctor. There were no proper safeguards against this.

The NHS exists “to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives”, not to help people to kill themselves.

We considered the effect on practitioners who did not join their professions to help people kill themselves. The Bill provided a degree of protection against involvement but only for clinicians, not for all the other people who enable the NHS to work — the administrators, the porters, the cleaners: if they did not want to engage with assisted suicide they would face possible disciplinary action, and would have to go to an employment tribunal to fight for the jobs which they needed to pay their rent or mortgage to feed their children etc.

There were so many unanswered questions — where could deaths take place, is it to be inside or outside the NHS, which drugs are to be used to kill people, what will it cost, how is it to be funded, (we had been told by the Secretary of State for Health that if it is to be provided by the NHS then NHS funding will have to be diverted from other unspecified processes), where will all the doctors, psychiatrists, social workers come from? There were so many other problems and questions, but there is no space to list them all.

During the debates, we faced hostility and endless accusations that we did not care whether people suffered or not. However, it is precisely because we do care — about the most vulnerable in our communities whose lives would have been endangered by the Bill — that I, and so many colleagues, acted as we did. In the end, the Bill ran out of time and was lost because it was so dangerous.