When the assisted dying bill returns to the Commons in a month’s time, MPs will vote on a very different piece of legislation than they were presented with on the first reading.
Though the government is still technically neutral, major changes to the bill have been pushed through by concerned ministers, who fear MPs could pass a deeply impractical bill at a time of immense pressure on the NHS and the courts.
Despite a huge social media campaign raising doubts about the bill, public support remains extremely high. Keir Starmer also remains solidly in favour. On Wednesday, at prime minister’s questions, he promised the bill’s sponsor, Kim Leadbeater, that it would be “implemented in a safe and practicable” way if passed by MPs.
It has taken hundreds of hours to try to make that happen. Ministers have proposed changes, put down in Leadbeater’s name, including the scrapping of the high court’s role in approving assisted deaths, and setting a lengthy four-year implementation period.
The latter was accepted grudgingly by Leadbeater and supportive MPs. “She didn’t want to have to do it,” one ally said. “It’s come from government.”
But after nine weeks of scrutiny by the bill’s committee of MPs, and about 150 amendments to the original bill, there are still huge unknowns, such as how it will be paid for and who will be responsible: the NHS or the private sector.
Despite intensive debate in the bill committee, there has been no resolution to some of the fundamental questions – and no official impact assessment has been done. One MP on the committee admitted: “I don’t think we have done all we could to make sure that these decisions get made properly by parliament. It is a massive unknown.”
But Dr Simon Opher, a Labour MP and former GP on the committee, said: “It is evident to many of us that the bill is now much safer than it was on second reading – perhaps a little more complicated.”
It will be Leadbeater’s task over the next month to convince MPs that her bill has been strengthened, not weakened.
The biggest change that could worry MPs is stripping out the role of a high court judge, which would be replaced by a panel of experts. That was a request from the Ministry of Justice, which warned of havoc and delay in the family courts.
For many of the bill’s backers, it was also a sensible change, which meant more direct impact from psychiatrists and social workers, who would sit on a panel with senior lawyers. But it may cause another problem – there are huge shortages in mental health provision and social work.
On Tuesday, Leadbeater pushed through another change. The original bill proposed a two-year implementation period – this is now to be delayed by a further two years.
That came from Wes Streeting’s Department of Health, already under enormous strain from the need to cut waiting lists and the abolition of NHS England. “She had no option,” a cabinet source said. “The system is not equipped in any way yet to make this happen.”
For MPs who have been sitting on the bill committee, it has been a gruelling nine weeks, sometimes sitting until 9pm, and finishing at midnight on Tuesday. There were almost 600 amendments to consider – though the vast majority of them were rejected. Of those that were accepted, 30 came from the bill’s opponents.
“By the end it became very fraught and personalised,” one MP on the committee said. There were particular clashes between two Conservatives on opposing sides – Kit Malthouse and Danny Kruger. Another MP said there had been a toxic social media environment. “People were getting absolute vitriol, with speeches clipped up, out of context,” one said.
Tom Gordon, a Lib Dem MP, was riled by the extension to the implementation period, but said he still believed the private member’s bill process was the right one. “I would have reservations about a government of any political persuasion trying to legislate on such an issue,” he said. “This bill genuinely does have the most robust and strongest safeguards of any assisted dying legislation in the world, and that was further improved throughout the process.”
But a colleague on the committee said they disagreed. “There is no doubt this bill is weaker than when it was passed last year. So much could have been improved and wasn’t. I voted against it, but I was open-minded. Now I feel more strongly than ever.”
Leadbeater will highlight major changes to safeguards, a disability advisory board, independent advocates for people with learning disabilities, mandatory training for doctors and panel members to detect coercion, and a guarantee that doctors must set out alternative end-of-life care to patients.
But other safeguards have been rejected, including stricter tests on mental capacity and a better definition of terminal illness to exclude anorexia.
“Many of the amendments were put down in good faith, but we had to be mindful of the risk of over-embellishing the legislation,” Opher said. “As a doctor who has worked in end-of-life situations, it was clear that some members of the committee did not have a clear understanding of how end-of-life medicine works.”
Opher said he believed that for some members of the committee there was an ideological opposition to the change and that some arguments made were not in good faith, including around doctors and profiteering. “What is not excusable is to try to concoct scare stories around flaky evidence,” he said.
After midnight, when the bill was finalised, members on the committee on opposing sides posed for a photograph. Opher said there was a sense of solidarity, even between adversaries. “It felt, last night, very emotional and in some way historic as well,” he said.
The bill will return to the Commons on 25 April – which may be its final day in the Commons, though there is a possibility that the final two stages, report stage and third reading, are split over two Fridays.
Since it passed its first stage in November – with a larger than expected majority – most MPs have switched off from the granular detail of the changes being made. Now those who wish to stop the bill will ramp up their campaigning again, seeking 28 MPs to switch sides.
MPs campaigning hard on the issue don’t expect their colleagues to engage properly again until the week before the vote. Opponents believe they have the momentum – and that many switchers will go public soon.
Within government, there is a belief that the bill is likely to pass the Commons, though the House of Lords is a huge unknown. But there remains a concern within No 10 about whether it is something the government should be facilitating given the state of the economy and public services.
“I think a lot of people are cross about the timing of this,” one cabinet minister said. “There are huge plates spinning and this is being seen by some as a priority?”
