If I were still an MP I’d be voting against Kim Leadbeater’s bill on assisted dying
BMJ 2024; 387 doi: https://doi.org/10.1136/bmj.q2501 (Published 12 November 2024) Cite this as: BMJ 2024;387:q2501I’m often asked if I miss working in the House of Commons. Of course I do; it’s one of the most amazing places in the world and remains the cockpit of our nation.
There are obviously days I miss it more than others, usually around the big national moments. Whatever your view of Kim Leadbeater’s private member’s bill—the Terminally Ill Adults (End of Life) Bill—its second reading this month will be one of those big moments.
Kim is a friend of mine, and we spoke before she decided to put her bill forward after it topped the private members’ ballot at the start of the new parliament. My advice was to proceed with great care, to remember that this will take over your career in many ways, and to read the report produced earlier this year by the Health and Social Care Committee, which I chaired, on the subject of assisted dying/assisted suicide.1
We did that work (one of the biggest select committee inquiries in history, as it turned out) to inform any future parliamentarians facing a bill of this kind. It’s been humbling to see how many MPs, peers, and journalists are accessing our report ahead of the pivotal vote on 29 November. If I were still an MP I’d be returning to it myself, but I’d be voting against Kim’s bill.
The way I’d approach this decision would be threefold. Firstly, do we as a state wish to cross the Rubicon of actually choosing to end human life? If so, do the provisions in the bill (as written on the page) protect against coercion and/or mission creep to something more? And, if that test is passed, what are the practical considerations in a publicly funded, doctor led NHS?
When a bill reaches a second reading you have to make a call—either to proceed with a bill to or stop it in its tracks—and, in truth, the decision for most MPs at this stage is the most personal and subjective.
A fair choice?
I voted against the Marris Assisted Dying Bill in 2015 and expressed in that debate my sense that today we live in a world obsessed by choice and consumerism. We want to have a career and the perfect family life. We want to shop every hour of the week. I found myself agreeing with the bishop of Bristol, who said at the time how the supporters of a change present it, in part, as a simple matter of individual choice, with “choice being the great God of a consumerised society.” I think that this is still true today. I believe that choice creates the burden; it doesn’t really set you free.
Will the bill protect against coercion or create a slippery slope, as has happened in some jurisdictions (such as Canada) that have previously introduced similar legislation?2 I don’t necessarily buy the “slippery slope” argument. Any future amendments to this bill would have to come back to parliament and undergo further parliamentary scrutiny—and come back they surely would. As part of our inquiry the Health and Social Care Committee travelled to Oregon (the first state in the US to legalise assisted suicide) and looked at a wide range of other countries. The balance of evidence says that campaigners tend not to stop once the principle is agreed, so why would the UK be any different?
This bill will likely propose six months as the point under which a terminally sick person can seek to end their life—with, I’m sure, the opinion of two doctors. Regardless, this does run up against the evidence I’ve consistently heard from palliative care consultants, who say that it’s difficult to predict whether someone will die in six months, as it’s a long time.
Furthermore, we must, in my opinion, significantly up our game in how we provide end-of-life care, rather than handing out the right in law to take a life away. Right now, palliative care is not equitably available—or good enough, in some communities—to be a fair choice.
Legislating is, of course, also a time to ask ourselves whether the practicalities of a bill match the principle, should that be overcome enough to vote “aye.” In many jurisdictions, such as a number of US states, medically assisted dying is widely available—if you can pay for it. In a taxpayer funded system such as ours, presumably the NHS would have to guarantee this choice to anyone eligible.
As the government and the NHS consider the much heralded “national conversation” towards the new NHS 10 year plan, does this bill mean that how the service aids death should be part of that conversation? At a time when the NHS says that it can’t fund the lifesaving breast cancer drug Enhertu (trastuzumab deruxtecan), or the Alzheimer slowing drug donanemab, are we to find funds for expensive lethal drugs to provide assisted deaths? These are all legitimate questions I would want to hear answered by NHS England and NICE, among others, before I went through the lobby to vote on a bill.
My select committee inquiry received more than 68 000 responses to our online survey on assisted dying and more than 380 pieces of written evidence before we did any fieldwork or heard in person from any witnesses. I hope that our report stands up and is useful to MPs faced with this vote of conscience later this month. Chairing the inquiry was a draining experience but left me clear headed, comfortable in my long held view that the law in this area should not be changed.
Footnotes
Steve Brine is a former MP for Winchester, health minister, and chair of the Health Select Committee. He retired from the House of Commons in July 2024. @BrineHealth
Competing interests: SB chairs a local Winchester charity (the Winchester Cancer Sanctuary) and co-hosts the Prevention is the New Cure podcast.
Provenance: Commissioned; not externally peer reviewed.