In a landmark vote with significant social implications, the UK House of Commons has approved legislation that could grant terminally ill adults in England and Wales the right to end their lives with medical assistance. The Terminally Ill Adults Bill successfully passed its latest stage, moving one step closer to becoming law after a deeply emotional debate among MPs.
The bill received backing from 314 MPs compared to 291 votes against, securing a majority of 23. While a decisive step, this majority was notably smaller than the 55-vote margin achieved during an earlier stage of debate in November.
Following this approval, the bill now proceeds to the House of Lords for further scrutiny. If ultimately approved by peers, ministers could have up to four years to implement the necessary measures, meaning assisted dying might not become legally available until around 2029.
MPs were permitted a free vote, allowing them to decide based on conscience rather than adhering to party lines. The vote highlighted divisions even among senior politicians; Prime Minister Sir Keir Starmer and former Prime Minister Rishi Sunak supported the bill, while Conservative leader Kemi Badenoch, Health Secretary Wes Streeting, and Deputy Prime Minister Angela Rayner were among those who voted against it.
Championing the Bill and Arguments For
Labour MP Kim Leadbeater, who has championed the bill through the Commons, expressed immense relief and delight following the outcome. Reflecting on a week marked by the anniversary of her sister Jo Cox’s murder, Leadbeater spoke of the emotional toll of the campaign and her conviction that the bill offers essential “choice at the end of their days” for terminally ill individuals. She emphasized that the legislation is fundamentally about how people die, not whether they live, and is needed to prevent “heartbreaking stories” of suffering and traumatic endings, including desperate trips abroad to countries like Switzerland for assisted dying.
Supporters argue the bill is a necessary step towards a more compassionate society, protecting terminally ill patients and their families from the agony and loss of dignity associated with a “bad death.” Celebrity advocate Dame Esther Rantzen, who has stage-four lung cancer, welcomed the vote, expressing relief that future generations of dying people could have the “confidence knowing they can ask for a quick, pain-free death.”
Arguments in favour often centred on dignity and autonomy. Labour MP Peter Prinsley articulated this, stating that while there is a sanctity of human life, in cases of terminal illness, the choice is between “death or death.” He argued that the sanctity of human dignity includes the right to choice, which should not be denied to the dying. Humanists UK chief executive Andrew Copson hailed the vote as a “historic step” reflecting public support for end-of-life choice, dignity, and compassion.
Outside Parliament, hundreds of campaigners gathered, many from the Dignity in Dying campaign dressed in flamingo pink, celebrating the result with smiles and tears. The family of Keith Fenton, who had Huntington’s disease and contemplated travelling abroad, shared their “absolute delight.” Pamela Fisher, a lay preacher and supporter, saw the vote as a “major step forward to the creation of a more compassionate society.”
Concerns and Arguments Against
Opponents voiced significant concerns regarding the potential risks posed by the bill, particularly to vulnerable individuals. Conservative MP Danny Kruger, a prominent opponent, noted the reduced majority as a sign of “support… ebbing away fast” and hoped the House of Lords would either reject the bill or “substantially strengthen it.” He questioned the moral authority of the vote, highlighting that fewer than half of all eligible MPs voted for the bill (314 out of 650+).
A primary fear among critics is the risk of coercion, either overt or subtle, for vulnerable people, including those with disabilities or the elderly. Baroness Tanni Grey-Thompson, a former Paralympian, shared that disabled people she speaks to are “absolutely terrified” and pledged to propose amendments in the Lords to tighten safeguards. George Fielding of the secular Not Dead Yet campaign described the vote as “incredibly disappointing,” viewing the bill as “ableist” and believing it endangers vulnerable people who may be experiencing “unprocessed hurt and trauma.” He urged the Lords to promote alternatives like better palliative care, social care, and benefits.
Sister Doreen Cunningham, a nun from the Sisters of Nazareth mission, also felt the current safeguards were inadequate, stating that while MPs discussed safeguards, “they’re far from what we would call safeguards.”
Some opponents, including former minister Sir James Cleverly, strongly criticised the evolution of the safeguards during the bill’s passage. Cleverly argued that promised “gold-standard, judicially underpinned set of protections” did not survive the committee stage, expressing concern that MPs were “sub-contracting” detailed scrutiny to the House of Lords. Dr Gordon Macdonald of Care Not Killing labelled the bill “deeply flawed and dangerous,” claiming important safeguards had been “watered down or scrapped.”
Concerns were also raised about the state of end-of-life care in the UK. James Sanderson, CEO of Sue Ryder charity, warned that “gaps in care could be leaving some people feeling it’s their only option.” He cited research showing that a significant majority of people believe terminally ill individuals could feel pressured due to a lack of adequate care, stressing the vital need for improved, well-funded palliative care regardless of the bill’s outcome, a point echoed by Jan Noble of St Christopher’s hospice charity. Conservative MP James Cleverly noted that many medical professional bodies, while neutral on the principle of assisted dying, opposed the bill’s specific measures, suggesting their concerns about readiness should be heeded.
Key Changes and Path Ahead
Since its earlier stages, the bill has undergone revisions. Notably, a controversial requirement for a High Court judge to approve assisted dying requests was removed. Under the current proposals, approval would be required from two doctors and a panel including a social worker, a senior legal figure, and a psychiatrist. This change drew concern from the Royal College of Psychiatrists regarding the potential diversion of clinicians.
Other amendments passed include closing a potential loophole to prevent individuals from qualifying based solely on life-threatening malnutrition (the “anorexia loophole”) and requiring the government to review palliative care services within a year of the bill passing into law. An attempt to exclude people with mental health problems or those who feel “burdensome” was defeated. New clauses aim to ensure independent advocates for individuals with learning disabilities, autism, or mental health conditions and the creation of a disability advisory board. Furthermore, the bill explicitly states that “no person,” including social care staff and pharmacists, is obliged to participate.
The debate in the Commons was highly personal and emotional, with MPs sharing moving stories and some visibly affected. Despite passing the Commons, the bill is expected to face significant debate and potential amendments in the House of Lords, where its path is described as unpredictable. Any changes made by the Lords would need to return to the Commons for approval.
The bill, framed by some as potentially the most significant change to UK social policy since the partial legalisation of abortion in 1967, proposes assisted suicide (where the patient self-administers the lethal drugs, unlike euthanasia where a professional administers them) for eligible terminally ill adults. As it moves forward, questions remain about funding, how it would be implemented within the NHS, and its impact on hospice care and the legal system. The fight for and against the legislation is far from over.
