MPs have voted in support of a bill that would allow adults in the last six months of their life to be medically assisted to die in England and Wales.
With 330 votes for The Terminally Ill Adults (End of Life) Bill – versus 275 against – the bill will continue to undergo parliamentary scrutiny with the support of the elected chamber. It will still have several steps to go through before any potential changes to the law would come into force.
The debate has split opinion among MPs – including those who are former nurses – and the wider nursing community.
In its current form, the bill sets out various safeguards for those who want to seek assistance to end their own life, including that patients must be 18, a resident of England or Wales with mental capacity to make the choice on assisted dying, and expected to die within six months.
Chair of the Health and Social Care Committee and Liberal Democrat MP Layla Moran was among those who voted in favour of the bill today.
She told parliament that she was doing so because she wanted ‘this conversation to continue’.
She acknowledged concerns by some MPs around the specifics of the bill, but reminded colleagues that this was just the second reading and that if in future they were still against it, they could vote in that manner.
‘The question I think we and I will be answering today is, do I want to keep talking about the issues in this bill? Do I want to keep grappling with the detail until I get to third reading, where I might reserve the right to at that point, vote, “no”. You can decide the question for yourself.’
Turning to the issue of palliative care, Ms Moran said it was clear from the sector, patients and their families that services are ‘not good enough’, adding: ‘We must do better.’
Former critical care nurse and now Labour MP for Sittingbourne and Sheppey, Kevin McKenna, was also among those who voted for the bill, as well as Prime Minister Sir Keir Starmer, according to parliamentary voting data.
Earlier this month a group of nurses, including palliative and public health specialists, wrote a letter encouraging MPs to vote for the bill.
The letter, published by campaign group Dignity in Dying, stressed the need for ‘choice’ at the end of life and said nurses regularly see patients suffering against their will, which has a ‘lasting traumatic effect’ on nursing staff.
However, a separate campaign group of more than 3,400 nurses, doctors and healthcare professionals wrote to the prime minister warning that assisted dying could ‘not be introduced safely amid a broken NHS’, according to The Telegraph.
Organised by campaign group Our Duty of Care, the letter said: ‘Palliative care is woefully underfunded and many lack access to specialist provision. The thought of assisted suicide being introduced and managed safely at such a time is remarkably out of touch with the gravity of the current mental health crisis and pressures on staff.’
Many MPs argued today that the wording of the bill does not go far enough, with some concerned there was a risk that people could feel coerced into requesting assisted dying.
Labour MP and former district nurse Paulette Hamilton was one of those who voted against the bill today.
‘I simply do not trust that this bill can be implemented ethically and safely. There are too many blind spots, and it is being rushed through too quickly and too little scrutiny,’ she told parliament.
She believed it would put ‘enormous pressure on disabled, elderly and poor people to opt for ending their lives so not to be a burden on their loved ones’.
And that it would ‘not do anything concrete to uplift the hospice and palliative care sectors’.
Sojan Joseph, Labour MP for Ashford and a former mental health nurse, also voted against the bill today, according to parliament voting data.
In a statement this morning, Mr Joseph said he felt the safeguards included in the bill were insufficient and that the vote had come ‘too early’.
He raised particular concerns around the adequacy of capacity assessments that would determine whether an individual had capacity to request assisted dying, and agreed with the argument that ministers should be looking to ‘invest in and rebuild’ palliative care services first.
What does the bill say?
The proposed bill sets out various safeguards for those who want to seek assistance to end their own life. These include:
- Patients must be 18, a resident of England or Wales and be registered with a GP for at least 12 months,
- They must have the mental capacity to make the choice to seek assistance and to have expressed a clear, settled and informed wish free from pressure or coercion,
- Two independent doctors must be satisfied that the person is eligible, with at least seven days between the assessments,
- A High Court judge must hear from at least one of the doctors and they can question others if appropriate,
- The patient must be expected to die within six months,
- They need to make two separate declarations about their wish to die, both of which must be witnessed and signed.
As it stands, the bill would require two doctors to assess each request for assisted dying, with at least seven days needed between each assessment to ensure the person meets the relevant eligibility criteria.
According to the bill document, a person is considered ‘terminally ill’ if they have an inevitably progressive illness, disease or medical treatment.
What would the nursing role be?
Under the bill, nurses are referred to under the title of ‘health professional’, which includes registered nurses, registered medical prescribers, a registered pharmacist or a registered pharmacy technician.
The bill states that the ‘coordinating doctor’ that is overseeing the patient’s end-of-life care provision may be accompanied by ‘other such health professionals’ – including nurses – that they think are necessary.
However, no registered medical practitioner or ‘other health professional’ would be under any ‘duty’ to participate in assisted dying provision.
The bill makes clear that employers must not impose any punishment or detriment on healthcare staff who exercise their right not to participate in the provision of assisted dying.
