Assisted dying bill brings critical state of palliative care into government’s focus
Aletha Adu
Sun 1 December 2024
The health secretary, Wes Streeting, exasperated many colleagues with his public explanation for voting against the bill. Photograph: Ian Vogler/Reuters
During last Friday’s debate in the Commons on assisted dying, Wes Streeting was seen ferociously nodding as MPs raised the need for better end-of-life care.
While the health secretary is yet to share his official view on draft proposals for a commission on palliative care, some of those behind it have taken comfort from his apparent gesture of support.
Streeting exasperated many of his cabinet colleagues, including Keir Starmer, with his public explanations for voting against the bill, but many Labour figures believe he was right to share his disapproval at the state of end-of-life care.
“They believe it’s fair enough for us to repeatedly blame the former government for the fiscal mess they left behind, so why can’t they highlight how much of a mess the palliative care system is for so many people?” one MP said.
They hope Downing Street will feel some obligation to support the independent commission’s work, given the prime minister has silently backed Kim Leadbeater’s private member’s bill so far.
Many supporters of assisted dying say legislation, which passed its first Commons hurdle on Friday, should go hand in hand with greater investment in palliative care.
About 300,000 people were cared for in the country’s 200-plus hospices in 2022-23, according to Hospice UK.
They cost £1.6bn a year to run, with only £500m coming from the government. The remaining £1.1bn is raised through donations, legacies, charity shops and other fundraising activities.
For some Labour figures, the timing of discussions around palliative care is in danger of overshadowing Starmer’s attempts to refocus his premiership this Thursday after a bumpy first few months.
One of them said: “His approval ratings are embarrassingly low, and we’ve had a rough ride already. Surely we can revisit this discussion in the near future?”
A backbencher signalled that Starmer appeared to have “shot himself in the foot”, claiming that if MPs had had more time to discuss the assisted dying bill, the prime minister could have had more space for his reset.
Morgan McSweeney, Starmer’s chief of staff, is understood to be among No 10 figures who feared that allowing assisted dying legislation to go ahead could prove a distraction from the government’s priority of rebuilding the NHS. That group could take the same view of reforming palliative care.
However well Starmer’s reset lands, discussions around the state of care for terminally unwell patients in England and Wales dominated much of the debate last week, to the extent that some MPs who backed it are now considering changing their minds.
“I’ve spend the weekend trying to convince myself I made the right decision for my constituents with the time I had. I didn’t vote yes just because it felt like that was the way the wind was blowing within parliament, but because I thought I had read enough,” one new Labour MP said.
“But having listened to some colleagues make their arguments, I do think we really need to consider whether funding that could help people in palliative care could end up going to doctors who are needed to ensure assisted dying can go ahead for people who do need it.
“I just want the commission to be able to get on with it as quickly as possible, and I can’t imagine I’ll be the only one.”
Opinion
After watching my mother die of pancreatic cancer, I had to vote for the assisted dying bill
It seemed extraordinary at the time that there was no way to end her suffering once and for all
So, the Ayes won it: 330 MPs voted to take forward Kim Leadbeater’s Bill, The Terminally Ill Adults (End of Life) Bill 2025-25, securing a majority of 55. It was an unusually large number of MPs for a Friday, but this was an unusually emotive and difficult second reading of a private members’ bill.
I supported the bill, driven by my own personal experience. Watching my mother die of pancreatic cancer was awful. She was well looked after. The NHS attended her at home, and a morphine driver helped with the pain. Indeed, it is possible that increasing the dose to overcome her pain hurried her passing. But her suffering was unnecessary. With absolute certainty of her imminent demise, it seemed extraordinary at the time that there was no way to end her suffering once and for all.
But against that was the story of my colleague Harriett Baldwin. Her family was told her father was just days away from death, but he went on to recover and live for a further 22 years. Personal experience, of family and constituents, dominated the debate.
But also debated was the process, the dangers of mission creep, of people being urged into a decision they might not have wanted to take, of doctors not emotionally or professionally qualified to make these decisions, of exclusion of family from knowledge that a loved one is taking the ultimate decision. All incredibly important points. Similarly, there was much talk of the parliamentary process, of how a private members’ bill is not the best way to take these things forward, and how it will be difficult to find time for the process to be sufficiently long to allow proper scrutiny of the issues.
The vote on Friday was to allow this bill to progress to the next stage. Kim Leadbeater MP has already said she is keen that the next stage – the committee stage – has time to take written and oral evidence. The bill will be scrutinised line by line and all the points raised (and more) will be debated. Then the bill returns to the main chamber for report stage, when all MPs can again make their points and amend the bill. And if it all passes through the Commons, the same process happens in the Lords. It is only when everyone has collectively agreed that this may become law, in around nine months time.
Make no mistake, this is a very big deal. But so have other private members’ bills been in their day. Legalising gay sex, legalising abortion – both were incredibly controversial at the time. Arguments of those changes being the thin end of the wedge have been tested. In the case of gay relationships, it could be argued that things have moved along a lot. But 11 years after same sex marriage was made legal, do we ever think of this as anything other than normal? Similarly, with abortion. From time to time, we debate the pros and cons of the foetal age limit and where it should be set. But do we ever, as a society, regret the important point that women should have a choice with what happens to their own bodies?
In a world where medical advances are achieving what might have been impossible just a few decades ago, should we not be debating, properly, and with a probability of a significant change in how we view end of life, the issue of how we finally end our days?
Of course this needs to be debated in the next stages, and I will be looking out for reasons to be proved I am wrong. But my instinct is that in the interests of those of us who suffer painful, miserable and horrible deaths, we should find a way to ensure the future suffering of such people is ended if that is what they choose.
Mark Garnier is the Conservative MP for Wyre Forest and Shadow Economic Secretary to the Treasury
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