NHS to choose how to help terminally ill die after MPs’ historic vote

Thousands of terminally ill people will be able to access assisted dying services within four years following a historic House of Commons vote that marks a seismic shift in the country’s social policy.

MPs narrowly approved the controversial Terminally Ill Adults (End of Life) Bill following months of fraught debate – but health professionals said questions remain as to how it will actually be implemented and how the NHS will be able to afford it.

Significantly, the two key cabinet members who will be charged with implementing the service – health secretary Wes Streeting and Justice Secretary Shabana Mahmood – voted against. They were joined by the Deputy Prime Minister Angela Rayner while the Prime Minister, Keir Starmer, voted for.

It is expected there will be both free and paid for options for people with fewer than six months to live to end their lives.

Under the bill, adults in England and Wales who have less than six months to live will be able to ask medical professionals for assistance in ending their life if they get approval from two doctors.

Questions over implementation

How they go about this is yet to be thrashed out.

In some countries that have legalised assisted dying, such as the Netherlands and Belgium, death can be caused by a lethal injection administered by a doctor.

Under Leadbeater’s proposals, however, the only option available in the UK will be for the patient to ingest a substance prescribed by a medical professional

The Health Secretary will establish the exact substance to be used during the implementation stage.

In some US states where the practice is legal, such as New Jersey and Oregon, a cocktail of drugs is given to the patient to take, often consisting of barbiturates, sedatives and opioids.

It is likely this would take place in a specialised clinic. It is understood a range of drugs will be approved in England and Wales so a cocktail can be administered.

Concern over NHS’s ability to cope

Health professionals have expressed concern over the extra burden the new laws will place on the NHS.

Streeting is not planning to comment on the legislation clearing the House of Commons, as it still has to go through scrutiny in the Lords, it is understood.

But last November, before the bill was put to a vote of MPs, he warned that the NHS would have to make cuts in order to deliver assisted dying as a service. He also said that it would create a “chilling” scenario where terminally ill patients could feel pressured into ending their lives to save the NHS money.

Daniel Elkeles, chief executive of NHS Providers, called for clarity saying: “Trusts will need clarity over how it is to be implemented, including which NHS organisations and staff will be involved in delivering this service.

“Alongside ensuring that the requirements of any assisted dying legislation are properly resourced, both in terms of staff and funding, with comprehensive training and ongoing support, trusts will also want to see better access and support for end of life care.”

Nuffield Trust Deputy Director of Research, Sarah Scobie, agreed, adding: “The debate on how that happens must begin: what organisations and staff will deliver it, what systems will be needed to ensure equal access, and how it can sit alongside existing care at the end of life.

“International evidence shows that assisted dying services tend to be publicly funded and integrated into the health care system. Successfully achieving that in England and Wales, with health and care services under extraordinary pressure and hospices struggling with a lack of comprehensive funding, will be no mean feat.”

And BMA medical ethics committee chair Dr Andrew Green said: “As the Bill reaches the Lords, there are a number of issues we would still want addressed. These include the need for an official information service to provide individual patients with tailored information about the range of options available to them, which should include access to palliative care, as well as assisted dying.”

What happens now?

This implementation stage will also be used to establish the number of assisted deaths that will be provided by the NHS and private companies, as well as the cost of the procedure for individuals who choose to access it.

An impact assessment published by the Government in May suggested more than 7,500 terminally ill people a year could seek state support to end their life within a decade, of which around 4,500 would complete the process.

The 149-page report expressed considerable uncertainty about the cost, but warned that it could cost the NHS tens of millions of pounds a year, including up to £2m in the first year for staff costs and up to £850,000 for staff training.

The Health Secretary will also appoint an Assisted Dying Commissioner to oversee the practice, which could cost the taxpayer around £10m a year, according to the report.

Each panel set up to decide whether assisted death should be approved would also likely cost around £2,000 to run, which it estimated could mean an annual cost of up to £3.6m.

Bill approved by a narrow margin

The Commons approved Kim Leadbeater’s private members’ bill to legalise assisted dying by a 23-vote margin on Friday afternoon.

Some 314 MPs voted in favour of the legislation following four hours of emotional debate while 291 MPs voted against.

Opening the debate, Leadbeater insisted that the bill would “correct the profound injustices of the status quo” and warned MPs that this was a “now or never” moment to help terminally ill adults.

Opponents of the legislation, however, repeatedly raised that the bill had been “drastically weakened” across its 90 hours of scrutiny.

Veteran Labour MP and Mother of the House Diane Abbott was among those urging colleagues to reject the legislation, arguing that there “has not been enough time to debate it”.

“What could be more unjust than to lose your life because of poorly drafted legislation,” she told the packed Commons chamber.

The bill will now be sent to the House of Lords for further scrutiny, and supporters hope it will be formally passed into law before the end of the year.

Once it receives Royal Assent, the implementation stage could last up to four years. However, the Government has the power to bring it in sooner if the necessary systems are in place.

England and Wales will also not be the only jurisdictions to legalise assisted dying. The Isle of Man is poised to become the first area in the British Isles to legalise assisted dying after its legislation passed a final vote in March.

Jersey’s parliament plans to debate a draft law on assisted dying later this year, with a possible start in summer 2027, following an 18-month implementation period if the law is approved.

Scottish MSPs also voted in May to support the Assisted Dying for Terminally Ill Adults Bill, which now awaits further scrutiny and a final vote later this year. Legalising assisted dying in Northern Ireland requires approval from Stormont’s Assembly.