Why is the UK's end of life bill so significant?

With 2024 coming to a close, the House of Commons voted on a landmark bill - which would allow some terminally ill adults to end their own lives. It was one of the most significant and sensitive topics to have been voted on by British MPs in recent decades. But what will it mean? And what still needs to happen for the bill to pass into law? I’ve been speaking with Linda Bauld who is a professor of public health at the University of Edinburgh…

Linda - This is an important bill. It's the terminally ill adult's end of life bill. And what it would do is make it legal for over eighteens who are terminally ill to be given assistance to end their own life. The reason it's important is because many countries around the world have looked at their aging populations, of course, and recognise that people who are nearer the end of life really should have more opportunities to think about how they die. Particularly people who are terminally ill and are experiencing a lot of suffering. So the bill just generally will be obviously for adults. They have to live in England and Wales, so it's the England and Wales bill. They have to have the mental capacity to make the choice, and to have that to be a settled and informed wish. And they actually have to make two separate declarations that are signed and witnessed. And then independent doctors have to be satisfied that the person is eligible. And the bit that's tricky and really hasn't been worked through and is different from other countries is a high court judge will be involved. They have to hear from at least one of the doctors. And they can also speak to the dying person or anyone else they consider appropriate. So it's really a physician assisted suicide and it could be a very important piece of legislation if it's passed.

Chris - What has actually happened in parliamentary terms though? Because there was a big vote and it passed through, but what does that actually mean in practical terms? They've had this first reading of it. Does anything actually change at this stage?

Linda - No, it doesn't change at this stage. What happens now is it goes through the parliamentary process. I think what's interesting about this is MPs are given a free vote. So normally for a new piece of legislation, at first reading, MPS would vote with their party and they'd be whipped to do so, which I always think is a tricky term, but that's the ancient term that we use. So free vote. And then what happens is it will go to committees. So there's a series of committee stages and there'll be further readings of the bill in the House of Commons, but also in the House of Lords. So we can't assume that this bill will become an act. It may not pass because what happens is through those stages, amendments can be introduced or people might change their mind.

Chris - In other countries where they do have equivalent legislation, I'm thinking Canada as one example, how has it gone down and been received and how does that compare with what is being proposed for the UK or rather England and Wales at this stage?

Linda - One piece of evidence I read suggests that over 200 million people have access to similar legislation. The first country to do this was Switzerland in 1942. Canada's important example, and so are many of the US states.They are different though, just in terms of how they operate their systems. So there's assisted dying and that means that the person who's terminally ill receives the drugs from a doctor and then they administer it themselves. So the person administers it. Assisted suicide is where you help somebody end their life. And euthanasia is the act of deliberately ending a person's life to relieve suffering. But assisted dying is what we're looking at here. So other countries have this as well. Oregon actually is probably the most useful example, Chris, because it's part of the US, the first part of the US to do this, I think from around 1997. And it's kept their legislation really quite similar throughout that period. And what they do in Oregon is actually quite similar to what's going to be in place in the UK. In relation to other countries, there are differences. So the groups that can be included, I think Netherlands and Belgium have some of the most expansive legislation. So children even are included in that under very specific circumstances. Some countries include people who are not going to die in the next six months, but are experiencing invariable suffering. So there's different versions of it, but I think what we're seeing internationally is a movement to consider a dignity in death really, which is what this is all about.

Chris - Would you regard 2024 then as a watershed moment for this?

Linda - It is a watershed moment because it's the first time that the UK parliament has voted in favour of it. I mean, in my area of research and public health, which often involves legislation on a range of issues, when you see a bill pass the first reading, even if it doesn't get through in that period it means it probably will come back in future years. So I think it's a watershed moment and in Scotland where I'm based, we would have separate legislation, but we've also seen a similar pattern of two bites of the cherry, so two previous rounds of legislation not passed. But the one that's coming before the Scottish Parliament now and will be coming forward next year. We'll see whether our MSPs vote in favor as has occurred in England.