Is the assisted dying bill doomed? – Politics Weekly UK
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When the assisted dying bill was brought before Parliament, it was pitched as the most robust and safest system of its kind anywhere in the world. A thorough and robust process involving two doctors and a high court judge. No other jurisdiction in the world has those layers of safeguarding. And then it changed.

I think it's really difficult to suggest that by having three experts involved, that is somehow a change for the worse. It's absolutely a change for the better. Not if those experts are people who already back the idea of assisted dying. With the stakes so high and doubts creeping in, can the assisted dying bill survive? I'm Gabby Hinsliff, filling in for John Harris, and you're listening to Politics Weekly UK for The Guardian. Not everything in politics is a matter of life and death.

But sometimes Parliament genuinely does hold people's lives in their hands. And today's episode is about one of those times. This week, the spotlight returned to the assisted dying bill after my Guardian colleague, Jessica Elgott, revealed that the requirement for a High Court judge to approve assisted dying requests is to be scrapped. Kim Ledbetter, the Labour MP behind the bill, says these changes make it safer, but that's not how everyone sees it. So Jess, the Guardian's Deputy Political Editor, joins me now. Hello, Jess. Hello. Hello.

Thank you for being with us today. I know you've been following this story really closely for a long time now. So, talk us through what's changed this week and why you think that change has been made. So, this week was a really, really pivotal moment for the bill. It already was going to be because it's the start of MPs who are in the committee looking at the bill, starting to scrutinise it and suggest any possible amendments.

But on the eve of that starting to happen, Kim Ledbetter, who's the bill's sponsor, the Labour MP for Spend Valley, she submitted her own amendment, which radically changes the way that an assisted death could be arranged. So before you have this sign off from two doctors, and then that would go to a high court judge to look at that evidence and to approve it.

She said this would make it the sort of safest in the world. There's no other country in the world that has this kind of judicial sign-off that has a court process involved. And I think that won a lot of MPs over as a particularly stringent safeguard. But now she has changed that. So she is removing that sign-off

each time by a high court judge. There'll still be a judge-led commission, but the commission will oversee panels, which won't be a judge. It'll be a senior lawyer, a psychiatrist, and a social worker, roughly that makeup. And they will be the ones signing off any potential request for an assisted death.

That means, she says, that it's safer for people who are concerned about coercive control. So, have a concern about possible victims of domestic violence who are being coerced to take their own lives or being pressured into doing so by their families. That social workers, psychiatrists who are good at assessing mental capacity, good at spotting abuse, be more likely to spot if that's happening. Rather than a high court judge who there was a lot of pressure on the court system to involve high court judges. Yeah, it's that.

pressure in some ways that's been an issue, isn't it? Obviously, you say she sold it as, you know, judge plus, this will be safer, this will be better. But does it feel in some ways, I mean, we'd heard during the committee process about and before about concerns about pressure on courts, you know, was there enough courtroom time available for this? Were there enough judges available to deal with these cases? Is the part of the concern around it that...

This isn't being done because this is a better way of doing it. This is being done in essence because the courts haven't really got time for it. Nobody wants to make available more courtroom time or funding for more courtroom time. And that therefore, this is kind of putting almost a sort of brave face on something that's being done through necessity.

I think that that's definitely true. That doesn't mean that it's still not the right thing to change it. I think you could make the argument that it's the right thing to change it because as a couple of High Court judges and indeed a Supreme Court judge has said, it's kind of vibes based.

the fact that having a high court judge sign this off is much better than having a psychiatrist or a social worker sign off. Ultimately, there are very few family court judges. There were already severe backlogs in the family courts. And we're not talking about having a case, having an adversarial case in front of these high court judges. It would probably end up being somewhat of a rubber stamping exercise if it went

before a high court judge. And so they have argued that in fact, an expert panel is likely to give it much more scrutiny and have much more expertise than a high court judge would. Now the counter argument to that is that if you are on a panel like this, if you're volunteering to be on a panel like this, you are much more likely to be predisposed

to the idea of allowing assisted dying. Because you're wanting to serve on a panel like this. Yeah, you're more likely to sort of agree with the process. If you're a high court judge, that isn't necessarily the case. You have got a moral duty, a legal duty to be neutral, to see it through a judicial lens. So that does change the relationship, I think, and I think some of the critics would say, between applying to a panel and applying to take part in a judicial process.

And as you say, whether or not it's the right change, it is quite a radical change. And it's clear that's been unsettling for a lot of MPs who felt, you know, this isn't the bill that they voted for a second reading. It's gone through, you know, why is it suddenly changing now? Why couldn't you have resolved all this before you bring the bill to this stage? Is it the manner in which the change has been made kind of at the last minute?

minute, that's the problem as much as anything. For some MPs, it's been quite difficult conversations with constituents to whom they've said, I'm supporting this bill because I feel it's absolutely copper-bottomed and it's all these safeguards. I think there was definitely a real soggy middle of MPs who were very torn about this in the run-up to the vote. And it ultimately decided that this idea of the strongest safeguards in the world was

that they could support it with confidence. For a lot of MPs, constituents are kind of less of the issue in that the popular view of this is that the public support of assisted dying. Most MPs that I spoke to had many, many more constituents contact them in support of this change, particularly with very harrowing personal stories.

And they would get letter writing campaigns from those who are against it. And people have very, very compelling reasons to be against it as well. But MPs aren't just making the judgment on the basis of the most harrowing stories they hear from constituents or indeed what they would prefer for themselves if they were in that situation. You have to legislate on the basis of the most vulnerable person, like the worst case scenario. And for them, I think that's why this protection of the high court being involved is...

was a very compelling argument to say, well, look, the High Court is where the worst things can happen and it's designed as a place to spot those things. A number of Labour MPs, one of whom we're going to speak to later on the podcast, wrote a mass email to their colleagues this week expressing concerns about the handling of the bill. How much disagreement or disquiet do you think there is in the Labour Party about this?

Jess, it's obviously, it was always going to be an emotive issue. People were never going to agree. But do you think it's got to a state beyond the usual divisions? It would be wrong to say that every single Labour MP is obsessing about this all the time because quite a few people, I think, sort of disagree.

spent a lot of time thinking about it in the run up to the November vote and then and now I've just kind of forgotten about it again but there are a certain number of people in the Labour Party and a big chunk of them for whom they're really really really kind of obsessive or interested or passionate about this bill on both sides

And because things, especially those on the anti side, because the vote has gone different way to the way they would have hoped, things have started to get quite angry and bitter. People are upset about this bill. They feel that there's a sort of great injustice about to happen. Therefore, I think that what you saw in the House

which was quite a good and generous debate between the two sides. You know, people would say this kind of thing when it's a moral question is often when the House of Commons comes to be at its best. And arguments were very respectfully heard. I think things have descended a bit further than that now. You've got quite a lot of social media attacks going on. This letter where four Labour MPs were directly criticising a colleague and not actually just criticising her for, you know, holding a different view to them, but a

about the conduct of the way that she presented evidence. They were talking about the way that Kim Laid-Beta had presented some of the evidence that the committee had heard and they said that she was portraying it wrongly. That's quite a personal attack to make and then to send it round to all of the other MPs in your party.

For a lot of new MPs, this is a big decision to have to make at a stage where, frankly, some of them are still getting used to how Parliament works. They're still quite green as legislators. Was it the right thing to do to introduce it this early in Parliament? And was it the right way to introduce it? I mean, in the past, we've always had private members' bills bringing about some big social changes. Everyone knows about the David Steele bill on abortion and so on. But was this, in retrospect, the right thing?

way to do it. Because a lot of people, it does kind of feel as if it's appeared out of nowhere, galloping over the horizon. There's been very little public consultation. There's been very little sort of sense of people being able to get to grips with it. If this is an issue that is going to affect the whole of society and it's for society to decide, have we really got a sense of what the country thinks and whether everybody's ready for this change?

The first thing to say is that if it was going to go through as a private member's bill, you know, it would have to go this early in order to get the amount of parliamentary time that it needed to be assured that it would get through all the different parliamentary stages. So then the bigger question is, is it right that this happened as a private member's bill?

And we're in this very strange situation where this is a bill that the prime minister really wants to see pass, but he is not prepared to make it a government bill. There have been cases where there have been government bills before that then become a free vote. There's not always a private member's bill where you have to have these kind of big moral questions. Obviously, there's precedent. Abortion is the key one.

What feels strange is so early in the parliament and so early for so many new MPs to be making decisions of this magnitude without a really sort of big inquiry or body of evidence or a commission behind it. And I think more and more MPs are wishing that the kind of things that are happening in the bill committee now, which is a constrained process,

could have been done via a commission and then via a private member's bill. So you would have a kind of body of work that took a year or so and where lots of evidence was held from lots of different people where recommendations were made. And then MPs can legislate on that and they can even reject things. You were never going to please everyone, even if you did a commission, about who was on it and who was invited to give evidence and who chaired it.

but it would have at least given something very academic to fall back on rather than the way that it's being done at the moment, which is in the Bill Committee, there's hundreds and hundreds of amendments by MPs having to be considered in a very constrained timeframe. It's a huge amount of work to get through in a very short time. So far, the Reform MPs, Lee Anderson and Rupert Lowe, have said publicly that they're withdrawing their support for the Bill. Do you think we're going to see other prominent shifters? And what do you

think is going to happen to the bill ultimately? Is there a danger of it falling? Because it takes a good 28 MPs to change their mind. So it's potentially quite a big shift if it's going to fall.

Yeah, I think the first thing to say is that 28 is quite a big number. The 55 majority that it went through on was a bigger majority than I thought it would get. And I think the psychology of these things is often that once MPs of any party take that step to say yes to something, to withdraw it is a big thing to do. On the other hand, I think that this change and the way it has been done is the most likely thing to have spooked people. If you could have

scripted a way that would be most likely to spook the most number of people, this would possibly be the thing to do it. If it passes by a few votes, is that in itself damaging? Does it need to pass convincingly to feel that Parliament really is behind this? Yeah, I think that that will be a very difficult thing if it passes by a handful of votes, five or six votes, less than 10 votes.

For two reasons. Firstly, because you want a change like this where the matters of life and death and the state's role in that, you want that to have been convincingly endorsed by Parliament rather than just narrowly. But secondly, on a more practical level, it's got to get through the House of Lords and it's not something that was in a government manifesto. This is a bill that's very likely to have issues in the House of Lords.

and they're much more likely to then proceed with it if it's got a convincing Commons majority. If it doesn't have a convincing Commons majority, then opponents of it in the House of Lords will see that as an opportunity to make more amendments, send it back to the Commons and eventually try and kill the bill that way. I have a feeling we're going to be talking to you again on this one. Thank you very much for your time, Jess. Thank you. Bye-bye.

Okay, let's pause there for a minute. And when we come back, we'll be hearing from two MPs on different sides of the debate about what it's like making such a morally challenging decision. Ryan Reynolds here from Mint Mobile. I don't know if you knew this, but anyone can get the same premium wireless for $15 a month plan that I've been enjoying. It's not just for celebrities. So do like I did and have one of your assistants assistants switch you to Mint Mobile today. I'm

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Welcome back. We're now joined from Westminster by Kit Mulhouse, the former Conservative Minister who voted for the assisted dying bill and is now sitting on the committee bill scrutinising it. And also by Jess Assato, the Labour MP for Lowestoft, who voted against and is a co-signatory of a letter expressing some concern about the way this bill has been handled. Hello to both of you. Hello.

Hi there. This is a very personal issue for a lot of people and a very emotive issue for a lot of people to which we all bring our own different personal experiences. I know my feelings about it were coloured by my father's death last year. I just want to ask both of you how you came to the positions that you...

now hold. Kit, how did you come to settle on the position you did of being in sport at this time? Well, it's been a long-term thing for me. I have to say that it started in my teenage years as most angst-ridden teenagers do. You think about...

of life and what it's going to look like. And I don't know what sparked me thinking about it, but I always had the view that if I was in extremis, it was something that I would want. And then over the many years since, life experience has confirmed me. Members of my family who've died in horrible circumstances have

But then also the last 10 years, I got elected in 2015 and immediately became chair of the all party group for choice at the end of life. And meeting a lot of dying and bereaved people campaigning in between has confirmed me of that view. So it's been a multi-decadal thing for me to get me to this point. It's a long term thing. And Jess, how did you come to the position that you hold?

Well, I guess similarly like Kit, when I was a lot younger, I think I supported the idea of choice at the end of life. But having worked in the domestic abuse sector for six years and the last three years in sort of child protection, my kind of knowledge of just what...

unfortunately humans are capable of doing in terms of coercing, controlling, harming others, has really given me pause to think on this bill. And my position is very much informed by the fact that there are many, many vulnerable people whose voices we never hear. And having been elected to Parliament very, very recently, my view is that if I could create a bill just for me,

I might be in favour of this, but I'm not here in Parliament to do that. I'm here to make sure that our legislation doesn't affect the most vulnerable, whether they are domestic abuse victims, disabled people, or simply people who feel like they might be a burden to society. So it's coercion that's a primary issue for you. Absolutely. Coming to the change this week and the dropping of the involvement of a High Court,

Judge, a lot of people were reassured by that, saw that as a safeguard. You mentioned it, I think, twice in your own statement to constituents about why you were supporting the bill. Can you talk us through how the committee came to change their views? What evidence did you hear that made you think, actually, we don't need our court judge involved, if that is how you feel?

There was quite a strong feeling in the House and particularly externally amongst medics and lawyers that something more exacting was going to be needed. We certainly heard from senior judges that what the judicial function was likely to be

And so I think talking to Kim, she thought, well, if we could insert, for example, psychiatric oversight, which was something that people were keen to see from a kind of capacity point of view, and from coercion, if there was more expert analysis of what was going on. So social workers in many circumstances are trained and indeed sensitive to looking for those kinds of things. And then having a kind of panel approach along what is the broadly the Spanish model was key.

The other thing, though, that we very strongly felt was there still needed to be kind of judicial oversight. So the creation of this sort of commission chaired by a High Court judge or similar seems sensible too. So you think of this as strengthening the safeguards in the bill? Jess, that's very much not your view, is it? Well, it isn't, although we are still waiting to see the full detail of what is being brought forward on this issue. I think that many of the issues around judges' capacity and so forth

were mentioned by Sir James Mumby in November. So it's not clear to me why this is only being debated right now. Sorry, when you talk about judges' capacity, you mean literally manpower available to do this, the idea that the courts don't have time, yeah. Yeah, that's right. It would absolutely sort of collapse the courts. There simply aren't enough judges and so forth.

But in terms of my perspective on this, we were really reassured, I think, as MPs in the second reading, that this was the highest form of safeguard for the bill, that it would be the most robust system of any other country.

And what I was really looking for was a judicial function, really, that would be able to take an inquisitorial role, a bit like you might have in a probate setting. So that's sort of what I was hoping this High Court judge's role would be. While it is obviously a good thing that trying to consult with more professionals, I would say that healthcare professionals, social workers, while lots of people think that they really, really understand things like coercive controlling behaviour,

My experience having worked in the sector is that actually very frequently both judges, health professionals, social workers do not understand the nature of coercive controlling behaviour, often miss it.

and are not receiving at the moment the absolute cultural training that they need to be able to understand and spot this in people before them. So if there's no profession that you think is reliably good at spotting this now, is there no safeguard for you that helps with this issue of coercion or is it about making sure that whoever is presiding over this decision is better trained at spotting coercion? Clearly, this is the problem with coercion. It cannot be spotted immediately.

in every case, even if we had the best training in the world. The fact is, is that coercive controlling behavior over particularly long periods of time is incredibly insidious. It's the drip, drip effect. And it may not even be a case that the perpetrator says, right, you know, you've got to do this. It could be the individual thinking,

I've had this happen to me throughout my life, and I'm going to take this option because my life isn't worth living because of the abuse that I've suffered for the last 40 years. So I don't think there is a system that can identify every single situation of coercive controlling behavior. I absolutely agree with Jess that training is key, right? So we need to look at training and make it as...

good as we can. You've got to remember that what we're comparing this to the legislation is the status quo. At the moment, we have hundreds of people a year with terminal diseases taking their lives in horrible circumstances in other ways. We've got people going to Switzerland, at least one person a week and increasing. And that's before you talk about the people in hospital who are refusing treatment or starving themselves to death because of what awaits them.

And in all of those circumstances, there is no assessment at the moment. There is no chance to have a conversation and try and detect these things. So while I understand Jess's point that she thinks we'll never be able to catch every case.

right? At the moment, we're catching no cases because the whole field is completely unregulated. And so what we're trying to do is bring regulation and order and supervision to what is currently a kind of horrible situation for so many families. But as I say, tolerating the status quo because of the situation that Jess describes doesn't seem to me to be a logical choice. What you're about

describing is a situation where there's no easy calls. There is likely to be suffering either way, whichever way the bill falls. Somebody's going to be unhappy. Somebody's going to be struggling. There's going to be potentially genuine human suffering either way. How difficult has it been

to take those decisions? And do you feel equipped to take those decisions? Do you feel that you've got, you know, to be on the committee as you are, Kit, do you feel that you've got the expertise, the time to deal with the amendments? And Jess, do you feel that, you know, as MPs, you have had enough of a grounding in the evidence, that you have enough time, that this process is suited to coming to the right decision? Well, look, I was elected as an MP seven months ago. And much of the first few months is really just trying to get your feet under the table and understand how to do the job.

well. This bill obviously was introduced very, very quickly. And I think that one of the problems with this, and it is a very difficult issue, very complex, it touches on many, many aspects of our life. But it's moving, as far as I'm concerned, at breakneck speeds. And as somebody who's not on the bill committee, but who has a deep interest in this,

Even I haven't been able to look through all of the amendments from last week, you know, trying to understand them. And there's 350 pieces of written evidence. I have not been able to look through all of that. And I very much doubt that anyone on the bill committee themselves have either.

Because actually, there were only a couple of days between hearing the witnesses last week and then starting work line by line yesterday. I would say to Kit and to others who are supporting this bill, why does it need to go so fast? It's not a government bill. Government bills, you know, always got a guillotine. They've got to get through because they've got a lot to do. On this one, why can't we take more time, give people the breathing space to be able to understand the implications of what you're saying?

Kit, have you felt that you've had enough time and you've had enough expert backup on the committee to deal with it? And to deal with it, it's quite a heated climate. I mean, it's got quite heated at times, hasn't it, the debate between some of the committee members?

Well, I do actually think we've got lots of time. There is a lot of written evidence, and we are all plowing through the bulk of it, although quite a lot of it, you can easily triage what is and isn't relevant to the particular section of the bill that you're dealing with at the time. And of course, while there are a lot of amendments, I would say probably two thirds of them are consequential. But the key thing is to remember is that we've been debating this issue now, admittedly just not, for about 10 years.

We obviously have lots of experience around the world where other jurisdictions have wrestled with the issues that lie behind this. So I do think that we're equipped to do it. I absolutely do. It's been an emotive and in some ways divisive process. It's pitted MPs from the same party against each other over something that evokes very strong feelings on all sides. Has it felt to you a comfortable debate to be part of, Jess?

No, it's not a comfortable process because I feel like we're being railroaded into things last minute. And the removal of the High Court judge is a really clear example of that. This is a private member's bill. It's one person's bill, not a government bill. We haven't seen the impact assessments. We don't know how it's going to be paid for. And at a time when

I get cases daily of people who cannot get a psychiatrist to understand the very, very serious mental health issues they have at the moment. I can't get somebody to see social workers when their children are really at risk.

I just don't know how we could be prioritising a system that is going to allow a small group of people to access all of these professionals when we can't get our current system right because it's so deeply underfunded and frankly broken. We've got so many things to try and fix at the moment, whether that's the family courts, whether that is the lack of domestic abuse support because victims don't have any services to go to, or the lack

palliative care. And I think that one of the things that Kit says that always gives me pause to thought is about the pain and suffering that people might face at the end. But this bill doesn't address that. That's not part of the bill. And actually, how do we know that somebody's pain and suffering couldn't have been relieved by earlier intervention, by better NHS, by more palliative care? One wrong death

Because we as legislators have not crafted a bill effectively, it feels to me to be one death too many. And that really sits on me. We need to think about what happens if it goes wrong. Is this a right forum to be making decisions at this moment? I mean, shouldn't this have been a government bill?

crafted by civil servants with, you know, probably a public consultation. You're taking, as Jess says, you know, you're taking huge decisions. The ramifications of this, if Parliament gets it wrong, are enormous. Do you feel comfortable doing this as a private member's bill?

Especially if we know it's what the Prime Minister wanted. Shouldn't the Prime Minister just come out and front it as a government bill? No, I absolutely am comfortable doing it, yes. And nobody, as Jess said, is taking it lightly at all. But this is how the House of Commons does things, right? This is the way things have been done in the past, from abortion to the abolition of the death penalty to the legalisation of homosexuality. The House of Commons

has a way of doing things that's been tried and tested over the centuries. And I do feel for Jess. I mean, I do think that when you're tipped into the House of Commons, it can come as a bit of a shock, the stuff that comes across your desk. But, you know, I'm afraid there is no other way in a democracy to get these things done. And I was gathering together in a convocation and agreeing through a process of steps and scrutiny that we're going to change the law in a particular area. That's how democracy works. And I'm afraid...

You know, Jess will learn, as I did, that she will be asked to send other people's children to war, maybe asked to send other people's children to war on the basis of a five-hour debate. Decisions have to be made. It's perfectly possible for us to spend years and years and years chewing over this issue. But while we do that, we perpetuate what I've described to you, which is a horrendous status quo.

which quite a lot of eminent people have said is just not sustainable and is seeing those of our citizens who can afford it increasingly heading off to other jurisdictions to take their lives with the dignity that they want to seek. And this is the key thing to remember. We're talking about autonomy for the dying here. And a choice that is against the bill is a choice to deny that autonomy to those people. And I'm just not sure that we can morally do that, given what they're being exposed to more and more in hospitals up and down the land.

I just feel it is a failure of our society. That's my worry, is that really what we are saying here is that we're giving up on people. We're giving up on the progress we can make. That's not right. That's not fair. From my perspective...

What I'm worried about is that we're actually giving a tool to abusers to use a state-sanctioned method of ending somebody's life. And I don't think that that should be swept away or under the carpet. You both have very strongly held views. You've both put them very articulately. You have a number of colleagues, both of you, who are at the moment still hanging in the balance, who have said that they would put this

bill forward at second reading, but reserve a final decision until they'd seen what came out of committee. When you're talking to colleagues who were in that position, who are perhaps more on the fence, who do feel sort of more torn, do you get a sense of which way they are leaning after this decision? Do you think this decision has changed the way people feel about the bill, Kit, first?

Well, I think people are naturally thoughtful about the process, but I haven't detected any significant shift away. People are inquiring about what it will mean and the implications. And they can see, certainly the people I've spoken to, the advantage of inserting this kind of more expertise in detecting what the safeguards are designed to detect.

You've got to remember, right, there's a huge amount of flack in the air online, right? So Kim and me and others, our motives are being maligned. There's a lot of abuse. Those people who are profoundly against the bill are naturally getting very cross about the process.

But in truth, I think most members of Parliament will, as they did a second reading, sit, be thoughtful, have a look at what's proposed and then come to a view. You don't think the bill will fall over this? You think the bill's still going to pass? Well, I don't think we can take anything for granted. But I don't see, given the change that's gone through, how anybody can say that this is less safe than it was before. Jess, how do you feel when you're talking to colleagues? What do you hear? Do you think the mood is changing? Do you think there's a shift against the bill?

Well, I think there are lots of MPs who support the principle of giving somebody who is in chronic and terminal pain the choice to end their life. And I think we saw that reflected in second reading. But what I am hearing is that colleagues are very busy. And

And they haven't had a chance to look at this bill. And I do think this is the sort of thing that probably should have either had a Royal Commission or it should have been a government bill because it isn't the same as what the Commons does every day. It is probably the most...

difficult piece of legislation in terms of its morality and the potential effects on our society that I would have seen in my lifetime and certainly in my time in Parliament. And I just don't think that the way in which this process is being run underlines the gravity of the issues being discussed in front of us. As you say, this has been an issue of extraordinary gravity and it's raised some extraordinary strong feelings on both sides. So I suspect we may be returning to it again. But for now, thank you very, very much for your time. Thank you so much. Thanks.

Thank you for listening. I hope you enjoyed today's episode. If you did, please do like and subscribe wherever you listen and think about leaving us a review. You can also get in touch by emailing us at politicsweeklyuk at theguardian.com about anything else you'd like us to discuss. For more on the topic of assisted dying, make sure to listen to Friday's episode of The Guardian's audio long read about a young Dutch woman who called off her death at the last minute.

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