Now that the assisted dying bill has passed its momentous third reading in the House of Commons, it may seem like legalisation in England and Wales is a done deal. But despite this significant milestone, the bill is not yet law and its journey through the House of Lords is far from a formality.
Authors
- Suzanne Ost
Professor of Law, Lancaster University
- Nancy Preston
Professor of Supportive and Palliative Care, Lancaster University
While the terminally ill adults (end of life) bill is now closer than ever to becoming law, both the Commons and the Lords must agree on its final wording. And just like in the Commons, there are passionate supporters and vocal opponents in the Lords. Peers are expected to focus their attention on a number of outstanding, and controversial, issues.
One of the biggest concerns that surfaced during both the report stage and today's third reading relates to the speed and process of drafting the legislation.
Because this is a private member's bill, introduced by Labour MP Kim Leadbeater , it was subject to strict timelines. Leadbeater had just 85 days to work with legal drafters and set out a policy framework before the bill was published ahead of its second reading in November 2024 .
Despite this, the democracy-supporting charity the Hansard Society has noted that the bill is "among the most heavily scrutinised in recent times", and it could ultimately receive up to 200 hours of parliamentary debate, especially now that it has moved to the Lords.
Still, the fast turnaround meant that many important decisions, such as what medications will be approved for use in assisted dying, have been left for the secretary of state to determine later through what's known as delegated legislation (secondary laws made without a full parliamentary vote).
One area likely to receive particular scrutiny is the bill's inclusion of so-called "Henry VIII clauses" . These are controversial powers that allow ministers to make changes to existing primary legislation, effectively altering acts of parliament without needing a new law. A key example is clause 38 that would let ministers revise the NHS Act 2006 to formally include assisted dying within NHS services.
Stronger safeguards but concerns persist
Several amendments aimed at strengthening the bill's safeguards were supported during the Commons stages. These included the introduction of independent advocates, a new disability advisory board, and additional protections for people with learning disabilities, mental health conditions, or autism.
An amendment from Labour MP Naz Shah was also supported at the third reading, ensuring that a person who chooses to stop eating and drinking will not automatically be considered terminally ill. This is a protection designed to prevent the system being used inappropriately.
Yet despite these measures, concerns remain. Critics worry about the risk of coercion , both from others and self imposed. There is particular unease about people feeling pressured to choose assisted dying because they consider themselves a burden .
Questions have also been raised about whether those with conditions like anorexia might qualify for assisted dying under the current wording of the bill.
Even with the new safeguards, including mandatory training for doctors to detect coercion and assess mental capacity, many feel the bill needs tighter definitions and clearer criteria to protect the most vulnerable.
The role of palliative care
The impact on palliative and end-of-life care continues to be a major point of debate. Today, MPs backed an amendment from Liberal Democrat MP Munira Wilson that would require the government to assess the state of palliative care services within one year of the law being enacted.
Peers in the House of Lords may push further on this issue. Some may argue that before a person can request assisted dying, they should first be referred to a palliative care specialist to fully understand their options. Others may want the law to spell out more clearly who is qualified to assess these requests.
Another key question is who should provide assisted dying services. The British Medical Association has previously suggested a model where assisted dying operates outside the core NHS system. This would be a kind of parallel service overseen by the health secretary but delivered by independent providers. This would be similar to how early medical abortions are offered in some parts of the UK.
Time is tight in the Lords, so peers will probably focus on a few high priority areas. Any amendments will need to be proposed, debated and approved quickly if the bill is to continue progressing this session.
Even if the bill passes, it includes a four year implementation period to allow for the development of more detailed policies, including training for professionals, protocols for medication and clearer guidance on safeguarding.
The passing of the bill in the Commons is historic. But the national conversation on assisted dying is not over. And the next phase will determine how this sensitive and deeply personal issue is handled in practice .
Suzanne Ost has previously received funding from the AHRC for her assisted dying research.
Nancy Preston receives funding from Horizon Europe, Horizon 2020 and the NIHR
