UK lawmakers begin crunch debate on allowing terminally ill adults to end their lives

LONDON — British lawmakers began a crunch debate on Friday a bill to help terminally ill adults end their lives in England and Wales, before a vote that could be one of the most consequential social policy decisions they will ever make.

The vote, which is due to take place around 2:30 p.m. (1330 GMT), is expected to be extremely close, with those on both sides of the issue voicing confidence.

As things stand, proponents of so-called assisted dying have the edge. When Members of Parliament, or MPs, last voted on the issue in November, those backing assisted dying won by 330 votes to 275.

Since then, the Terminally Ill Adults (End of Life) Bill has been scrutinized, leading to some changes in the proposed legislation, which is being shepherded through Parliament by Labour lawmaker Kim Leadbeater rather than the government.

Divisive issue

In opening the debate, Leadbeater relayed how she had heard hundreds of stories from people who saw their loved ones die in traumatic circumstances.

''Not supporting the bill today is not a neutral act. It is a vote for the status quo," she said. "And it fills me with despair to think MPs could be here in another 10 years' time hearing the same stories.''

Proponents of the bill argue those with a terminal diagnosis must be given a choice at the end of their lives. However, opponents say the disabled and older people could be at risk of being coerced, directly or indirectly, into ending their lives to save money or relieve the burden on family members. Others have called for improvements in palliative care and greater investments in hospices to ease suffering as a better and more moral alternative.

Diane Abbott, a veteran left-wing Labour lawmaker, urged MPs to ''speak up for the voiceless one more time, because there is no doubt that if this bill is passed in its current form, people will lose their lives who do not need to, and they will be amongst the most vulnerable and marginalized in our society.''

Passions were running high outside of Parliament where hundreds of people gathered to make their voices heard.

Supporters were dressed in clothing emblazoned with the phrase ''Campaign for Dignity in Dying,'' while opponents held up banners urging lawmakers not to make the state-run National Health Service the ''National Suicide Service.''

The vote is potentially the biggest change to social policy since abortion was partially legalized in 1967.

What lawmakers are voting on

The Terminally Ill Adults (End of Life) Bill would allow terminally ill adults aged over 18 in England and Wales, who are deemed to have less than six months to live, to apply for an assisted death.

The terminally ill person would have to be capable of taking the fatal drugs themselves.

Proponents of the bill say wealthy individuals can travel to Switzerland, which allows foreigners to legally end their lives, while others have to face possible prosecution for helping their loves ones die.

How the vote may go

The outcome of the vote is unclear, as some lawmakers who backed the bill in the fall only did so on the proviso that there would be changes made. Some who backed the bill then have voiced disappointment at the changes, while others have indicated Parliament has not been given enough time to debate the issues.

The vote is a free one, meaning lawmakers vote according to their conscience rather than on party lines. Alliances have formed across the political divide.

If 28 members switched directly from backing the bill to opposing it, while others voted exactly the same way, the legislation would fail.

Timeline if the bill passes

Friday's vote isn't the end of the matter. The legislation would then go to the unelected House of Lords, which has the power to delay and amend policy, though it can't overrule the lower chamber.

Since assisted dying wasn't in the governing Labour Party's election manifesto last year, the House of Lords has more room to maneuver. Any amendments would then go back to the House of Commons.

If the bill is passed, backers say implementation will take four years, rather than the initially suggested two. That means it could become law in 2029, around the time that the next general election must be held.

Changes to the bill

Plenty of revisions have been made to the measure, but not enough for some.

Perhaps the most important change was to drop the requirement that a judge sign off on any decision. Many in the legal profession had objected.

Now any request would be subject to approval by two doctors and a panel featuring a social worker, senior legal figure and psychiatrist.

Changes also were made to ensure the establishment of independent advocates to support people with learning disabilities, autism or mental health conditions and the creation of a disability advisory board.

It was already the case that doctors wouldn't be required to take part, but lawmakers have since voted to insert a new clause into the bill extending the provision to anyone.

The wording means ''no person,'' including social care workers and pharmacists, is obliged to take part in assisted dying and can therefore opt out.

Government stance

There is clearly no consensus in the cabinet about the measure.

Prime Minister Keir Starmer has indicated he will back the bill on Friday. His health secretary, Wes Streeting, is opposed, but said he will respect the outcome.

There are also questions about how it would impact the NHS, hospice care and the legal system.

Nations where assisted dying is legal

Other countries that have legalized assisted suicide include Australia, Belgium, Canada and parts of the United States, with regulations on who is eligible varying by jurisdiction.

Assisted suicide is different from euthanasia, allowed in the Netherlands and Canada, which involves health care practitioners administering a lethal injection at the patient's request in specific circumstances.