The right to an assisted death will become law in England and Wales within four years as MPs backed a historic societal shift in parliament on Friday by a tight majority. But what does it mean for the future?
When could the first assisted death happen?
It may be some years away yet – although no later than 2029. There is no timetable but, under the terms of the legislation, it needs to start within four years after the law is passed.
The bill is likely to be given royal assent by the end of the year, if it passes smoothly through the House of Lords. However, there are many details about the process that are yet to be ironed out, including how the system will work either within the NHS or outside it, that could delay its implementation.
What about people who are sick now?
Many people with terminal illnesses campaigning for a change in the law will be relieved by the legislation but are not certain to benefit from it themselves. It could take years to implement, so those with a shorter life expectancy are unlikely to be eligible for an assisted dying service.
Will doctors need to be trained?
The training and qualifications of doctors is one of the points yet to be resolved, although it has been decided that medical staff will not be compelled to take part in assisted dying services.
Other subjects that need to be discussed include the type of lethal substance to be administered, the forms of identification patients would have to provide, the records that would have to be kept by doctors and the codes of practice around the assisted dying process – as well as the location and type of services.
How could it be done?
There are many logistics to thrash out, with health minister Stephen Kinnock and justice minister Sarah Sackman in charge of implementation. One possibility is integrating a service into the NHS, which would oversee the process of moving from palliative care to assisted dying for those with less than six months to live.
An alternative would be to have a separate unit outside the NHS available through third parties, similar to the situation in Switzerland. A hybrid model could look like the way in which abortions are carried out by separate providers such as the not-for-profit British Pregnancy Advisory Service and others, but ultimately overseen by the NHS.
The bill makes provision for the service to be carried out for free, but if it is publicly funded then it would get money that is currently not wholly provided to end-of-life services such as hospices, which tend to raise money as charities.
Can the Lords block it?
The idea was not in the Labour government’s manifesto, so convention dictates that it could be killed off in the second chamber. It could also be so mired in difficulty and delay in the Lords that it ran out of time.
However, given it has been voted through in the House of Commons, it is highly likely to pass at some point, as most bills do – probably before the end of the year.
If it were to run out of time in this parliamentary session, then it would not be carried over to the next because it is a private member’s bill.
Another MP would have to put it forward and start all over again, unless the government decided to take up the cause and propose its own legislation.
Will it be significantly changed via amendments?
Undoubtedly, some peers will attempt to change the legislation, and many MPs acknowledge there is still room for improvement. There are some outright opponents of the legislation as well, such as Tanni Grey-Thompson, a disabled peer and Paralympic medallist.
But the most likely outcome is that peers will refine the legislation before it is sent back to the House of Commons and then ultimately passed. Kim Leadbeater, who introduced the bill as a backbencher, said recently that she thinks the House of Lords will end up voting in favour.
What about Scotland and Northern Ireland?
The bill applies to England and Wales, with the Welsh parliament denied a veto over the legislation. Scotland is currently going through the process of examining its own legislation. There are no plans for assisted dying to be introduced in Northern Ireland at the moment.