Ian Dunt
@iandunt.bsky.socialI'm going to do some coverage on here of the assisted dying debate. If you're not interested please mute this thread now. It'll probably go on a while.
On the numbers, this debate should be won by the reformers. Supporters of assisted dying have a lead among MPs who have declared. They have a lead when you break down MPs by religion, which is a strong predictor. & they have a lead if you break undecideds in proportion to those who have declared.
If you were putting money on this, you would bet on reformers winning. However, those undeclared votes are a totally unknown variable. It's a free vote, early on in a parliament, with fresh-faced MPs.
Why are they undeclared? Genuinely undecided? Nervous to take a public stand? Or secretly on one side or the other? And if so, which one? My hunch is reform will still win, but it is very, very uncertain.
If you want to quickly brief yourself on the issues and the international evidence I did an explainer last week iandunt.substack.com
Trying to make a damn bit of sense of the assisted dying debate
Everything you need to know about a profound change in the law
iandunt.substack.com
I've seen a couple instances of angry vitriolic language. But, unfashionable as this is to say, the overwhelming majority of contributions I've seen from both sides have been thoughtful, sincere and respectful. I'm expecting to see the same in the Chamber today.
Basics: Debate starts around 9:30. The Speaker will decide if a wrecking amendment is allowed early on. If so, MPs will vote on it at the end. Don;t worry too much about this. He probably won't allow it and if he does MPs will probably kill it. We should see votes around 2:30pm.
If it passes, the bill goes to line-by-line scrutiny at committee stage and eventually to the Lords. If it fails, the issue is dead, probably for another ten years.
OK we're off. The Speaker has *not* selected a wrecking amendment, which would have effectively killed the debate. Good. This matter can be rejected or accepted it shouldn't be denied.
Leadbeater is now describing what happens under the status quo, particularly how palliative care cannot always prevent suffering.One man whose wife asked him to kill her, but he could not do it. Another who tried to commit suicide. Another who could not accompany his mother to Switzerland.
"We are not talking about a choice of life and death. We are talking about giving dying people a choice of how to die."
"The law is not clear & it does not protect individuals". This is correct. People are very unlikely to be prosecuted if they help someone go to Dignitas. But they will undergo a very long detailed investigation, costing thousands in legal defence. And must operate under cover of secrecy in death.
Leadbeater raises coercion. She says there is currently no legal protection against coercion. This bill would establish it - it has severe penalties for coercion. I find this argument ingenuous but unconvincing. Coercion to go to Switzerland is surely much less likely than a domestic legal system.
A series of really interesting, thought-through interventions, both supportive and critical, come from across the House - the far left of the Labour party, the Tory benches, the Lib Dems.
A key point: given the bill says only those who have six months to live can apply for assisted dying, how likely is coercion really? Would families really push to have their loved one pop off a few months earlier? Seems absurd. Another MP counters that those months can save thousands in care costs.
Things start to deteriorate slightly with Oliver Dowden asking for guarantees that "judicial activism" will not get rid of her safeguards. Leadbeater replies, correctly, that Strasbourg has repeatedly made clear that this issue is up to member states.
Deeply upsetting story from Leadbeater about a patient who vomited faecal matter in his final hours, then inhaled the faeces and died. He couldn't be sedated. Was conscious throughout. The family said the look of horror on his face at the end will never leave them.
These stories are really harrowing. The point behind them is that even if palliative care could guarantee that we would experience no pain at the end - which it cannot - it cannot guarantee that we would experience no suffering. It cannot guarantee dignity or autonomy in death.
Leadbeater: "How can we allow this but not a compassionate and assisted death?"
Leadbeater's approach is incredibly affecting and humane. She is reading out a list of stories from people she has spoken to - currently those who committed suicide rather than leaving a disease to take its course. "Hearing these stories is not easy, but it is important that we do."
There's an important constitutional point being made here. This is a free vote. Advocates of the bill cannot just sit there and force it through with their majority. And look what happens: people have to try and convince critics of their proposal.
Usually, debate in the Commons is lifeless. Everyone knows the government will win. Everyone knows an amendment will be defeated. That is not the case today. Interventions are therefore more likely to be meaningful and substantive, rather than theatrical demonstrations of tribal hatred.
For instance, Lib Dem Daisy Cooper asks about Clause 93b. It states that an assessing doctor "may" refer people to further psychiatric assessment if they have doubt about their mental capacity. She wants "may" turned to "must" & for training requirements to be strengthened.
Leadbeater says she is willing to work with her on that. What you're seeing here is how legislation should be debated in a legislature - practical concerns alleviated, changes made to reflect anxieties, leading to improved law. We very rarely see it in Westminster.
Leadbeater says that if the bill goes through, the bill committee will be able to take witness testimony, with representatives of all sides of the debate on the committee. This refers to the stage of the bill with line by line scrutiny, usually conducted in a smaller room by a selected group of MPs.
Leadbeater: "A vote to take this bill forward today is not a vote to implement the law tomorrow. It is a vote to continue the debate, to subject the bill to line by line scrutiny in bill committee, at report stage, and further reading, and then of course the bill will go to the Lords."
"But the debate can only continue if colleagues join me in the aye lobby today and I wholeheartedly encourage them to do so." And with that, Leadbeater is done.
There's a lot to complain about here. A private members bill was completely the wrong way to go and the fact it was only published after months of debate is kinda unforgivable. But Leadbeater has been an excellent advocate for this: Decent, kind, empathetic, logical. That was a very good speech.
Danny Kruger, Tory, stands up to argue against the bill. "I like and admire her greatly and I know that we have more in common than might appear today." This is a reference - which I dunno, maybe I'm getting old, I found very poignant - to Leadbeater's sister Jo Cox.
Kruger, interestingly, seems to base his opposition on procedural grounds. First, he says it has not been given enough time. He's right, but this is the case for nearly all the bills that are introduced in the Commons. It's odd to only become annoyed about it now.
He also says the bill won't be changed in committee. This is usually true, but it is unlikely to be true here, because of the absence of whips.
His argument - potentially an effective one - is that MPs should not back it if they are uncertain. Leadbeater's was that they should back it if they're uncertain. In both cases, that argument is based on the likelihood of changes at committee stage. Both are aiming squarely for those undecided MPs.
He focuses on the definition of terminal illness. He says - correctly - that there is no possibility of certainty here. He says the bill defines it by the doctor thinking it's "reasonably expected" within a six month period.
Kruger is asked what the importance of six months is. This is a sensible question. It is arbitrary. it actually comes from a back-of-a-fag-packet calculation made in the 90s in Oregon when they legalised, based on average Medicare spending.
Since then it has become a weird kind of global precedent, repeated in several countries passing assisted dying legislation. Kruger then suggests that the arbitrary nature of the six month limit opens it to legal challenge. "Of course it can be challenged on human rights grounds".
On that I suspect he's wrong. We haven't seen that elsewhere. Why would we see it here? His broader point on expansion is accurate - we could see it on categories. But the six month limit does not seem relevant.
Interesting. Richard Tice, from Reform, gets up to defend the bill. Kruger rather enjoys that. He says sarcastically that Leadbeater will be overjoyed to have Tice's support.
A point of order is raised about his use of the word "suicide". A Labour MP says the word is offensive. Needless to say, this is not a point of order.
Quick note on terminology: Some people reject the use of the phrase 'commit suicide', which implies illegality ie 'commit' murder etc. They prefer 'died by suicide'. There is also a split in the assisted dying debate. Supporters tend to use 'assisted dying'. Opponents tend to use 'assisted suicide'.
The British Medical Association (BMA) uses the term ‘physician-assisted dying’ to cover both scenarios.
Most of Kruger's arguments have been sound. He now veers off badly, saying: "The evidence is that with this new option and the comparative loss of investment and innovation in palliative care, real choice narrows." This is falsifiable and is false.
There is no evidence for the view that assisted dying leads to a decrease in palliative investment. Instead, there is extensive evidence that assisted dying leads to an improvement in palliative care.
Diane Abbot, Lab, stands. She will oppose. Compares it to capital punishment. Says the state should not be involved in taking a life. "It was a good principle in 1969 and it remains a good principle today." I think if you teased that point you would find it very weak indeed in any number of ways.
However, having Kruger followed by Abbott against the bill is like a pincer movement in the Commons, dragging in a very wide range of opinion, from the Christian right to the socialist left. That's a formidable opposition right there.
Abbot now makes what I think is the strongest argument against the bill. She talks about people who worry that "assets they had hoped to leave for their grandchildren are being eroded by the cost of care" and "there will even be a handful who think they should not be taking up a hospital bed".
She goes on that the provisions on coercion might not work. "Coercion in the family context can be about not what you say but about what you don't say. The long meaningful pause."
There is some evidence of this internationally.
Why is this compelling? Britain has a quite specific context. First, we store a lot of family wealth in the home, through property prices. Secondly, we have very expensive end-of-life care, which can disintegrate that wealth. Put that together and you can see the potential pressure.
I find Abbott's other arguments less convincing. She insists that she is not against assisted dying in principle, but that she is unconvinced by the safeguards of this bill.
It is fine to oppose this bill on principle. The argument on practical grounds is harder. I am unaware of a single international country with a stricter regime. If someone thinks these provisions are too lax it's hard to imagine any set of proposals which would satisfy them.
Andrew Mitchell, Tory, speaks out for the bill, talking about a young man he met who had recently lost his father.
"In the end he put a bag over his head and used his dressing gown cord to hang himself. He said this to all all of us: 'If you are ever in this position, let's hope that god will help you because they certainly won't'."
Andy Slaughter, Lab, a very thoughtful, rational and humane figure, just made a very thoughtful, rational and humane speech.
Kit Malthouse, who I have not always admired, is making a very interesting speech. "Centuries of art, literature and religion taught me that death was something noble or even slightly romantic. When I became an adult I learned pretty quickly that that was not the case."
"The deathbed for far too many is a source of misery, torture and degradation. A reign of blood and vomit and tears. I see no compassion and beauty in that. only profound human suffering."
On NHS funding: "Are you seriously telling me that my death, my agony is too much for the NHS to have time for, that it's too much hassle? Even the claim that it would overload the judges, that I should drown in my own faecal vomit because it's too much hassle for the judges to deal with."
"We send things to the NHS and the judges all the time. Is anyone suggesting we shouldn't be creating a new offence of spiking because the judges are overworked? Of course not." It's a very effective speech from Malthouse - fiery, indignant, logical.
"I want to address directly those people considering voting no... A vote against this bill today is not a passive act. "
"I have to break some news to you, whatever happens to the bill today, people with terminal illness will still take their lives. If the bill falls today we're consigning those people to take their lives in brutal violent ways, as they are doing at the moment."
An MP tries to object by saying that they should be discussing palliative care instead. Malthouse responds that this debate has kickstarted the discussion on palliative care and that that happens all around the world.
Malthouse discusses the case of a man who killed himself by jumping in front of a train. He waited until 2am so he would minimise disruption to the public. I dunno why but that kind of broke my heart.
"By not passing this bill we would deny to Mark supervision, conversation, access to doctors, periods of reflect, advise, and even if he went through all that and decided it was still too much, we would give him a much better end."
I have to say, I did not wake up this morning thinking that Kit Malthouse would make the best speech I had heard in the Commons for many months. But that's exactly what just happened.
Layla Moran, Lib Dem, zeroing in on that key point as both sides fight for the votes of the undecideds.
"This is the second reading. The media is asking all of us: 'Are you for or against this bill?' I would urge you to think of this question differently. The question I think we are answering today is: 'Do I want to keep talking about the questions in this bill'."
That causes real hubbub. MPs can tell that this issue is precisely where the bill will live or die. James Cleverly intervenes. "She is misrepresenting what we are doing at this point with this bill. We are speaking about the specifics of this bill. This is not a general debate."
Cleverly really is wrong about this, on a strict basis. Second reading is about principles. Committee stage is about details. None of this really stacks up of course - both stages are usually just a vacuous theatre of nothing. But that;s how it;s supposed to work.
Moran's point is that if you are against the principle, vote against. But if you are undecided on principle and worry about practicalities, then take it to committee and work on them there. You can always vote against later, at third reading, if you are unsatisfied.
Sudden moment of drama at Moran targets Wes Streeting specifically. The health secretary is in a very difficult position here. He went further than many people thought sensible in his opposition, grounding it in warnings about palliative care. Now Moran treats him like the leader of the opposition.
Moran: "I say to the sec of state: the gauntlet has been thrown down. if he wants someone like me not to vote for this bill... put firm commitments on palliative care on the table... then also commit to afterwards bringing a bill like this back".
Streeting looks very uncomfortable as he peers back at her, his head resting back on the bench.
Moran: "I would say to those who... are using process arguments: What does the bill that does address assisted dying look like that you might vote for? And if the answer is that there is none, then let's at least be open about that."
She ends by reading out a statement from one of her constituents, who had brain cancer which might return, sitting in the public gallery. "I am terrified that I will suffer a long painful death. If I knew I had the choice to have a good death, these worries would disappear. Please change the law."
Meg Hillier, Lab, v.impressive, opposes the bill. She refers to the Abbott argument on the involvement of the state.
"This is a fundamental change in the relationship between the state and the citizen and the patient and their doctor. If we have a scintilla of doubt about allowing the state that power, we should vote against it today."
This is particularly interesting because it's a liberal argument against assisted dying, which is usually typified by liberal arguments for it - basically on the rights and freedoms of the individual.
On the verge of tears she speaks about when her daughter was very ill with acute pancreatitis. "I had not intended to speak about this today." The bill wouldn't have covered her. but she didn't know if she would live or die. "She was in pain but it was managed."
She starts to break down. "I hope she forgives me for raising her personal situation in this House today."
Tory MP Edward Leigh, insists that palliative care can prevent pain. "There is no need for [the fear of dying in pain]. When I talk to consultants, practitioners, in palliative care, they say that they can manage pain." This is not correct.
A 2019 report by the Office of Health Economics found that 21% of palliative care patients dying in hospitals had unrelieved pain. Its modelling concluded that even if we achieved the perfect level of palliative care, 50,709 palliative care patients a year would still die in some level of pain.
The repeated references to patients vomiting up faeces in their final moments also show that even if we could prevent pain, we would not prevent suffering. Morphine can do a lot. it can't do everything.
As if to directly counter him, the next person up is Labour MP Doctor Peter Prinsley. "When I was a young doctor I thought it unconcionable. But now I am an old doctor, and I feel sure it's the right change."
"I have seen uncontrollable pain. Chocking. And I am sorry to say the frightful sight of a man bleeding to death while conscious as a cancer has eaten away at the corroted artery. I know the terrifying loss of dignity and control in the last days of life."
David Davis, Tory MP, says he'll vote for the bill. He also takes a shot at James Cleverly. "I say to those who make procedural comments in this," he says, peering over his glasses, "second reading is a point of principle, not a point of conclusion."
Tory MP Alicia Kearns. "For those whose religious beliefs drive their arguments today, I will always defend your right to practice your faith... But to deny choice to others, especially those with only 6 months to live where their personal choice does you no harm, is wrong."
Finally someone says it. "We have to be honest with ourselves, this bill has been read far more vociferously than most bills that come before this House. Most bills... have come to parliament with far less than 14 days to consider. The policing bill - six days. Illegal migration bill - six days."
Thank God someone said it out loud. MPs criticising the lack of time are entirely correct. It would just be helpful if they actually complained about that for other bills as well.
Julian Lewis, Con, speaks out against the bill. But he also asks a question which has been hovering around this debate for weeks: "Have doctors the freedom to administer pain relief which may shorten life."
I don't know the answer to this question. But people have told me several times that there was a bit of a nod-and-wink culture when their loved one passed away, as pain relief and assisted death overlapped in some way.
Others have said that things changed for the worse after the Shipman murder case, forcing arrangements into a grey and unspoken world and needlessly prolonging painful deaths.
Labour MP Lizzi Collinge: "We've heard the term Rubicon. There seems to be the idea that this is a completely new kind of decision... in medical practice. But actually, patients, doctors and high court judges are already making life or death decisions every day."
She is making such an interesting and important point, even as her voice falters talking about a close family member. She says she starved herself to death through withdrawal of treatment. She was unable to swallow and relied on artificial nutrition.
"When it became more invasive, she said enough was enough. As a mentally competent adult she could make that call. "People are already legally able to die early through withdrawal of treatment."
"Her capacity was assessed by a doctor and she was allowed under current law to die early." What a perceptive, impressive speech.
"Good palliative care and assisted dying are not at odds. They are not in conflict. they both aim for the same thing: a good death, surrounded by the people you live, with minimal pain and without fear."
Lovely words. Too ambitious of course. I'll be absolutely shitting myself when the time comes, no matter how comfortable they've made me. Although I will of course be demanding an absolute bucket of drugs to see me off.
Robert Jenrick is speaking but I don't see any reason to inflict it on you. Watching him grapple with issues of moral importance is like watching a mop try to use Windows 95.
He's quoting Jeremy Bentham, God help us. Get my wife's name out of your fucking mouth.
Ah yes, "activist judges in Strasbourg". Of course. What an insufferable monstrosity he truly is.
It's really telling that Jenrick is the only person who has lowered the tone. Everyone else has been really impressive and thoughtful, on either side.
Dr Neil Shastri-Hurst, Tory MP but more importantly a surgeon and a healthcare barrister, gets up to speak.
"I'm also instructed by my own experiences, my persona experiences... of those patients who I failed. I failed because I did not give them the good death that they deserved... We can improve the palliative care offering in this country. But it is not a binary choice."
Such a strange atmosphere in the Commons. It's partly because of the lack of a whip. Partly because many MPs are still fresh and therefore nervous speaking in the Chamber. Partly because it's so tight. But I think mostly because there's so much emotion.
I've lost track of how many MPs have nearly started crying as they spoke. They're all reliving the deaths they've been through. Nearly everyone has mentioned the bedsides of loved ones they've sat next to. It has provided an electric emotional charge and also a deep sense of sadness.
I can't even imagine the amount of emotion Leadbeater will have had to soak up over the last few weeks. Today alone, she is the recipient of so many of these speeches and the pain they're communicating. Presumably it's been like this away from the Chamber too.
Leadbeater asks a point of order. She said earlier she had spoken to the highest levels of the judiciary. She's clearly been given a scolding. The Judicial Office asks her to make clear they have not offered support to the bill.
I dunno man, that wasn't at all the conclusion you'd come to from what she said, but whatever.
In other news, it's been a while since I sat through an entire debate and I would estimate that perhaps 25% of the Commons is younger than me. I hate it.
Closing speeches. Kieran Mullan is kind of speaking for the opposition, even though the opposition has no fixed view. He gives a very thoughtful speech.
"Access to assisted dying could reduce suffering for the terminally ill. That is a choice some people would like to have. Some people would make that choice without any undue pressure. If you vote against this bill today, they won't have that choice."
"I caution against avoiding facing up to that hard moral reality but arguing that whatever people may far about dying can always be managed by modern medicine. For all it can achieve, modern medicine cannot achieve everything."
"I don't think opponents of this bill can deny this any more than proponents of this bill can deny that if this law is passed it would represent the crossing of a significant legal, societal and moral Rubicon."
"Every other expectation we have of the state is to have it extend and protect life. We would instead be asking the state to procure the medicines, provide the staff, and sign off in the courts, a process that is designed to, and will to, someone's death."
What a speech. What a profound moment for MPs. To be treated like adults, for once. "We should vote with great humility. And with respect for each and every vote cast in whichever direction."
What an exceptional statement. The single best speech I've heard from the Tory front bench for a terribly long time, although admittedly that's a low bar and this was only technically a front bench speech. Still. The wins. Take them where you can get them.
Alex Davies-Jones summed up for the government. Kit Malthouse then claimed the closure, which agreed (don't worry about all that). The Speaker gets up and divides the House. MPs are now voting on the bill.
To be clear - there are no other votes, no amendments or further motions. It's a straight yes or no on whether the bill should proceed.
If MPs vote against it, I suspect the issue will be dead for a decade, possibly more.
If they vote for it, it goes to committee and report stage, which involve line by line assessments, then a general third reading vote, and then to the Lords. There will be a long, long way to go. But the expectation is that it will probably pass.
Not long until we find out now.
Assisted dying bill passes
Ayes: 330
Noes: 275
There are no cheers. No noise. Silence. I've never seen a victory like it before in my life. This sense of growing recognition and moral responsibility.
And then, because this is arguably the most preposterous country on earth, Speaker Lindsay Hoyle says: "Right, thank you everybody. We're going to move on to the ferrets bill if people wish to leave."
He's not lying either. That's exactly what's about to happen. whatson.parliament.uk
Private Members' Bills - What's on - UK Parliament
Animal Welfare (Import of Dogs, Cats and Ferrets) Bill: Second Reading
whatson.parliament.uk
Full article on today's debate, free to read for everyone...
This was the single most impressive parliamentary debate we've seen in years.
iandunt.substack.com
Assisted dying: Triumph for reformers during a historic day in Westminster
This was the single most impressive parliamentary debate we've seen in years.
iandunt.substack.com
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That was my first ever BlueSky parliamentary thread. Basically the same as the other place, but without all the cunts.
There'll be more. See you soon.