Terminally ill people in England and Wales are to be given the right to an assisted death in a historic societal shift that will transform end-of-life care.
After months of argument, MPs narrowly voted in favour of a private member’s bill introduced by Labour’s Kim Leadbeater, which could become law within four years.
Her bill, which passed by 314 to 291 votes, a majority of 23, was hailed by campaigners as “a day for the history books, where facts have prevailed over fear”.
The emotional debate in parliament was dominated by pleas from opponents of the bill for stricter safeguards against coercion by abusers, concern from disabled people and warnings about the fundamental change in the power of the state when granted new rights over life and death.
The prime minister, Keir Starmer, voted in favour of the bill, while MPs were given a free vote. It will head to the House of Lords and peers are not expected to block its progress, though opponents said they would continue to fight the bill there. Royal assent is widely expected by the end of the year.
It will give people with less than six months to live in England and Wales the right to an assisted death after approval from two doctors and a panel including a psychiatrist, social worker and senior lawyer.
Opening the debate, Leadbeater said now was the time to seize the moment, to “correct the profound injustices of the status quo and to offer a compassionate and safe choice to terminally ill people who want to make it”.
The Labour MP for Spen Valley said it was “not a choice between living and dying – it is a choice for terminally ill people about how they die”. She said rejecting the bill was “not a neutral act, it is a vote for the status quo … and it fills me with despair to think MPs could be here in another 10 years’ time hearing the same stories”.
Terminally ill people and families were in the public galleries watching the debate and at a rally in Parliament Square. Dame Esther Rantzen, terminally ill with lung cancer, whom Starmer promised he would make parliamentary time to debate the bill, said she had never quite believed it would come to pass.
“It won’t come in my lifetime, I won’t live long enough, but I am so relieved it will help future generations to look forward to a good death. I am astonished I have lived to see the moment,” she said.
Concerns were raised by disability activists, who held a protest outside parliament, and MPs opposed to the bill made passionate pleas that it would lead to people being coerced into ending their lives early.
The bishop of London, Sarah Mullally, a former chief nursing officer for England, said it would be a service introduced amid multiple risks to the most vulnerable, including serious shortfalls in social and palliative care.
“It does not prevent terminally ill people who perceive themselves to be a burden to their families and friends from choosing assisted dying,” she said. “And it would mean that we became a society where the state fully funds a service for terminally ill people to end their own lives but shockingly only funds around one-third of palliative care.”
Opening the debate for those opposed to the bill, the former foreign secretary James Cleverly said he was an atheist but had rejected the bill because he believed the right safeguards were not in place.
“We were promised the gold standard, a judicially underpinned set of protections and safeguards,” he said, citing concerns from professional bodies including the Royal College of Psychiatrists. “I disagree with [Leadbeater’s] assessment that it is now or never, and it is this bill or no bill, and that to vote against this at third reading is a vote to maintain the status quo. None of those things are true.”
The cabinet was deeply split on the legislation. Cabinet ministers to join Starmer voting in favour included Rachel Reeves, Yvette Cooper, John Healey, Liz Kendall, Pat McFadden, Heidi Alexander, Ed Miliband, Steve Reed and Peter Kyle.
Among those opposed were Angela Rayner, Bridget Phillipson, Jonathan Reynolds, Wes Streeting, Shabana Mahmood and Darren Jones.
The Labour peer Charlie Falconer will take over shepherding the bill through the Lords, with backing from Conservative peers including Michael Forsyth and the former Scottish secretary Alister Jack.
Should the bill pass the Lords, there will be no provision in place for a number of years. The government and NHS have four years to implement the bill, though Leadbeater has said she hoped it would be ready sooner. There are no answers, as yet, as to whether the NHS would provide the service or private providers, or whether it would be free at the point of use.
Terminally ill patients with a prognosis of six months will have be of sound mind to proceed, but MPs rejected an amendment that would have prevented anyone from accessing the service on the basis of feeling too much of a burden to loved ones. There will be criminal sanctions on any family member found to be coercing someone to choose to hasten their deaths.
Through the debate, proponents of the bill sought to argue that MPs could not allow the status quo to persist.
The Labour MP David Burton-Sampson said his Christian beliefs had meant he was initially against assisted dying but the exertions from constituents who described their loved ones dying in excruciating pain had persuaded him to support it.
“In my view, this bill has more controls than it had, the debate has been ongoing for many years, it has gone through hours of scrutiny … I believe in choice and while I believe assisted dying is not for me, it should be a choice for others,” he said.
Many speaking in support or against the bill told of some of the hardest moments of their lives, such as the Conservative MP Mark Garnier, who spoke of his mother’s drawn-out death from pancreatic cancer. He said she had endured more suffering and anguish compared with a constituent with the same disease who ended their life under assisted dying laws in Spain.
Labour’s Siobhain McDonagh’s voice broke with emotion describing her sister’s death from brain cancer, and her fears her life would have been shortened had such a law existed sooner.
From both Labour and the Conservatives there were warnings that the bill would herald a watershed moment that could not be undone. The mother of the house, the Labour MP Diane Abbott, said MPs should oppose the bill on behalf of the marginalised.
“I came to this house to be a voice for the voiceless. Who could be more voiceless than somebody who is in their sickbed and believes they are dying? I ask members in this debate to speak up for the voiceless one more time,” Abbott said.
Two MPs, the Conservative MP Tom Tugendhat and Labour’s Chi Onwurah, said they were deeply concerned about the fundamental shift in the role of the state, giving it the power to end life.
The Labour MP Vicky Foxcroft, who resigned a whip on Thursday night in protest at the government’s disability cuts, spoke against the bill citing her fears for disabled people, as many campaigners protested outside parliament.
“The vast majority of disabled people and their organisations oppose it,” she said. “They need the health and social care system fixing first. They want us as parliamentarians to assist them to live, not to die.”
MPs deliver powerful speeches in assisted dying bill debate – video
Starmer, a strong supporter of the law change, had made his decision to vote at third reading some time ago, but No 10 declined to disclose it in advance on the prime minister’s insistence, conscious that making a firm commitment to do so might be too leading when the government was neutral.
Before the final vote on the bill, MPs passed several new amendments, including two from opponents of the bill. One would bar those who refuse food and water from being classified as having a terminal illness, though MPs concerned about anorexia said it may not prevent that slipping through the gap. The other would commission the health secretary to report on the state of palliative care.
