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Alexandra Mullock, professor in health law and policy at the University of Manchester, says that despite the defeat of the assisted dying bill, the debate is far from over.
On 11 September, the latest attempt to legalise assisted dying in England and Wales ended in defeat, with the Terminally Ill Adults (End of Life) Bill failing at second reading in the House of Commons by just 16 votes.
For supporters of assisted dying, the result raises the question of whether, after coming closer to changing the law than ever before, the opportunity for reform has now been lost for another generation. And if it hasn’t been entirely lost, the route back won’t be easy.
One striking feature of the September vote was the absence of a number of Labour MPs who had previously supported the bill. Thirty-seven Labour MPs who voted for it at third reading in June last year didn’t vote for it this time, while opponents mobilised more effectively.
While we can’t speculate why these MPs were absent, we do know that in the three months since the bill’s third reading, the political context has changed substantially.
Under Keir Starmer, assisted dying had a prime minister personally sympathetic to reform. His experience as director of public prosecutions had placed him at the centre of difficult decisions about whether those who accompanied relatives abroad to die should face prosecution.
New prime minister Andy Burnham brings a different perspective. Although he hasn’t rejected assisted dying in principle, his emphasis has been on improving social care and end-of-life provision.
This matters because a central objection to assisted dying is that autonomy may be compromised when good alternatives are unavailable. If a dying person cannot reliably obtain high-quality palliative care, or fears becoming a burden because adequate social care is unavailable, can a request for an assisted death always represent a genuinely free choice?
That concern may help explain the loss of parliamentary momentum. Some Labour MPs may have been influenced by the prime minister’s assertion that we need improvements to ensure that England and Wales have the health and care infrastructure necessary to introduce assisted dying safely.
The problem of the missing detail
One of the shortfalls of the Leadbeater approach was the unanswered question of operationality and the impact on existing services and healthcare professionals.
Questions about where assisted dying would take place, who would provide it, how professionals would participate and how the service would interact with the NHS and existing end-of-life care are not peripheral matters. They go to the heart of whether legislation can work safely in practice.
Yet significant elements of implementation were to be determined through delegated powers after Parliament had approved the legislation.
For critics, that asked MPs to take too much on trust. Whatever one’s position on assisted dying itself, some may argue that Parliament should have designed the architecture of such a profoundly new healthcare service before, rather than after, deciding whether to create it.
This should be a lesson for any future bill – legislation establishing assisted dying needs to answer operational questions so that people understand where the service will fit into existing provision to ensure that Parliament is making a fully informed choice.
Another Commons bill in the immediate future would face an obvious political obstacle. With a prime minister placing palliative provision and social care at the centre of his domestic agenda, supporters of assisted dying may struggle to rebuild a parliamentary majority unless they can demonstrate that concerns about palliative and end-of-life care have been addressed.
That could take years.
Social care is an especially difficult problem. Governments have spent decades trying to reconcile rising demand, workforce pressures, local-authority finances and the question of how care should ultimately be funded. Palliative care may present a more tractable challenge, but achieving consistently good provision across England and Wales would still require sustained investment and reform.
And then there’s the House of Lords.
The Leadbeater Bill’s experience there left considerable frustration among its supporters. After passing the Commons, it encountered hundreds of amendments in the Lords and ultimately ran out of parliamentary time when Parliament was prorogued in April.
That episode generated a constitutional argument alongside the ethical one: what should happen when an unelected chamber prevents a bill already approved by elected MPs from reaching a final decision?
Assisted dying supporters in the Lords may therefore be tempted to begin again. But unless the underlying objections to the legislation have changed, another Lords bill could encounter many of the same difficulties.
It is nevertheless important not to mistake this defeat for a return to the political landscape of the past.
In September 2015, Rob Marris MP’s Assisted Dying (No 2) Bill was defeated at second reading by 330 votes to 118. Ten years later, the Leadbeater Bill secured a Commons majority at third reading in June last year.
Support for reform has clearly grown, but not yet into a parliamentary coalition durable enough to carry assisted dying into law.
The lesson from Jersey
For campaigners looking for a route forward, Jersey offers a useful example. Rather than treating assisted dying principally as a parliamentary contest, the island followed an extended process of public engagement, consultation and detailed consideration of how a service would work in practice.
Its Assisted Dying Law was approved by the States Assembly in February 2026 and received Royal Assent in July. The service is expected to begin in September 2027, allowing eligible terminally ill adults with decision-making capacity and a voluntary, settled and informed wish to die to seek an assisted death.
There are important differences between Jersey’s model and the proposals debated at Westminster. But its significance lies as much in the process as in the legislation itself. Public opinion was considered alongside ethical and clinical concerns, while the practical arrangements for delivering assisted dying received detailed scrutiny before the law was finalised.
Jersey therefore provides a model worth watching. It demonstrates an alternative way of approaching an issue that combines medicine, ethics, law and deeply held personal values: establish what the public thinks; subject the proposals to sustained ethical and professional scrutiny; determine how the service will operate; and consider end-of-life care alongside assisted dying rather than treating the two as competing policy questions.
The lesson from Jersey may be that assisted dying and good end-of-life care should not be treated as competing priorities. A future Parliament may be more receptive to reform if it can be confident that assisted dying represents a genuine choice, rather than an alternative to inadequate care.
For supporters of reform, the immediate priority may therefore be to improve palliative and end-of-life care, learn from Jersey’s experience and develop the detailed clinical and regulatory framework for any future legislation.
The Leadbeater Bill has been defeated, but the shift in parliamentary opinion since 2015 suggests that the debate is far from over.
