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Members of ParliamentMPMPMPMPYour browser does not support the element. in Britain usually have a party line to toe. But occasionally, on matters of conscience, they are given a “free vote” and the chance to exercise their judgment independently. On November 29th s must make up their minds on one of the most consequential issues of all: whether people in England and Wales have the right to an assisted death. That is the date of the second reading of a private member’s bill put forward by Kim Leadbeater, a Labour backbencher, which would legalise for terminally ill adults.The public debate draws heavily on the experience of other countries, some of which passed assisted-dying laws decades ago. Yet comparisons can mislead as well as inform. Opponents of assisted dying frequently point to Canada to warn of the risk of a “slippery slope”: the scope of the law there has widened over time and the number of people choosing to end their lives in this way has risen sharply. But Canada’s law has been shaped by successive court cases, and had relatively expansive eligibility criteria from the outset.When legislatures are in charge of the process and define eligibility narrowly, as is the case with the proposed bill in Britain, the picture is very different. Both the domestic courts in Britain and the European Court of Human Rights have indicated that assisted dying is a matter for a parliament or state to legislate, notes Stevie Martin of the University of Cambridge. Nineteen Anglophone jurisdictions have passed assisted-dying laws restricted to the terminally ill. None of these has broadened. As s weigh up their votes, a much more instructive comparison than Canada lies in Australia, and in one state in particular: Victoria. Its assisted-dying law was the first passed Down Under, in 2017, and is almost a mirror image of Ms Leadbeater’s.A terminally ill person there can be prescribed a lethal drug only after making multiple requests; if they have less than six months to live and are of sound mind; and if two independent doctors agree, pending approval by a senior civil servant. Mental illness cannot be grounds to apply. All these measures feature in Ms Leadbeater’s bill (though the approver in England and Wales would be a High Court judge).Victoria’s experience offers s in Westminster three lessons in particular. The first concerns how Britain should have approached such contentious legislation. First, a parliamentary inquiry into end-of-life care built consensus for a change. Next the state government convened an advisory panel that consulted hundreds of experts and the public to work out the details. The resulting private member’s bill, introduced by the health minister, finally passed after over 100 hours of debate.Contrast that meticulous, government-backed approach with the process in Westminster. Ms Leadbeater had not thought much about the issue until she topped a private members’ ballot in September. She has had to rely on the unpaid help of a former parliamentary drafter to write the bill. Although Sir Keir Starmer, the prime minister, supports the principle of assisted dying, his government is neutral (and the health secretary, Wes Streeting, is active in his opposition). The debate next week will last only five hours.“The 29th of November is the start of the parliamentary process,” says Ms Leadbeater. The government has pledged to allow proper time for scrutiny if the bill passes its second reading. But Rachel Maskell, a Labour and opponent of assisted dying, is right to argue that the process feels “rushed”.The second takeaway from Victoria’s regime, after five-and-a-half years in operation, is that a law that looks an awful lot like Ms Leadbeater’s bill . The number of cases each year is rising but small: 0.84% of all deaths in Victoria in 2023-24 were assisted. Three-quarters of assisted deaths are cancer-related; the median patient age is 73.The explicit coercion some fear seems not to have occurred. Dr Anna Negus, a doctor in Western Australia, has assisted around 80 deaths there; she has never seen a hint of coercion. “To the contrary,” she says: “Families often try to talk their loved ones out of it.” It is reasonable to worry that some people might choose an assisted death because they fear being a burden. But some seem to find reassurance in having the option: a fifth of those who are given the medication in Victoria never take it.Victoria collects feedback from families after a death. With over 500 responses, it is the largest survey of its kind in the world. “The most common word in the narratives is ‘peaceful’,” says Professor Michael Dooley, who heads the statewide pharmacy service for assisted dying.There is no evidence that uptake is higher in areas where access to palliative care is patchier (see next story). Four-fifths of those who take advantage of the law are receiving palliative care, funding for which has increased every year, notes Euan Wallace, the most senior civil servant in Victoria’s health department and the official who approves the requests.One thing is especially striking: how uncontroversial the law now is. When the law first passed, “I had clinicians pushing a finger in my chest telling me I’m a monster”, says David Speakman, who was then chief medical officer of Peter MacCallum Cancer Centre. “That’s no longer the case.”Not everyone is reconciled to the law. Robert Clark, a former lawmaker who opposed the assisted-dying bill, remains convinced that the safeguards are a “charade”. For him, a civil-servant review amounts to little more than a “tick-box exercise”. But Professor Wallace, the civil servant in question, rejects this characterisation of his role. He reads three to four applications a day, and requests more information if he is unsure whether they are compliant. He was initially uneasy about the law but changed his mind when he saw its impact on patients and their families. “It is a deep privilege to be involved,” he says. “It’s an amazing piece of human kindness.”Indeed, the third lesson from Victoria is that Ms Leadbeater’s bill risks being not too lax, but too restrictive. It is telling that other Australian jurisdictions, all of which have since followed Victoria’s lead, have included fewer safeguards, not more. In June, for example, the Australian Capital Territory passed a law for those with a terminal prognosis without specifying a time-frame for how long they had left to live.There is little prospect that Victoria’s law will liberalise soon, some small tweaks aside. A five-year review, which is also built into Ms Leadbeater’s bill, can consider only its operation and not the legislation itself. “Sometimes I wish it hadn’t passed,” admits Jane Morris, who runs Dying With Dignity Victoria, a pro-assisted dying lobby group.Yet the proposed regime in England and Wales would be even stricter than Victoria’s. As part of the approvals process, doctors could be forced to appear in court. In contrast to Victoria, where a pharmacist leaves medication with the patient under lock and key, they would have to be present for the death. Under Ms Leadbeater’s bill, to ensure that the wish to die is settled, patients must usually reflect on their decision for 21 days; the cooling-off period in Victoria is nine days. Far from being a slippery slope, the biggest risk with Ms Leadbeater’s bill is that it is a straitjacket.
