As a doctor who has spent years caring for people at their most vulnerable moments, I have watched the assisted dying debate unfold with growing concern. The wish to avoid unnecessary suffering is natural, and patients and families deserve kindness and respect at the end of life. But the question we should be asking is not simply whether assisted dying should be legal, but whether we have any business introducing it while the systems meant to care for dying people remain broken.
Andy Burnham, the prime minister, has said as much. Speaking at a care home recently, he argued that assisted dying should not be introduced while Britain’s palliative care and social care systems remain under such strain. He’s right. A choice between a death without adequate care and a death prematurely self-induced is not a real choice at all.
A promise of control that doesn’t hold up
Parliament is preparing for another vote on assisted dying in England and Wales on 11 September. But I fear the offering has been mis-sold to the public. Many people imagine a system where a person facing a terminal illness can choose the exact moment and manner of their death, free from distress. The legislation does not and cannot provide that certainty.
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A patient who self-administers medication to begin the dying process may still experience complications. The process may take time; it may require medical intervention. It may not happen where or when the person imagined. The promise of absolute control can become something different in practice: an appearance of choice that does not always deliver the agency people expect.
A state-controlled medicalised dying process is still a process, one where there remain risks of complication and suffering. The reality is more complex than the promise of a perfectly controlled death.
Medical bodies are raising the same concerns
I am far from the only medical professional worried about assisted dying being available on the NHS. The Royal College of Physicians, the Royal College of Psychiatrists, the Complex Life and Death Decisions group from King’s College London, the Royal College of Pathologists and the British Geriatrics Society have all raised concerns about the bill’s flaws. The concern that comes up again and again: is it really a free choice when palliative care and social support fall short?
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A person’s wish to die does not happen in isolation from their circumstances. It can be shaped by whether they feel supported, whether they fear becoming a burden, whether their family is coping and whether they have access to the care they need. That is why the state of our care systems cannot be treated as a separate issue from assisted dying.
The way care is delivered right now is uneven. Timely access to palliative and social care remains too often determined by where someone lives rather than what they need. Some families have excellent end-of-life support available. Others, particularly in rural areas and constituencies experiencing high inequality, face waiting, uncertainty and having to fight for services that should be guaranteed.
This is the crux of the matter. Introducing a legal pathway for assisted dying while a postcode lottery in care continues means asking vulnerable people to make a choice that isn’t really free. The option to die becomes the default when the option to live comfortably was never properly offered.
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Scotland’s vote and the road ahead
In Scotland, this concern was expressed clearly. In March, 85% of Labour MSPs voted against the legalisation of assisted dying in Holyrood. The bill introduced in Westminster by Kim Leadbeater, the Labour MP for Spen Valley, in October 2024 did not fare much better. Too many concerns about patient welfare meant the House of Lords would not rubber-stamp the flawed text.
And yet, on 11 September, MPs will be faced with yet another vote on assisted dying before the care systems are improved to a level which even makes that debate appropriate. A Labour government founded the NHS on a principle that remains as important today as it was at its creation: that healthcare should be there when people need it most, regardless of their circumstances.
Burnham has his priorities right. This is the wrong debate at the wrong time. That is why I, and many others, will be voting against this bill, in pursuit of comfort, dignity and appropriate care for people who are vulnerable and dying.
