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Time is running out to right the wrongs of England and Wales’s assisted dying legislation. The House of Lords is holding committee sittings, which involve line-by-line examinations of the bill, on 5 and 12 December. Meanwhile, the second stage of the Scottish assisted dying for terminally ill adults bill has recently been completed. In many ways, the Scottish legislation is even more troubling.
The issue with the private member’s bill on assisted dying has always been a question of priorities. The shocking revelations from the National Audit Office and Hospice UK in October about the worsening financial crisis faced by end-of-life care are a sharp reminder of what needs to be changed if we are to be fair to dying people.
No one can doubt the sympathy that the bill’s supporters feel for the plight of those struggling with pain and fear at the end of their lives. But the starting point should not be a hastily implemented law to allow doctors to administer death – it should instead be improved end-of-life care.
The report revealed that financial shortfalls faced by hospices are growing by the year. Out of 2,000 beds in England, 380 are now out of use, removing thousands of days and nights of care every year. Staff at Hospice UK are aware of at least 20 hospices that have recently announced cuts, one of them being Derbyshire’s Ashgate Hospice, which can now only afford to staff six out of its 15 inpatient beds. The result is that the number of patients cared for by hospices in the UK – 310,000 last year – has plateaued for the first time, and many hospices are now running waiting lists.
According to the Commission on Palliative and End-of-Life Care, between 450,000 and 540,000 of the 600,000 people who die each year in the UK would have benefited from but didn’t receive palliative care, either in a hospice or through hospice care in the community. Although 56% of those with a preference say they would choose to die at home, 43% of deaths take place in hospitals.
With its proposed overhaul of the palliative care system, the government has, to its credit, promised better access to care at home and fewer trips to A&E. But there is a long way to go when, as of today, just half (51%) of those who need it have had specialist palliative care at some point during their final days. And while ministers have recently given £100m towards adult hospices and £80m for children’s care, Hospice UK says this has been wiped out by rising staffing costs and by local health authority decisions. Not having proper contracts for the services they provide and with no agreed costs for commissioning palliative care, hospices report having to fall back on the funding they receive from their charity shops. Nearly 60% of hospices ended their last financial year in deficit, and this year the sector is issuing warnings over longer-term funding.
It is the poorest communities that lose most from the patchwork of end-of-life care. More than one in four people who die between the ages of 20 and 65 are in poverty. Yet evidence from St Christopher’s hospice in south London found poorer communities are less likely to have a hospice service than wealthier ones. As Dr Jamilla Hussain, a palliative care consultant in Bradford, has also shown, ethnic minority communities are less likely to access end-of-life care services.
If the House of Lords has a purpose that is easily understood by the public, it is bringing expertise, experience and wisdom to a debate that requires sensitivity. For the problem it has to confront is that the most consequential parliamentary bill of our generation – a law that will determine the rights to live and the rights to die – privileges the legal right to assisted dying without guaranteeing anything approaching an equivalent right to quality palliative care for those close to death. The Lords could suggest that the assisted dying law should not be implemented until we have delivered on the excellent recommendations of an end-of-life care report recently submitted to the government. And this is the position I would propose be taken by elected MPs, who should make the final decision when, as is inevitable, the amended bill is sent back to them.
We are also facing the possibility of a two-tier system in Britain. The Westminster bill includes a six months or less life expectancy timeframe as part of the eligibility criteria. The Scottish bill currently does not. The Scottish bill is now much thinner in terms of steps in the process. Whereas the Westminster bill has a multidisciplinary panel (senior lawyer, psychiatrist and social worker), which must issue a certificate of eligibility before assistance is provided, the Scottish bill is entirely doctor-led with no external input. So there is a sharp divide between what Scotland proposes – to allow assisted dying when a condition is reasonably expected to cause premature death, with decisions left to doctors – and what the English bill requires. Because this could lead to people moving between the two territories, there is a case for intensive consultations between the two parliaments.
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In a June 2025 poll by the campaign group Care Not Killing, 65% agreed that the government should prioritise sorting out palliative, social and end-of-life care before considering whether to introduce assisted dying. Given the damning evidence of underfunding in end-of-life care, the message that the members of both parliaments should now take on board is that assisted living matters too.
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Gordon Brown was UK prime minister from 2007 to 2010
