Keir Starmer’s new commitment to holding a vote on assisted dying should be welcomed. It is now undeniable that this controversial and profound issue – at the intersection of ethics, medicine and law – must be properly grappled with by Parliament. Putting collective heads in the sand is simply not sustainable.

Around 200 million adults around the world are able to access medical assistance to die. For example, Esther Rantzen, whose recent campaign has brought the issues back into the spotlight, has joined Dignitas in Switzerland.

Like some other affluent people suffering with terminal disease here in the UK, Ms Rantzen will take advantage of foreign jurisdictions to ensure their agony is not prolonged. Less fortunate people, who may have the very same desire, remain unable to do so legally at home.

‘The law around assisted dying is a mess’

In the UK, the law is a mess. Whilst assisting a loved one’s death is illegal in England and Wales, with theoretical stern criminal sanction, the law and guidance to enforcing authorities is confused.

For example, assisting with a person’s death carries a punishment of up to 14 years imprisonment pursuant to the Suicide Act 1961, Crown Prosecutors are advised not to pursue such a charge where the ‘victim had reached a voluntary, clear, settled and informed decision to commit suicide’ and any person assisting was ‘wholly motivated by compassion’. The Scotland Parliament is likely to reform their laws, meaning that we will have an unaligned union on the issue, causing further injustices.

This ridiculous legal environment has been caused by Parliament’s inability to gasp the nettle. There have been hundreds of lengthy investigations by the police, which very rarely lead to criminal charges and only goes to extend the agony for families, who are uncertain and isolated in tortuous circumstances.

The Supreme Court has repeatedly urged Parliament to look once more at this issue, as the courts are put in increasingly difficult positions with an archaic law disconnected from the reality. Now is the time to deliver that certainty.

‘No easy answers’

But there is always a reason why Parliament has passed the buck. Assisted dying is fiendishly difficult to navigate. There are understandable and profound moral objections to any liberalising reform. On the other side, there are the stories of loved ones dying in anguish, desperate to end the agony.

There are no easy answers. Even those advocating change accept safeguards would need to be implemented and rigorously enforced to avoid abuse. There is a challenge to ensure the law avoids situation whereby people feel pressured to take such action because they deem themselves a nuisance to families and those that are caring for them.

There is also the risk, articulated by former Prime Minister Gordon Brown, that any reform would deplete the urgency in terms of research in and development of palliative care. There are ‘slippery slope’ arguments about the rights of disabled people.

These are all legitimate and weighty concerns, but they are not, in my view, insurmountable for sensible and careful legislators. The House of Lords Bill published in 2021 is a sensible starting point, providing for a terminally ill person with mental capacity to request assistance to end their own life. They must be reasonably expected to die within six months, evidenced by separate medical practitioners, with independent witnesses and expert evidence as to capacity. A ‘cooling-off’ period was also provided for, before the decision was to be made by a High Court Judge.

Therefore, that there is a need for the issue to be reconsidered by Parliament is undeniable and there is at least the building blocks of legislative change to scrutinise.

‘Normal consultation processes do not meet the challenge posed’

Perhaps the more important question is how Parliament should grapple with this issue. A free-vote is clearly right for such a moral question, but the normal consultation processes for legislation does not quite meet the challenge posed.

Indeed, whilst the cross-party Health and Social Care Select Committee published a report recently, it failed to fully appreciate the wholly inadequate status quo. The report, whilst useful, merely offered a summary of different views and experiences abroad, and explicitly states that the ‘report is not intended to provide a resolution to the debate, but act as a useful resource for future debates’. It was, with respect, a classic piece of parliamentary posturing without dealing with the fundamental issue in hand.

To deal with the fundamentals, there is an opportunity and imperative to involve the public. Citizens’ assemblies have been mooted and MPs voting on the issue should be supported in involving their constituents in the debate with public meetings. Parliament should provide for longer sessions, in both chambers, but also for relevant committees.

The well-cited example from Ireland and a citizens’ assembly helping to unpick the political lock on the issue of abortion is a useful model here. However, I would like to see any use of deliberative democracy have parliamentarians and Parliament at its heart, as part of, or alongside assemblies. Ultimately, these issues must be determined by MPs, acting as representatives but not delegates.

It is time, finally to confront this issue. That does not mean rushing to a conclusion, but implementing a rigorous and careful process, which ensures that any final vote is determinative and provides much-needed clarity.