Next Friday, Members of Parliament will vote on Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill, which would legalise assisted dying for adults in England and Wales who are terminally ill and expected to die within six months. Naturally, the Bill has attracted a great deal of controversy and criticism, and is opposed by a wide range of parliamentarians across party divides.

The progress of Ms Leadbeater’s Bill is of great importance to us in Scotland, too. We currently have Liam McArthur MSP’s Assisted Dying for Terminally Ill Adults (Scotland) Bill in its initial committee stage at Holyrood, debating the same issues. However the Scottish Parliament chooses to vote on Mr McArthur’s Bill, if Ms Leadbeater’s Bill does not pass into law the implementation of Mr McArthur’s would become significantly more difficult.

As the Scottish Government has pointed out, the powers that would provide for an “approved substance” to be used to carry out assisted dying in Scotland are reserved to Westminster, and that substance’s use would need to be allowed by the UK Government. The two bills, from a Scottish point of view, are intertwined at this point.

Read more by Mark McGeoghegan

Objections to both have ranged from the principled to the pragmatic. On the strongest, principled end, many parliamentarians of faith oppose the bill on the grounds of religious prohibitions against the taking of life, including one’s own, but many parliamentarians who do not hold religious beliefs are equally opposed to assisted dying. On the other end, plenty of parliamentarians who, in principle, believe that assisted dying should be legalised have serious concerns about safeguards and the practicalities of doing so.

Personally, I believe that assisted dying should be legal. For terminally ill patients facing imminent death, the ability to choose the timing and manner of their death is a profound expression of personal liberty. It allows individuals to die with dignity, on their own terms, and to avoid unnecessary suffering. For me, the principle of personal autonomy sits at the heart of the assisted dying debate, and our default position ought to be to respect that personal autonomy. The question we ought to ask is when do we have a right, as a society, to restrict that autonomy in the name of a broader, societal good?

However, I have significant concerns that have been echoed by opponents of both Bills. The prospect of patients or the elderly being pressured - or feeling pressured, even if no pressure is being applied - to end their lives is unconscionable. That prospect is intensified by the reality that palliative care in the UK is in an atrocious state, and it is perfectly foreseeable that terminally ill patients without the means to access private palliative care would choose to end their lives prematurely. And there is the additional concern about the capacity of the NHS, north or south of the Border, to administer assisted dying without adversely impacting existing services.

I put substantially less stock in slippery slope arguments. If we accept and put into law the principle that we have a legal right to assisted death under a strictly defined set of circumstances, those circumstances cannot be widened without us subsequently deciding, through legislation, to do so, having had that further public debate. And while there are parliamentarians who would want to extend those circumstances, they are in a small minority.

This position is broadly in line with majority public opinion. According to Opinium polling, 78% of the Scottish public support legalising assisted dying, and research conducted by King’s College London’s Complex Life and Death Decisions Group found that 63% of the public in England and Wales want assisted dying to be legalised in this Parliament.

The King’s College research found that even supporters of legalising assisted dying had concerns about safeguarding. Sixty-one per cent said they were concerned about people being pressured to end their lives prematurely if the law were changed, including 53% of those who support legalising assisted dying. Fifty-five per cent of supporters said they would change their mind if it transpired that someone had been pressured into ending their life under the policy, and 48% would change their mind if it emerged that lack of access to other care was driving such decisions.

That data doesn’t exist for Scotland, but I would be surprised if public opinion here varied significantly from public opinion on the risks of legalising assisted dying in England and Wales. The public supports legalising assisted dying, but only if these risks can be thoroughly addressed.

Both bills seek to provide a legal framework within which the choice to have an assisted death can be made safely and ethically, with appropriate safeguards to protect vulnerable individuals. They both require multiple assessments by independent medical professionals, a mandatory waiting period, and legal oversight to ensure that the decision is voluntary and informed. Moreover, countries where assisted dying is legal, such as the Netherlands and Belgium, have demonstrated that with proper regulation, the risks of abuse are minimal.

Kim Leadbeater (centre) with Dignity in Dying campaignersKim Leadbeater (centre) with Dignity in Dying campaigners (Image: PA)

Opponents of these bills argue that the safeguards aren’t strong enough; so amend the Bills to strengthen them. Risks around lack of access to palliative care are harder to address. But unlike opponents of the bills who have called for greater investment in palliative care instead of legalising assisted dying, I do not see the two as opposites. We have the opportunity to engage in a broader conversation about end-of-life care and to invest in provision in which palliative care is complemented by assisted dying as a choice for those for whom palliative measures are insufficient.

MPs should vote in line with their conscience next Friday, and those who oppose assisted dying in principle should vote against Ms Leadbeater’s Bill progressing to be considered in committee. But those who support assisted dying in principle, but have practical concerns, should vote in favour of it. Doing so will keep the public and parliamentary debate alive, would recognise the will of the public that assisted dying be legalised in this Parliament, and allow for pragmatic concerns about safeguarding to be thoroughly debated and the bill amended to strengthen those safeguards if necessary.

And if, at the end of that process, those concerns have not been assuaged then those MPs should vote against passing the bill into law, in line with both their conscience and the public’s will.

Mark McGeoghegan is a Glasgow University researcher of nationalism and contentious politics and an Associate Member of the Centre on Constitutional Change. He can be found on BlueSky @markmcgeoghegan.bsky.social