🇬🇧 Where are the citizens in the UK's debate on assisted dying?

MPs will vote this Friday, but we argue that there is a better way with citizen deliberation

Today we have another long read for you. This one is by our British colleagues, COO Lucy Reid and International Advisory Council Member Hugh Pope, who reflect on the UK’s upcoming vote on assisted dying.

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The UK faces a major decision this week. Parliament votes on Friday 29 November on whether to move forward with legislation that would allow terminally-ill adults to ask for their lives to end. Scotland already has legislation in progress, so the bill relates to England and Wales only.

MPs will be free to choose which way to vote, which makes the proceeding more authentic than simply following a party line. The reason that parliament is even discussing the matter this week is a pure stroke of luck, since Kim Leadbeater MP came top in the annual lottery of individual private members bills to be discussed, and she chose this topic. Having come first in the draw, Leadbeater was approached by a wide range of groups and journalists keen to have their cause selected - from puppy-smuggling, to online safety, and pavement parking.

She chose assisted dying because of the rare opportunity to debate something of national significance, where polling indicated that the public not only wanted to see a change in the law, but also wanted the debate on assisted dying to happen.

Four recent public opinion polls indeed show about two thirds of the UK population is in favour of permitting assisted dying/assisted suicide. You can hear more on Leadbeater’s thinking on a recent episode of The Rest is Politics - Leading.

But even within parliament there are concerns that the fact that this bill comes from an individual MP, not the government. A similar bill in 2015 failed to pass by 330 votes to 118.

Despite the fact that MPs are undoubtedly taking the bill very seriously - with talks and presentations being held by ‘both sides’ on evidence from other contexts and on the views of the British public in the run up to the session, and some MPs holding round tables in their constituencies, the chamber has only five hours to debate the issue on Friday. According to BBC Political Editor, Chris Mason, over 100 MPs have indicated they would like to speak - amounting to three minutes each.

We at DemocracyNext have no position on assisted dying. Yet we do have a strong position on how our communities and countries can deliberate on such matters.

Complex, polarising, moral issues like assisted dying are exactly suited to being assessed by randomly selected citizens’ assemblies, where deliberation - not debate - is at the very heart of why assemblies work. If the UK government and parliament once again cannot work out what to do in a reasonable time, they should mandate a national citizens’ assembly to find out what the British public really is ready and willing to do.

One reason for our conviction that a citizens’ assembly would work best came from being invited to observe France’s recent Citizens’ Convention on the End of Life. Here 185 citizens were randomly selected from all over the country. They were well-briefed by more than 60 experts over nine weekends from December 2022 to April 2023, they deliberated with excellent facilitators, and they found 92% consensus on 67 proposals.

What was remarkable about the exercise was not just the clarity and comprehensiveness of the policy proposals – and President Emmanuel Macron's willingness to embrace them – but the credibility and legitimacy of the process. A striking 184 of the 185 citizens stayed for the whole nine weeks. Almost all signed off on a balanced, 170-page report that recommended that the government lift the country's ban on assisted dying, alongside steps to improve palliative care.

“In this Assembly, everybody was listened to. When you read the report, there is a large part of the work that is about palliative care. It's because of this that those of us who were against some of the measures voted in favour overall, because we felt that we were really listened to."

- Assembly Member, French Convention citoyenne sur la fin de vie

Another example of how the citizens’ assembly model can help comes from within the UK. The English Channel island of Jersey, a self-governing British territory, decided in May 2024 to start drafting legislation permitting assisted dying in the case of terminal illness. It did this as a result of the recommendations of its own 23-person citizens’ jury.

In England itself, a similar citizens’ jury was privately organised by the Nuffield Council on Bioethics on the topic in April-June 2024. Here, 20 of the 28 members able to attend the final session agreed – 16 of them strongly – that the law should change to permit assisted dying. They had met for seven sessions and were briefed by nearly 30 experts, advocates, and people with lived experience of all sides of the issue. At the end of their deliberations, the Jury produced a statement, saying:

“Over the last ten weeks we have worked together on the basis of respect and kindness. We have shared our values, ideas, ideologies that people as individuals have, and we have heard everyone’s thoughts and opinions. Merging those together to come to a conclusion has been very special. We have not always agreed on the way forward, but we do all strongly agree on the need to have an open conversation across society about assisted dying in the context of a wider discussion about the end of life, helping to remove fear around death.” 

Criticisms of the concept of citizens’ assemblies in the UK media and by one MP, Jack Rankin, seem unfair. Rankin says they have no legitimacy because the organisers come from civil society; in fact, the state administrations of France and Jersey mandated their assemblies.

Rankin also charged that citizens are “nudged” in one direction or another by organisers manipulating evidence and experts. We witnessed quite the opposite in Paris. In the UK, there was no sign of bias.

The Nuffield Council on Bioethics citizens’ jury in action in 2024.

Indeed, UK jury member Daniel – one of the minority of eight who voted against allowing assisted dying – told the Nuffield blog that after being presented with the evidence, he felt that “one of the most significant outcomes for me has been confronting the possibility that assisted dying can be a far cry from the often-idealised portrayal.” Jury member Kait told a video interviewer she felt no pressure from organisers: “At no point [did we feel] we were pushed in any certain direction. It was: "Here's this information. How can we support you?””

It is still early days for citizens’ assemblies. The first modern version was held 20 years ago, and most of the 1,000 or so convened since then have been held in the most recent several years. When well organised, they have created a new consensus on fraught policy issues: triggering breakthrough legislation on same-sex marriage and abortion in Ireland, finding compromises on nuclear power station construction in the Netherlands or becoming a leading forum for many countries to debate action on climate change.

Citizens’ assemblies have another advantage. As people, elected MPs are usually not a representative cross-section of society. In the UK parliament, only one third are women, the average age is 50 and 29% went to private fee-paying schools, compared to 6% in the population at large. A typical randomly selected citizens’ assembly, even the smaller group of citizens chosen for the Nuffield Council-organised jury, is drawn from all social groups, geographic locations, and age groups.

Furthermore, few MPs are likely to have spent the 24 hours over eight weeks that the Nuffield-organised citizens spent learning, thinking and deliberating on the facts at hand – let alone the 27 days devoted to assisted dying by the citizens’ assembly in France.

If the Nuffield Council-organised jury perhaps seems too small or lacking in an official mandate, then parliament could instead decide to convene a larger, well-publicised, government-backed citizens’ assembly. The prime minister could give his word that their recommendations would be implemented, or if not, the country would be given detailed explanations as to why not. Such an idea has already been mooted in UK media, indicating how much readier public opinion is for a thorough new approach to an issue that could affect any of nearly 600,000 people who die in the UK each year.

“This process has definitely shifted something. I’ve never been consulted on something that mattered before. I think there’s a lot of hopelessness among people my age and younger, so … they’ve lost a lot of faith,” said Helen, another member of the Nuffield Council citizens’ jury. “But maybe processes like this, a citizens’ jury, would give people hope.”