The House of Commons was silent. The results of parliamentary votes are normally greeted by cheers or jeers, but Friday’s decision by British MPs to endorse assisted dying was a moment of gravity.
“I’m a bit overwhelmed,” admitted Kim Leadbeater, the Labour MP who had watched impassively as her bill to allow terminally ill people to legally end their own lives was backed by 330 to 275 votes.
This was politics at its most raw. After five hours of impassioned, emotional and harrowing debate, MPs approved one of the biggest social changes seen in England and Wales in a generation. There was no celebration.
The vote made a mockery of party lines. Sir Keir Starmer, Labour prime minister, and Rishi Sunak, his Conservative predecessor, backed the bill, which would give terminally ill adults the legal right to “request and be provided with assistance to end their own life”.
In the No division lobby Reform UK leader Nigel Farage rubbed shoulders with Labour leftwinger Diane Abbott; health secretary Wes Streeting voted alongside Tory leader Kemi Badenoch.
In a packed House of Commons, MPs publicly grappled with their consciences, some explaining how they had changed their minds over years, or even over the past few days.
Former Tory cabinet minister Andrew Mitchell said he had “completely changed my mind on this subject” since he first entered parliament 37 years ago.
“I have sat in my advice surgery with tears pouring down my face listening to constituents who have set out so clearly, speaking with such emotion, about how their mother, brother, father or child had died in great pain and great indignity,” he said.
“I want this choice for my constituents; I want it for those whom I love; and I want it, perhaps one day, for myself.”
Labour MP Marie Tidball, a disability rights campaigner, said she was planning to vote “in a way that I thought I never would: I will vote in favour”.
Describing her “difficult journey” arriving at that decision, she said she had reviewed evidence, reflected on her own experiences of being born with a congenital disability, and listened to constituents.
Tory MP Danny Kruger said he was “very disappointed” with the outcome, but said he hoped that colleagues might ultimately reject the measure if it was not significantly improved later in its parliamentary stages.
“There’s so much wrong with it,” he said. “All of the safeguards around coercion, around the definition of terminal illness, around capacity around the way the judges work, around the way doctors work.”
Leadbeater will now have to steer her bill through exhaustive scrutiny with no certainty it will eventually receive royal assent.
The bill will be studied line-by-line in its Commons committee stage, at which unusually, Leadbeater has announced, outside experts will be invited to give evidence. It will then face weeks of close interrogation and amendments in the House of Lords, before MPs have their final say.
Although it is a private member’s bill, on which the government is neutral, Friday’s vote leaves the prime minister facing the huge challenge of devising a workable plan for delivering assisted dying, with all the ramifications that has for the NHS and judiciary.
Starmer has already told his ministers to start engaging with the bill, with Leadbeater saying she hopes the first assisted deaths could take place in just two years.
“The government’s responsibility is to make sure any legislation which comes forward is workable,” said a Downing Street official. An official impact assessment will be carried out.
Starmer has also instructed that Leadbeater should get the necessary help in drafting any amendments to the bill, as ministers try to shape the final outcome.
How the new service will be implemented across England and Wales still poses substantial questions. Doctors unions are calling for assisted dying services to be organised and funded separately from normal NHS care.
Streeting has previously warned that any new assisted dying service could come at the expense of other competing pressures and priorities facing the NHS, which is grappling with long waiting lists and an ageing population.
Under the bill, NHS patients will be asked to make two separate declarations of their intent to die, and two independent doctors would have to agree that the person meets all of the necessary criteria, with seven days between each ruling.
The legislation stipulates that no doctor would be under any obligation to participate in the process, and that any lethal medication offered would be self-administered.
One section of the bill that will also be subject to careful scrutiny and potential amendment is the stipulation that a High Court judge must sign off a patient’s request for an assisted death.
Former senior judges have voiced their concerns that their involvement risks being a “rubber stamping” exercise and does not provide adequate safeguards. Some have said a judge should be able to talk to the person wishing to end their life.
Others have questioned how it would work in practice given the big backlog in the courts, and given the need for a person at the end of their life to have their case heard within a limited timeframe.
The government is also now likely to face calls to improve the standard of palliative care services in the NHS as any new law comes into force.
On Friday the scale of these challenges ahead seemed to weigh down on a silent House of Commons, until the Lancastrian Speaker Sir Lindsay Hoyle lifted the mood by moving on to the next business: “The bill on ferrets.”