MPs Vote on Assisted Dying for the Terminally Ill

The form has a box on it. Somewhere in a hospice today, while MPs debate a few miles away, a doctor is filling in that box, and the box says: prognosis, less than six months. It is a small box. It has to hold a great deal.

That box is the actual subject of today’s vote, though nobody phrased it that way on the floor of the Commons. The bill under discussion would let terminally ill adults in England and Wales - not Scotland, not Northern Ireland, a detail worth sitting with, because it means a patient in Cardiff has a legal option that a patient in Edinburgh does not, and geography has once again been promoted to a moral category - seek assisted dying if a doctor certifies they have fewer than six months left. Everyone arguing about this bill today is arguing, at bottom, about that number, because the number is doing something rather clever: it is pretending to be a fact when it is actually a decision wearing a fact’s coat.

Ask any oncologist, off the record, how reliable a six-month prognosis is, and you will get a small, uncomfortable laugh. Medicine can tell you a great deal. It struggles to tell you a date. The royal colleges have said as much for years - prognosis beyond a few weeks is informed estimation, not measurement, and everyone with a stethoscope knows a patient who was given six months and got three years, and one who was given a year and got six weeks. This is not a criticism of doctors. It is a description of dying, which declines to keep a diary.

So here is the mechanism worth noticing, the one the straight debate keeps stepping around: Parliament, today, is not settling the ethical question. It is relocating it. A vote in Westminster feels like a resolution - hands raised, tally taken, history noted - but what the six-month clause actually does is take an argument that MPs found excruciatingly difficult to have in the chamber and hand it to a hospice consultant in an office with bad lighting, who now has to decide, alone, whether this particular patient’s particular decline fits inside a box that medicine itself says is more prayer than prediction. The vote gives Parliament the appearance of drawing a hard line. The hard line is then drawn, in practice, by clinicians and tribunals working case by case, patient by patient, with no vote, no debate, and considerably less institutional cover than the people who wrote the clause enjoyed.

The strongest defence of the six-month rule is that it is at least testable - better than the looser “unbearable suffering” standard used in some other jurisdictions, which invites its own argument about who gets to judge another person’s pain. That is a fair point, and it deserves an honest answer rather than a dismissal: the rule is testable in the sense that a number is always testable, but the test does not measure what it claims to. It measures confidence, not time. A confident doctor writes six months. A cautious one writes “uncertain, likely limited,” and that patient may find the door to the whole process simply does not open, not because their suffering was less, but because their doctor was more careful with language. The safeguard, in other words, does not sort the terminally ill from the merely ill. It sorts the certain from the honest.

None of this is an argument against the bill, or for it - that fight belongs to people with more skin in it than a satirist. It is an observation about what legislatures do when faced with an ethical question too large to hold comfortably: they carve off a piece small enough to vote on, call it a safeguard, and leave the actual weight sitting on the desk of whoever has to fill in the box next. The six months is not a medical fact. It is a comfort blanket, and comfort blankets, as anyone who has ever taken one away from a child knows, are for the person doing the leaving quite as much as for everyone left holding the form.