I’m an expert in medical ethics – to me, assisted dying is the right idea at the wrong time

What does it mean to you to die a “good” death? Is there a right answer?

Not really. I would get a hundred different answers if I asked the question to a hundred different people. Dying is more common than almost any other function we carry out. We all die. But how we want to die is also deeply personal and individual. I’ll wager a funeral flower arrangement that your idea of a good death is not the same as mine.

The question of what constitutes a good death is at the heart of the assisted dying bill being voted on in the Commons on Friday, but for me, focusing on assisted dying misses the point. People do not die good deaths in Britain today, and it has nothing to do with the lack of access to assisted dying.

I’ll come right out and say that I support the concept of an assisted death. As a medical ethicist who has built a career arguing for the peoples’ right to make decisions about their own health and bodies, assisted dying is the moral and logical conclusion to supporting and upholding patient autonomy.

It provides dignity and prevents suffering. But, as anyone who knows me won’t be surprised to hear, medical ethics theory rarely plays out as expected in practice.

People don’t make decisions according to ethical theory. Doctors do not always have a patient’s best interests at heart. Not all options are available to everyone. People are messy, they live messy lives, they make messy decisions, the social world they live in is not only messy, but largely outside of their control too.

Let me explain: people in Britain struggle to access the healthcare they need every day. Austerity has caused the degradation of the services we need to offer truly holistic and supportive palliative care. Those most in need of support often lack it the most. In fact, just a few years ago, Hospice UK found that about a quarter of all Britons cannot access the palliative care they require.

That means 25 per cent of our population is likely not dying “good” deaths. Like every other aspect of health, dying is unequal. Who you are, where you live, your age, ethnicity, gender, how able-bodied you are – all of it impacts how good your death is in this country.

Health inequalities are just the tip of the iceberg when it comes to dying. In Britain, we are getting how we support and fund death wrong as well. How? Well, the majority of hospice care in the UK is delivered by charities, with the NHS funding a mere 30 per cent in England. Palliative care is often a cobbled-together group delivering services – with who is delivering it and what exactly is on offer tantamount to a postcode lottery relying on charity and volunteers. It is unstable and unsustainable. The palliative and end-of-life sector itself recognises that it does not have the capacity to provide the care needed.

Some 73 per cent of providers feel there is not sufficient capacity to provide palliative care in homes or care homes, and 52 per cent said this is also true for the hospital and hospice sector. We are not able, in 2024, to support a good death – far from it. We are getting ahead of ourselves with this bill, because we haven’t even got the basics right.

Disturbingly, speaking to the BBC two days before the vote, Leadbeater seemed to be suggesting that our lack of capacity in the sector was a reason to vote the bill in. That it would avoid future traumatic deaths because right now, as she put it “you have people taking hours to die, days to die, traumatising loved ones”. This suggests that for her, assisted dying could save our broken palliative care system.

It won’t because it’s not supposed to. Assisted dying is a form of palliative care, not an alternative.

Assisted dying is not the answer to a crumbling palliative, community and social care service. It will not free up capacity. It will not provide support where it is lacking. It will not support those at the end of their lives to die in peace in their homes. It will not hold the hands of the dying.

On Friday, MPs are voting blind, because there is so much to fix in the health and social care system before we have a clear view of how something like assisted dying would work.

Given how broken our care systems are, it would make sense to start with fixing them so that we can be sure we have a rock-solid system that supports normal dying. That way we can see what is actually possible before getting ahead of ourselves. For now, assisted dying is the right idea, but at the wrong time for Britain.

Dr Alexis Paton is a lecturer in social epidemiology and the sociology of health and co-director of the Centre for Health and Society at Aston University. Dr Paton is also chair of the Committee on Ethical Issues in Medicine at the Royal College of Physicians and a trustee of the Institute of Medical Ethics