LONDON — It took months of careful convincing, tugging at heartstrings and countering deeply held concerns — but Britain’s House of Commons has passed legislation to legalize assisted dying. After a highly charged and at-times toxic debate, MPs on Friday voted by 314 to 291 votes to back giving terminally ill adults in England and Wales with less than six months left to live a route to medically ending their lives. Further legislative skirmishes in the House of Lords are due before it becomes law. But if the does leap those final hurdles (and the expectation is that it will) it won’t be because of the government. This potentially seismic change to the nation’s social fabric was concocted and carried through by a backbench Labour MP. POLITICO has spoken to dozens of legislators and campaigners on both sides of the debate to tell the in-depth story of how the Commons decided to overturn the status quo. ‘MY PHONE STARTS GOING MAD’ Kim Leadbeater was more surprised than anyone when she came top of a private members’ bill ballot last year, giving her a once-in-a-lifetime opportunity to shepherd through a new law. It was in a wood-paneled committee room in the recesses of Britain’s Parliament that a white-gloved hand plucked ball number 238 out from a glass jar on the morning of September 5. The MP overseeing those formalities announced with all the pizazz of a seaside bingo caller that it was Leadbeater who had topped the ballot. “Well done to Kim, you are number one, and you will be — gosh — very busy indeed,” they said. At that moment Leadbeater was getting changed in one of the estate’s bathrooms, having returned to Westminster after playing tennis against political rivals. “I took all my clothes off,” the Labour MP said with a laugh in an interview with POLITICO earlier this month, “and my phone starts going mad. I thought, oh my god, it’s a Thursday morning, what the heck is happening here?” Such were the extremely low chances of being picked at all, Leadbeater hadn’t realised it was the draw that day. But she was immediately inundated with queries about what issue she would take on. “I’ve got no idea what you’re talking about,” she told those at the end of her phone. “So I put some clothes on and made my way back to the office and went ‘what just happened?’” It was, as Leadbeater described it in the interview from her office overlooking London’s River Thames, “the day my life changed forever … again.” ‘WE’RE HERE TO CHANGE THE LAW’ Leadbeater’s journey to being elected as MP for Batley and Spen (now renamed Spen Valley) is uniquely tragic.  Her sister, Jo Cox, represented the community until a week before the Brexit referendum in 2016 when she was shot and stabbed by a far-right extremist — murdered as she went to meet voters at a routine surgery in her Yorkshire constituency. Leadbeater would go on to run a charity in her sister’s name, but when the seat again became vacant in 2021, she was put forward for the acrimonious by-election to follow. She won by just 323 votes, in a time when Labour was at a low ebb in the national polls. In the proceeding years, through Labour’s stint in the depths of oppositions then its first months in government, Leadbeater’s identity, as she puts it, was “very much around being Jo’s sister.” So she bided her time as the phones rang across her offices in Westminster and back in her constituency — with various lobbying groups trying to attach themselves to her golden ticket from the private member’s ballot. Leadbeater insists that No.10 Downing Street never got in touch to ask her to take up the issue, but neither did they need to. The prime minister’s long-held support for reform would be crucial in the government not crushing the bill. It was 2015 and the last time the Commons considered changing the law on assisted dying was when Starmer, the fledgling MP for Holborn and St Pancras, made his first big intervention in the political arena.  Just months into the job, Starmer, the former chief prosecutor for England and Wales-turned-MP, advocated — in detail — why the nation needed to break from the status quo in which people who help someone end their life could be jailed for up to 14 years. In a speech described politely as “lawyerly,” he set out how he changed legal guidance to make it less likely that people motivated by compassion would face prosecution if they helped dying relatives end their lives abroad, a not uncommon act for those who have sufficient resources.  That day MPs threw the legislation out comprehensively, with the pro-change camp losing by 212 votes. But it stuck Starmer’s staunch support on record — and as he came closer to seizing high office for the Labour Party it ensured he was repeatedly asked about it. It was after a conversation with Esther Rantzen, the veteran U.K. broadcaster who has terminal cancer and has passionately advocated for assisted dying, that Starmer in March last year promised to give MPs a free vote on a change in the law if he won power.  It didn’t end up in his manifesto but upon taking office he made clear he would allow sufficient parliamentary time to be devoted to a backbencher who proposed changing the law. Leadbeater didn’t have the personal connection to assisted dying that many advocates would later spill out in powerful testimony. But she recalled a conversation with a constituent with Huntington’s disease in the lead up to 2024’s general election. “We’re here to change the law,” she thought. “We’ve got a responsibility. If we look at a situation which is wrong, we’ve got a responsibility to do something about that.” As her colleagues lobbied her to take on the issue, Leadbeater consulted with her parents. “Obviously their primary concern for me is my happiness, but also my safety,” she told POLITICO. “And on a controversial issue like this, that is something you’ve got to consider.” Kit Malthouse, a senior Conservative MP who is a long advocate of assisted dying, described Leadbeater winning the ballot as a moment “the planets aligned.” Not only was Leadbeater popular, she had spent her time so far in the Commons fostering cross-party alliances. “It was the right dynamic in Parliament. The right person came first in the ballot,” Malthouse said. “The only issue was to get Kim to say yes. To her eternal credit she did.” PASSIONS RUN HIGH On October 3, Leadbeater announced it was assisted dying she’d go for. In the following weeks, she set out her proposals for the change in law for England and Wales, fit with a raft of safeguards. First among them was it would only apply to adults with a terminal diagnosis of less than six months to live. She pleaded for restraint and a calm debate on a subject that polling suggests has the support of public opinion. A convergence of proposed changes across Scotland and the crown dependencies of Jersey, Isle of Man and Guernsey suggested too that this could be the moment for reform in England and Wales too.  But within weeks the passions were running high. Political opponents were mounting fierce attacks — and even then head of the Church of England Justin Welby was calling it a “slippery slope” that would leave people feeling compelled to end their lives. Supportive MPs received a barrage of angry messages both on email and on social media, called murderers by the more extreme opponents of the change, which critics preferred to call “assisted suicide.” If the plan commanded broad support generally, the opposition in some quarters was particularly intense. It was particularly challenging to hear for an MP whose own sister had been murdered on the job. “On this issue, which means so much to so many people, she would have been the first one to say, just keep going,” Leadbeater said of Jo Cox. Starmer set aside typical collective responsibility for the Cabinet, which usually dictates that ministers take the same position on policy. They would be allowed to vote as they please, but were ordered to remain neutral on the passage of the bill and on the issue. In reality, they were anything but. Health Secretary Wes Streeting and Justice Secretary Shabana Mahmood were the two cabinet ministers whose briefs would most directly be impacted by the proposals — but they were also the two biggest opponents. Mahmood told the Times newspaper she would vote against it because of her “unshakeable belief in the sanctity and the value of human life” as a Muslim.  Streeting, who voted for a change in the law in 2015, also let it be known he would vote against the bill over concerns the state of palliative care in the U.K. means patients cannot make an informed choice. Then Streeting suggested the change could lead to cuts in other NHS services and ordered a formal review into the cost of the proposals. Leadbeater publicly said she was “disappointed” by Streeting’s intervention in particular, as privately those around her admitted it presented the moment of maximum jeopardy.  Others put it less discreetly. One prominent pro-assisted dying campaigner, who like other parliamentarians in this piece were granted anonymity to speak candidly, told POLITICO they were extremely “fucked off” with Streeting. Not only is he an influential figure in the Labour Party, he is the health secretary that would have to implement assisted dying. Campaign groups launched lobbying operations and high-profile supporters and critics were enlisted. Rantzen kept the pressure up, but disability rights activists, including the actor Liz Carr and paralympic wheelchair racing champion Tanni Grey-Thompson were prominent anti voices. Grey-Thompson, a member of the House of Lords, warned of a “seismic shift” in the way the health care system treats the most vulnerable people. The state of end-of-life care became one major point of contention, so too did the coercion of patients into ending their lives early. Every step of the way Leadbeater was there on the airwaves and current affairs programs to try and make the case and combat the concerns. “It has taken over her life,” one of her supporters said. But she was aided by a team of aides and MPs from across the political spectrum to push through the change, with senior figures in each party launching informal whipping operations to tally the supporters and help win over those weighing up how to act. ‘THE WORST OF PARLIAMENTS’ MPs got their first formal say on November 29, debating the principles of the legislation at what’s known as the bill’s second reading — and given a free vote on what was considered a matter of conscience. Those on both sides stood to tell harrowing personal stories as they made their cases. The debate was genuine and the grandstanding was minimal. A not-insignificant portion of MPs expressed their skepticism but said they’d vote in favor this time to allow the debate before giving their final verdict at third reading.  After MPs filed into the division lobbies in to register their votes late least year it became clear the supporters had won. 330 MPs, including Keir Starmer, voted for, 275 against — majority 55. The Commons was silent as the votes were read out. Leadbeater told POLITICO “it was a huge relief” but knew there was “still a huge amount of hard work ahead.”  The shenanigans to follow would only help sour the debate. “It went from the best of parliaments to the worst of parliaments,” one wavering MP acknowledged this week. A committee of MPs was compiled by Leadbeater to scrutinise the proposals line by line, coming up with key amendments to make it workable. It was finely balanced to be representative of the debate and reflect the political make-up of the house. But some opponents were still not happy, with one anti MP saying that Danny Kruger, a Conservative on the Christian right, was a “useful bogeyman.” The process saw a number of significant changes to the bill as neutral civil servants helped with honing of the legislation. Leadbeater had previously described the role of high court judges as being an important safeguard against coercion, but she scrapped this in the face of Ministry of Justice pressure over the extra strain cases would place on already stretched courts. Instead expert panels formed of a senior legal figure, a psychiatrist and a social worker, will scrutinise decisions.  A longer, four-year implementation period was introduced, health workers were given an opt-out of participation and they agreed that the Welsh parliament would get a say before its implementation there. Last year a symbolic vote in favor of assisted dying was lost, raising questions about whether Wales’ Senedd would back it in the future. MPs in the anti-camp had long been divided in their opposition. Objections came from disparate directions, including religious ones, fears about the provision of palliative care, and concerns that society’s most vulnerable may be coerced into dying. “We have a unity of purpose, it’s about choice. But the opponents are against it for various different reasons,” said Christine Jardine, a prominent Liberal Democrat supporter. But in the weeks leading up to the final vote, opponents did coalesce around a more unified cause. They rallied against the “chaotic” process of the private members’ bill and attacked what they saw as a distinct lack of scrutiny for such a big changed. They were in turn accused of adding to the chaos themselves, causing delays to subsequent votes by holding up the division lobbies. Malthouse, the pro-assisted dying senior Conservative MP, said of his opponents: “They clearly made a tactical decision after second reading. On the grounds of principle they had lost. All they had to go on then was process.” When the Commons came to vote on the amendments at report stage, the mood was fractious. Leadbeater got her new clauses banning advertising assisted dying and allowing doctors to opt-out — but an opponent’s amendment preventing doctors discussing the process with under-18s was passed too.  Interventions from medics including the Royal College of Psychiatrists raising concerns about the bill in its existing form were particularly potent. A trickle of MPs said publicly they were switching to support — but this was outweighed by those who announced they would vote against, including with interventions to POLITICO. After MPs stated their cases for and against in an impassioned chamber on Friday afternoon, the result was clear. Leadbeater’s legislation passed 314 to 291 votes — trimming the majority in favor down from 55 at second reading to just 23 this time around, in a reflection of the late-stage agonizing that had gone on among lawmakers over the bill. On the eve of the final debate, Leadbeater’s Labour colleague Vicky Foxcroft resigned as a government whip in protest at unrelated proposals to reduce the spiraling welfare bill by reducing the number of people in receipt of a disability payment. But Foxcroft stood up in the chamber Friday to say that although she backed assisted dying in 2015 her time as a shadow minister for disabled people had caused her to reconsider. “They want us as parliamentarians to assist them to live, not to die,” she said — passionately arguing she couldn’t back the legislation because the process hadn’t sufficiently listened to the voices of the vulnerable. WHAT’S NEXT? Some opponents believe it’s still possible the unelected House of Lords, where longtime supporter and former justice secretary Charlie Falconer is likely to pick up the baton, will try to vote it down. Leadbeater said: “I would be extremely upset if that were to happen, and I would be extremely disappointed and surprised, actually, if that were to happen.” The Lords have been supportive in the past and most just expect further honing of the bill. Tanni Grey-Thompson said “I’m not sure we can stop it” but “our role since I’ve been in the Lords has been more and more about fixing legislation.” Technical questions remain over whether there are sufficient Fridays within the current parliamentary term for the private member’s bill to be debated further if a back-and-forth with the Lords known as “ping pong” can be completed — though supporters expect the government won’t let it founder.  The 2029 “backstop” for actually implementing the change happens to coincide with the deadline to hold Britain’s next general election, but Leadbeater’s team believe there’s little chance ministers would want the issue hanging over the campaign. The legislation is now largely out of her hands. But it could be years before it actually allows the first person to medically end their suffering in their final days — and perhaps decades before assisted dying is accepted as normal in the U.K. Leadbeater will forever be associated with the monumental change and supporters will long celebrate her for it. But with that she can expect to be called upon to assuage the very real concerns that will persist. Esther Webber and Noah Keate contributed to this report.

The United Kingdom’s recent vote to move toward the legalization of assisted dying represented a historic moment for the country — but it also mirrors a wider trend in Europe. Countries are on a path to liberalize their laws to expand end-of-life options to include euthanasia and assisted suicide. To some experts, the latest position in the U.K. reflects what is a growing and inevitable trend among Western European countries. Various forms of assisted dying are already legal in Austria, Belgium, Luxembourg, the Netherlands, Spain and Switzerland. “It will not happen in all countries at once, but especially in Western Europe and Northern Europe, if there are no laws available yet, there will be an urge to have such laws,” said Martin Buijsen, professor of health law at the Erasmus University Rotterdam. “I think that’s inevitable.” But to others, there are concerns that existing laws are already being pushed beyond their intended purpose, and fears that this slow trudge toward assisted dying being the norm could lead to harm — especially to vulnerable people. In Switzerland, for example, the recent use of a suicide pod stirred controversy and led to several arrests, while in the Netherlands, young people with mental health conditions are also legally taking their own lives with help from the state. “I have seen no jurisdiction in which the practice has not expanded, not one single jurisdiction,” said Theo Boer, professor of health care ethics at Protestant Theological University. “By imposing really strict criteria we can slow down the expansion … but they will not prevent the expansion.” For the U.K. this was the country’s second attempt to pursue such a law. This time it heeded lessons from its first failed attempt (making the conditions more restrictive) — and perhaps from stories from across the Channel. LEARNING THE LESSONS Assisted dying can refer to both euthanasia and assisted suicide. In euthanasia, a physician or provider administers a patient a fatal drug to deliberately end their life; while for assisted suicide the patient is legally prescribed lethal drugs they must take themselves to end their own life. In several of the countries that have legalized assisted dying, the number of people using it to end their lives is increasing. In 2023, 9,068 people died from assisted dying in the Netherlands — 5.4 percent of deaths that year. This is up 4 percent compared with 2022 and up 87 percent from 2013. Similarly, in Belgium there were 3,423 cases of euthanasia in 2023, up 15 percent compared with the previous year and comprising 3.1 percent of total deaths in the country. The Netherlands and Belgium were the first European countries to legalize euthanasia in 2002. Some have raised the alarm at the increasing number of people choosing to end their lives, warning governments debating similar laws to be aware of this phenomenon. “What I saw was not only the increase in the numbers — which for me was a sign that it was no longer the last exception, the last resort — but it became more and more a default way to die,” said Boer. “In addition to the numbers, we saw an expansion of the pathologies underlying euthanasia requests.” Boer had initially supported the Dutch euthanasia law and was a member of the Dutch euthanasia review committee. But he has since become an outspoken critic of this law and has warned other governments debating similar bills of the possible “side effects.” The rising number of patients — especially young people — with mental health disorders dying by euthanasia has also spurred fierce debate in the Netherlands, Buijsen said. The number of euthanasias for patients with psychiatric disorders doubled over the last five years, from 68 to 138. Similar debates arise around cases of minors and patients with dementia, he said. But it’s not a one-size-fit-all. According to researchers at the University of Bologna, the proportion of euthanasia and assisted suicide on overall deaths “continues to vary widely” in countries where the practice has been legalized for years, “mainly due to the circumstances under which [they] were adopted into law and the different practices approved.” Switzerland, for example, is one of the most popular destinations for foreigners looking to access assisted dying, and has been offering legal assisted suicide since 1942. POLITICAL AND SOCIAL BARRIERS It has taken some countries several years to push their assisted dying laws over the finish line, amid opposition from conservative parties, religious institutions and highly emotive debates. The Portuguese parliament approved an euthanasia bill four times over three years, but conservative President Marcelo Rebelo de Sousa vetoed all drafts. Eventually, the parliament overturned his veto in 2023 and forced him to sign the bill. But even today, the legislation has not been published in the country’s official journal, meaning it’s not in effect. While in countries such as Italy and Ireland, the powerful presence of the Catholic Church has historically steered the conversation away from legalization for years. It’s only recently, however, that things are changing. In Italy, the country’s Constitutional Court ruled in 2019 that assisted suicide was permissible when patients are able to make decisions and are in overwhelming pain. This led to Italy’s first case of assisted suicide in 2022 — despite there being no law to allow it. While in Ireland, progress on the debate shows the Church’s influence on policy may be weakening. Irish MPs earlier this year endorsed a parliamentary report calling for assisted dying and presented a “Voluntary Assisted Dying Bill 2024” to the lower house in June. But Ireland is also among a group of countries impacted by political upheaval. The Irish bill lapsed with a snap election and the dissolution of the Dáil. Similarly, France was debating an assisted dying bill earlier this year, but the process was interrupted by the dissolution of the government and subsequent snap election. And in Iceland, MPs presented a bill on euthanasia in March 2024, but the government fell in October, leading to a parliamentary election in November. TIMING IS EVERYTHING Timing and a country’s political landscape play a crucial role in determining the success of such proposals. And while the issue does not fall neatly along party lines — some Labour MPs in the U.K. were very vocal in criticizing the change of law — a left-leaning government or parliament are much more likely to pass similar bills. At the same time, conservative figures such as Boris Johnson and Marine Le Pen have spoken against euthanasia. In Spain, far-right party Vox challenged the country’s euthanasia law in 2023, but failed. Spain passed its law to legalize assisted dying in 2021. “If the [U.K.] vote had been taken before general elections, the outcome might have been somewhat different,” said Buijsen. “You will need, in some way, a kind of a progressive majority in parliament in order to have these laws passed.” The requirements of accessing assisted dying also vary greatly. While some countries, like the British bill, require the patient to have a terminal illness, others such as Belgium and the Netherlands only require that the patient is experiencing constant and unbearable suffering with no cure or prospect of improvement, including psychological suffering. Other Western European countries to have approved assisted dying include Luxembourg in 2009 and Austria from 2022. Countries including Scotland, Jersey and the Isle of Man have started the debate and made attempts to introduce legislation in recent years. In Germany, assisted dying falls into a gray area. The practice is illegal but the Federal Constitutional Court decriminalized it in 2020. A GEOGRAPHICAL DIVIDE While Western European countries are increasingly entertaining the assisted dying debate, Eastern and Central Europe are moving at a much slower pace. No countries in Eastern Europe have legalized assisted dying or are currently entertaining legislative proposals. But that doesn’t mean the topic is not entering public discussions. Veljko M. Turanjanin, law professor at the University of Kragujevac, in Serbia, said the country has seen several discussions to legalize euthanasia, as the public opinion and many medical professionals seem to be in favor. But the strong influence of the Orthodox Church has slowed progress, he said. “I think in the state where the government and the Church are linked close, it will not be an easy task for the government to pass such kind of legislations,” Turanjanin said. But when countries in the region do eventually move toward legalization, surrounding countries are likely to follow suit, he said. “I think when [Serbia and Croatia] legalize euthanasia or assisted suicide, the other countries will do the same.”