Top Cabinet minister suggests Brits may have to pay for assisted dying like in Switzerland amid fears new law will heap pressure on broken NHS - as MPs warn they could yet pull their backing for Bill

A senior Cabinet minister today suggested Britons might have to pay for assisted dying in England and Wales following MPs historic vote in favour of new laws.

The House of Commons on Friday approved the second reading of the Terminally Ill Adults (End of Life) Bill by 330 votes to 275, majority 55.

If it completes its passage into law, the Bill will allow terminally ill adults with less than six months to live to seek an assisted death with the approval of two doctors and a judge.

But it is unclear whether assisted dying will be fully publicly funded - and there are fears it will heap pressure on Britains already-struggling NHS and courts system.

Some MPs who backed the Bill hinted they could yet change their minds as the legislation passes through Parliament, amid concerns over palliative care provision and safeguarding.

Those opposed to the Bill also said the legislation could be voted down at a later stage if MPs are not satisfied with changes, with one saying: Theres a very strong sense that its not over.

Pat McFadden, the Chancellor of the Duchy of Lancaster, did not rule out Britons having to pay for assisted dying as he pointed to the example of Switzerland, where nearly 350 have ended their lives at the Dignitas facility.

Pat McFadden did not rule out Britons having to pay for assisted dying as he pointed to the example of Switzerland, where nearly 350 have ended their lives at the Dignitas facility

The House of Commons on Friday approved the second reading of the Terminally Ill Adults (End of Life) Bill by 330 votes to 275, majority 55

Campaigners gathered outside Houses of Parliament on Friday to demonstrate their opposition to assisted dying

Asked whether assisted dying would be publicly-funded in England and Wales, if MPs pass the legislation, Mr McFadden told Times Radio: Look, I think all that still has to be considered.

As you know, people currently have to pay for this themselves if they go to Switzerland.

So all those questions of costs, safeguards, all the issues that have been raised have to be considered during the committee stage, the clause by clause examination of the Bill.

And thats the right way to do it because its a huge change. And you could see that on the faces of the MPs who are voting for it or against it on Friday.

Liberal Democrat MP Layla Moran told the BBC yesterday that while she voted for the Bill, concerns surrounding existing palliative care provision in the UK remained.

I think all of us want this to be a good Bill, she said. I would hope that colleagues across the House, especially those who voted for it, reserve the right to vote no at further stages.

Senior Tory MP Sir David Davis – another backer of the Bill – used his House of Commons speech to ask ministers for more time to scrutinise it, to give us the time to get this right.

He told the Commons: Im going to vote for it today, but I want the Government to help me be able to vote for a good Bill at the end of this.

Labour MP Chris Webb suggested his position on the issue may change as the proposed legislation progresses through its parliamentary stages.

He said a statement he believes this Bill deserved to progress to the next stage for further robust scrutiny and debate and he will consider my position again in the ensuing stages.

Tory MP Danny Kruger, who led opposition to the Bill in the Commons on Friday, told The Sun there were a couple of dozen people who could switch their votes if they arent satisfied with the final shape of the Bill.

Theres a very strong sense that its not over - which is very encouraging, he added.

The Bill has been introduced by Labour backbencher Kim Leadbeater as a private members bill and the Government has taken a neutral stance on the proposed legislation.

A string of Cabinet ministers - including Health Secretary Wes Streeting and Justice Secretary Shabana Mahmood - voted against the Bill on Friday.

This has led to questions about how the Government might enact the legislation, if it is passed into law.

The Sunday Times reported that Cabinet ministers have privately warned legalising assisted dying will eclipse the Governments priorities and heap pressure on the NHS and justice system.

One cabinet minister told the newspaper: I really feel for Wes.

Irrespective of anyones personal views on this issue, there will be a huge pressure on him as this Bill progresses to establish both an assisted dying service, while reforming palliative care, which will … absorb a lot of time, energy and resources.

Another Government figure said: This will consume a lot of Government time and energy on top of the challenges we already face to bring down the NHS waiting lists and deal with the court backlog.

Now we are expected to add to that the creation of a new service, which will undoubtedly divert focus from the governments key priorities.

A Whitehall official said: It will create costs, obviously, and stretch a court system already at breaking point. There are only a finite number of judges.

Assisted dying Bill: What happens next?

– What happened on Friday?

The Terminally Ill Adults (End of Life) Bill cleared its first hurdle in Parliament.

The historic vote came nine years after MPs in the Commons voted against assisted dying in 2015.

MPs debated for four-and-a-half hours before voting on Labour MP Kim Leadbeater’s Bill.

They voted 330 to 275, majority 55, to approve it at second reading.

– So what now?

The Bill will now go to committee stage where MPs can table amendments.

Also on Friday, a motion was approved to allow the committee considering the Bill to have the power to send for people, papers and records as part of its sessions.

Amid concern from some about the Bill being rushed through or not receiving enough scrutiny, Ms Leadbeater has said it could face another six months of parliamentary scrutiny, insisting: “There is plenty of time to get this right.”

The Bill will face further scrutiny and votes in both the House of Commons and the House of Lords, meaning any change in the law would not be agreed until 2025 at the earliest.

– Will it definitely become law?

Only if both the House of Commons and House of Lords agree on the final wording of the Bill.

Some MPs have indicated that their continued support at a further vote is contingent on being assured of appropriate safeguards in the Bill.

Among them was Conservative grandee Sir David Davis, who told the Commons he would only support it at its later stages if it was given more time.

– How soon could an assisted dying service be running?

Ms Leadbeater has suggested an assisted dying service would not be up and running for around another two years from the point the law was passed, with “even more consultation to make sure we get it right” at that stage.

– Who would be eligible?

Only terminally ill adults who are expected to die within six months and who have been resident in England and Wales and registered with a GP for at least 12 months.

They must have the mental capacity to make a choice about the end of their life and be deemed to have expressed a clear, settled and informed wish – free from coercion or pressure – to end their life.

– How would the process work?

The terminally ill person must make two separate declarations, witnessed and signed, about their wish to die.

The process must involve two independent doctors being satisfied the person is eligible and the medics can consult a specialist in the person’s condition and get an assessment from an expert in mental capacity if deemed necessary.

A High Court judge must hear from at least one of the doctors regarding the application and can also question the dying person as well as anyone else they consider appropriate.

– How long would it take?

There must be at least seven days between the two doctors making their assessments and a further 14 days after the judge has made a ruling, for the person to have a period of reflection on their decision.

For someone whose death is expected imminently, the 14-day period could be reduced to 48 hours.

– What safeguards are there?

It would be illegal for someone to pressure, coerce or use dishonesty to get someone to make a declaration that they wish to end their life or to induce someone to self-administer an approved substance.

If someone is found guilty of either of these actions, they could face a jail sentence of up to 14 years.

– Would doctors have to take part?

No. Doctors would not be under any obligation to take part.

Doctors who do would have to be satisfied the person making their declaration to die has made it voluntarily and not been coerced or pressured by anyone else.

They would also be required to ensure the person is making an informed choice, including being made aware of their other treatment options such as palliative and hospice care.

Doctors would not be under a duty to raise the option of assisted dying with a patient.

The Bill states that there is nothing to stop them “exercising their professional judgment to decide if, and when, it is appropriate to discuss the matter with a person”.

– What about judges?

It is not thought judges would have the same right to decide whether or not to take part in the process.

Although the Equality and Human Rights Commission (EHRC) has suggested this might be something Parliament can consider.

Ms Leadbeater has said while it would be a new area of work for judges, they are “used to making these difficult and complex decisions and being part of this process”, citing current procedures around decisions on turning off life support machines for terminally ill people.

Former director of public prosecutions Sir Max Hill, who is supportive of the Bill, said High Court hearings to decide on applications could be held in public.

– Who would administer the medication?

The dying person must take the medication themselves.

No doctor or anyone else can give the medication to the terminally ill person.

It has been suggested it might be the case a terminally ill person might be able to take such medication by pushing a button.

– How many people are likely to use an assisted dying service?

Ms Leadbeater said evidence from elsewhere in the world where it is legal suggests assisted deaths account for between 0.5 and 3 per cent of deaths.

She said it is likely take-up would be in the hundreds, rather than thousands.

– Will there be any scrutiny of how a new law operates?

The chief medical officers in England and Wales and the health secretary would be required to monitor and report on the operation of the law.

The health secretary would also be required to report on the availability, quality and distribution of appropriate health services to people with palliative care needs, including pain and symptom management, psychological support for those people and their families, and information about palliative care and how to access it.