The furor over a landmark bill legalizing assisted suicide in the United Kingdom is growing more acute day by day. Originally scheduled to proceed to a near-final vote in the House of Commons on April 25, resistance to the measure continues to build so that final passage now seems far from assured. Meanwhile, news stories about assisted suicide in Canada and the United States show that Britain is not the only locus of historic debates over the future of a practice that confronts a foundational principle of Hippocratic medicine — “First, Do No Harm.”

The U.K. bill, which passed its first vote last November, is now in the Parliamentary stage called Third Reading, having completed what is known in Britain as the committee stage, where a smaller group of members of Parliament (MPs) gathered to hear testimony and considered amendments to the bill, called the “Terminally Ill Adults (End of Life) Bill.” Fourteen of the 23 members of Parliament who participated in the committee stage were supportive of the bill in November but perhaps dozens of the original votes for the bill, which passed the full Commons 330-275, were cast with the expressed intention to move the legislation along to the next stage of the process and not to provide final endorsement.

As it turned out, the committee stage elucidated continuing criticisms of what is also known as the Leadbeater bill, for its prime sponsor, MP Kim Leadbeater, a Labour Party member from Spen Valley, who is a younger member of Parliament with a history in physical health as a personal trainer. The committee stage ended on March 25 with the adoption and rejection of various amendments that did not, overall, resolve questions about the impact of the legislation.

The vast majority of the amendments, and the bulk of continuing concern, can be traced to the bill’s lack of safeguards for the most vulnerable people under its jurisdiction. The lack of specific protection for the mentally ill, the financially stressed, people who fear becoming a burden on society or their family, people with physical anomalies that are difficult but not a harbinger of death in the near term — all of these, not slippery slope arguments so much as recognition of the self-sacrificing character that might persuade someone to end their life via assisted suicide, were debated in the committee stage without positive resolution. One proposed amendment would have ensured that applicants could not seek assisted suicide “because of an impairment of judgment arising from a mental disorder.” It was voted down, 12-9. Another amendment ensuring that applicants must be told the side effects of lethal drugs was rejected, 13-9.

Last week, the bill moved again before the full House of Commons in what is termed the Report Stage. As in the United States, a measure fraught with medical judgments about not only the capacity of individuals to choose assisted suicide but the adequacy of physicians and other providers to evaluate patients and assess palliative care and other options has continued to spur professional medical opposition. The Royal College of Psychiatrists (RCP), in advance of the debate on May 16, issued a statement reaffirming its inability to support the Leadbeater bill. Among the statement’s concerns is the lack of “a requirement for holistic assessment of unmet needs” that might lead a vulnerable person to request assisted suicide. “Treatable needs,” the RCP said, “such as intolerable pain, financial hardship and inadequate care or housing can make a person want to die. Yet the Bill makes no provision to assess unmet needs at any stage, nor consult others involved in the person’s care or life.”

The RCP statement raises practical concerns as well about the lack of a sufficient number of psychiatrists able to participate in the review panels envisioned under the bill. In the committee stage, Leadbeater advocates replaced the guarantee of individual judicial review of requests for suicide with the panel approach, and each panel would be required to have a psychiatrist among its members. The RCP argues that this is unworkable. Moreover, it raises the concern that while the bill now allows physicians, including psychiatrists, to refuse to participate in assisted suicide decisions and refer patients to another doctor instead, psychiatrists “are still required to signpost patients to information on AD/AS. For some psychiatrists who wish to conscientiously object, this would constitute being involved in the AD/AS process.”

On May 9, another RCP, the Royal College of Physicians, while still officially neutral on the legalization of assisted suicide, issued a formal statement powerfully objecting to the adequacy of the safeguards in the Leadbeater bill. It endorsed the concerns of RCPsychiatrists that another longstanding U.K. law, the Mental Capacity Act, is inadequate to the task of properly assessing the validity of a patient decision to elect suicide, compromising doctors’ ability to participate in these judgments. “We are concerned,” the RCPhysicians declared, “that patients would not have equitable choice of services because of the inequity of availability, and under-provision of end of life care and palliative care in England and Wales. These inequities of care are particularly present for more disadvantaged populations. There are widespread shortages in health and social care staff who provide these services, alongside increasing demand and very wide variation of where, when and how the services are delivered or available.”

The medical professionals’ judgments are matched by those of a wide variety of social service agencies in the nation, some of whom have taken to labeling the proposal a “state suicide service.” Groups described by one media outlet as “including Christians and other religious groups, humanists, medics and disability groups” rallied outside Parliament last Friday in opposition to the bill, which they say will have a devastating impact in an environment where health and social services are inadequate and will drive many patients to select death due to a perception of no better alternatives.

The U.K. might be the current leader in this debate over the future of a Culture of Death, but it is not the only place where this controversy is roiling the public mind. The Leadbeater bill would cover England and Wales. Meanwhile, the Scottish Parliament on May 14 voted 70 to 56 to approve separate legislation to legalize assisted suicide in that nation. The bill, backed by member of the Scottish Parliament (MSP) Liam McArthur, titled the Assisted Dying for Terminally Ill Adults (Scotland) bill, is described as “extreme” by right to life advocates. Unlike the British bill, which requires a judgment that an applicant for suicide have only six months to live, no time limit is specified — only that the person have an “advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death.” Opponents contend this definition is so vague that it could reach people whose death is decades in the future, including “conditions such as anorexia, Down’s syndrome, and people with disabilities.”

Recent media reports from Canada describe how some physicians there are promptly suggesting assisted suicide to patients with less than terminal conditions or who have been denied medical care they seek under the nation’s unitary health care system. The situation has become so stark that in mid-April even the United Nations Committee on the Rights of Persons with Disabilities (UNCRPD) slammed the underlying Medical Assistance in Dying (MAID) law as promotion of “negative, ableist perceptions” of disabled people. As in the U.K., where social service availability is under question and budgets are strained, the impulse to advance death-dealing initiatives to reduce costs is an underplayed aspect of the debate.

In the United States, news is more mixed. A proposal for assisted suicide failed in Nevada, a relatively liberal state not known for its taste in sound social policy. A bill, which has received favorable votes in the legislature, failed when Republican Governor Joe Lombardo issued a strong veto threat against it: “Expansions in palliative care services and continued improvements in advanced pain management make the end-of-life-provisions in AB346 unnecessary, and I would encourage the 2025 Legislature to disregard AB346 because I will not sign it.”

Meanwhile, in New York, where assisted suicide would potentially affect a large swath of people, the state legislature greeted the month of May by passing the Medical Aid in Dying Act (A136/S138). U.S. Congresswoman Elise Stefanik (R-N.Y.) promptly scorned its passage as “putting the elderly, disabled, and terminally ill at risk of coercion and despair.” While the bill passed the State Assembly by a margin of 81-67, advocates for the disabled and their allies hope that the opposition of 20 Assembly Democrats on final passage and the need for New York Senate approval may upend the bill before it reaches Democratic Governor Kathy Hochul, who has not expressed her intentions should it reach her desk.

If approved in New York, assisted suicide would be the law in 11 states and the District of Columbia. Budgetary woes in the United States alongside erosion of respect for human life are a potentially potent combination in the debate over New York’s and similar laws. As in the U.K., disability groups remain strong opponents of these statutes. They have played a major role in the U.K. in holding up passage of the Leadbeater bill, which may yet fail of final adoption and which has consumed far more time and debate than its original sponsors hoped for. An organization in the U.K. called Our Duty of Care frames the debate well. It opposes assisted suicide because “Vulnerable people must be protected from pressure to take their own lives. The lives of disabled & dying people have value and worth. Trust in the clinician-patient relationship must be preserved. It’s the only way to prevent future extension to children, people with non-terminal illness and those who are tired of life.”

We will soon know if the heroic campaign by churches, disability campaigners, members of Parliament, media voices, right to life groups, and medical leaders in the U.K. will be enough to block a law its sponsors thought would sail through to Royal Assent. In many ways, this may be the most important bill considered by any democratic body in a generation. In any event, the narrow margins at work here are a strong reminder why every vote counts.