British lawmakers must decide on Friday whether to support assisted dying in an emotional vote which has split parliament and the country.

Lawmakers will debate proposals to allow mentally competent, terminally ill adults in England and Wales, with six months or less left to live, the right to choose to end their lives with medical help.

The first attempt to change the law in a decade has caused a national debate in Britain, with former prime ministers, faith leaders, medics, judges and ministers in Prime Minister Keir Starmer’s government weighing in on the subject.

Were parliament to back the bill, and see it through the full legislative process, Britain would follow other countries such as Australia, Canada and some U.S. states in launching what would be one of its biggest social reforms in a generation.

Polls show that a majority of Britons back assisted dying and interviews on the streets in London this week showed that many people want those in the last months of their lives to have a greater sense of control.

The legal status of assisted dying in different countries

SWITZERLAND

Switzerland legalised assisted dying in 1942 on the condition the motive is not selfish, making it the first country in the world to permit the practice. Doctors can prescribe drugs and administer them or had them over for self-administration. A number of Swiss organisations such as Dignitas offer their services to foreign nationals.

UNITED STATES

Medical aid in dying, also known as physician assisted dying, is legal in 10 states: California, Colorado, Hawaii, Montana, Maine, New Jersey, New Mexico, Oregon, Vermont and Washington, plus the District of Columbia. Oregon was the first state to legalise it under a law which came into effect in 1997. It allows mentally competent patients who are terminally ill and with less than six months to live to ask for life-ending medication. People from outside Oregon may travel to the state to take advantage of the law.

NETHERLANDS

The “Termination of Life on Request and Assisted Suicide (Review Procedures) Act” came into effect in 2002. A doctor is immune from punishment for euthanasia and assisted suicide where patients are experiencing “unbearable suffering with no prospect of improvement”. Minors can request euthanasia from the age of 12 but require parental permission before the age of 16.

BELGIUM

Belgium legalised medically assisted dying in 2002 for the terminally ill and for people experiencing unbearable suffering, which includes patients with psychiatric conditions. Since 2014, those under the age of 18 who are terminally ill are covered by the law as long as they have parental permission.

CANADA

Canada introduced “Medical Assistance in Dying” in 2016 for those whose death was deemed to be “reasonably foreseeable”. Five years later, the law was extended to permit people with a “grievous and irremediable” medical condition to request assisted dying. The country has delayed until 2027 a plan to extend medical assistance in dying to include those with a mental illness.

AUSTRALIA

Voluntary assisted dying for the terminally ill or those with a condition that is causing intolerable suffering is legal in most Australian states, after being introduced first in Victoria in 2019. Doctors can prescribe medication for self-administration or administer them where required.

SPAIN

Spain approved a law in 2021 which allows euthanasia and medically assisted suicide for people with incurable or debilitating diseases who want to end their life.

GERMANY

Assisted dying had been legal in Germany until 2015 when the country outlawed its provision on an organised or commercial basis, effectively banning it in many cases. Five years later the country’s top court ruled in favour of groups providing terminally ill adults with assisted suicide services, but lawmakers are yet to finalise new rules.

FRANCE

Doctors in France have since 2016 been allowed to put a person who is close to death and in great pain into deep sedation, but not to administer life-ending medication.

President Emmanuel Macron earlier this year backed new legislation which would allow assisted dying for those with incurable conditions and a bill was introduced in April, but elections in June and July interrupted the proposed law’s progress.

IRELAND

A cross-party Irish parliamentary committee recommended this year that the government should legalise assisted dying in certain restricted circumstances.

A majority of lawmakers in October voted in favour of “noting” the committee’s findings. With a national election due on Nov. 29, it will be up to the next government to decide whether to consider proposing a new law.

BRITAIN

A bill to allow terminally ill adults with six months or less left to live the right to end their lives was introduced to parliament earlier in October and will be debated on Nov. 29.

“I am in favour of assisted dying as long as the backup is there to make sure that it is that person’s wish, no coercion at all,” said retired secretary Anne Ransome, 71.

But support in parliament appears less secure, with some lawmakers wanting more detail and others more time to examine the legal and financial implications. Many of those opposed to the bill are concerned that people could be coerced into ending their lives.

TWO DOCTORS AND A JUDGE

Under the proposals, two doctors and a High Court judge would need to verify that the person had made the decision voluntarily. Pressuring or coercing someone into ending their life would be punishable by up to 14 years in prison.

Lawmakers will be permitted to vote with their consciences instead of along party lines, a move which has opened up splits in the governing Labour Party, with the health and justice ministers opposed to the bill and others in support.

Starmer has supported assisted dying in the past. He will vote on Friday but has not said how.

Labour lawmaker Kim Leadbeater proposed the law, saying legislation needed to catch up with public opinion.

“Dying people are having horrible deaths, and we have got a responsibility and a duty to give them the choice,” she told BBC Radio.

If lawmakers vote in favour of the bill, it will proceed to the next stage of the parliamentary process, and face further votes in 2025. But the outcome is unpredictable. Opponents could attempt to “talk out” the bill so the debate ends without a vote.

Opponents believe the process has been rushed, and some in the judiciary and health service have questioned how the process would work, including how judges would communicate with the person wishing to die.

For others, improving palliative care should be key.

“This is all very rushed,” Gordon Macdonald, CEO of campaign group Care Not Killing, said. “There’s been lots of assurances about safeguards … But in every jurisdiction in the world where it’s happened, the safeguards have been removed or eroded over time.”

Were the bill to pass it would follow in a long tradition of social reforms emerging from what are known as private members’ bills, including abolition of the death penalty, abortion legalisation and the decriminalisation of homosexuality in the 1960s.

Scotland is considering a separate change to its law which could allow assisted dying.