A report on assisted dying, produced by a ‘commission’ formed by think tank Demos, makes big headlines today. The commission, whose year of hearings and evidence gathering was chaired by former Lord Chancellor Lord Falconer, has no official status. But, by its composition, the commission has done its best to acquire moral, professional and political weight.

Witness the line up of its members - including a former Metropolitan Police commissioner, ex-chairs of health and social care regulators, an academic with a specialism in disability and equality issues, prominent medical professionals and a member of the clergy. (Though the latter, Reverend Canon Dr James Woodward, dissents from some of the findings.)

Certainly the ‘buy-in’ from the bodies and individuals who are both pro- and anti-reform of the law on assisted dying was every bit as good as a government-appointed commission could have expected. The director of public prosecutions (DPP), disability charities, the former president of the General Medical Council, Sir Graeme Catto (though not the BMA), and lawyers and individuals involved in the cases that focused attention on the issue of assisted dying all took part. And while not all will like the ‘findings’, the views of all are well represented - this was a commission that wanted to show how it got to those findings, and takes 400-plus pages to show it.

Briefly, the findings, as noted in the Gazette’s news coverage today, were that there is a ‘strong case’ for providing the choice of assisted dying for terminally ill people. Necessary safeguards include the requirement that a patient must take ‘the final action that will end their own life’. The person must have a ‘settled intention to die’. And a death certificate must record it as an assisted death, allowing a monitoring body to review cases to check they had complied with the law.

Although the commission notes that it is not its role ‘to promote a change in the law’, its findings on what could be done will tend to please those who support changes to make assisted dying easier. The findings won’t satisfy all reformers, but more of that below.

Divisions in public and professional opinion are sharp on assisted dying, and I’m not trying to find for one lobby or the other here. But I did want to draw attention to the way some issues played out around human rights, disability, and the role of the DPP. There are also some difficult issues around access to end-of-life care, mental capacity, and care for people with serious long-term health needs.

Keir Starmer QC, the current DPP, in addition to giving evidence, found himself ‘claimed’ by both those who were pro-, and anti-, reform.

After interim guidance issued in September 2009, Starmer published a Crown Prosecution Service ‘policy’ on prosecutions and assisted dying. The CPS had, in recent years, found no ‘public interest’ in bringing a prosecution against family or friends who assisted the end of a terminally ill person who had expressed a settled intention. The possibility that any assisted death could result in a prosecution, reform campaigners argued, caused unnecessary stress to all involved. The policy offered some clarity.

So Starmer’s policy was held up by opponents of reform as evidence that the current approach worked. Those campaigning for reform noted that, as prosecutions clearly were not in the public interest, one might as well remove all doubt with a change in the law.

Even more interesting, I think, were the arguments to be had around human rights and disability. For human rights principles were also claimed by both sides in this debate. Disability charities, including Scope, Leonard Cheshire Disability and MenCap are opposed to a change in the law. Their representatives argued that disabled patients rights around end of life decisions too often were not sought or respected. A change in the law would therefore leave them more ‘vulnerable’.

Having listened to some disabled campaigners who oppose reform in the past, I sense these charities also have a wider point to make here. That is this - that, with care, support and accommodation for disability falling short of need in our society, they are wary of allowing any change that seems to downgrade the argument that, with decent support, anyone with a disability can lead a full and worthwhile life. This is very much the ‘social model’ of disability, and for many types of disability the model includes some powerful arguments.

But powerful testimony also came from representatives of those who believe they have been discriminated against in their right to die. Bindmans partner Saimo Chahal, noted her client Tony Nicklinson’s argument: ‘The current law disproportionately affects his right to personal autonomy as somebody who is too physically disabled to end his own life.’ Nicklinson was paralysed from the neck down following a stroke, but his condition is not terminal. In a July 2010 statement, he said: ‘I am fed up with my life and don't want to spend the next 20 years or so like this.’

Those who support Nicklinson’s right to die, then, will be disappointed in the commission’s conclusion that in any ‘safe’ change to the law, reform would cover terminal conditions only. From the perspective of people like Nicklinson, their rights could be ‘sacrificed’ to bolster broader arguments for the ‘social model’ of disability.

None of these arguments is for the faint-hearted.

So where does the commission’s report leave the debate over assisted dying?

High profile deaths at Switzerland’s Dignitas clinic of eloquent, terminally ill people who knew their own mind, and the campaigns of Debbie Purdy and others, had already started to shift public opinion on assisted dying. (Opponents to reform sense that, and have accused the BBC and others of ‘bias’ in their coverage of the issue.)

Two things in particular have, to date, held reform of the law back here. One was the political establishment, which prefers to avoid the issue. The other was the sense that sufficient safeguards could not be put in place to protect the ‘vulnerable’ from being pressurised in to seeking an assisted death, when what they needed most was better support.

The commission’s claim that it has found safe ways to change the law therefore takes the debate a step closer to reform, as does the inclusion in the commission of establishment luminaries who are cross-party and cross-profession.

And for those opposed to reform, what obstacles remain? Well here’s one. The commission also calls for ‘better access to, and more uniform availability of, end of life care across the country’. The NHS, however, is moving into an era where uniformity of health commissioning and provision will become more, not less, varied. Social care, in many places, is in an unresolved state of crisis.

‘Uniform availability’ of care is not a total pre-requisite for a change in the law on assisted dying - but critics of a change in the law will object that without sufficient care and support, no one can be certain that an individual patient has not decided to end their life through a ‘settled intention’ based on their prognosis, rather than through fear of the poor care they will receive.

My suspicion is that while ‘uniform availability’ is an important and valid notion, it was included to reassure and maintain consensus among the broad church represented by commission members. But for those hoping to see reform, it is also one of the arguments most likely to delay or prevent a change in the law.

Eduardo Reyes is Gazette features editor