The report on assisted dying, produced by a ‘commission’ formed by thinktank Demos, and part-funded by author and campaigner Terry Pratchett, made headlines last week for stating that there were practical ways that the existing law on suicide could be changed to allow the terminally ill to choose an assisted death in the UK.

There were few surprises in the responses from those who oppose change. Umbrella group Care Not Killing called the commission a ‘bent jury’, and said: ‘The current law exists to protect those who are sick, elderly, depressed or disabled from feeling obliged to end their lives.’ In media interviews last week disabled peer Baroness Campbell was eloquent in support of these points.

The law has had a central role in this debate to date, not because it is a useful guide to our ethical, emotional or intellectual approach to the issues, but because of the practical difficulties it seemed to throw up. If section 2 of the 1961 Suicide Act is no longer wanted, what construction could replace it that did not allow badly supported people to feel ‘obliged’ to end their lives?

The director of public prosecutions Keir Starmer QC is the lawyer on one faultline between two opposing camps, having issued guidance on the Crown Prosecution Service’s ‘policy’ on prosecutions in assisted dying cases.

Starmer’s policy is held up by opponents of reform as evidence that the current approach works. Those campaigning for reform note that, as prosecutions were not, by the CPS’s own account, in the public interest, the law can be safely changed.

Equality and human rights principles are also claimed by both sides. Major disability charities are opposed to a change in the law. In presentations to the commission, they argued that too often disabled patients’ rights around end-of-life decisions were not respected. Any change would leave them even more ‘vulnerable’.

I sense these charities also have a wider point to make. 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, which includes some powerful arguments.

But powerful testimony also comes 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.’ (Paralysed from the neck down, Nicklinson’s condition is not terminal.)

Supporters of Nicklinson’s right to die will be disappointed by the commission’s conclusion that any change to the law should cover terminal conditions only. From the perspective of people like Nicklinson, their rights are ‘sacrificed’ to bolster broader arguments for the ‘social model’ of disability.

These debates are not for the faint-hearted. They involve, in effect, some people telling Campbell they want a change in the context of their death that will make her feel less safe and less valued; and Campbell in effect telling them that they must live on in a life they do not want, because a change in the law would signal that society had lowered the value of her own life.

So the commission’s claim that it has found ‘safe’ ways to change the law - protecting Campbell, but allowing some others to make their choice - would remove a key practical obstacle to reform.

For those opposed to reform, what obstacles remain? Well, the commission also calls for ‘better access to, and more uniform availability of, end-of-life care’. Here commission members make common cause with many who oppose reform. But for those hoping to see a change any time soon, this, not the challenges of law reform, is now the practical argument most likely to delay or prevent a change in the law.

Eduardo Reyes is Gazette features editor