Live Debate: Lords Chamber

Lords Chamber

Friday 23rd January 2026

(began 2 weeks, 3 days ago)

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10:05

Lord Watson of Wyre Forest (Labour)

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Third Third Reading Third Reading of Third Reading of the Third Reading of the Licensing Hours Extensions Bill Lord Watson of Wyre Forest.

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To move that the bill be now read a third time. The question is that this bill be now read a third time. As many as are of that opinion will say content. To the contrary, not content. Contents. Have it.

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content. Contents. Have it. I beg to move that this bill do now pass.

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now pass. Which anyone who wants to say something might say something. Yes. I'm very grateful for that guidance, sir. My Lords, this is a modest bill, but a useful one. It makes a small procedural change to the Licensing Act 2003 that will allow the government to act more swiftly and sensibly when communities wish to come together to make moments, moments of national significance, before turning very briefly to the substance. I want to thank those who have helped this bill on its way.

I am grateful to my hon. Friend, the Member for Wrexham, Andrew Ranger, who steered it through the other place with care and persistence, and before that, before the last general election. My hon. Friend for South Shields, Emma Law. I'd also like to thank the Minister and officials and the clerks of the House and staff for their guidance and constructive engagement and support throughout. And I'm particularly grateful to noble Lords on all sides of this House who took an interest in this bill.

You recognise that this bill can bring a little joy in difficult times to landlords and the wider hospitality sector, which is navigating tough economic conditions. Our pubs and hospitality venues are not simply businesses, they're places of belonging where people gather to celebrate, to commiserate and to feel part of something shared. I should also like to particularly thank the noble Baroness Monckton of Darlington Forest, who cannot be with us today because of pressing family commitments. But she has asked me to extend an invitation to visit the North Star pub, a pub she helped open earlier this year through her charity team Dominica, which provides training and employment opportunities for young adults with learning difficulties.

And I'm pleased to say that the good people of the British Beer and Pub Association who support this bill have agreed to accompany any member that would like to take the Baroness up on her kind invitation. And in that same generous spirit, I'd like to thank my Chief Whip, the noble Lord, Lord Kennedy, who is known, who is known for his generosity. And he has asked me to convey the offer to every member in the House today that were you to visit the Baroness Monckton pub.

He would be delighted to buy you all a drink. Now, my Lords, by moving to negative resolution, this bill ensures that licence extensions can be made when they are genuinely useful to communities and businesses, while fully preserving parliamentary oversight. Either House retains the right to object and to secure a debate. Scrutiny remains intact. It's simply better calibrated to the decision being taken. Nothing else changes. Extensions remain exceptional, discretionary and tightly defined. What does change is the ability to use an existing power well at a moment when it matters.

So with the support of the house, we will cut unnecessary delay, reduce administrative burden, support hospitality businesses and help communities celebrate together when the occasion calls for it. So, my Lords, I say cheers to you on all sides for the support before we call time on this bill and before last orders are called. I invite the House to see it safely through

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the. Offer of the noble Lord, Lord

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Offer of the noble Lord, Lord Kennedy. Could I ask the noble Lord whether the first time this bill and hopefully act, comes into and hopefully act, comes into operation, he will by everybody

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present around here today? I know as I know, the noble Lord is an expert on election law. There is an expert on election law. There are certain circumstances where that might be illegal, but I fear that he is correct on this one, and I would gladly take him up on that offer. For those reasons, I commend this bill to the House.

10:10

The Earl of Effingham (Conservative)

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The question is that this bill do now pass. do now pass. >> My Lords, please let me thank all noble Lords who made valuable contributions to this private contributions to this private member's Bill as it has made its way through your Lordships House. way through your Lordships House. When in government. We did indeed support a similar version of the Bill, as proposed by Emma Lewell-buck from the other place, which sadly failed to pass before the general election. His Majesty's Loyal Opposition are therefore pleased to welcome the measures in the Bill as put forward by the noble Lord, Lord Watson, and we thank him for both his work on the Bill.

In addition to his efforts to promote all sectors of the UK music industry. As chair of UK Music at Second Reading, many noble Lords share their extensive knowledge of the hospitality sector and the meaningful, meaningful, positive impact that this legislation will have, ensuring that pubs, bars and other licensed venues can adapt during national celebrations such as royal events, major sporting victories or cultural milestones is beneficial to both businesses and communities, allowing everyone to celebrate together and contributing in some part to economic growth.

Replacing an affirmative resolution with a negative resolution Statutory Instrument provides a faster and simpler mechanism, whilst at the same time retaining the option for consultation and maintaining the relevant safeguards. My Lords. The net result should be that everyone benefits. Yes.

10:12

Lord Lemos (Labour)

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My Lords, if your Lordships pass >> My Lords, if your Lordships pass this bill today, it will not go back to the Commons, but will go straight to His Majesty the King straight to His Majesty the King for Royal Assent. Well, my Lords, I thank and congratulate my noble friend Lord Watson for bringing this Bill forward, as well as my hon. Friends Andrew Ranger and Emma Lou in the other place. I thought I wondered whether we should extend the Licensing Act to celebrate the passing of this bill.

But. But I don't intend to test the opinion of the House on that question. The Chief Whip would have a heart attack, and I understand he has plans for the weekend. But it also would also bring my late blooming political career to an abrupt end. In an earlier debate on this bill, the noble Lord Lord Sandhurst promised to drink more British beer if this bill passes. So I think the drinks in the North Star are actually on the opposition, as well as the obvious economic benefits of this change.

I don't want to trivialise this bill. My Lords, what we celebrate, when we celebrate, how we celebrate, where we celebrate, and with whom we celebrate, are all markers of our shared national identity. These are the occasions where, as a nation, we show the better angels of our nature. With that and with and my thanks again to the noble Lord, Lord Watson, and all those who have supported this Bill and with the government's support. I commend

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this bill to the House. The question is that this bill

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The question is that this bill do now pass. As many as are of that opinion will say content contrary, not content. The contents have it. House to be again in committee on the terminally ill adults. End of

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life bill. Lord before the House considers

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Lord before the House considers that motion. Can I just just make a few remarks before we get on to

10:14

Legislation: Terminally Ill Adults (End of Life) Bill - committee stage (day 7)

committee? I want to thank all noble Lords for the constructive discussions and kind words this

10:14

Lord Kennedy of Southwark (Labour)

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discussions and kind words this week. I understand, empathise with the concerns being raised about the suggestion the House would sit beyond 3 p.m. I am striving to find an approach to minimise the impact on the house, and I've looked seriously all the options given and seriously all the options given and this is very difficult. The options are presented last week were the suggestion of the house should sit suggestion of the house should sit from 7 p.m. to 10 p.m. on a Thursday or earlier on a Friday.

I've discussed these suggestions with the usual channels the clerk assistant and I'm grateful. Their advice, as well as from noble Lords who put them forward. My Lords, I'm also conscious that the House accepted a motion from a noble friend, Lord Falconer of Thoroton, that more time is needed to scrutinise the Bill. There is no easy solution, my Lord, or an option preferred that except for the whole House, the Bill remains and will remain a private member's bill. No government time will be allocated for the bill.

I believe it is right, therefore, that it is considered on Fridays only. I know some Lords would prefer to sit late on a Thursday. Blind mind for the pressure that put late night puts on the house and the staff, especially when we have another Friday sitting the following day. I do not think this is the right course of action. I also spoke to the House authorities about sitting early on a Friday, but for many teams of staff, this would increase the pressure to be here even earlier in the morning to show how to prepare to sit at 9 a.m.

I do not, therefore, think the sitting earlier than 10 p.m. would ensure we're in the best. Scrutinise the bill. As I sent out previously, and as a result, I will not seek to adjourn the House at 3 p.m. today, but will instead seek to do so at around 6 p.m. Of course, this is a matter of the house and not me. As Government Chief Whip and Captain of the Gentlemen at Arms. It remains in the hands of noble Lords and the house, and any noble Lord may seek an early adjournment if they wish to do so.

By moving the motion that the House be resumed. My door remains open to all noble Lords to discuss matters concerning the Bill. My Lords, I have also heard concerns about the pressure for longer days to put a noble Lords who wish to debate most and all the groups in target, and I have been asked about a lunch break. I'm happy to facilitate a break that would adjourn the House for pleasure. During pleasure for around 40 minutes at 1 p.m. That requires a break mid group, although I'd hope we would not be the case.

I also want to put on record my thanks to the staff of the house, both the staff here today and also staff who work in the days ahead to ensure our debates take place today. Can I say also that you know, at all times when we consider this bill, we should always have the front of our mind, kindness, courtesy and respect the hallmark of our debates in this chamber, and especially when we debate the bill before us today. My Lords, with that, I think we should turn the substance of the bill and make more progress on the bill.

Before the noble Lord sits down. He very kindly allowed a number of us to make representations to him during the week, saying that his door is always open, and indeed it was, and I thank him for that. However, the point that I raised last week about those of us who do not live in

10:17

Lord Empey (Ulster Unionist Party)

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London running to six or thereabouts, and that's what it means, makes it impossible for any of us to get most of us to get home. Therefore, we would require to stay Therefore, we would require to stay over until Saturday. Now, given that this is a private member's bill, given the pattern that has been adopted in private members bills since I have been here, and given the fact that we are effectively discriminating against effectively discriminating against a group of people who do not live in the local area, I think that as a matter of principle is a mistake.

And if we allow that to happen on a regular basis, that means that people who are not resident in the south east of England are put at a disadvantage. The point about leaving early and not observing the normal courtesies. I understand the point, but if you put an amendment down, the whole point is to get and hear the response of the Minister and the promoter of the bill. It is not simply an ad hoc thing that can drift off at a certain point in time.

So without any question of doubt, this decision means that those who have to travel a significant distance from this house to get home every week are at a disadvantage. And that's a precedent, because it might be those of us who live further away today, but it could be a different group of people in the next time round. I think that's a mistake, and I'm not satisfied that to leave it just as it sits, and I would not like to be in a position where we had a situation where people were bouncing up and down to ask the House to resume at some ad hoc arrangements.

I think it should be an agreed situation with the promoter of the bill, so that we don't have this business of people doing a count around the room to see if they can get the house resumed. I think we would have a much more mature and professional way of doing the business, but I leave the point with the Chief Whip that this discriminates deliberately against people who do not reside in this area.

10:19

Lord Kennedy of Southwark (Labour)

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Can I firstly say thank the Lord Low huge respect for the noble Low huge respect for the noble Lords, and I thank you very much for his kind. We dealt with our discussion this week. That is why discussion this week. That is why when I said last week that I was, you know, colleagues Lord Rose could leave earlier if they had to travel back back home. I fully accept the point that I made that. Of course, when you move your amendment, you actually want to hear the response.

I fully accept that. What I'm very happy to do this again is to try to find some way forward is that if noble Lords do find they've got to leave for travel arrangements, they can't hear the response from the Minister. I'm very happy to arrange for that, to have a meeting or a briefing to go through that response so they get more rather than have to read it in Hansard. So I hope that's something I'm trying to find ways to square an almost impossible circle here.

But I do appreciate

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the comments of Lord. To be again in Committee on the Terminally Ill Adults Bill end of life Bill Lord Falconer of Thoroton.

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life Bill Lord Falconer of Thoroton. Would I beg to move that the House do once again resolve itself into a committee on the bill?

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into a committee on the bill? The question is that the House do now again resolve itself into a committee on the bill. As many as are of that opinion will say content. To the contrary, not content. To the contrary, not content. The contents have it. My Lords, Lord Shinkwin, Lord Shinkwin and Baroness Campbell of Surbiton will be taking part remotely. I remind the committee that unless they are leading a group, remote speakers speak first after the mover of the lead amendment in a group, and may therefore speak to other amendments in the group ahead of members who table them in clause one, amendment 35 Lord Birt.

My Lords, I.

10:21

Lord Birt (Crossbench)

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Rise to move. Amendment 35 and all the other amendments listed in all the other amendments listed in my name and that of the noble Lord Lord Pannick, who, having assiduously attended, as all will have noticed, our sessions on the bill thus far, deeply regrets that he cannot be present with us today. My Lords, our discussions today have focussed overwhelmingly on risk, and I do not for one moment dispute the necessity and the value of doing that, and I will return to how best we can manage those risks later in my remarks.

But, my Lords, let us not forget that we are not pioneers. 30 countries, states or jurisdictions across the world have already introduced assisted dying, the first over 80 years ago. A steady stream this century and hot off the press. Just two days ago, an assisted dying bill for the Channel Island of Jersey passed its first reading by a 2 to 1 majority and is expected to pass into law next month. So it is, at the very least, equally important, my Lords, that we don't just focus on risk but lean on the well established experience of others when considering the critically sensitive matter before us, which we know from serious studies, carries overwhelming public support.

For my part, my Lords, I've been exposing myself to the Australian experience with considerable help from senior practitioners for which I am most grateful. Without exception, those to whom I have been exposed come over as deeply caring and enormously considered, and what I have learned from them, and from the copious data that is available, is reflected in the amendments before you today. Much that I have discovered, my Lords, has been surprising as well as enlightening. First, applications for assistance in Australia are not automatically accepted.

Something like one third are turned down. Second, around 75% of those seeking assisted dying have cancer, and somewhere between 75 and 90% of all of those who come forward are already in receipt of palliative care, more motivated by their distress and misery than by their pain. And whilst I completely agree with all noble Lords who have stressed how vital it is to have effective, universally available palliative care, it is clear, my Lords, that it is not sufficient for many experiencing truly horrific medical conditions.

For those who have not read it, I commend Jonathan Dimbleby's moving account. In a recent New Statesman of his brother Nicholas's harrowing final days. Nicholas had fallen victim to motor neurone disease. It became impossible for him to take solid food without choking. He then had a tube inserted into his stomach, through which he had to feed himself. Nicholas became increasingly hard to understand. He was barely able to move. He lost control of his bodily functions. He was often frightened and sometimes terrified.

He gasped in vain for breath. Nicholas Dimbleby finally and mercifully died, my Lords, in February of 2024, other UK practitioners I have met recently and simply by chance, have shared with me equally horrific accounts of deaths that they have witnessed in the ordinary course of their work. I think, my Lords, that such experiences must explain why in Australia, whilst around 10 to 15% of those seeking an assisted death apply some months in advance of their anticipated need, a significant proportion wait until their suffering is unbearable.

As a result, around 25% of applicants die within nine days of their first request. I repeat, my Lords, 25% of applicants die within nine days of their first request. A further 25% die within 10 to 19 days. Thus, my Lords, in Australia, around 50% of applicants die within 19 days of their first request. Those leading Australian practitioners in my Lords insist that sheer misery is the primary determining motivation of individuals seeking assisted dying and further, to illuminate the complexities of the process.

Around one third of those who ask for and who are given the death potion do not take it and choose to die a natural death. Furthermore, one of Australia's most senior and experienced practitioners tells me that whilst no. I'm sorry, I have an argument to put, I'm not going to take any interruptions at all. In. Furthermore. Furthermore, one of Australia's most senior and experienced practitioners tells me that whilst in theory it must be a risk, she herself has never experienced a single example of coercion.

On the contrary, she says, she has on occasions experienced the very opposite loved ones understandably pressing someone wanting assisted dying not to embark on that course of action. Overwhelmingly, her experience is of applicants who know their own minds, who are perfectly able to make a considered decision. From all of my discussions, my Lords, I've concluded firmly that if this Bill passes into law, it is vital that the processes are based on day to day realities as well as risk, and work efficiently and sensitively for any individual of firm and settled mind, coming forward in a state of deep distress.

So, my Lords, we need more flexibility in the timelines of the process than the present Bill allows, and a fit for purpose organisational focus that delivers promptly and humanely for individuals in severe need. So Lord panics and my amendments. In our amendments, we propose three key measures one to create a new organisation, the Assisted Dying Help Service, to enable the individual easily to navigate the complex process set out in this bill, which in essence we retain.

Two to ensure that the assisted dying process is expeditious and when conditions demand it, flexible. And three, that the Commissioner acts solely as a regulator with oversight, but without any delivery responsibility. The process currently set out in the Bill, My Lords, before us, is involves a ten stage process, three separate medical consultations with three different doctors, a confirmatory panel and two periods of reflection one of seven days, the second of 14 days, the latter of which can be shortened absent a bespoke organisational focus, my Lords.

This process in a stressed NHS could take a wholly inappropriate and disproportionate period of time. Hence our proposal that we adopt a notion present in many jurisdictions of a purpose built organisation. An assisted dying help service that would provide a personal navigator to take the dying person and their loved ones through the whole complex process, providing introductions, keeping to timelines, piloting the individual through their final challenging and traumatic journey. We also propose an amendment appropriate flexibility at every stage, with safeguards for doctors to act with urgency if the individual's condition demands it.

The final argument, my Lords, for a bespoke delivery organisation. The final arguments are based on global comparisons. We estimate that in due course, once the system is well established, something like 7000 people each year in England and Wales will avail themselves of the assisted dying opportunity. A focussed organisation can acquire dedicated medical and other staff, create a network of consultants, specialists and volunteers to call on, including, for instance, to provide palliative care. A focus organisation can offer and validate training can issue an update, advice for practitioners, can develop appropriate tech supported systems for managing the complex process set out in the bill.

Absent such an organisation, my Lords, the provision of an assisted dying service could be chaotic and prolonged. I will mention two other matters covered by Lord Pannick and my amendments one. We propose in the first medical consultation that the doctors should take the patient through all the options available, including palliative care and hospice opportunity. But having sat through the whole of the Committee stage so far, I have further concluded that at Report stage we should formally build into either the first or the second consultation a requirement for the medical practitioner to explore whether the individual's request is influenced by any of the following factors an inaccurate prognosis or their vulnerability, particularly resulting from disability or their mental incapacity or their financial concerns, or finally their possible exposure to coercion, and moreover, that help as it hand from the Assisted Dying Help Service, which would offer an alternative to assisted death for anyone found to be at risk in any of those ways.

We also propose that the Commission's role should simply be, as a regulator, its prime responsibility oversight of the assisted dying health service. It would ensure that practitioners are compliant with the provisions of the law, and that data is collected and trends reported, and it would issue guidance and guidelines where necessary. My Lords, I hope that the sponsors of this Bill will be persuaded of the benefits of the additional measures we propose, which no doubt can be improved even further in dialogue before Report stage, not least with those who have concerns about the Bill.

But I conclude, my Lords, by asserting that we should put no obstacle in the way of someone, of sound mind, of a settled view, in deep distress, with death imminent, being allowed a dignified ending to their life on

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earth, and at a moment of their choosing. My Lords, I beg to move. Amendment proposed clause one,

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Amendment proposed clause one, page one, line 14. After life, insert the words on the Marshalled

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List. I thought we were. Taking the

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I thought we were. Taking the remote. Contributors first, but if we're not, since there are amendments on the paper from my noble friend Lord McKinlay of Richborough, to which I have attached my name with his

10:34

Lord Harper (Conservative)

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10:45

Lord Carlile of Berriew (Crossbench)

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The noble Lord, my noble friend Lord Birt, was, of course, perfectly entitled to refuse my perfectly entitled to refuse my attempt to intervene in his speech. I am, however, disappointed that he I am, however, disappointed that he chose to defy the determination of this House, that we should not have repeated Second Reading speeches. Every one of us here can stand up and make a Second Reading speech on any of these amendments. If we defy that determination, and I hope that he will not do it again, I'm sure it was a misunderstanding on his part about the way in which he was able to move his amendment.

As to his amendment, I'm afraid I'm suspicious about his group of amendments, and I think he gave the game away in the way in which he later turned to his amendments and referred to them. It's clear that he is very keen on there being a more extensive provision for assisted suicide, that people far beyond the scope of the noble and learned Lords Bill should be able to claim and achieve assisted suicide. And behind his amendment and some of his amendments I agree with, I would love to see better care for people who are facing the end of their lives.

But behind his amendments is a death service as the noble Lord Lord Deben and the noble Lord, Lord Harper said, what he's providing is a way to death, not a way to enjoy and make the most of the rest of your life. And I would urge noble Lords not to support these amendments, because I regret that their motivation is not even consistent with that of the sponsor of this bill.

10:47

Lord Stevens of Birmingham (Crossbench)

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10:54

Baroness Hollins (Crossbench)

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into mainstream healthcare, does appear to normalise the practice, and to lower barriers to the use of assisted dying. And international evidence is instructive because where it is embedded within publicly funded healthcare systems, such as in Canada and the Netherlands, uptake rises steadily over time and eligibility criteria broaden. And you know, as we know in some jurisdictions, it is available to minors. People with non-terminal conditions, psychiatric diagnoses and even people with learning disabilities or autism. As my own published research on the Netherlands has shown, I.

I also agree with my noble friend Lord Stevens that assisted dying is not a treatment. It's a further reason why it should never become part of the National Health Service. The substances proposed to be used are neither treat nor prevent disease. They fall outside the legal definition of a medicinal product, and the drug regimens proposed are unlicensed, have not undergone appropriate clinical trials, and they lack international consensus. They're not even available. Licensed for human use in the United Kingdom, the drugs, which have been more widely and successfully used to to, to to provide a the much lauded, pain free and quick death, such as in Switzerland, the noble my noble friend Lord Birt seems to seek to introduce similar criteria as he used in Switzerland, not just about terminal illness, but he spoke about suffering and pain and conditions which have actually not eligible under the law as it is currently of the bill as it's currently proposed.

So in Switzerland, non-profit organisations such as Dignitas operate within the narrow but deliberately legal space created by article 115 of the Swiss Penal Code, and this states that assisted suicide is only punishable when carried out for selfish motives. That means if it's provided purely out of compassion with no personal gain, it's not a criminal offence. Enabling Dignitas and other similar non-profit organisations to function lawfully, so long as they demonstrate altruistic intent and ensure the individual acts autonomously. Interestingly, article 115 of the Swiss Penal Code containing only only one clause I think just one sentence when it became law in 1942, one wonders whether the sort of rather smoke and mirrors of the is it 59 clauses in this bill and the various clauses introduced by my noble friend Lord Burt to to disguise actually a very similar intent.

It's sort of it's, it's, it's kind of a little bit concerning about the sort of potential changes and development of this, of the various proposals that are before us today and if indeed something very straightforward as is provided in Switzerland was intended, I do not understand why that wasn't proposed in the first place. We do not want this in the National Health Service.

10:57

The Lord Bishop of Newcastle (Bishops)

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My Lords, I just have a very brief thank you brief comment to brief thank you brief comment to make. In his opening remarks. Lord Birt moving his his amendments cited Australia. However, I'm sure cited Australia. However, I'm sure the noble Lord is aware that no Australian jurisdiction is recognised as one of the ten comparable jurisdictions to the bill in terms of eligibility criteria and the government's impact assessment, the most comparable. In fact, New Zealand and the United States. We had this kind of discussion in the select committee actually, and resolved by receiving evidence from New Zealand.

So I think we do need to be consistent and be mindful of the government's impact assessment and ensure that our comments align with

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that. I agree. Entirely with the.

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Entirely with the. noble Lord, Lord Stevens, and his vast experience and Baroness Hollins with hers. My point is a simple one. It's one that's been troubling me as a lawyer for a long time. It's conflict of interest as time. It's conflict of interest as an internal conflict of interest here within the health service. Are you going to spend the money on this, or are you going to spend it

10:58

Lord Sandhurst (Conservative)

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on palliative care? And will this affect decision making by medical practitioners? And I've talked to a number one of them, a member of my family. I won't embarrass that family. I won't embarrass that member of my family by saying more. And it is a matter of real concern And it is a matter of real concern because this isn't treatment. It's something quite different. And we something quite different. And we don't have to have non-medical things like, as we've heard, Department of Work and Pensions assessments done under the NHS label.

And it is contrary to everything the NHS stands for. There will be a conflict of interest within any trust if it is funding this and administering this as to where the money goes, is it going to be given more money specifically and will that be limited? The obvious overseeing Secretary of State for this is the Secretary of State for justice, because you're going to be dealing with life and death, the administration of life and death, not simply trying to cure people and save them from death.

It's quite different. You're saying you can die and we are satisfied that there are no bad people around you who are encouraging you to opt for this course. And there will be the selection of the panel and the management of the panels, and the panels will be performing a quasi judicial function. Like other assessment panels. And so the obvious place for this and it will remove all well, not all, but it will remove or limit at least and reduce the risks within the health service.

If a separate specific budget is given to the Ministry of Justice, and then we'll know what is being spent. Otherwise the X, Y, Z trust will say, gosh, what do we take this from? I'm not going to give emotive examples, but that is what is going to happen in practice. And so we need to know that this is a specific service. And the country has said it will have X million or hundreds of millions a year to run it, but it will be on top of and ancillary to anything which the ordinary health service provides to people who actually want to live or live, at least in comfort.

So I think we really have to be told by the promoter and by the Minister, who is going to be responsible for choosing the panel for a point for overall, which Secretary of State, because there are a lot of references to Secretary of State in this bill, who is going to be the Secretary of State, and will it be the Secretary of State for health or whatever is the relevant one at the time, or will it be the Minister of Justice? I give way, yes.

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Thank the Lord for giving way. Is it also the case that in terms of looking at this much more from a justice prism, if we are looking at the issue of assisted dying, that one of the broader elements, which I think is important to establish where a death has occurred, is has there been any criminal action or there been any criminal action or criminal intent within that, both in terms of the administration of that, but also where there is a that, but also where there is a situation of people coercing somebody to die as to whether there's criminal action there, which is another reason why where this sits, if it is to happen, should be much more with the justice side of things than the

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health side of things. That's why I had, perhaps rather briefly, an elliptically at the briefly, an elliptically at the start, talked about sort of bad agencies and people. That is not agencies and people. That is not the health service's primary role. It will happen from time to time. It will happen from time to time. And I know medical professionals and I mentioned this, I think at Second Reading, who has a relative Second Reading, who has a relative who is in charge of safeguarding in a major north London major London trust.

And one of the concerns they have and what they have to deal with day to day is, in fact families who are not all united in their support for an elderly and tiresome, relevant relative and in fact very often would like them helped on their way. I won't say more, but I think the point is clear that this structural point is a major failing in this bill.

11:03

Lord Moore of Etchingham (Non-affiliated)

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Lord Stevens. >> Lord Stevens. >> Who speaks from great experience and professional knowledge, made a and professional knowledge, made a very clear case about how the assisted Dying navigator is quite assisted Dying navigator is quite outside the normal purposes of the National Health Service, and I guess it could be described as in

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effect as a form of advocacy, or in the ancient world, the the. Dead were were carried across

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Dead were were carried across the River Styx by Karen. And it seems to me that that role would be performed by the navigator, because performed by the navigator, because where is he navigating? He's navigating you to the River Styx, and he's not trying to navigate you anywhere else. Now, if that is actually included in the National Health Service, it creates a quite Health Service, it creates a quite different purpose from from the normal purposes, as noble Lord Stevens has described.

And I wonder, therefore, whether we should consider whether this is actually amounts to the National Health Service trying to persuade people to accept assisted dying. And if it does amount to that, and if you think of the vulnerability of the individual cases, so often, so, so often will occur, could it be argued that his might become an institutionalised form of coercion?

11:04

Baroness Royall of Blaisdon (Labour)

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You point out that I believe this is not a choice between investing in palliative care or in or changing the the laws that we or changing the the laws that we have in assisted dying service. We need to do both. And I am mindful of the point made by the noble Lord of the point made by the noble Lord Lord Stevens about the lack of response from the Department of Health, and I think it would be very good if some of some others of us could press for that, because it would be interesting to know how, when, and how much the government is going to invest in palliative care.

Because whatever we believe about assisted dying, we all fundamentally believe that palliative care needs more investment, and it shouldn't be a

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matter of postcode lottery. Yes.

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Yes. My Lords, I'd like to ask the noble Lord Lord Birt to reflect on the equality implications of this suggestion of a special treatment suggestion of a special treatment service for those. Seeking assisted death. It's just that, following on death. It's just that, following on from the previous contribution, in fact, the noble Baroness Baroness

11:05

Baroness Fox of Buckley (Non-affiliated)

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Royall, everybody, it seems to me, would want for themselves or their would want for themselves or their loved ones a personal, state funded navigator. If you're a patient, but maybe for care. But I mean, those people on trolleys, those people waiting for operations, those people trying to find their way into the care system. And can we into the care system. And can we all have one? And if we don't afford every patient in the country a personal navigator, isn't that an unequal access to services? It just seems a two tier system if you want, and one which I would think that the the public would not approve of.

On another issue, can I ask the noble Lord Birt as well to detail what the workforce demands this service would require from the NHS? Following on from the noble Lord Lord Stevens excellent contribution, but I note that the assisted Dying help service, which, by the way, is awarded significant regulatory powers in these amendments that sorry which will not be subject to approval by Parliament, but will have the power to set training and qualifications for practitioners. That seems like rather a blank check, but I would like to know what the skill set of skill set of a navigator would be and who decides? But in all seriousness, this whole new sort of shadow service being set up with its own qualification system recruitment.

We're not quite sure who they're going to. I mean, it's a bit worrying and just my final query really is I know that a lot of supporters of the bill are frustrated and have raised problems with some of the amendments that have been tabled on the basis that they're somehow creating bureaucratic, preventative barriers to people who genuinely want to afford of an assisted dying service. In other words, that there's an attempt to overengineering the process and therefore I could maybe commend the noble Lord Lord Birt on this creative attempt at cutting red tape.

However, in relation to this, these particular amendments, we all know that mandated timelines can mean shortcuts that could make the process unsafe. Could he comment on that? Because speed and process driven decision making is risky in any instance, but where careful assistance and safeguarding is contested, where, for example, it seems rather dangerous, panels apparently would have to decide within two days of referral, even sitting, by the way over the weekend and bank holidays to make decisions which, by the way, I think that we should apply that to everyone in the NHS and they should do operations over the weekends and bank holidays, and doctor's surgery should be open over weekends and bank holidays, and I wish the courts would sit over bank holidays and weekends and so on, because then we wouldn't have to get rid of jury trials, allegedly.

But anyway. But that would mean a referral on a Friday evening would have to be decided by a Monday. How would a panel have time to investigate everything, read everything thoroughly? Surely they just end up skimming things. And I do really worry as well about the reflection period being cut to 24 hours when experts warn that initial depression after diagnosis, which is completely understandable, might well be temporary treatable. It certainly remedial, could last a few weeks, but then could be replaced by a more positive attitude.

And in fact, the CEO of mind told the Lords select committee they've gone to the brink, they've come back and then have then been able to say 3 to 6 months later, I'm so glad that that did not happen. And the all I'm saying is saying, oh, we're being really efficient. We're going to make sure that your reflection is cut to 24 hours so that you can get what you want. Might well be that you don't get what you would want if you'd had a bit longer to reflect.

11:09

Lord Goodman of Wycombe (Conservative)

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An unreality. >> About this debate, which gives rise to a question for the sponsor of the bill and a question for the Minister. And the unreality is this that the noble Lord Lord Birt, has made the case for his amendments. And my noble friend, the Lord Harper and others have made their case against them. But there is hung about this whole debate, and an assumption that the NHS will deliver assisted dying. But can I remind the House that there is no guarantee of that in the Bill? If noble Lords would kindly turn to the Bill? Clause 41, for the only reference to the National Health Service, is that regulations under this section may, for example, provide that specific specified references in the National Health Service Act 2006 to the Health Service continued, etc.

that's the only reference to the NHS in the Bill. We don't know whether the NHS will or will not deliver assisted dying services, which is an

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extraordinary weakness in the Bill. So yes, I'm very happy to give away. The noble.

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The noble. noble Lord for giving way. And he and I sat on the select committee on this bill, and he may committee on this bill, and he may recall that I pressed the Minister specifically on this point to clarify who would be delivering an clarify who would be delivering an assisted dying service in this country, should this bill be accepted. Only after a number of accepted. Only after a number of questions did the Minister acknowledge that it was the government's intention that the NHS would commission an assisted dying service, but he couldn't clarify or confirm if it would be delivered by the NHS, by the private sector or by the voluntary sector or charitable organisations.

And in fact, if it was the private sector, if they would be allowed to generate any profit. So we are still unclear and it's very, I think, very challenging for us and I hope that the Minister, in her response, might at this moment be

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able to give us further clarity on that very important point. The Baroness is quite correct.

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The Baroness is quite correct. That's exactly what happened in the Select committee. And for my sins, I sit on a surfeit of committees I sit on a surfeit of committees and also on the Delegated Powers Committee, which drew attention to this very deficit in the bill. So this very deficit in the bill. So the question for the noble Lord, Lord Faulkner, is, since the Minister was questioned in Minister was questioned in committee by Baroness Berger, and in the weeks that have have followed, has he had any guarantee from the government that the government will ensure that the Secretary of State, by regulation, does ensure that the NHS delivers voluntary assisted dying services? Has he had that guarantee or not? And when the Minister replies to the debate, can she cast some light on this matter so that we know whether or not the proposal that Lord Birt has put forward and my noble friend, as opposed really has any basis in reality at all?

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Yeah. Well, I it was a delight to hear that noble Lady Baroness Fox of Buckley.

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Fox of Buckley. Hit every nail on the head of everything that is wrong with the noble Lord Lord Birt amendment. And I rise to speak to the amendments in the name of my noble friend Lord McKinley of Richborough. And my noble friend Lord Harper, and I noble friend Lord Harper, and I have signed some of them. I have done so because the bill, as drafted and now is proposed to be drafted and now is proposed to be amended by the noble Lord Lord Birt and the Noble and learned law.

Lord Pannick promises choice whilst

11:13

Lord Blencathra (Conservative)

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quietly engineering speed, centralisation and a single minded pathway to assisted death. That is pathway to assisted death. That is not a neutral design choice. It reshapes incentives, it shifts resources, and it narrows real resources, and it narrows real options for people at the end of life. But otherwise I will. I will give three examples sharp examples give three examples sharp examples of why the noble Lord Lord Birt amendments are wrong and end with a direct challenge to the noble and direct challenge to the noble and learned Lord, Lord Falconer of Thoroton.

First, the bill's timelines turn life and death decisions into a fast track. The amendments proposals turn into fast track process. From first declaration to possible assistance. The clock can run down to 30 days or as little as 18 days. If death is deemed imminent, panels must decide within 48 hours of referral. Reports are forced within 24 hours. Reflection periods can be cut to 24 hours. My Lords, that is extraordinary. Courts take months to resolve urgent life issues. Prognosis measured in months, are notoriously unreliable.

Rushing assessments in this way risks premature deaths, misdiagnoses and inadequate explanation of reversible causes of despair. The amendments in this group push back against the amendments I have signed, and my noble friend's amendments pushed back against that compression. Second, my Lords, as others have pointed out, the assisted Dying Help Service and the personal navigator create an asymmetric system. The navigator is designed to shepherd people quickly through the assisted dying pathway. There is no equivalent statutory guarantee that a person will get timely access to palliative care, hospice support, social services or a person to get timely access to mental health interventions.

In practice, a patient could reach assisted death faster than could gain access, pain control, a care package, or a meaningful social intervention. As the noble Lady said, you can get a GP appointment these days. That's a perverse appoint, a perverse allocation of scarce resources and a distortion of choice when one option is actively facilitated and the others are not, choice becomes a funnel. And third, my Lords, the bill permits remote and pre-recorded assessments. Video cannot reliably reveal who was in the room, what pressures exist off camera, or the subtle cues clinicians use to test capacity and voluntariness.

Evidence from telemedicine and remote and remote court hearings shows the limits of video for assessing vulnerability. The criminal offence of coercion, of course, is reactive. The assessment process must be preventative. Face to face contact is not a nostalgia. It is a practical safeguard against coercion, miscommunication and error. The amendments insist on personal steps and verification, and face to face steps are therefore not bureaucratic nitpicking. They are essential protections and even more so if you are going to have a fast track procedure like this.

So in conclusion, my Lords, the noble and learned Lord Dear Lord Falconer of Thoroton has argued for a patient centred, safe system. I put it to him now, will he accept that a system which institutionalises speed creates a dedicated navigator only for assisted death and allows remote assessments, cannot credibly claim to be the highest standard of patient protection? If he truly believes in patient choice, will he support amendments that restore time for reflection, parity of support for palliative options, and a presumption of face to face assessment so that choice is informed, free and real, not the product of a fast track service designed to deliver an outcome.

My Lords, this is not about denying choice. It's about ensuring that the choice is genuine. And I do

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support the amendments proposed tabled by my noble friend Lord Harper. Just before the noble Lords

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Just before the noble Lords concludes. Can I offer my house? My apologies for not being fully engaged today. I have appointments engaged today. I have appointments elsewhere. I have my father's funeral just yesterday, and I remember during the Covid period we remember during the Covid period we had that sign up that the Minister stood behind. What was it? Stay at stood behind. What was it? Stay at home, protect the NHS, save lives. My my real concern now with the thought of a navigator that only has one direction.

Are we going to? I know it sounds rather flippant, but will it be save the NHS? Choose a navigator, choose death seems to be the rather chilling direction that the concept of a navigator, and one choice only seems to be

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directing us towards death. I feel. Tempted to try and answer that. Very quickly.

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I too will be leaving the house before I suspect we get a vote on this, or at least some decision from the Minister about what the minister's going to say. But I have to say that this discussion about to say that this discussion about the cost of treatment is not a reasonable one. I don't think that reasonable one. I don't think that it's one that the noble Lord Stevens did not discuss this actually in his speech, but I think the speech of the noble Lord Birt is overwhelmingly important, because actually it's about the notion of our sensitivity.

In this situation. There are many people who go to the health service who do not get treatment. It's not always a treatment. I for years was pioneering in vitro fertilisation, which was really not successful for a very long time. We've got 16 babies worldwide in the first four years. There are now millions of happy families as a result, who would not be. Many of them actually are living partly in this house some of the time. And the fact of the matter is, of course, when we discuss this, the people who opposed in-vitro fertilisation in this House and believe me, there were many of them, were often the same people who would have probably refused to accept assisted dying either.

The fact of the matter is that the health service develops. It's not static. It changes depending on what the need is. In vitro fertilisation, instead of now being a orphan subject, it is now a major treatment funded by the health service and unfortunately it

11:18

Lord Winston (Labour)

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should be more funded. But actually we're getting a lot of success doing it in the way we are and we doing it in the way we are and we will increase that. It's also fair to point out that actually there are many treatments all the time in the health service which are the health service which are developing, which of course are not funded at the time when the debate is made, take the number of cancer treatments, which are extremely expensive, with the most expensive drugs.

Very often, of course, we drugs. Very often, of course, we have to deal with the internal market in the health service, but we persuade the people who understand the need for health care and who are actually faced with the patients and have to treat them in the best way, begin to understand that that money I won't, won't give way. Because forgive me, I'll answer the end. I'm almost finish what I have to say. The fact of the matter is that this is not a true argument, that many examples in my practice, probably about 60% of the time when people came to my clinic.

And it was always true, even when IVF was successful, where I refused them treatment, I refused to treat them not because there was no money, although we couldn't afford. To treat them, but because I thought the treatment would actually increase the distress they had. Because the treatment was so unlikely to be helpful. Actually. In fact, when that happens to people, it is a kind of death within them, but they have the great advantage that they can mourn that death and overcome it by doing other things.

Unfortunately, in this situation, when people are dying in the way they are often horribly. There is something that we need to try to do purely out of compassion.

11:20

Lord Markham (Conservative)

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11:28

Baroness O'Loan (Crossbench)

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My Lords, my Lords. are in the name of Lord Pannick and the noble Lord Lord Birt. What they propose is a framework for a propose is a framework for a completely new process outside that already created by this defective bill, requiring a service both at bill, requiring a service both at service and assistance, including the provision of assisted dying assisted suicide every day of the year. As has been said, public holidays, Christmas, Easter, etc. from 8 a.m. to 6 p.m.

unless the doctors in the house and the drug is being administered, in which case he has to stay. There's no impact assessment, as has been said of the cost of this new service, and it is a relevant matter. Concerns must arise, given the advice of the Health Secretary, that there was a there is already a lack of access to high quality end of life care, and there are tightened finances within the NHS, which could add to the pressure faced by dying patients. So these amendments require a new service, must be part of the NHS and we have heard arguments against that and I support those arguments.

They impose deadlines, they create processes for enforcing those deadlines, which will provide assisted death at a time when a person who is terminally ill will, in many cases struggle to access palliative care, and may never even be able to do so. The assisted suicide service will take priority. There is no process, as has been said, for a personal guide to get palliative care or necessary social care. Would the noble Lord, Lord Faulkner, be willing to accept amendments which would require palliative care treatment options to be available and accessible within similar structures and timeframes? We are being told that a system is to be established, which will have to take priority over all the other processes because, as we were told two weeks ago by the noble Baroness, the Minister, what Parliament wants the government will deliver.

But, my Lord, the government isn't delivering a health service despite the best efforts of many of those employed in it. We would be naive to think that the government could deliver this without diverting resources from other health service processes or from the justice system. There isn't a bottomless pit, the noble Baroness said last week in the context of the amendment, requiring that an application for an applicant for assisted death must have been recently visited by a GP. That that again faces poses operation of channels challenges for GP resources.

I ask the noble Baroness, the Minister, if the NHS cannot deliver an occasional visit by a GP, how could it deliver an assisted dying process? And I ask the movers of these amendments what will be the cost of them? We need to know and what will have to be sacrificed to pay for them. If the noble Lord, Lord Faulkner, is minded to accept these amendments, can he provide your Lordships with a costing of the proposed service in all its elements? My Lord, there has been no consideration of the consequences for people like GPS, 76% of whom already say that patient safety is being compromised by excessive workloads.

My Lord, the process which the amendments advocate is undeliverable having regard to the scarcity of the relevant personnel such as clinicians, nurses, lawyers, social workers, psychiatrists, it hasn't been impact assessed. It would require greater concentration of resources. There are major issues in relation to access for all people, and I am among those who have written to the noble Baroness, the Minister for an updated Equality Impact Assessment. If, for example, a person were to seek such death and to choose to die at home, then assistance in reaching this goal would have to be present and available every day between 8 a.m.

and 6 p.m. and when the patient decides that the time has come, the doctor is required under clause 25 to remain with the person until they have died or changed their mind. And my Lord, this process of assisted death isn't instantaneous can take up to 30 hours in some cases, such as one in Australia, which I heard about a meeting organised by the noble Lord, Lord Falconer. It took seven days and under the bill the doctor has to stay with the person.

Given the comments I've just quoted about the availability of doctors, can the noble Lord, Lord Faulkner, the noble Baroness, the Minister, tell us how he proposes to ensure that doctors are available to provide the service? Given the very public statements by the Royal Colleges and professional associations about their negative views of the Bill and the established shortage of practitioners, the amendments will give control of the processes of dying away from the Secretary of State to this assisted dying health service. My Lords, it is not a health service one.

When one examines the amendments, it's an assisted. It is an entire process and it should be called the Assisted Dying Service. Amendment 77 one requires that it has a regional structure, and that is it will validate training qualifications, provide licences, etc. Can the proposals of these amendments all the noble Baroness, the Minister, tell us how the structure will be established, managed, supervised and held to account? The primary point of contact, as we've heard, will be this personal navigator.

One of the difficulties I have with this, my Lords, is there's no definition in the 35 amendments tabled by the noble Lords of who might be a personal navigator, what qualifications they should have. There seems to be no requirement that they even have some form of medical, nursing, etc. qualification. Yet their task will be to ensure that the services required by the person concerned are delivered as required, and to the timeline set in the act. This presumes that the personal navigator is able to understand precisely what the person is seeking, and to ensure that the person understands the consequences of what he or she is seeking, not only in terms of death, but in terms of the difficulties which may arise after lethal drugs have been taken, and to record and to report on these timelines, and to enable personal navigators to assist people requiring assistance to obtain exemptions from the timelines.

This isn't a mere administrative job, my Lord. They'll have to be consideration with the person seeking death of what they want to follow in each of the timescales provided for in amendments two, 333013, two one, etc. it's complex. If assisted death can be made available in 30 days, but accessing palliative care takes months, will there be choice? My Lords, I will not rehearse the truncated timescales, but the effect of them would be that a person could make a choice for assisted death and be dead in 30 or 32 days, depending on the interpretation of the amendments, or in 18 days if death is considered to be imminent.

And as we have heard, suicidal ideation is common following the delivery of a terminal diagnosis, and it's often the case that people fear death and the process of dying. But that is remediable short term bout of ill health and my Lords of prognoses, as we have heard, only 32% in the weeks and months range are exercised, are accurate. My Lords, these amendments will not provide time for adjustment. People will be ushered down a path, a rapid path, and lost to their loved ones when time and the provision of care and assistance will almost inevitably result in a decision to live to the end with dignity.

The amendments impose time limits, which seems must be met. Yet a doctor may not be able to carry out that necessary first assessment within 24 hours. A second doctor, a further assessment with another 24 hours following the seven days of reflection. Can the movers of these amendments explain why the personal navigators will be given some sort of coercive powers? The personal navigator will not be able to force compliance with these standards, unless there is a disregard of all other professional commitments of those involved and consequential harm to other patients.

My Lords, the timescales of this bill are unachievable as things stand, and equally unachievable will be the 48 hour turnaround right through the year, even at Christmas, which is required that panels be established at a time when there is a significant shortage of lawyers, social workers and psychiatrists. The Royal College of Psychiatrists has said it won't engage, and it's profoundly unlikely that there will be any ability to provide such a service as is required by these amendments. And in any event, can I ask the noble Lord, the Minister and the noble and learned Lord Maude Faulkner, what safeguards exist against coercion when timelines of this compressed? What opportunity will there be for the considered professional assessment which will be necessary? My Lords, the noble Lord, Lord MacKinnon, and the noble Lord, Lord Harper, by a series of amendments, seek to ameliorate the situation created by these amendments, and I support them in those attempts.

But, my Lords, the amendments in the names of the noble Lord Lord Birt and the noble Lord Lord Pannick are simply unworkable at the present time.

11:37

Lord Polak (Conservative)

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I have great respect for for Lord Birt, and I think his practical ideas are are very practical ideas are are very sensible. But I think there's a much more fundamental problem which probably frustrates him, and that probably frustrates him, and that this, this whole. Bill, this is we're being the government is sort of hiding from us what in fact it wants to do. And I don't blame the Lord Faulkner for this either, because we're being encouraged to pass a bill which will put enormous obligations, as we've heard on the health service, its budget, its people, whilst at the same time noble Lords are given no direction by the government.

Will they pay? Do they have the money? And if they have the trained staff to deal with it? So whilst HMG hides behind this flawed private member's bill, noble Lords are being urged to legislate blind. It's not remotely acceptable or responsible for noble Lords to make life and death decisions when there is no clarity about the future intentions of the government. And so I go back to, to to Lord Birt. Great idea. But who pays for this? Lords.

11:39

Lord Lemos (Labour)

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I apologise. >> I apologise. >> To the noble Lord. Can I can I just remind noble Lords of the guidance of the House, which is that your Lordship should not summarise or repeat others at length? I know I try and find a length? I know I try and find a different way to say this every week, and I, broadly speaking, fail. And I also realise that your Lordships have spent a lot of time preparing your remarks, but it is my duty to remind you of the guidance of the House.

11:39

Lord Mawson (Crossbench)

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I have tabled two. it's the place where all this detail comes onto the floor of the House. And debates like this, even though they're complicated and difficult. Difficult. I've always encouraging to people like me and the people involved in this, even though they take very positions I like a lot, but I sat in the down the corridor listening to the debate there, which had lots of emotional stories on both sides of this debate and good points and all that, that.

But it was not this level of detail we are dealing with in this House. This is encouraging to me. My life has been spent in the East End of London on housing estates, dealing with practical issues, with a very grey area of the world. And often, if I'm honest, the dysfunctionality in practice and in detail of the NHS on housing estates, I have had to deal with the GP, who is doing female circumcisions in his surgery, that none of the systems had even noticed.

The GP that had given out bought a cheap fridge from G and Q and given out 10,000 legal injections and no notice because actually there was lots of ideology about race that was preventing anyone coming to terms with the detail of that. And my colleagues and I really got into the health system as the noble Lord Lord Deben knows, following the death of a young woman called Jean Wiles, dying of cancer in appalling circumstances with a disabled mother, a mentally ill dad, two children sleeping in the same bed and the absolute failure of the NHS systems and processes and machinery to deal with that stuff.

And we would not have built the Bromley by Bow Centre, which now has 55,000 patients and is starting to operate across the country with a whole programme I now lead. If it had not been for the noble Lord Deben who act as the then Secretary of State, actually intervened in a very serious practical matter following a senior level enquiry at the London Hospital, and enabled us to build the first working model of an integrated health centre that tried to deal with this complexity. The NHS, in my experience, and dealing with it with colleagues across the country, is broken.

It is in a great deal of difficulty. In my experience. Our GPS are overwhelmed by bureaucracy and a whole range of things and they're excellent people. So, my Lords, my point in making

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this, because I come from the world of practicality. So I'm sorry to intervene again,

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So I'm sorry to intervene again, but I would invite the noble Lord to address the amendment directly. I was. Just going to do that. So I

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Just going to do that. So I address the I address the amendment because I worry that whilst intellectually a navigator and this intellectually a navigator and this amendment seems very straightforward intellectually, what I'm trying to suggest to you what I'm trying to suggest to you is that the real practical world out there, when you engage with it, as my colleagues and I have done over the last 40 years, you see something quite different.

11:42

Baroness Coffey (Conservative)

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It's amendments two, eight, >> It's amendments two, eight, seven A and B and 771ZB. This my noble friend, I call on my noble friend Lord Birt we went to the same school, admittedly not at the same school, admittedly not at the same time, but I'm very conscious that he has come at this with an approach of actually a lot of research. As he set out. I, the noble Lord, knows that I disagree with him, but I do understand why he is trying to speed up.

But I do wonder if he has taken account of evidence presented already. The noble Baroness Lane-Fox of Buckley talked about I think it was CEO of mine, but also Marie Curie spoke about this, and indeed the Royal College of Psychiatrists, particularly thinking of the speeding up about that moment of reflection is really important. And by accelerating, I think the noble Lord is already suggesting that that while in his clause 774771 people should be, patients should be aware of their right to withdraw from the assistance process at any stage.

There is quite a lot in here, which I think sets out a framework that could be done through the NHS, and I completely agree with what the noble Lord Lord Stevens of Birmingham said and and others just indeed the noble Lord Mawson. It really does worry me about how if this ends up in the NHS, I think it will accelerate in becoming a routine end of life. And in my meetings with the Royal College of GPS, they've been very clear. They do not want this to be part of the NHS and they absolutely would resist it.

Being part of the NHS contract. I will give way to my. Just very briefly, can I just on that point and I think the point raised earlier about conflict of interest. One of the problems if this is in the NHS is the money, the drugs to the cost of the drugs to end someone's life, according to the impact assessment, cost £14.78. The cost of healthcare for four months, or the saving you would make from four months of healthcare not used would be £13,075.

And anybody with any experience of NHS budgets knows that that contrast inevitably will drive people

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towards being pointed towards assisted suicide. Yeah, yeah. Well, I do understand where my

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Well, I do understand where my noble friend is going with that. I intend to come back to some aspects of this when we get into informed of this when we get into informed consent, because I was somewhat struck by what the noble Lord Lord Winston said, where he declined to give treatment because he wanted people to, in effect, accept they were dying. I think is what he said. I better go back and check that I better go back and check that because I don't want to misquote him, but I've seen that myself.

I've seen that with my mother, where doctors just hadn't treated her. And then when it came to it, when it was near the end, we had to fight to avoid even having a DNR on the ambulance to get her to go so she could die at home in a place of her choice. That's true patient autonomy, not somebody trying to override that. In terms of thinking through, though, some of what the noble Lord has put forward in his propositions, others have already reflected on the concerns about working days and whether that's practical.

I'd be grateful to hear from both the sponsor and the Ministers what assessment they've done of these amendments. I'm also concerned in terms of 771, clause two G, providing publicly available information on assisted dying. How does that start to vary about what is considered advertising, which is explicitly ruled out in other parts of the bill? And the key point of my amendments is actually linking to almost this becoming its own service within the NHS. Now this starts to remove.

There are various clauses that start to remove powers from the Voluntary Assisted Dying Commissioner. This service would start to appoint the panels it's taking up at the moment. All the training, all the licensing and all those different things. Now it's my understanding that this does not happen in the NHS today. What your what we actually get and what I propose with my amendments is that for a start, we have a separate regulator through the Care Quality Commission also, that we have the General Medical Council undertaking the roles that they do for other parts of what happens in the NHS today.

So I think if the noble Lord Lord Birt brings this back at Report stage, he'll think more carefully about how to make this practicable, because I hope that the Minister will actually say this is simply not operable, even if well intentioned, and what the noble Lord is seeking to achieve. Now, the noble Lord Lord Mawson has just started talking about the East End of London. I think it's important that noble Lords consider carefully the evidence that has been given to this House, but also evidence outside about the real concerns of people from Bame communities.

It's very evident that people are in those communities seem particularly worried about this, and that has been communicated directly to this House through witnesses. But instead of not trusting the NHS as it is today to get the treatment, imagine as you go in and you're unsure, your GP is already overworked. Here you go. Here's some information. Somebody can hold your hand. It, I think, worry that too many people would actually stay away from the NHS when they desperately need treatment for other aspects of their lives, whether that's about addressing prostate cancer or other the rare cancers that we debated in the chamber last week.

The other thing, just to remind noble Lords, and I appreciate this is probably the third time I've said it, but for me, this is coming back to the practical experience of when the NHS was left to deal with end of life care. In certain ways, the Liverpool care pathway was so horrific that I cannot in any way see how it can be controlled. If we were to adopt the proposals put forward by the noble Lord Lord Birt, we saw it go badly wrong and I'm pleased that Ministers intervened at the time.

Eventually it took time, yeah, but that it did happen. And we need to make sure that instead of a lot of these regulations or these other aspects of running this service, if we are going to have it. And by the way, I do agree with my noble friend Lord Sandhurst. I think it should be more of an MoJ focus. Inevitably, it's become a big health focus. And what's not clear here in the what the noble Lords have set out in their proposals is how this interacts with the whole Wales situation.

But clearly, now that the sponsors of the bill, I think, have about 12 officials from Department of Health and Social Care working on this bill, I think it's 3 or 4 times the number of MoJ. Clearly, there should be some understanding of where this is, how it's going to work, and I genuinely hope that the Minister will start to share that. So this House can make informed choices when we're considering such a significant change in what could be the future of our NHS.

My Lords, I'm.

11:50

Baroness Berridge (Conservative)

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Grateful to the noble Lord Lord Moore for answering much of what would have been my intervention to would have been my intervention to the noble Lord, Lord Winston. And in my 15 years in your Lordships House it is the usual practice to give way, but I recognise that noble Lords have the prerogative not to accept an intervention. But what I do find surprising, and have never known before, is that the noble Lord is now no longer in his place, and that is, my Lords, not in accordance with the advice that the Chief Whip gave this morning, that we should treat each other in this House with respect.

The only additional point I would make that the noble Lord, Lord Winston, was referring to is I do believe that it is entirely different to talk about the amazing work that he clearly did that was really on the televisions. I grew up about the creation of life, and also as the noble Lord. Lord Markham has talked about the pathway that midwives give for the safe delivery of that created life. It is very different for us to be talking about the situation where the state would be paying for and facilitating lethal drugs to enable a citizen to end their own life.

Looking at the amendment.

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If I may, actually responding to the the earlier point, I believe both Lord Winston and Lord Mackinlay, who also isn't in this place, mentioned that they had appointments that they needed to go to, that I'm just saying that's where that's why I believe Lord Winston isn't here now. I just want.

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To I do hope that he will be writing to me personally about this in relation to the evidence on in relation to the evidence on which the noble Lord Lord Birt is basing his argument. I was surprised at the noble. The right reverend Prelate has mentioned the the Australian non-comparable, but in the impact assessment, the delivery model at 8.4 states that in most jurisdictions where assisted dying is legal, it is provided through the healthcare system. So looking for international comparators is an unusual approach.

But I do want to state that in relation to these 30 jurisdictions that we keep hearing about, some of them are like the Isle of Man and Tuscany in Italy, and only 13 of the 50 states in the United States. This isn't as many progressive politicians like to say. There is this wave and we must get with the wave, because actually, Denmark in 2024 considered this. The the Council of Danish Ethics said 16 out of 17 members voted for them not to introduce assisted dying into their jurisdiction.

And only yesterday the French Senate has not gone forward with legislation. So if this is in no way a sort of progressive train that we need to get with, the second point that I would make is in relation to the speed of these decisions for families. We know that the bill is philosophically based on individual autonomy, which is an anathema to many communities. So for families to know that within 18 days this was done as well will only compound what we do believe will be complicated grief.

And in relation particularly to fitting this speed of service in with what we know is increasing uncertainty of diagnoses for 18 to 25 year olds because of various positive effects of treatments for them. And sadly, with the deficiencies that the noble and learned Lord, Lord Faulkner has admitted, that exists with clause 43 in relation to advertising. I'm sorry, I don't think I'm a cynic, but I can see a competition. I can. I get to 18 years and 18 days and be the first young person to go and meet that milestone.

That is something we don't want to have that culture of speed in this process and limiting the reflection. And I also just finally want to say, maybe I'm the only noble Lord sitting here without the benefits of the pre-legislative scrutiny of a consultation white paper, but I do with many amendments. I'm thinking, well, how is this service going to fit together with a panel, or is it going to be a judge, or is it going to be a judge with a couple of other members? And that really is the deficiency that at Committee stage, I still think we are trying to put right pre-legislative scrutiny, the lack of pre-legislative scrutiny, and I

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don't know whether that is indeed possible. She raised the issue of speed, and it comes back, I think, to a point that Baroness Fox raised earlier, often in public policy earlier, often in public policy issues, there's a trade off between the speed of a decision and the quality of that decision. Sometimes quality of that decision. Sometimes whenever we short circuit or fast track decisions, it can inevitably lead to a greater level of mistakes

11:54

Lord Weir of Ballyholme (Democratic Unionist Party)

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lead to a greater level of mistakes that are that are made. But in a wide range of other public administration or public policy decisions. There's at least the advantage that if a mistake is being made, there is the opportunity at a later stage to come back and correct that, to perhaps appeal that decision, to review it, to reverse a mistake that has been made. Of course, the major problem with this that if we do fast track things and it leads to a death which shouldn't have occurred, we cannot bring the person back to life.

That's why I think there has to be. I agree, perhaps with one remark. I think in response to Lord Markham made, which was that he said he perfectly acknowledged that in response to an intervention from Baroness Berger, that that we should actually be having the safest possible system. I see him nodding in place in relation to that. I find that very difficult, therefore, to say if we're having the safest possible system with a system, if these amendments go through which fast tracks those decisions and inevitably will lead to greater levels of mistakes and greater shortcuts.

11:56

Baroness Finlay of Llandaff (Crossbench)

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In introducing this group of amendments, the noble Lord, Lord Burke, I think, to describe the proposals that we've got in the proposals that we've got in the Bill as potentially chaotic and prolonged as one of the reasons that he was introducing these and these this group of amendments is in some ways something or nothing. The proposals make the case for a profound imbalance, with assisted death actively facilitated, accelerated and led through the dedicated service with speed. As the noble Lord Lord Stevens has said, this is not in scope for the NHS and NHS services and we have to look also at the NHS Constitution.

So I ask the Minister whether, in the light of some of the proposals, there is a plan to rewrite the NHS constitution as well as the fundamental principles of the NHS, as read out by my noble friend Lord Stevens of Birmingham. The amendment structural conflict is between efficiency and caution. So can the noble Lord Lord Birt in responding, explain how the clock will be stopped and by whom, and whether a request to shorten the process will trigger enhanced scrutiny, and how that would be done? And will all the assessments be face to face to improve the chances of detecting coercion to death? And will all the contacts with the navigator be recorded and audited, so that one can be sure that the auditor is not themselves acting in a profoundly subtle and coercive way? Now the navigator seems to bypass a search for many things, and without the amendments in the name of the noble Lord Lord Mackinlay and others, I cannot see how that imbalance would be corrected.

So at least the imbalance is there. But there is something about amendment 77 one, because it gets to the heart of the problem, and that is it tries to stick all of this as a profound NHS responsibility. The NHS, as we've currently heard, cannot cope. We have patients on extra beds in the middle of wards. We have patients in corridors being looked after seriously ill people. We have patients sitting on plastic chairs waiting for a bed, sometimes dying on those plastic chairs.

The NHS is not the place to have a dignified death in the hospital setting in a lovely, planned way, as seems to be being described and designed by some people. People are working into the ground to try to manage the workload that they have at the moment and has have been said. The workforce themselves are indeed completely on their knees. GPS are already overstretched. Evidence suggests that assisted dying would require around 30 hours of an individual case. Yet many palliative care doctors and psychiatrists would opt out, therefore decreasing the pool.

Also involved in the way that these amendments are put together. If I might just respond to some points that have been raised during debate over the question, the public want this in polls. When the public are asked what they understand about assisted dying, 52% say it's your right to stop treatment. Well, they already have that right. Nobody should be treated against their will and they should be supported in that decision. And 17% of people think that assisted dying is hospice care.

We've heard about in in remarks made today about people dying horribly and we've heard about research moving progress forward. So I ask the noble Lord noble and learned Lord, Lord Faulkner, why is there no requirement in this bill that everything which is undertaken is subject to rigorous evaluation and research, with the data available to be looked at in detail.

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And in the spirit of helpfulness on public opinion and whether people understood the question. people understood the question. Again, there's numerous surveys on this. Probably a very, very clear one is the wording is do you think one is the wording is do you think doctors should be allowed to end the life of a terminally ill patient at their request, for which there was support of 75% of 18 to there was support of 75% of 18 to 34 year olds, 80% of 35 to 64 year olds, 78% of 65 plus year olds.

I don't think you could get a question clearer than that, or a

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level of public support greater than that. I'm grateful to the noble Lord

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I'm grateful to the noble Lord for his. I'm grateful to the noble Lord for his intervention, but I actually think we need to stay actually think we need to stay focussed on the amendments in this group and not get diverted off. And that's what I'm trying to do in terms of palliative care provision. terms of palliative care provision. I, I am extremely worried that the amendments put down to amend the amendments of the noble Lord Lord Birt had to be limited because palliative care is repeatedly being deemed out of scope in this bill.

And that is a major problem. When we hear about bad deaths. We know that actually, if clinicians act with urgency and have a 24 or 48 hour limit before they call for specialist palliative care intervention, so there is rapid intervention with highly specialised knowledge that the the all of the outcome measures show an improvement using things like the iPod scale and so on. And family reported outcomes can also improve. So to view bad deaths as something that we should just leave going and tolerate, and that the only solution is the proposal and in these amendments, I think actually does not recognise the reality of the services that are available already.

The noble Lord, also, in introducing his amendments, quoted extensively from Australia and painted it out as being everything perfect. I just would like to briefly countenance that by quoting from the Honourable Robert Clark, who was the Victorian Attorney General in 2010, to to 14, who wrote has written about assisted suicide, the Australian Experience, and he describes a change in attitudes with the ethos of the medical profession moving away from the practitioner's primary duty to solve the problems the patient has, and a grave risk that this will leave over time to doctors forming views that the patient ought to be opting for assisted suicide and becoming inclined to regard patients that they they should go down that road.

He also highlights that there are things going wrong. I won't detain the House because of time, but I do think there are other alternatives. And he does point out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Even though I know that there is a clause in the bill which tries to avoid that, but there is concern that that clause is incomplete in the bill.

So I do think when we quote the international evidence, we do also have to be quite balanced in it. The proposal, in the amendments, in the name of Lord McKinley, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment, and it does begin to move us towards viewing some kind of proposal like this as being completely outside NHS services, but not planted in the NHS. And then, of course, the funding question arises because if funding erodes palliative care funding, which has happened in other places, then we really have a problem because the evidence recently to the Public Accounts Committee showed that if you've got specialist palliative care in place and available as it ought to be, the savings to the country would be about £800 million a year.

12:05

Baroness Fraser of Craigmaddie (Conservative)

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Yeah. >> Intending to stand up today. So I apologise. But this group hasn't gone at all how I thought it would gone at all how I thought it would go. When I looked at amendment 771 and the Assisted Dying Health and the Assisted Dying Health Service, I was confused because I had thought that navigators might take a similar role to those of independent advocates. And we have a group about the importance of independent advocacy, which I'm a huge supporter of, and who can advise people on other, whether it's care or health or other treatments.

And that's coming up in 19 groups time. But what it seems to me that that this, that amendment 771 is doing is, is sort of in it's it's illustrating the flaws of the entire bill, whether it's geographical provision or training and qualifications, the right of practitioners to withdraw, and actually the need to support vulnerable people. So we've also had a debate today about funding and funding of what would be assisted dying health service. We have another group, group Group 30, which I hope we get to on the on the provision of assisted dying service by groups other than the NHS.

And may I suggest noble Lords opposite to to take the noble Baroness Royall suggestion to press the government to provide clarity before we get to that group, both on the funding of an assisted dying service, but also following on from the noble Baroness. Lady Findlay's point on the funding of the future funding and support for hospice care. Because I have an amendment in that group 30 and the reason I put it down was because I think that the the proposals of this bill have missed a bit of a trick, because I think if you want to set up an assisted dying service, then you should do so in parity with the current arrangements for the hospice service.

So if we understand what the funding for hospice service is going to be, then we can have our debate in Group 30 on alternative provisions.

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In my intervention I mentioned future of palliative care. I did not mention the costs of assisted dying service, which I'm very dying service, which I'm very willing to ask for as well. But at that stage I was focusing on palliative care.

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palliative care. noble Lady, for her intervention. I think both would help us because I think we've got we've got the confusion about the future of support for palliative care, and we've got the confusion as to we've got the confusion as to whether or not the funding of assisted dying service will or will not take away from other services within the current NHS provision. And just finally, I just want to say that it's very different to the Scottish Bill, which very specifically does say that it's

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going to be within the NHS. Before the noble Baroness gives way. It may aid the House to know way. It may aid the House to know that it was before Christmas that the Minister and the other place the Minister and the other place indicated, via a statement, that the government is currently developing a palliative care and developing a palliative care and end of life care modern service framework for England, and that it's planned publication date is it's planned publication date is the spring of this year.

And in that context, I think, I hope that the government and the Minister here will hear the calls from people both supporting this bill and those that are not supporting this bill, that it would be very, very helpful to us all in the deliberations of this bill. If that framework and the details of it and the funding of it are provided to this House as soon as possible.

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Yeah. Lords, the. Just on that point that she's mentioned about funding, mentioned about funding, unfortunately the Minister has now communicated it won't happen until autumn 26, which any former Minister knows means December the 24th for this House gets to know

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you would like. My Lords. I wonder.

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Can the proposer of these amendments Lord Birt tell us, has he got any indication from the relevant Royal Colleges that their members would be available for this

12:09

Lord Empey (Ulster Unionist Party)

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service? The idea that you're going service? The idea that you're going to have senior clinicians on a 24 hour basis, 365 days a year, I wish hour basis, 365 days a year, I wish that our facilities had sufficient capacity, but, my Lords, it's nonsense. There's not the remotest possibility of the National Health possibility of the National Health Service and the relevant colleges and the relevant clinicians being available. And if I am wrong, and if the noble Lord Lord Birt has got an indication from from them that their members will be available, then the sooner we get that information here, the better.

But I just cannot see it. I mean, we can't even deal with what we've got at the moment, never mind adding to the burden. But on another issue I have to say to the noble Lord, Lord Falconer, it's 12:10. The time we get this group finished, we'll be at the lunch break. And I have to say to the noble Lord, and I said it last week, if we're going on at the rate we're going, he is partly responsible because he has got to bring forward meaningful amendments.

So we see the colour of his money now and not in weeks to come.

12:10

Lord Falconer of Thoroton (Labour)

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We're debating other people's >> We're debating other people's amendments at the moment. This debate is particularly debate has debate is particularly debate has raged pretty far and wide. These are not my amendments. They raised three particular issues. First, should there be a new organisation, assisted dying health Service? Secondly, should we ensure a different and more expeditious series of arrangements than that put in my bill? And thirdly, the Commissioner should only act as a regulator. Those are the three essential parts.

I think there is merit in much of what the noble Lord Lord Birt has said. I'm not in favour of an assisted dying help service. Secondly, my bill sets out very, very detailed provisions for safeguards which are longer and less flexible than that proposed by the noble Lord, Lord Birt. And as far as the Commissioner being solely a regulator, I'm not in favour of that. I think you do need a regulator, and the CQC has been suggested in relation to provision.

That seems quite sensible. I simply rise to say we've raised so far and wide. I'm slightly miffed at the idea that the Lord MP is saying that I'm detaining people from their lunch because we've had this long debate.

12:12

Lord Empey (Ulster Unionist Party)

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Well. well. The reason I raised the point was merely to to indicate the length of time this is taking, and the fact that a lot of the motions that are on the Order Paper and the proposals could be addressed if we had amendments put forward by the noble Lord, Lord, which he indicated in an email last week, would be forthcoming. And they're

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not here. Just say to the noble Lord who's raising this point? The point he's raising this point? The point he's making, I think, is that the reason why the noble Lord Lord Birt put down these amendments is because down these amendments is because it's not clear from what the government has said or what the government has said or what the bill says about where this service is supposed to be. And I see the noble Lord Lord Birt is nodding at noble Lord Lord Birt is nodding at that.

The point is, if the sponsor of the bill had set out on the face of the bill, more detail about how it was going to work, where it was going to sit, there had been a proper process. Many of the amendments that have been tabled by people with concerns would not have needed to have been tabled, and we would be moving faster. It's because of that gap and that failure that is the sponsor's responsibility, that this is taking a long time, but it's necessary scrutiny to get the bill right.

That's what the public would expect

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us to do, my Lord. I do think that we can clear

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I do think that we can clear quite a number of these things away by taking one central issue. The by taking one central issue. The big problem about government is that it isn't a single issue that that it isn't a single issue that faces you. It's a whole range of issues and you have to get a balance between them. So when we balance between them. So when we talk about cost, it's perfectly possible to say that there is a majority of people who want this thing, and there's a majority of people who want that thing.

The Minister and the government have got to decide how they share the money that's available out between

12:14

Lord Deben (Conservative)

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these things, and that is crucial to any decision made by this House. to any decision made by this House. And my concern is that we are not facing up to that. This is a single issue being presented to the House, issue being presented to the House, as if it can make decisions about single issues, irrespective of the single issues, irrespective of the effect of the decision that they make on all the rest of the single issues, which people also have strong views about.

If you ask the public, did they want more money for palliative care, they would almost universally say yes. If you ask the public, did they want a National Health Service where they could actually get an appointment with their GP within a week, they'd say, yes. If you ask the public, did they want a National Health Service where there was someone who helped them through complicated arrangements? They would say, yes. The problem for this House is that we have to decide.

First of all, what is the burden that these proposals place upon the National

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Health Service, the judicial service, the government as a whole. In terms of hopefully being

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In terms of hopefully being helpful? The it is in the impact assessment, it is 28 million or as

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assessment, it is 28 million or as I said, 0.000175 of the NHS budget. I'm afraid.

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I'm afraid. I I'm sorry. I'm perfectly happy to accept the intervention. And I do understand why Lord Birt didn't accept any intervention, because he might have found it difficult to answer the questions that we are asking. But the point I'm making is very simple and it still remains. We have to make a decision always among priorities. The problem with this decision is, and that's why it should have been a government bill and not a private member's bill. Is that as a private member's bill, it is a single issue bill.

It's promoted by people who want this to be decided, irrespective of its effect upon everything else that happens. And it is not acceptable, it seems to me, for the government and this is the purpose of my comment. It isn't about how much the proponents think is going to cost, it is about what is the effect of this over the rest of the National Health Service, and where is it going to fit if this bill is passed and the government really cannot get up and say we are entirely independent and we really it has got to say to us, if this bill is passed, where do they see it sitting? Because the proponents of the bill have not expressed this.

What is the real cost? Not the sum of money, but the effect of it on the rest of the service provided. And thirdly, it has got to say to us, how does that impact the essential demands that the public have for so many other things? Now we can argue about what the public thinks about this bill, and I'm pretty sure that I have a view that they think about this bill rather different from what the bill actually is.

But we can argue about that. But what we do have to say is that the public also has very strong views about what money should be spent in other areas, and we have to get the government to tell us how much it is going to cost. From the government's point of view, what will be the effect on the other services provided, where it is going to sit if it is passed, and how are they going to overcome the problem that many of those who may be asked to support it have said they won't? Those are things for the government to tell us, and so far, the government has been unable to put answers to any of those questions, which is the reason.

The second reason, the other is the point that the noble Lord has just made about amendments. But that's the second reason why we have constantly to go on in detail to argue about this bill.

12:19

Lord Rooker (Labour)

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Example. >> On the. >> 8th of January, a column 1416 Lord Stevens made a short speech Lord Stevens made a short speech consisting of about six specific questions. One of them was about the interaction of the health the interaction of the health service and this bill. Later on that morning, I said to my noble friend in intervention, he should come back within the next ten days and answer those questions. The fact that he's refused to do so, and the suspicion is he has no intention of doing so, is why the amendments will keep being raised.

And that's basically the point that Lord MP was making. There is a suspicion that they won't be answered, and if we can do that, then we could make more progress anyway, because of the nature of the amendments that are down.

12:20

Lord Gove (Conservative)

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I'm wholly in agreement with Lord Rooker and indeed Lord Deben that greater clarity, both from the that greater clarity, both from the promoter of the Bill and from the frontbench, would assist the House in making sure that its mind can be made up on these delicate issues? Lord Birt used to be my boss when I was a junior journalist at the BBC. I owe him a great deal, and in framing this amendment, he has shown that a fine mind, by insisting on speed and precision, can show us just what expedited delivery of a public service can achieve, if only the skill with which Lord Birt has ensured that the ratchet moves forward at speed in this legislation had been applied, for example, to our planning system or to any of the other areas where government is laggardly and failing.

And as Baroness Fox of Buckley pointed out, if the same degree of precision had been applied to the operation of our courts and tribunals, we would not need to be contemplating the end of trial by jury. But in putting forward this proposition, I fear that Lord Birt is guilty of falling prey to two fallacies. The first is the gadarene swine fallacy, the idea that because so many are moving in one direction that we must follow expeditiously. He cited, of course, the fact that Jersey has voted for a form of assisted dying.

And of course, we're aware the debates are carrying on in Scotland and Wales. I shan't go into the devolutionary and union ramifications of those debates here will return to those later. They're critically important. But as was pointed out by Baroness Berridge, the arc of history does not bend in any one particular direction, and certainly not in the direction that Lord Birt wishes to see it bend. We have been reminded this week that Denmark can say no to being told what to do by others, not just in geopolitics, but in other areas as well.

What we can learn from Denmark, and indeed from the French Senate, is that the consideration of the detail of legislation matters. And that takes me to my second point. The other fallacy, which was inherent in his speech is the Robespierre fallacy, the belief that one can discern and interpret the general will and then push in a particular direction, as we've heard on the floor of this House, opinion polling on the question of assisted dying gives us almost the conclusions that we might want to have.

I was struck by the opinion polling cited in the British Medical Journal, which was cited by Baroness Finlay, which pointed out that the majority of those asked, when they were compelled to share what they thought assisted dying meant the majority thought that it either meant the withdrawal of existing treatment at a particular point at the request of the patient, or improved palliative care. Now, of course, Lord Markham cited other opinion polling as well. But the critical thing is that that opinion polling points in different directions.

It causes me concern, but it is the purpose of this House and the purpose not to attempt to di general will and to enact it, look at specific legislation and to decide whether or not it is fit for purpose. And that takes me to another point about the assisted dying health service and question for the promoter of this amendment, for Lord Birt, for the promoter of the bill, Lord Falconer, and of course, for the frontbench. It is undoubtedly the case that if the legislation that were sorry, if the amendment that were standing in his name and Lord Pannick name were put forward, that the process would accelerate relative to that which is contained within this bill, and yet at the same time, it is the case that a new service is being set up, which has a number of colleagues here have pointed out, might draw resources away from other aspects of the NHS.

How is it possible that a service that is set up explicitly to accelerate, to be a concierge service in that way will also attract, be staffed and operate in a way which ensures that at every point, objective, neutral, balanced advice is offered, is it not in the very nature of those services that those staffing it? And one has to ask who would volunteer for that role? Who would be paid for? That role? Will become

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engineers of a particular purpose. Exactly. Is it not the case that those who would move towards recruitment who would move towards recruitment in this area would be people who would be motivated? I'm sure, from the best of the most idealistic of the best of the most idealistic of motives, but those who would want to advance the path to death and to to advance the path to death and to accelerate suicide, rather than to incur reflection. And that takes me to a question for Lord Faulkner.

to a question for Lord Faulkner. Lord Filkin might well say that this is an amendment from the back Benches, not something that he has been party to, and that we, as the House might consider it overall, and he might well say that he himself has his own timetable in this legislation to which he's attached, that he would like us to pay particular attention to as we reflect on the bill. But the question for Lord Faulkner is if he could, would he back Lord Birt and Lord Pannick amendment? Is he in sympathy with the desire to accelerate this process? And it is not a enough for him to say, look, I haven't put this forward.

The key question is if he is in sympathy, will he say so? And if not, why not? And if he believes he is not in sympathy, I will. I will give way, I will, I will give way. If he believes that he is not in sympathy, is that because he thinks it is right that there should be appropriate reflection, greater reflection, and that there is something momentous about this decision? And is it also right that

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he believes that this would mean a diversion of resources? I'm very happy to give way. I support the safeguards in my

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I support the safeguards in my bill. I support them because I think they are the right safeguards. think they are the right safeguards. So I do not support the proposals made in relation to that. I think the bill has got to be properly safeguarded, and I think my bill

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safeguarded, and I think my bill gets the balance right. I'm grateful to the promoter of

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I'm grateful to the promoter of the bill for that, but that is a broad defence of the legislation as written. And it takes us to the question for the Minister. The critical question for the Minister, which relates both to resource and to timing, the government have committed additional money for palliative care for hospices and that is welcome. £100 million for adult care in hospices, £80 million for children's care in hospices. But those who lead the hospice service say that that additional money has already been swallowed up in additional costs.

It does not augment palliative care, and yet money is going to inevitably be diverted if we pass Lord Pannick amendment and set this service up. And of course, money will be diverted as indeed the promoter of this bill acknowledges. And yet, as Lord Stevens has pointed out, we have not had from the government any adequate response of what additional resource might be devoted to palliative care, despite the fact that we had a national report into end of life care produced by Marie Curie Cancer Care and others more than 15 months ago, there has been no adequate response to that report, as the former Prime Minister, Gordon Brown, has said, it is unconscionable that we should pass this bill.

Until we have had that response from the government, it would be illuminating to know what the government's plans are. Are resources, not just if this amendment is passed, but for care overall. But there is another responsibility on the front bench as well. Is it the case that the in the particular framing of the bill that we have in front of us, that a future government or administration could create the service that Lord Birt wants by the simple assertion of a Statutory Instrument? 90 minutes debate, no proper vote, and then suddenly the creation of exactly what Lord Birt wants with his assisted dying help service.

And it will not be good enough for Ministers once again to talk about studied neutrality and to canter through the speech that may have been written for them by diligent public servants in their own department. We need to know if this bill is passed. Could it be the case that the service that Lord Birt wants could be created by Statutory Instrument without appropriate scrutiny? Because if it does mean that if that bill does mean that, then what we know is that we are creating a bill with holes, opportunities, lacunae, slippery slopes, whatever language you may wish to use, a bill which is in itself unsafe.

12:29

Baroness Royall of Blaisdon (Labour)

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Yeah, yeah. >> Yeah, yeah. >> I'm not a whip. I have been here all morning, and I think that many all morning, and I think that many of the issues have been debated at length this morning, and I think the questions asked by the noble Lord Lord Gove are very pertinent, but I would suggest that perhaps it would be good to hear from the front benches at this stage.

12:29

Lord Moylan (Conservative)

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Yeah. >> Yeah, my Lords. >> My Lords, I'm all right. My Lords, I will I'm going to be brief. Lords, I will I'm going to be brief. I only want to make one point. I'm slightly surprised I'm making it because it's one that I would have because it's one that I would have expected others to have made in the course of this now quite lengthy debate, although it was hinted at by my noble friend Lord Harper and by the noble Baroness, Lady Fox of Buckley, and that is to do with public reaction.

The noble Lord Lord Birt said that in Australia, a very large percentage. I'm afraid, I'm afraid I forget the figure, but a very large, large percentage of applications for assisted dying came from people with cancer diagnoses. Last week we debated and and gave a Second Reading to the Rare Cancers Bill. One of the features of rare cancers. And collectively, they're not that rare. Collectively, they account for over 40% of cancer diagnoses. But one of the features of rare cancers is that the prognosis at the time of diagnosis is so short in many cases that they would be immediately be in scope for this bill.

And what these the effect of those cancer diagnoses and many of us have had or in our family, we have had that experience. The effect is absolutely catastrophic and it creates a huge sense of anxiety, first of all, anxiety about how one is to going going to go through this process. What does it involve? Secondly, the obvious anxiety of whether you're going to be able to start your treatment within the NHS target deadline and if if these amendments were adopted, what families will see is that while they are left in their anxiety, those who opt for assisted dying will be given a Rolls Royce service.

They'll be given a personal navigator. They'll be expedited through the process. They're hand-held at every stage, something which the NHS simply can't afford to do. In the case of people who are suffering from cancer and want to live. And I think there will be a profound sense of injustice and indeed revulsion if these amendments are carried and such a service is established, it's politically and in real. In real,

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it is simply unreal what is being proposed. It cannot advance. Here.

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Here. Here I have listened carefully to what the noble Lady has said, to what the noble Lady has said, but I do believe it's important that members who feel that they have a contribution to make, that

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have a contribution to make, that they're able to make that contribution without being cut short. Forgive me. I did not realise

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Forgive me. I did not realise there were other people who wish to speak. It was a pause.

12:32

Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)

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I'd like to thank you for that. I find that this has been a telling debate thus far, because we are debating something and we're told some of the points are based upon opinion polls that are taken. We are not an elected chamber, and therefore we don't have to be swayed by how we're going to get elected the next time. And therefore, it is so important that we do not make laws on opinion polls, but in fact, we carefully debate the issues and therefore we I trust that we make mature decisions, seek to get the bill right, because the issue that we're debating is one concerning life and death.

The other thing I found somewhat surprising, whenever it was talked about the cost and a lot of persons are rightly demanding an answer concerning the cost that the noble Lord, Lord Markham, has a number of times mentioned the cost, I would suggest, and I was in this house whenever he was a Minister. He's not now answering for the government. I believe it's important that the answer comes from the government Minister and give us the up to date costs, because in actual fact, any of these issues that have ever happened, costs do not minimise over the years.

In actual fact, actually they increase and the cost will find at the end of the day escalates. We heard yesterday that the cost of the. It would be 3.4 billion yet suggested on the the the the benches opposite it was 34 billion. And so therefore I'm sure that members realise that there's a quite a difference between those two. Maybe there's a point in between level between 3.4 or 34, but nevertheless we're talking about massive sums of money and we are talking about money that will be taken from, could be taken from another part of the health service, which in many places of the country, and certainly in Northern Ireland, the health services is, is, is crying out for money and they need every pound that they possibly can get.

But I do believe that this bill has been defective as it came from the other House. But I do believe also what has been proposed by the noble Lord Birt in actual fact makes the bill worse. The proposal here undermines choice even more. There's no equity of access under these amendments. Now, what genuine choice is there? If you get an assisted death within 30 days, but you have to wait months for palliative care, that you need palliative care, which is not available in many parts of the province and certainly not the country, certainly not equally available right across the country.

So I would ask this question do the supporters of these amendments accept similar amendments which require palliative care treatment option to be made available and accessible within the same time frame as what is given? Now? I know they might say yes, we would accept that, but it's not a reality. There is no reality that within 30 days you will get palliative care because it is not available in many parts of the United Kingdom. How is it fair that terminally ill people get a personal navigator to support them through the process of getting an assisted death, but they don't get a personal navigator for gaining access to the palliative care they desperately need.

I do believe, noble Lords, that there are issues that need careful reflection. And can I say, in the light of what the noble Lord MP said, I have in debates over past, in the weeks we've been debating this, I noted that the noble and learned Lord Faulkner did say that he would reflect on some of the issues that were raised, but up to this time, I haven't heard really what that reflection has brought about and changes that need to be made in this bill.

So therefore could we get and perhaps it would speed up the debate if we could get some knowledge of some of the reflections that he has and some of the changes in the light of the debates that are already taking place that he will actually make, to make this bill more acceptable to many members, noble Lords in this House. But the issues I believe that we need to continue to reflect upon is the extraordinary speed that is suggested by noble Lord Birt Anthony undermines safeguards, mandatory timelines, forced decisions.

Without proper investigation, pounds must decide within two days of referral, even over weekend. Now I know of no other decisions you made in Hansard that you can be promised that, and also no judicial precedent for such years, because courts take months for life and death decisions. And yet this process is so fast. And then we come to prognosis inaccuracy. And that seems to be ignored. As I said to Lord Pannick in the previous debate, I have known people who are given a six months prognosis, and they lived three years later.

So therefore there is no prognosis in accuracy. Rushing assisted death risks, premature deaths. And then we come to mental health risks. Reflection periods cut to 24 hours, experts warn depression after diagnosis is often temporary and treatable. Why can't patients get assisted death in 30 days but wait months for palliative care? And also, amendments erode protections rooted in law and ethics. Suicide prevention remains government policy. And could I ask the Minister in conclusion, these questions? How can panels make life and death decisions within 48 hours without sacrificing due process? What safeguards exist against coercion when timelines are compressed, as suggested by the noble Lords and their amendments? And how will the National Health Service meet these demands? When GP and social workers are already overstretched? I think what we have got in the past debates and up to this moment, numerous questions, but from the noble and learned Lord Faulkner and the frontbench in the government, we have got very few, if any, real answers that we can hold on to.

12:40

Baroness Grey-Thompson (Crossbench)

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My Lords, I read. lot of interest in terms of whether a different way would be possible, and I thank my noble friend for tabling them. But in him raising tabling them. But in him raising Australia, I agree with Bishop of Newcastle. It is not an accurate, accurate comparative country to look at and actually what it does make me feel even more strongly. And the Minister will have received a letter this week from many of us asking for the impact assessment to be looked at again, and one of the reasons for that is that the impact assessment looks at about the first ten years of Oregon.

And if we compare data between Oregon and Australia or actually the state of Victoria, it took Oregon 17 years to reach the same number of deaths that they hit in the state of Victoria, not Australia, the state of Victoria, in the first 12 months of their bill passing. And I do accept that the first voluntary aided death in Victoria was described as beautiful. But in the time that that legislation has been acted, it has thrown up many, many issues.

20, 23 to 24 there were a number of complications with intravenous injections. There were technical problems. In 5% of cases, there were 10% of cases where the death took longer than expected. One person took seven days. In 29 responses. The death took more than two hours. In seven reported cases, it was more than six hours and the longest was 11 hours. So I think we have to be really careful painting other jurisdictions, you know, as as the sunny uplands. And of course, there was a case that was reported in the Times on the 22nd of March last year, where the man had requested the drugs to end his life.

He decided he wanted to have longer left to live, and his wife gave him the drugs anyway because, I presume she decided it was his time to go. So it is a very different jurisdiction. But I think it again raises the issues of coercion. And we also have to note with Victoria that since their legislation has passed, elder suicide has risen by 50%. So these are the things that we must take into account when we are looking at what happens in this country.

Also, I do thank the noble and learned Lord for arranging a meeting last year where we were able to meet some of the Australian medics, but that gave me even more cause for concern because in a telling of a story of a man who had taken a while to come to the decision to have an assisted death, the day he finally decided to have it, he started taking the obnoxious mixture he didn't want to carry on, and his family said, but dad, you've decided to die today.

You need to keep taking the mixture. So all these things do worry me. When we look at the speed with which these navigators might be able to push someone towards assisted suicide, I think in principle a navigator sounds great, but they're only pushing people one way and we don't know enough about the training. Whether potentially an AI bot might be used at some point and has been raised. You know, this could potentially just be debated in 90 minute debate of Statutory Instruments.

So I think we have to look much more carefully at at these areas. And I don't think these amendments are adequate for what we want to do. And my noble friend also raised the extremely sad case of Nick Dimbleby. But as far as I understand, with his condition of MND, he would not be eligible for assisted suicide under this bill. So I would welcome the noble and learned Lord, Lord Faulkner to confirm that. And it's been raised in different ways and on different days about our experience of pain are very different.

We've in the debates, we've talked about incontinence, what one person thinks is awful. I kind of live with it. It's OK. My noble friend talked about someone being peg fed and unfortunately, the the inequality of the system in this very chamber. The fact that my noble friend Baroness Campbell is not able to respond in this group of amendments because she can only speak at the start, she can't intervene later, so she's not able to listen to the debate and pick up points.

I'm sure she'll be able to raise it. And I sort of beg your tol have to raise this in another group. But talking about being being peg fed has enabled her to survive and to contribute. So, you know, I, I do worry about the inequality of, of this chamber in terms of actually people being able to to contribute properly. However, in terms of specific amendments two, two, three, which looks at, you know, it could happen in four days, I don't believe there is any system that will be able to, in the period of that time, assess whether somebody has been coerced.

Amendment three, three, six, which says the second assessment could happen after a period of reflection after seven days. Well, that doesn't even vaguely take into account the five stages of grief. And there aren't that many papers on people with spinal cord injuries, but one that I've read says it can take up to seven years for a wheelchair user to get over the experience of traumatic injury. So if you take that into account, people will be forced very quickly through to to ending their lives when the ability to deal with the issue that's in front of them hasn't been taken into account.

And amendment 571, which talks about 18 days, I don't know any system or policy that we have in a country that gets the right support around a disabled person in 18 days, it just doesn't exist. And we mustn't forget that anybody with a terminal condition by nature of that has a disability. So if I was trying to get a new wheelchair, the absolute minimum time it would enable me to access a wheelchair through the NHS would be 18 weeks. And that is if myself or another wheelchair user had the most simple wheelchair that was available.

A complex wheelchair could take 18 months, and I've got cases in my inbox that have taken up to 3 or 4 years for a chair to be provided, and jumping very quickly back to Australia. Look, a gentleman there requested to end his life because he was told the wait for support service at home was ten months and he just decided he couldn't live with that. So, you know, these are the things that we must take into account. I agree with the noble Lord Lord Gove in terms of polling, I I'm sure your Lordship chamber will be very grateful.

I've crossed out pages of polling that I was was going to quote, but what it does show is that there is a lack of understanding of what assisted suicide actually means, and a lot of people don't understand that you can actually refuse disease modifying treatment but still receive palliative care. So actually, in terms of the education, there is so much more we need to do to educate people in terms of what services they can access. The final thing I want to say was a report that came out from the Commons Library on the 8th of January, 2025, and again, this is about addressing the the speed of which the navigator might push somebody through.

They looked at data of 300 patients who were referred to hospice care in London for palliative care, 33 of those 11% had a very strong desire to hasten their death. But after four weeks hospice care, a quarter no longer desired a hastened death and the remainder had a hastened death dismissed. So the amendments in front of us wouldn't give any time to allow a person to absorb any information, or to be able to actually clearly make that decision. And I don't think that in this current format would be an addition to the bill.

We hear a lot about this bill being enforceable and workable. We've been told it's the safest bill in the world. I would like the noble and learned Lord to commit to making this bill safe, not just safer.

12:48

Lord Kamall (Conservative)

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My Lord. This has been a long and comprehensive debate, and a and comprehensive debate, and a number of points have been raised, and I will try not to hasten it. Sorry, I will, I will try and hasten it, actually, in many ways, hasten it, actually, in many ways, actually. Well, maybe we should slow down, but can I start by thanking the noble Lord, Lord Burke, for the amendments in the group and and the whole idea of establishing the assisted dying Health Service as a noble Lord said it is based on well established experience, and I think it seeks to address a number of important questions that the current draft of the bill does not address.

How will important services, such as care for the families of those who are seeking assistance under the bill be provided, who will publish the appropriate information about the provisions of the bill in the public domain, and how will those seeking assistance be supported throughout the process? And I think these are thoughtful amendments. But a number of Lords are quite rightly raised concerns about the potential downside to speed and efficiency in this case, in amendments. In my name, my noble Lord, Lord McKinley, seek to ensure that a personal navigator allocated to the person seeking assistance.

That is a very good. It sounds like a good suggestion, but he also adds, there must not be a presumption that the person will necessarily continue the process to its end when they appoint that navigator. That does give the option of the person who seeks it changing their mind. But we have discussed a number of issues that were discussed today. We have discussed throughout the bill, and there are a number of questions. I have more for the noble Lord, noble noble Lady, the Minister, rather than the sponsored a bill.

But I think many noble Lords did have questions for the noble Lady, the Minister, on the specific question of the assisted dying help service, and a duty to publish information on provisions of the act. Can I ask the noble Lady, the Minister, what consideration the government has given to the interaction about assistance with ending one's life? Sorry, the legitimate dissemination, dissemination of information about assistance would end in one's life and the encouragement of suicide prohibited by law under the Suicide Act 1961.

I know that came up very early on, but I think in this specific context it's worth repeating. And a number of noble Lords have rightly asked about the workability of the health service. And so, so, and also asked about what might the cost of the managing the service be and the running costs, and do Ministers feel that resource in the service adequately might undermine the effective delivery of other parts of government? And a number of nobles have said, actually, that the government has not really answered those questions about the resources available and where the money will come from.

Once again, I'm taken back to the very first. Sorry to the Second Reading of this debate where the noble Lord Lord Stevens and also noble Lord Lord Hunt of Kings Heath, a former health Minister, both said, we know how the system works. This money will come from somewhere and it will be at the expense of palliative care. We assure that that will not be the case by those who support the bill, but also the government. Ministers themselves have said that a sufficient money will be made.

But I asked almost the same question that the Lord Deben asked in a letter. I asked it a less eloquent way than the Lord de Mauley the question. I asked that same question a couple of weeks ago to the Minister from the Department of Justice and last week to the noble Lady, the Minister from the Department of Health and I. And to be fair to the government, I have received an answer from, from from the noble Lady, the Minister, and if noble Lords will allow me, I will just touch on a few extracts from that letter rather than and I will paraphrase where possible, the noble, the noble Lady Minister's letter to me said that you sought confirmation that the government is confident that palliative care will be sufficiently funded so that those who may seek assisted dying services are offered a real, as opposed to a theoretical choice on palliative care to support them making a more informed decision.

So far, so good. As my noble friend Lord Gove said, the government is support. The letter talks about the support for the hospice sector, £100 million for adults and £80 million for children. I am almost a government Minister, responded. I know, but I think we have to be fair to the government when we are when we are challenging the government on this. But the noble Lady Minister also mentions the all age, palliative care and end of life care modern service framework for England to improve the services.

Now the noble Lady Baroness Berger said it would be published in spring 2026. The letter itself says it will be published in the autumn 2026. But I think the noble Lady Minister has answered that and also said, and let's be fair, that is better than the answer that many Ministers from all parties have given over the years, where they often say at pace, or what's the other phrase, oh, in due course. So at least, at least that gives us a real time frame.

And the noble Lady Minister also talks about it being aligned with the ambitions of the ten year plan. Now, what nobody says is.

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Just on that point. I got a copy of that letter as a noble Lord Dear. It's worth just saying in the ten It's worth just saying in the ten year plan, there is no ambition for high quality universal palliative high quality universal palliative care that's not there. So if the plan they're going to publish in the autumn is aligned with it, I the autumn is aligned with it, I think what we can see is for the next ten years, this government doesn't plan on making available universal, high quality palliative universal, high quality palliative care, which I think is a real problem for decisions taken under this bill.

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I thank my noble friend for that intervention. I was just I was before commenting on the on the content of the bill, I was actually content of the bill, I was actually seeking to lay out, just to be fair to the government, what the government has told me so. No, no,

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government has told me so. No, no, no. Pursuing the important. Point that the noble Lord is

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Point that the noble Lord is making the Minister for care, Stephen Kinnock, was before a Commons committee on this very Commons committee on this very point that Lord Harper has discussed and declined to give any commitments about the content of the modern service framework for palliative care, declined to say that resources would be made available to fill the gap. And the only specific commitment I think he gave was that perhaps a new 24 seven phone number would be put in place in 2027, I believe.

As well. I think that reinforces the point that I am going to come to, if that makes sense. So the noble Lady Minister ends the letter by saying, I hope through these actions we hope to ensure sustainable funding for palliative care and end of life care sector in the long term. This is the government's stated intention. Now, what I will say to all noble Lords, the next bit says I hope this letter has provided clarification on the queries you raised. Now I will let noble Lords be the judge of whether that does provide clarification.

And to be fair, noble Lady Minister did copy the letter to all peers who tabled amendments. As my noble friend Lord Harper said, but also put a copy in the library. Could I urge all noble Lords to read that letter to see if they themselves believe it provides the clarification that many noble Lords are seeking, and, if not in future weeks, we should come back to this point and raise these issues again with the government. If we feel that that that the government has not given clarification in that letter.

So what I will ask the Minister, I hope that the Minister will take that on board when she comes to answer. And if the Minister does not have the answers to many of these questions, whether they we should wait for other nobles to read that letter and then maybe raise those questions again and ask whichever noble Lady the Minister is on duty in future weeks to answer the questions where we still

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believe that there are gaps. For the noble sits down. I'm really grateful to him for really grateful to him for referring to that letter and actually quoting the amounts of actually quoting the amounts of money in it. Does he recognise that those are one off funding? That is not recurring funding, and there is no intention for funding to increase as cost of living increase as cost of living increases and so on, and to meet the gaps that we've been talking

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about in services. I'll be very careful because I'm not answering the government. I'm just I'm just trying to reflect just I'm just trying to reflect that letter. But all I will say, when it came to the children's hospice funding, the Minister did make clear this was funding over make clear this was funding over the next three years, which in total will account for 80 million. We all know how governments work. We all know how governments work. And we and you know, I'm not sure any government could give a commitment between beyond 3 or 4 commitment between beyond 3 or 4 years or beyond another election.

So I do believe, to be fair to the government, if they have answered the question about how much resources they will be allocating, it's up to noble to decide whether they believe that is sufficient, but also up to all noble Lords, whichever side of debate they are on whether they feel the government has not answered those questions, to come back in future weeks and to press the Minister on duty.

12:57

Baroness Blake of Leeds (Labour)

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13:09

Lord Falconer of Thoroton (Labour)

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13:23

Lord Birt (Crossbench)

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13:36

House Adjourned During Pleasure

OK. OK.

14:15

Legislation: Terminally Ill Adults (End of Life) Bill - committee stage (day 7)

14:15

Lord Blencathra (Conservative)

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My Lords. In clause one. Should I do that again in clause one?

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Amendment 39 a Lord Blencathra. Lords, I rise to move my amendment 39 A and speak to amendment 39 A and speak to amendment 238 B and 553G. Now the purpose of 398 39 A is to require that the patient's understanding is demonstrable, not assumed. This amendment, I believe, my Lords, goes to the heart of, I should say, my Lords before before I start, I do wish to thank the noble Lord, the Chief Whip, for his very wise decision to have a 40 minute lunch break.

Since the average age of this house is 41, it's more like a break. That was. But it was very convenient. Whatever it was. So on to the substance of amendment. It does go to the heart of autonomy because the bill repeatedly invokes autonomy as its moral foundation. Yet it does not require that the patient's understanding be demonstrated in every other area of medicine. Informed consent requires evidence that the patient has actually understood the information here, where the outcome is irreversible, the evidential threshold should be higher, not lower.

The bill currently requires doctors to explain and discuss certain matters, but nowhere requires confirmation that the patient has absorbed or understood them. That is a fundamental flaw. I would suggest. Nice guidance, GMC guidance, element, summary judgement all emphasise that consent is valid only when the patient understands material risks and uncertainties and alternatives. The Bill omits these requirements. International comparators, Oregon, California, Victoria all require explicit discussion of risks and complications. England and Wales will be an outlier if we do not require demonstrable understanding.

This amendment simply aligns the bill with established medical ethics and legal precedent. And finally, on this amendment, my Lords, it protects clinicians without a demonstrable understanding requirement. A doctor could comply with the act while failing to meet professional standards. That is a recipe for litigation, confusion and moral hazard. My amendment 28 be introduces a safeguard that is standard in every jurisdiction where assisted suicide is legal. A written acknowledgement ensures that the patient has been informed of the risks, including prolonged dying, vomiting, seizures or or failure from the drugs that they understand them.

Without this, the bill creates a parallel medical system where the usual rules of consent simply do not apply. The bill currently requires doctors to discuss, quote, the nature of the substance. Unquote. And what to do in the event of complications. But it does not require them to explain that complications may occur. Are what those complications are. There is a glaring omission. A patient cannot meaningfully consent to a life ending drug without knowing that it may not have worked as intended by lawyers.

For those noble Lords have experience on cancer treatment or or chemotherapy, one knows that before one gets it well is to spend about an hour with a clinician or the oncologist, ticking boxes on the form and explaining and saying that you do understand all the potential downsides. I recall having a complete a seven page form to do so. So, my Lords, it's important that patients do consent. This amendment also protects clinicians. The bill grants civil liability exemptions for doctors acting in good faith, but without a written acknowledgement.

There is no evidential record that the patient was informed of the risks. This exposes clinicians to professional risk and undermines public trust. And finally, on this amendment, my Lords, it is modest. It is proportionate and entirely consistent with the principle of autonomy. Turning to my amendment 553G and the Montgomery Compliance Clause. This is to require doctors to apply the principles of Montgomery v Lanarkshire when informing patients of material risks. This amendment embeds the leading that leading case on informed consent into the bill.

Montgomery requires doctors to inform patients of material risks and reasonable alternatives. The bill does not currently require this. That omission is extraordinary in a process that ends in death. Without this amendment, the bill creates a parallel medical system where the usual rules of consent do not apply. That is ethically indefensible. If anything, the standard should be higher than in ordinary medicine, not lower. This amendment also protects clinicians by ensuring they are not forced to choose between complying with the act and comply with their professional obligations.

And finally, on this amendment, my Lord, I believe it aligns the bill with international best practice. So, my Lords, these three amendments together make the policy clearer, leaner and fairer by tightening rules and strengthening enforcement. Amendment one removes ambiguity and speeds decisions, reducing disputes and legal exposure. Amendment. My amendment two lowers operational friction and cost by streamlining processes and clarifying responsibility, and that improves efficiency and predictability during implementation. My third amendment I have spoken to enhances fairness and future readiness by embedding equitable principles and scalable mechanisms, increasing stakeholder buy in, and adaptability as circumstances evolve.

So, my Lords, the result is a more enforceable, cost effective framework that better serves stakeholders today while remaining flexible for tomorrow. I believe my

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amendments are practical, complementary. Oh. Nice for interrupting, but you referred to amendment one, amendment two, and amendment three. amendment two, and amendment three. I didn't know which amendment two was, and I apologise.

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was, and I apologise. I realised I should have said my amendment. My amendment one, of course, is I spoke to my First Amendment as 39. So I should rephrase. My amendment 31 removes ambiguity and speeds decision. My amendment 23AB lowers operational friction and costs, etc. by streamlining processes and my amendment 3553G enhances fairness and future readiness by embedding equitable principles and scalable mechanisms, etc. So, my Lords, those three amendments, I believe, result in a more enforceable, cost effective framework and a better serve stakeholders today while remaining, as I say, flexible for tomorrow.

Amendments are practical, complementary and strategically aligned to deliver measurable improvements in performance, compliance and stakeholder confidence. I commend them to the House and to the noble and learned Lord Falconer of Thoroton. I beg to

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move 38 a b 39 a. Amendment proposed in clause one,

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Amendment proposed in clause one, page one, line 14. At the end, insert the words on the Marshalled List.

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List. I tabled amendments 43 with A312

14:22

Baroness Coffey (Conservative)

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>> I tabled amendments 43 with A312 and 340, effectively consequentials and then 188 A. So I'm planning to speak to those 43 brings in the speak to those 43 brings in the concept or the phrase demonstrably. Now, I appreciate that noble Lords may think this is dancing on the head of a pin, but it's my understanding that the the use of demonstrably is well known in legal practice and effectively requires evidence. Now, I appreciate that there are other aspects of the bill where actually, when it was first introduced, had specific forms of setting out, and that's been replaced by a variety of regulations and other powers, etc.

which I think we just need to be clear that what does that really mean in terms of thinking through being informed conceptually is meaningless, unless we can establish that the person can demonstrate to healthcare professionals and others that they understand assisted dying, they understand the process, and they are absolutely committed to what to this journey on which they go. Now, one of the things is that the bill currently requires to discuss certain matters, but does not require evidence, in effect, that the patient is actually understood them.

And I make this point. I appreciate one of the things about the current clause three of the bill is that the Mental Capacity 2005 act, which is an MoJ level but used in the NHS, only requires effectively a balance rather than something much firmer in terms of probabilities of understanding. One of the particular things is really about understanding the impact of the drugs, the lethal drugs that people are going to be given. There may be examples. I think my noble friend has already referred to international examples where we can see, I think in Victoria and Australia and Oregon and the USA, where there are greater, firmer elements of how it can be demonstrated, identified and verified that this decision is being made.

But I think it's also should be recognised that we need to make sure that the doctor is setting this out may say, well, your death actually is going to be quite straightforward and it may not be may take longer, but it may not actually be as painful. And it's those sorts of risks that I think people on this journey, I accept that they're close to dying. But what that really means in terms of how that comes about in and we haven't got into the detail yet of understanding which drugs are going to be used in the in this process.

Now, one of the reasons that I tabled the amendment to do with the Montgomery compliance is because there was a significant ruling it was actually to do with. Liability, negligence, that sort of approach. The Supreme Court at the time, back in 2015, effectively made sure that patient centred focus became the norm. And there was a more recent ruling in 2023 about in the case of McCulloch. But in essence, what that was suggesting is that whereas in 1985, the House of Lords judges here went on about the professional basically making the decision more or less the key ruling in the 2015.

And the principles behind that are just show that it really is case law that's helped evolve what's ended up becoming guidance. And I think we should be clear in this bill that what exactly what approach we want to have. And that's why I appreciate for the Minister, this may seem a bit nebulous, but I was trying to get get this as a probing amendment and why we might take this as being the basis now, what a subsequent Supreme Court ruling did in in McCulloch was the NHS themselves were basically saying, oh, we're back to bowling more or less the original test, but I can't have spoken for ten minutes already.

No, no, no, no, I didn't think so. Right. I've no idea how long I've spoken for, to be honest. But there we go. It certainly wasn't ten minutes, and I had hoped the noble Baroness Freeman of Steventon who I had, I know she had to leave early, but this is one of her key areas of expertise, and she teaches significantly on this and in in different places around the country, including the NHS and the role. What one of the presentations that she shared with me is that the director's advisory role involves dialogue and the aim of which to ensure the understanding of seriousness of condition, the doctor's duty, sorry, the information the information provider has to be comprehensible.

The doctor's duty is therefore not fulfilled by bombarding the patient with technical information, which they may not reasonably be expected to grasp, let alone by routinely just demanding signature on a consent form. So what I'm trying to make sure by trying to instead of just rely on case law, that may change, that. We end up being very clear that this has to be a patient centred focus and the principles on which we expect this process to happen. I think that the other aspect is, which we'll get into in a group a little bit later, is that I'm just trying to make sure if we go down this route, what this really looks like for the person involved at a pretty scary time of their lives.

And I want to I've seen it happen too often, I'm afraid, with things like noise and other issues and people not necessarily being given. I think good advice when they are patients and the patient and the doctor knows best. So I want to be crystal clear that somebody who's going through quite a difficult moment needs to be aware of not only options, but also risks and what the balance might be on. Whether you go with a lethal dose of certain drugs, or whether you take a different route in order to end your life in a good way.

And that's why I propose these amendments today. today.

14:29

Baroness Lawlor (Conservative)

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My Lords, my amendments 55 2.6319319342387453 and 513. All are about the same thing in this group. They are designed to ensure that those contemplating assisted suicide fully understand the effects on their bodies of the drugs they will be given, and know about possible complications. As it stands, the bill in 1202 and 12 to C4 and 12 to C, 12 to D merely requires that doctors explain that the how the drug will kill them, and that they discuss what ought to be done in the effect in the event of complications.

It does not require any sort of explanation about what these complications may be, or how likely they are to occur. Now, that is important, and it's important to insist on on this point when when amendments similar to mine were proposed in the House of Commons, they were rebutted with the claim that subsections 12, two C4 and 12 two c, d already require explanation of the complications. But as we can see from a reading of precise reading of these clauses, I'm afraid they do not under the bill as it stands.

Therefore, those choosing suicide will not be given giving informed consent, since they have not been made aware of the full range of potential complications and consent is not informed. Indeed, the General requires that before patients can give consent and the known risks of harm and the uncertainties attaching to them are explained to them, this lack of requirement to explain complications is also contrary to what has been generally established as the law since 2015. As noble Lords have explained in the Montgomery versus Lanarkshire case.

The law generally requires that all material risks of any course of action are explained to the patient, and so they can make their decisions. And in my experience, this has always been this has always happened, even to the point of consultant saying, you know, this means you could die. Indeed. Moreover, a requirement of the sort imposed by my amendment is a feature of assisted regulation elsewhere. And we've heard about that. But the laws of Oregon, California and Victoria require all patients to be informed of the potential risks of taking the substances in questions.

It's quite precise, as part of the process of consent to assisted suicide, it is not as if this risk is negligible or a minor one. Assisted suicide has been legal in the Netherlands for two decades, as we know there fully a third of those dying in this way experience effects such as pain, restlessness, shortage of breath secretions, nausea and vomiting. Their deaths, therefore, are far from painless. In Oregon, between 2012 and 2022, there was a rate of 11% of side effects, including from very serious complications as regurgitation, seizures and survival of of the supposedly lethal drugs.

Those choosing assisted suicide are likely to expect that death reached in this way will also be swift, but in many cases that is not so. They'll be wrong to think so. Half of all the deaths in Oregon took over 53 minutes. Similarly, in Canada, the incomplete statistics there suggest, even incomplete, that there is a 5,050% chance of an assisted death taking more than an hour. Occasionally, the working of the drugs can be much slower still, and assisted patient in Oregon took over five days to die.

Now I. I know that some may object that for any other medical procedure, the worst possible complications would be the death of the patient. Surely when death is the desired end, talk of complications is irrelevant, they may say, but this objection misses the point. That avoidance of pain is one of the main motivations for assisted suicide. Those choosing this form of death need, therefore, to be told about what pain is likely to be associated with it. In order to make an informed choice.

Another motivation is dignity. In my view, the conception of dignity is invoked as it is in this context is a false one. But that's beside the point here. When we are considering informed consent, someone seeking assisted suicide because they believed that their death will be more dignified than if they were left to die naturally, needs to know before giving an informed consent the risks that there is assisted dying will bring. It can involve seizures, vomiting or or other complications or pain that that it might be prolonged over hours or even days.

And the whole process of poisoning might be successful and might need to be repeated, might be unsuccessful, and might need to be repeated. This, my Lords, is what my amendments require, and I hope the noble Lord, the Lord, the sponsor, will give

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some consideration to meeting them. For the purposes. Of the point I'm making, I'm

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Of the point I'm making, I'm going to proceed on the assumption that was put forward by the sponsors, that drugs used for assisted death are to be treated as assisted death are to be treated as a healthcare intervention, although I do not actually accept that this assumption is correct. But if that assumption is made, then the legal assumption is made, then the legal and ethical standards governing informed consent must apply in full.

14:35

Baroness Hollins (Crossbench)

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informed consent must apply in full. And I added my name to amendment 55, which would require that the person, the patient understands fully the physiological effects of the lethal drugs used for assisted suicide and their possible complications. So the General Medical Council provides guidance on decision making and consent to medical professionals, and it requires that a clinician must be satisfied that a patient has given valid consent before an intervention, unless there are certain legal exceptions which would not apply to assisted dying.

The guidance is explicit about what is form consent requires. Patients must be given clear, accurate, up to date and evidence based information, and for every option, clinicians must explain the potential benefits, the risks including side effects and complications, the uncertainties involved and the likelihood of success. And where there is uncertainty about outcomes or about the quality or limits of the evidence, the clinician has a duty to be open about that uncertainty. Informed consent is not compatible with ambiguity being concealed, minimised or glossed over.

So who provides this important information for the consent process? Well, the the the MHRA regulates medicines in the United Kingdom by assessing their safety, quality and efficacy before licensing and by monitoring harms after licensing through the Yellow Card Scheme. I intend to return to this in a later group. The GMC's explicit that a clinician should only propose or prescribe a medicine or treatment when they have sufficient and reliable have sufficient and reliable information, so. This includes agreeing with the patient by giving a clear explanation of the benefits, the risks, the common and serious adverse effects, and what to do if problems arise.

Now, just thinking about the protocol, the drug protocol. There is currently no internationally agreed prescribing protocol for assisted dying. There are a wide range of drug types, combinations and doses being used with significant variation even within individual countries. Protocols include varying combinations of barbiturates, benzodiazepines, opioids, cardiotoxic agents and neuromuscular blockers. Under the current bill, the intention appears to be that the drugs to be used for assisted dying would be prescribed off licence, so an unlicensed drug is one used outside the terms of its licensed indication and under existing GMC guidance, prescribing an off licence drug requires the clinician to be satisfied that there is sufficient evidence to support its safety and efficacy.

But there's no systematised clinical research, no standardised reporting and marked variability in practice, and the pharmacokinetic and pharmacodynamic data available for these drugs individually come from therapeutic use, which is quite different to the very high doses or combinations required to induce death. So the government's impact assessment refers to an experimental drug regime regime from Oregon, one of the few jurisdictions that has published the outcomes of orally ingested food substances. These drug combinations are not the product of conventional clinical trials, but a form of human experimentation that was introduced without prior scientific evaluation and bypassing conventional regulatory frameworks.

A combination of four drugs was chosen out of necessity because of restricted access to barbiturates, rather than good evidence of safety and efficacy, and subsequently a fifth drug has been added in an attempt to reduce the median time to death. So rather than the quick and pain free death advertised by the sponsors and campaigners, what has been documented are significant adverse effects. As reported by the noble Lady Baroness Lawlor, the drugs generally regarded as most effective in assisted suicide are barbiturates, particularly high dose pentobarbital and, less commonly, secobarbital.

These were the agents used in Oregon before restrictions on their export to the USA. Because of their use in capital punishment. This restriction forced assisted suicide providers to look for alternatives. The barbiturates cause death by reducing brain activity, leading to loss of consciousness and respiratory arrest, and that they're the same agents used in veterinary euthanasia in the United Kingdom, where they are subject to very strict veterinary regulatory requirements. But these substances are not licensed for human use. In the United Kingdom, they are class B controlled drugs under the Misuse of Drugs Act, meaning that they cannot be prescribed, imported or possessed without Home Office authorisation.

The assertions made in the other place, and in the government's impact assessment that appropriate drugs are already licensed and available for off licence use appear to be incorrect, and I would welcome the noble Lord. The Minister's response to this, please. And despite this, the proposed approach does not involve licensing by the MRI, nor appraisal or guidance by Nice. No clinical trials are required. Instead, the bill grants the Secretary of State the power to specify the drugs and procedures by regulation, including their manufacture, supply and storage, thereby thereby bypassing the established regulatory frameworks that apply to every other drug.

I could describe what the consent process might look like, you know, because if you remember, you know, when you get a drug prescribed for you, you get a leaflet which sets it all out and it tells you what the indication is. It tells you what the likely success is. It tells you what the most common complications are. You know, 1 in 10 is very common, 1 in 10 very common are the kind of side effects or complications or adverse effects described by the noble Lady.

You know, imagine saying to the patient, outcomes are variable. Many complications have been reported suggesting that 1 in 10 people who take the combination of drugs may experience vomiting, seizures, or may regain consciousness. 1 in 10 is very common, and you would also have to say that there's no guidance or certainty about what support would be provided to you if you experience these very common adverse effects. And this is what the obtaining of informed consent would look like under the current bill, that would not be acceptable to any regulator or professional body.

Or I suggest to any patient who had the capacity to consent.

14:43

Baroness Berridge (Conservative)

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Tries to support amendment 39 a by my noble friend Lord Blencathra, and I'm pleased to see my noble friend Lord Wolfson at Dispatch Box, because although I support the amendment, I think it's more in that it enables us to raise some important principles here, not necessarily the details. I am grateful to the noble Lady, Lady Collins, for outlining informed consent and mentioning that the patient has to have sufficient and reliable information, and the noble and learned Lords Bill says that there should be a clear, settled and informed wish.

Now, I think this is another occasion in which I fear that the Bill is legislating for an analogue age, because much as well of the principle of around informed consent, I think really is from a situation where the patient is gaining much, if not most, of their information from the clinician or support staff. Now that is not the case today. Obviously, we know that people have got access to many, many, many more sources of information.

Now, the question I'd ask actually of the noble, the the Minister and the sponsor of the bill is what is the situation in regard to reliable information or an informed wish, if in front of the clinician, as a young person who basically has just been watching on a doom loop information, that is false. We have the problem now and I don't think informed consent. There may be an issue of the development of the law here. When you've got people with a lot of misinformation or false information.

So from the wording precisely of the amendment, it's not clear what the duty, I think would be of the clinician if they are aware that the person has an informed wish, but it has been informed by false information, and it is sometimes noble Lords surprising when one reads in the newspapers of, for instance, a mother whose child got very, very seriously ill had not taken the MMR vaccine because of believing it was connected to autism. Now that was debunked many years ago, but it is for that reason, I think, that looking at what is an informed wish, what is informed consent to this.

And it's very important if I look and I think it's an issue that will come up in other amendments, my own office is struggling in getting access to reliable information. The algorithm on Google and the algorithm on Google Scholar at the moment will point you to Pro. It's really difficult, even if you in certain settings, have to go to non IP addresses to get access to information. So that's just the context in which I'm trying to work. And then I envisage young people trying to get hold of information.

This is also really important because there's no coronial under the bill at the moment. No coronial, no legal analysis of the death and civil liability has been excluded on the grounds that as long as you're acting in good faith now, are you acting in good faith as a clinician? If you are aware that the person in front of you is has an informed wish, but it is based on a lot of false information, and you have that as evidence in front of you.

So I think we really do need, and I do hope the noble Lord Lord Wharton I haven't given him notice. I think we do need to consider in our age what is informed consent and what is the duty to then say no, that information I'm giving you reliable information based on X, Y and Z, the studies, the peer reviewed studies and massive cohorts of patients. But the person in front of you is acting on erroneous information. So I do hope that the noble and learned law can actually give us some indication as to what is the situation, because I think, particularly with younger patients, being able to look at what is informed consent is very important.

14:47

Lord Empey (Ulster Unionist Party)

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The there are other some amendments in a later group on this amendments in a later group on this subject. Group 50 about the substances and their approved substance and regulation. But I think, as has been pointed out by Baroness Hollins, if you buy a packet of aspirins, you get a sheet that gives you the different risk levels. But what I would like to know from the government is what will be done to ascertain how this list of approved substances is compiled.

We know from examples that have been quoted earlier today that sometimes things go wrong. And when you go through any medical procedure yourself, you are always asked to sign a piece of paper. And if you consent to this and quite often, sometimes you're practically maybe on the on the slab when you're asked to sign it. So the point I'm getting at is how have we done any homework on what these substances should be? Have we analysed internationally how they have interacted in the circumstances where assisted suicide is being promoted or available? Have we got any of that information? Because we know and even it has been mentioned in circumstances where execution has been operated in certain American states, even there where multiple substances have been used with one purpose, sometimes it doesn't work out.

And and we know that has been the case. And I, I can't think of anything worse if we go down this track. And I think it's while the promoter of the bill has made his position clear, it is a matter for the government as well. Government have to tell us, have we done any meaningful research? What is the legal framework? How are these substances to be handled, bearing in mind they'll be going all over the country? They're not just going to a single place.

Pharmacies throughout the hospital system are very pressurised, very pressurised environments, and you would have to retrain. And given the nature of these substances, there would have to be special circumstances employed in every pharmacy in practically in the United Kingdom, where this would be required by pharmacy, I mean hospital pharmacy. So you know it. It's a I fear it's another example of something where we're half baked. It's not worked out. It's not researched, it's not available. So we have blank spaces where we are lethal substances.

But what are they. And all the question. Yes.

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Interrupting in a group 50 we are dealing with the process of the selection, the approval and the selection, the approval and the regulation of substances. In this group. We're dealing with making group. We're dealing with making sure that the patient is properly informed before they make the informed before they make the decision. Many of the questions that the noble Lord raises about how are we going to choose them, etc. are perfectly valid, but could

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etc. are perfectly valid, but could I suggest we deal with them under group 50? So, as I said at my when I opened my remarks that I have amendments in Group 50 for that purpose. But you see, there is an inextricable link between having the knowledge about these substances and having informed consent. So it's not exactly you can't can't mentalize it just as easily as that. So the the people who are overseeing the consent of, of the person also has to have that knowledge.

The risk factors have to be made available to the patient. And that is my point, because there hasn't been sufficient research done into these matters. I'm not convinced at this stage that the information being provided to the patient is accurate, because how can it be if the research hasn't

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been done? Restrictive amendments is indeed about the process of information about the process of information giving, and in the lead amendment 39 A this is about the person having an understanding. Now in any having an understanding. Now in any process of giving information, there's no point just giving the information. And if you like

14:51

Baroness Finlay of Llandaff (Crossbench)

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15:03

Lord Harper (Conservative)

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Brief points. >> First of all. >> In this group of amendments, I'd like to support the point that Baroness Berridge made about how we Baroness Berridge made about how we deal with misinformation. I think that's actually very important. An exchange I had with health Ministers on the subject of flu vaccination was very enlightening when because we discovered that a very significant number of people that work in the health service are vaccine hesitant, and at least some of those are because of some of the scare stories we read about vaccination.

And those are people who will, I suspect, be more informed than the general public because they work in the health service. And so I think actually how we deal with dealing with misinformation is very important. But the main question I had, and this is one where I'm pleased to be in this house surrounded by expert lawyers, is a legal question. It's on amendment 188 A, which my noble friend Baroness Coffey has tabled about putting current case law in statute.

And my question, I suspect, aimed at the Minister, but I if he's not able to answer it today, I'd be grateful if he could write to us. It's just a legal question about whether that's actually helpful. And if you take the current case law position and put it in statute, is that sort of helpful in the sense of giving Parliament's imprimatur on we're comfortable than we think that the current position is helpful and does it in any way inhibit or prevent the development of further case law? Because, again, I'm conscious because of what Baroness Berridge said.

A lot of the information that people get is from online sources. And because of the fast changing nature of the world and artificial intelligence and so forth, I would want to make sure that in this area, evolving ways of people getting accurate information they can rely on were able to be taken into account by case law. And equally, case law could take into account information sources that are not reliable and reputable and give guidance to clinicians, therefore, about how they dealt with informed consent.

And of course, the danger of putting some of that detail into statute is it does take some time to update. So I'm sort of looking for factual guidance about whether that is or isn't helpful for us to put into statute, whether it's better to leave it for evolving case law, which is a factual question. As I said, I hope the Minister can either deal with it today or can write to us.

15:05

Baroness O'Loan (Crossbench)

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My Lords, I rise very briefly. I rise in support of these amendments. The process is designed only to kill, but inevitably, as our kill, but inevitably, as our Liberal colleagues have explained, there will be complications and people react differently to people react differently to different drugs. Very simply, only with full information. With a patient be able to consent. Without it, that consent cannot exist. So I've got a question for the noble Lord noble and learned Lord. Lord Falconer, why is the doctor required to discuss the nature of the substance, how it will bring about death, how it will be administered, but not tell the patient that it may not be successful? And why must the doctor discuss with the person their wishes in the event of complications? Why is there no requirement to simply explain and discuss the risks of complication? And how can a patient give informed consent if the noble Lord does not intend to accept these amendments, could he tell the House what his intentions are? Noble Lady and other noble Lords to clause 12 of the Bill, in which 12 d it says specifically discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance.

Under section 25. That's what I just said. I said, why must the doctor discuss with the patient their wishes in the event of complications arising? Why is there no no requirement to

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explain and discuss the risks of complications? No. What you. Do, what you would do.

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With the noble Lady. Except it is actually the duty of a doctor under the GMC, under any medical, under the GMC, under any medical, any any intervention that a doctor takes to explain to the patient the takes to explain to the patient the risks and the benefits, and then to make sure that the patient understands those. It is normal understands those. It is normal medical practice, and it's been written on the bill to make sure that that exactly is the case and

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is written within the report. You simply say, we're seeking to establish whether this is a regime establish whether this is a regime under the Health Service and health regulation or where it does lie. I

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think there are questions to ask. Actually comment that actually

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Actually comment that actually the whole thing, the obligations that have just been explained refer to medical treatment. And this is to medical treatment. And this is not a medical treatment. So the previous comments I don't believe are accurate, because the normal clinician's responsibility is one of the things that we do need clarifying. And is it the case that

15:08

Baroness Berridge (Conservative)

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when one looks at the clause 12 sorry, sorry 12 two D yes, it is sorry, sorry 12 two D yes, it is their wishes. In the event of complication, there's no obligations. The noble Lady, meaning there's no obligation to meaning there's no obligation to talk about the risks of complications. So those are different things. Your wishes and different things. Your wishes and the risks. So is it your

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understanding of this clause. 12 two D that.

15:08

Baroness Lawlor (Conservative)

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While there is an obligation to discuss their wishes in the event of complications arising, there is no obligation to discuss exactly what those complications could be.

15:09

Baroness Finlay of Llandaff (Crossbench)

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I wonder if it might be helpful just to add to that, that in normal procedure you would explain to a patient what the complications may patient what the complications may be, but in that you will also say what you will do. And this bill doesn't say what you will do, which is why I pointed out that somebody who is very drowsy and beginning to reawaken from a huge dose of lethal drugs wouldn't be able to self-administer a further dose.

And this bill is very clear that the practitioner does not then, or does not administer the fatal dose. It must be done by the person themselves, and therefore we have a bit of a gap here, because you can tell them what might happen, but it doesn't seem that you can tell them what you will do in the event of it

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happening, and how it would be managed. Down.

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Down. What about the patient. Who says, I'm not interested in the complications, I just want the the complications, I just want the injection as soon as possible? What stage is that allowable under medical practice? I have refused medical practice? I have refused information from patients from a doctor myself in the past. People

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do have that autonomy, don't they? I've. Of course, patients are welcome to refuse. I'm slightly worried by the phrase given by the noble Lord that the patient will say, I just want the injection, because the bill is very clear. This is about self-administration. And so you have to discuss with the patient how they are then going to inject themselves with this lethal dose of drugs, and whether they will do it with different syringes. Will they have a will they have a mixture in a syringe and the mixture in a syringe and the complications of trying to do that.

So I think the noble Lord actually, in asking the question, has just illustrated the nub of the problem. illustrated the nub of the problem.

15:11

Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)

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15:22

Lord Carlile of Berriew (Crossbench)

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If somewhat historic, member of the General Medical Council, can I the General Medical Council, can I confirm that the GMC has absolutely no guidance relating to ending no guidance relating to ending someone's life because it is simply unlawful to end someone's life at unlawful to end someone's life at the present time? I hope that I can try and simplify what's been discussed. I agree with Lord Blencathra that there is a need to add something, though possibly not very much to this bill to ensure that consent as consent is included.

There are, I think, four stages. We're talking about the application. That's not consent, it's just an application capacity that is measured. That's not an application. The discussion in clause 12 is a discussion. And I say to the noble Lord opposite, that's most definitely not the obtaining of consent. And then there's the issue of obtaining consent, which includes the effect of any drugs to be used. And that is what I think Lord Blencathra is seeking to add to this bill.

If I can just very briefly give an example from my own experience, I had an extraordinarily formidable and occasionally difficult mother, and on one occasion she had a heart attack not long before her death, and she was taken into a cardiology unit, a very good unit in Blackpool. So I rushed up to Blackpool at high speed and found myself in the ward with my mother, whose eyesight was not good, whose hearing was not good, but whose brain was as good as any in your Lordships House and a consultant and the consultant explained that he could do an operation which he'd done once on a male patient aged 91, but he was prepared to try it on my mother, and she was very enthusiastic to have any medical treatment that she could have that might prolong her life, which, after all, had only lasted by then for 98.5 years.

And once we'd had the discussion, the doctor proffered a form to me, the cardiologist, and it was a consent form. And my reply, which response, which I'll abbreviate, went something like not likely. She's perfectly capable of consenting herself, but it must be explained to her so that she can hear it clearly. So why don't you sit down while I explain what you have said to me, and you correct me if anything is wrong? And in due course she signed the consent form and had the operation.

Happily, the operation was entirely successful. Sadly, the effect of the operation gave her such a pounding heart that the rest of her bodily functions couldn't cope with it, and she died a few weeks later when she said to me during the period before her death, darling, I never thought it was would end like this. I thought to myself, thank God she signed the consent form, not me. So consent has a very conspicuous real meaning. It requires full understanding from the patient.

It can go horribly wrong, as unfortunately it did for my mother. I wish we'd been able to celebrate her 100th birthday, but that element of consent, consent, consent a bit like education, education, education is not clearly set out in this bill. It's not a major change to be made. And I would invite the noble and learned Lord to incorporate it.

15:26

Lord Wolfson of Tredegar (Conservative)

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My Lords, the. seeking to establish a higher bar for reaching eligibility by requiring that informed consent be demonstrably shown. There are also amendments in the group tabled by my noble friend Baroness Lawlor, that seek to ensure the patient has been made to understand the physiological effects of the drugs used. And let me deal with each of these points. But fairly briefly, given the time on demonstrable consent, this is primarily, I would suggest, a question of workability.

It's a view of everybody, so far as I've heard, that a person must consent to receiving assistance, and this bill only allows assistance. Of course, if the person themselves take the final step. That in itself is an important safeguard. But these amendments do pose an important question to the noble Lord, the Minister. What work has the government done to date on establishing a process to ensure that all those receiving assistance under the provisions of this act will, in fact, have consented? What checks will there be on the service providing this assistance? How will Ministers or others respond to complaints or allegations of malpractice in relation to a person's consent? And all those questions touch on what I think is the key point, which is the practical day to day implementation of the bill and ensuring its provisions are complied with.

Most of the speeches in committee have actually dealt with the second issue, which is my noble friend, Lady Lawlor's amendment. And of course, it stands to reason that a person in receipt of assistance should be given all the information they need to ensure they are making an informed choice, and that would certainly seem to me to include the physiological effects of the drug they will take. And of course, when patients receive any drug or have any medical treatment, a doctor will explain the proper dosage, how it will affect them, and it will also advise on potential side effects.

And one would assume, again, it seems to me that the same level of explanation would be provided by doctors in this case, but I would be interested to hear whether the noble Lord, the Minister, and or the noble and learned Lord, the promoter of the Bill, will confirm that in due course. Now, my noble friend Baroness Berridge threw me somewhat of a curveball, which was to say, what is the duty on a doctor? Now, this is a very detailed question. I'm not I'm not going to give a very detailed answer given the time, but it is notable, I think, and I think this is actually an important point because it shows how how things have changed over the years.

If you go back quite a long way to the Hippocratic Corpus in the fourth to fifth centuries BCE, that actually says this, it advises physicians to reveal nothing to the patient of their present or indeed future condition. Quotes for many patients through this cause have taken a turn for the worse. And before we think that rather old fashioned, given the time I did have, of course have a full speech prepared from the fifth century onwards. But given the time, I'm going to miss out about 2000 years and go to a great shame and go to the House of Lords decision inside away where Lord Templeman, formerly of this parish, so to speak, said this the provision of too much information may prejudice the attainment of the objective of restoring the patient's health, which of course is quite close to the Hippocratic approach, but very far away from where we are now.

Of course, in the decision in Montgomery to which my noble friend Lord Blencathra amendment is focussed, the Supreme Court moved on and now says this. And just let me quote this, because I think this is the key point. This is in paragraph 87. The doctor is therefore under a duty to take reasonable care, to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments. And I think that is, I would suggest a clear statement of the current law.

So it seems to me that the real question is, is it clear beyond doubt that that duty applies? In the case of assisted dying? I would have thought it would, but it's not clear to me that it does. And I would look, if I may say respectfully to noble and Lord, the promoter, I'm really looking to the noble Lord, the Minister, for reassurance on this point, because the hospital doctors are employed by NHS trusts and so the government must have a position on this.

And I think on this point, it really would be unacceptable for the Minister to say, well, we'll let you know what our view is if and when the House or Parliament decides to pass the act, the government must have a view on whether doctors employed by NHS trusts would be under this duty in respect of this provision of service. So I do in particular look to noble and learned Lord Moore, the Minister for that. Finally, I have always regarded my noble friend Lord Harper as a very sensible chap, but I am afraid he rather undermined that status by his remarkable statement earlier today, when he said he was happy to be surrounded by lawyers.

Despite that, I think he's sensible. I regard that as a rare slip on his part. He did raise an important point, which is this is it sensible, therefore, to put the current case law into statute, or is it better to make it clear on the face of the statute that whatever the prevailing duty is on doctors in regards medical treatment also applies to this? I would respectfully suggest that the latter is a better option, because it allows for the development of case law in relation to the duty, but it does bring us back, I think, to that central point.

And I do look to the noble Lord, the Minister on this, is it the case that it is clear that doctors current duty to patients as to explaining risks and material risks applies to this? And if so, what is the problem in putting that on the face of the bill in terms that the prevailing duty, whatever that may be, would apply here as well? And I look forward to the noble Lords, the Minister's answer, and of course, to the response from the noble and learned Lord, the noble and learned Lord, the promoter.

Yeah. Good. My Lords.

15:33

Lord Katz (Labour)

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I let me start by thanking noble Lords for the insightful debate today. As you all know, the government remains neutral on the principle of assisted dying and on the passage of this bill, whether and how the law in this area should change is, of course, a matter for Parliament. The government has no major workability concerns with any amendment in this group. But these amendments introduce concepts which largely duplicate what is already in the bill. I speak first to amendment 39, tabled by the noble Lord Lord Blencathra.

This amends only clause one, and so it introduces inconsistency with later clauses in the Bill, which relate to the doctor's assessments. Furthermore, it's currently unclear who would be responsible for determining whether the individual has the required understanding of their diagnosis and the other matters specified. Amendment 188A and amendment 553553G tabled by the noble Lady Baroness Coffey and the noble Lord Lord Blencathra, would require registered medical practitioners to apply the principles from the Supreme Court case of Montgomery versus Lanarkshire. When discussing material risks with someone during a preliminary discussion.

These amendments would have limited effect, although I note that it is not usual drafting practice to refer to specific cases in legislation, because doing so means that those references can become outdated when case law is further developed or modified. And I hope that addresses the point that the noble Lord, Lord Harper, or rather the question raised by the noble Lord, Lord Harper, made in in his contribution. For my part, I love being surrounded by lawyers. But then, of course, I am a North London Jew.

As the noble Lords Amendment amendment 4343, 312 and three four row tabled by the noble Lady Baroness Coffey seek to require that the person requesting an assisted death has a clear, settled and demonstrably informed wish to end their own life. My Lords, there is no definite definition of demonstrative demonstrably within the Bill. Therefore it will likely be given its natural meaning, and this may result in little or no practical change to doctor's consideration of the the eligibility requirements. Noble Lords may wish to note that these amendments apply to doctor's assessments in clauses ten and 11, but do not apply to the panel's determination of eligibility in clause 17.

Turning to the amendments in the name of the noble Lady Baroness Lawlor, these amendments may seek to place a greater emphasis on the person's understanding of the physiological effects of the substance used to end their life, and any possible side effects. While these amendments present no major workability concerns, the current drafting could lead to some ambiguity. For example, the amendments introduce language that's inconsistent with language elsewhere in the bill. For example, lethal drugs instead of approved substances. This amendment could be seen as duplicative given the existing requirements in clause 12.

See part four for the assessing doctor to explain to and discuss with the person the nature of the approved substance to be provided, including how it will bring about death and how it will be administered. The noble Lord, Lord MP, raised issues and amendment 180, which tabled in his name in the name of the noble Lord Lord Taylor of Holbeach, and this amendment would require the assessing doctor as part of the preliminary discussion, to explain and discuss with the person proved substances the risk, complication and failure rates, and any possible contradictions in the person's specific case.

This may be seen as duplicative as clause 12, part 12 two, C, part four, and D all require the assessing doctors as part of both the first and second assessments to explain and discuss the nature of the approved substance and discuss with the person their wishes in the event of complications. This amendment would also mean the discussion takes place at the preliminary discussion stage, which is earlier than the bill currently provides for. I would, however, add, as noted during during the exchanges over over this amendment, that actually there is a again, we can look forward to a longer discussion on approved substances and regulation of those substances at.

Actually, I believe it's going to be Group 49 as things currently stand, beginning at amendment 537. So we can we can look forward to that. Turning now to the noble Lady Baroness Hollins, who made some contributions on in in respect to impact assessments. The impact assessment considers a range of scenarios and presents potential future impacts based on available evidence and international comparisons. It's clear that this does not represent a policy position from government. The impact assessment was developed to inform parliamentary debate and sets out what we knew, based on the bill at the time.

Should the bill received Royal Assent, it allows for the Secretary of State to develop a robust regulatory framework for approved substances and devices used for assisted dying, for assisted dying. In relation to the noble Lord. Lord Wolfson's points about preparing a process for ensuring consents around questions about practice. I would say that I think rightly, this is this is an issue of policy. And so it's a question more rightly for the for the bill sponsor than for for government.

But obviously, if there were if, if the bill gets royal assent, the government will ensure safe and effective delivery of the of service. And in relation to the last point, the noble Lord Low Lord Wolfson made about doctors current duties to patients and whether this should be on the face of the bill. Again, this is the choice for Parliament. What is it on the face of the face of the Bill he raised, if I may, if I may say a number of a number of comments.

And so I will commit to take away reviewing Hansard and trying to address any any comments from the government's perspective. That and I'll write to the noble Lord if if I've missed anything in that response. Having said all that, as the noble Lords will be aware, these amendments have not had technical drafting support from officials and as such, I am able to confirm if the drafting is fully workable, effective or enforceable.

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I simply seek a point of clarification. I. I note that the clarification. I. I note that the government's position was that it wouldn't. It didn't envisage any serious operational difficulties with the substance of my amendments on effects of physiological physiological effects of the drugs, but it had difficulties with the but it had difficulties with the approved substituting a different form of words because it wasn't consistent with the bill. Were that consistency, there would a government in seeking to implement this bill as it is, would it require that the the rules be brought into line, as has been suggested here with prop current medical practice to discuss and to ensure that to see that the patient is given the full assessment of what could happen and what the risks could be.

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Just to repeat, and I hope this helps, we, the government doesn't see any major workability concerns. see any major workability concerns. Our concern specifically is with the drafting, and that uses different language from language that already exists in the in the that already exists in the in the bill. And there is a risk we feel that of duplicating, giving and increasing existing excuse me increasing existing excuse me existing requirements in clause 12 for the assessing doctor to to to explain and discuss with the person explain and discuss with the person what approved substance would be would be provided and how it would bring about death.

So there could be the risk of that duplication. But there's no major workability issues.

15:41

Lord Falconer of Thoroton (Labour)

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15:51

Lord Mawson (Crossbench)

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work in practice, how one will ensure in this process with the panel and the doctors you will have in that process, the people with the language and other capabilities the language and other capabilities and skills to really know what informed consent is and how much is informed consent is and how much is that going to cost to ensure that all those elements are in this process.

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process. The Lord makes a good point. How

15:52

Lord Falconer of Thoroton (Labour)

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do you dealing with a wide range of cultures, establish that it is the informed wish of the individual person that they want an assisted death you can't prescribe on the death you can't prescribe on the face of a bill how you would do it in every case. But there is in every case. But there is absolutely no doubt, as far as the Bill is concerned, that the establishment of that informed wish establishment of that informed wish is the is the basic foundation before you get there.

And therefore, in each case, if it's a different

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culture, if it's a different language, then that has got to be got through before you could be satisfied. And before.

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And before. Grateful for the noble Lord. Oh.

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No.

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No. Thank you very much. Sorry. Thank you very much. I was right behind you. I'm very grateful to behind you. I'm very grateful to the noble Lord for his explanation of informed consent. There is, I think, a little bit of doubt as to whether giving people lots of

15:53

Lord Carter of Haslemere (Crossbench)

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information leading to an informed wish actually encapsulates them wish actually encapsulates them fully understanding it. So I was wondering, isn't the answer to this to putting a definition of informed to putting a definition of informed consent? Wouldn't that be sensible? Because then it's there in black and white. I've got it here. AI is and white. I've got it here. AI is very helpful sometimes, isn't it? Informed consent is a process where Informed consent is a process where a person voluntarily agrees to medical treatment, research or procedure after receiving and understanding all relevant information, including risks, benefits, alternatives and consequences.

And they have the capacity to decide and are free from pressure. There's a beautiful little definition there. You could put it straight into the definition section and everyone will be happy. About that.

15:53

Lord Falconer of Thoroton (Labour)

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Really carefully about that. But what the language is, is it the what the language is, is it the person's clear, settled and informed wish in relation to it? Interestingly enough, the law, the Supreme Court, over a period of years constantly changes what in individual case informed consent if in fact they informed wish in this bill might be the essence of the word informed is that you've got enough material to make the decision. So I am I hear what the noble Lord, Lord, Lord Carter says, I see what AI says about it, but I think it's better just to say informed wish.

15:54

Lord Carlile of Berriew (Crossbench)

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I apologise to Lord Carter. I >> I apologise to Lord Carter. I couldn't see him behind me, but the noble Lord has been using the noble Lord has been using the phrase informed consent and phrase informed consent and informed wish. The noble and learned Lord has been using the phrases informed consent and informed wish as though they are definitely synonyms. And I just wonder why we have not seen the phrase the word consent with the word informed next to it in this bill, because informed consent, as he has let slip, really is a very well understood concept, and putting it in the bill would take away most of the doubts that some of us expressed.

What's the problem?

15:55

Lord Falconer of Thoroton (Labour)

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The format of the bill is, is it >> The format of the bill is, is it your wish to receive assistance? It has to be an informed wish. There's has to be an informed wish. There's no need. It seems to me to add in another concept of informed consent. When you've got informed wish, that's perfectly adequate.

15:55

Baroness Finlay of Llandaff (Crossbench)

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Sits down. He has not responded to the question as to what the doctor does. If the patient develops the complication of not develops the complication of not dying now, the patient may begin to reawaken, but it is not clear at all if they say, I want you to suffocate me. If they say, I want you to inject me with lethal drugs, I want you to force me to to re-ingest or whatever. What is the doctor to do? Because the bill requires the doctor to be present, either until death occurs or until the patient changes their mind or until the procedure fails.

So it would be helpful to have it clear that in the event of a complication, the doctor is just to stand back and let things happen. Because any intervention, such as clearing the airway when the patient is vomiting, would in fact be a resuscitative intervention.

15:56

Lord Falconer of Thoroton (Labour)

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16:11

Lord Blencathra (Conservative)

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Particularly not. >> Shaking my head. I think it was made clear that the power of attorney could not be used for this purpose.

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This has been another interesting debate, and and possibly more important than the speeches we all made at the speeches we all made at the beginning has been the last 40 minutes of real debate and interchange with the noble and learned Lord, and I'm left with a feeling that many colleagues in the House feel. There's a lot of unanswered questions here and some uncertainties we may need to return to it. But, my Lords, I will follow the instructions of the companion and the government whips, and I will not seek to respond in any detail to the many good points raised by noble Lords.

I merely wish to say, remind the House that in the course of the debate we heard from Baroness Coffey lawyer, Lawlor Hollands, Berridge, Finlay of Llandaff alone. Lords MP. Harper McCrea of Magherafelt. Lord Carlile of Berriew Leonard Lord Carlile of Berriew Lord Wolfson of Tredegar and Lord Mawson, and what they all had in common was they were all deeply concerned that the definition of informed consent is not strong enough in the bill, and something more needs to be added. Now, the noble and learned Lord, I think, was relying on section 12 to see for a little for the nature of the subject.

The doctors have to discuss the nature of the substance to be provided, and subsection D discuss with the person the wishes in the event of complications. But there is nothing in there to say. They've got to decide to discuss the complications with them or the or the possible side effects. I think the noble and learned Lord and he may pick me up if I put the wrong words into his mouth. I think he said under this, explaining the nature of the substance that could possibly.

I think he was worried possibly include discussing the the possibility that there could be complications and side effects. My Lords, as the key points are, there are two key points I rose in my opinion.

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Apologise if the noble Lord is suggesting I said possibly. You might have to say what the complications were. If there are complications or a threat of complications. I didn't say that. I said if there were the prospect of

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said if there were the prospect of complications, you would have to say. I think I'd need to check the records. I firmly remember the records. I firmly remember the noble Lord using the word possible. It would be possible to discuss it in this. And I think most noble Lords who have spoken don't want a possibility of it being discussed, but a certainty of it being discussed, and that may require an amendment to this part of the Bill. Many noble Lords made the point that you can't get any NHS treatment or any medical treatment these days, unless the doctor takes elaborate steps to explain all the consequences, the downside, the things that could possibly go wrong and that extends through all aspects of health.

My Lords, two days ago I went down Victoria Street to buy a packet of Nightmares and boots. I was interrogated. Have you taken this medication before? Are you taking another medication with it? Are you aware it can make you drowsy, practically asking, are you. Are you going to fly a jet plane after it? My Lords, if it goes to that extent in selling drugs and the my noble, noble Lords were concerned that when people are getting treatment to help cure their lives, they get they get every single thing explained to them that they don't get it explained to them in detail.

If it's if it's a treatment to kill them. Now, some may say, well, what does it matter if you're going to take a drug that's going to kill you? Why do you need to know the side effects? Well, you don't need to know the long term side effects, of course, but you do need to know the side effects. What? Which those drugs may have. And I think the noble and the noble Lord. Lord Goddard said the nice guidelines say that nothing can be supplied unless there's no drug can be supplied, unless it's done by nice, approved by nice, but nice approved drugs to treat you.

They don't approve a killer or a lethal dose. And we've seen from the United States in their death row places where people are given a cocktail of drugs. In the old days, it was straightforward. It was a drug which could kill you. Now, I think they're given drugs, which are each one is able to help your life. But when you give them in combination to put one to sleep and slow the heart and all the other things, those cocktails eventually kill them. And we've seen horrendous stories where the cocktails do not work, and they do wake up, and the questions raised by noble Lords about what would happen if a patient, given this lethal cocktail or a lethal drug wakes up, and then we just don't know what the consequences would be.

But the final point is this, my Lords, it was unanimous from every noble Lord and Baroness who spoke that they feel an amendment is necessary somewhere. The words they used were we need reliable information, or the word demonstrably inserted or patient needs to be fully informed that they understand the physiological effects and a full understanding, or the or the Montgomery decision. My Lords, I suggesting to the noble lawyer report, I think it's no good saying we're not going to amend the bill.

He needs to come back with a simple little amendment. This report, which synthesises those concerns we've all had that the current wording is inadequate and put something in the bill, and it may be simply adding something to subsection 12 to C4, where it says the nature of the substance that is to be provided. He may need to add words, the nature and side effects and complications of the substance which may be provided. That I think, was the mood of the house.

And I think at report he will need to come back with something better. So, my Lords, I conclude by saying, since we had such a powerful speeches by all noble Lords in Baroness Paul would would noble and learned Lords in the House. Forgive me if I said, I think the Latin quote, the Latin expression res ipsa loquitur applies here. The thing speaks for itself that something needs to be done, and since the thing speaks for itself better than I can, I beg leave to withdraw my amendment.

Yeah, yeah.

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Is it your Lordship's pleasure that this amendment be withdrawn? Amendment is by leave, withdrawn. We now come to the group of We now come to the group of amendments beginning with amendment 39, clause one, page one, amendment

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39 Lord Blencathra. My Lord, I will be relatively

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My Lord, I will be relatively brief in moving these amendments. I d-group them for a technical reason, d-group them for a technical reason, and they are quite narrowly drawn. And I know that a group coming up, led by the noble Lady Baroness Berger, which is more wider ranging, I think is more important than mine, and I would say, if any noble Lords wish to speak on the principle of these, then perhaps it may be better waiting for the noble Ladies group of amendments than mine.

So my 39 B says that the wish is to ensure that a person wish to die is

16:17

ADMT: 39B Lord Blencathra (Conservative)

driven by their illness, not by poverty, loneliness, lack of care or other remedial pressures. And or other remedial pressures. And this restores the link between the justification for the bill and the actual operation of the bill. The political case for assisted dying political case for assisted dying has always been framed around unbearable physical suffering caused by terminal illness, yet the caused by terminal illness, yet the bill contains no requirement that the person's motivation must arise from that illness. Without this from that illness.

Without this amendment, the bill becomes a general choice and adversity scheme where any reason financial distress, lack of care, fear of being a burden can drive the decision. The noble and learned Lord has now explicitly said that he is, quote, strongly against saying poor people should not have that choice. End quote. That is an admission that the bill permits assisted death for reasons of poverty. This amendment, my amendments correct that it ensures that the motivation must be principally attributable to the illness itself, not to the state's failure to provide care, housing or support.

This is not about denying autonomy. It is about ensuring autonomy is real, and a decision driven by poverty or abandonment is not a free choice. This amendment ensures that the bill remains what the public believes it to be, a response to suffering caused by terminal illness, not a response to social failure. My amendment 39 C draws a clear line financial distress, lack of housing, lack of social support cannot be the primary motivations for an assisted death, and without those safeguards, the bill risks becoming a mechanism by which poor and unsupported people are offered death instead of help.

My Lords, this bill is presented to the public as a response to unbearable physical illness. Suffering unbearable suffering caused by terminal illness. Yet the bill contains no requirement that the person's motivation must arise from that illness. Without these amendments, the bill permits assisted death for reasons Parliament never intended to be. Loneliness, poverty, lack of housing, lack of care, a whole host of reasons feeling like a burden on the state or on your on on on your your your dependents. The noble and learned Lord has now accepted that these motivations are valid choices.

That is a dramatic shift, if I may say so, from his own 2012 commission, which said that motivations were never legitimate and that safeguards must prevent them, peers entitled to ask what has changed other than the political need to keep the bill workable? International evidence, my Lord, shows that non-medical motivations dominate assisted dying requests. Pain is not the primary driver. We hear that being a burden as a driver, a loss of autonomy and Parliament must decide whether it is uncomfortable, whether it is comfortable legislating for that.

And finally, my Lords, I say these amendments ensure that asking why has consequences if the answer is poverty, loneliness or lack of care, the response should be support, not a lethal prescription. These amendments restore coherence, I believe, the safeguard, autonomy and prevent the bill becoming a general choice and adversary scheme. I beg to move.

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Proposed clause one insert the words as printed on the Marshalled

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List. Well, in the interests of being brief, rather than repeating everything that my noble friend said, all I will say is I look forward to the answer from both the sponsor of the bill and also the sponsor of the bill and also the noble Lords Minister.

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noble Lords Minister. I thank the noble Lord Lord Blencathra for tabling these amendments. I note his his wish to to keep this brief and so we can move on to a later, a later group to discuss the issues he raises in in greater breadth as he says, amendment 39 seeks to exclude anyone whose primary motivations for the request for an assisted death are financial concerns, lack of housing or lack of social support. This would require someone to establish the motivations of a person requesting an assisted death, and it is not clear who would make this assessment or how they would make it.

It's. It's also unclear how a number of the phrases in the amendment are meant to be interpreted or assessed, including financial concerns, lack of housing, or lack of social support. Because these terms are not defined. The amendment also conflicts with later provisions of the bill setting out how eligibility is assessed in more detail, which would cause confusion if passed. Considerable further policy and drafting work would need to be done to clarify the intent. My Lords, I make no, particularly in the spirit of brevity.

I make no comment on the other amendment in this group. However, as noble Lords will be aware, the amendment has not had technical drafting support from officials.

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My Lords, I'm grateful for the way that this has been dealt with. way that this has been dealt with. We have discussed this a lot, both at Second Reading and Committee, at Second Reading and Committee, and I have made absolutely clear that suffering, whilst it may very that suffering, whilst it may very often be the cause for somebody wanting an assisted death, is not the trigger for it in the sense that it's a legal requirement why people want to end their life in the context of a terminal illness is for them to decide the effect of

16:22

these amendments is that a person is only entitled to an assisted death if the reason for them wanting the assisted death is the symptoms, suffering, or prognosis of terminal illness. I am not in favour of inquiring as to precisely what is the cause. Severe misery may well be the cause in the context of a terminal illness. In my view, this provision unduly limits the entitlement to an assisted death. So I'm against these amendments because they go right against the principle of the bill.

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I think the noble and learned Lord is utterly wrong in his last pronouncement. Misery should not be pronouncement. Misery should not be a reason for an assisted death. The misery may be able to be removed. I think I heard my my, my noble friend Lord Moylan in in the Second Reading stated that many people don't actually want to die. They want the they want the things that are causing them the feeling to die,

16:23

Lord Blencathra (Conservative)

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to be removed. They want better housing. They want better relationships with their family. They wish their love life was better, whatever or they want out of total misery. So I think the noble noble and learned Lord is utterly wrong in extending in seeming to extend the the the reason for dying beyond the severity of the terminal illness itself. But, my Lords, we will probably discuss this in better and more detail in the next group of

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amendments. So I beg leave to move to withdraw my amendment. Lordships pleasure that this amendment be withdrawn. Amendment amendment be withdrawn. Amendment is by leave withdrawn. Amendment 39 C Lord Browne Clapham. Not moved. C Lord Browne Clapham. Not moved. Not not moved. We now come to amendment 40 which has already been amendment 40 which has already been debated. Baroness Lawlor not moved. Amendment 41 Lord Carlile not moved. Amendment 41 Lord Carlile not moved. Amendment 42 Baroness Finlay not moved.

Amendment 43 Baroness Coffey not moved. Not moved. Therefore, we now come to the group of amendments beginning with amendment 44. And I do advise noble Lords that Lord Shinkwin will be taking part in. I understand that he will be taking part in this group of amendments remotely. So in in clause one, amendment 44, Baroness Berger Lords, I.

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Rise to speak in support of

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Rise to speak in support of amendments 44, 313, 341, 452, 511, and 580. In my name, which are and 580. In my name, which are distinct to the group we've just addressed in a very quick fashion, but a different variation of the but a different variation of the same discussion. This group. Certainly amendments within this group seek to make a simple but group seek to make a simple but substantive clarification to the bill, which is that assistance in ending life should be available only where a person's clear, settled and informed wish to die arises because of their terminal illness, and not for any other reason.

As drafted, the bill not only does not require a causal link between a person's terminal illness and their request for an assisted death, it actually does not specify any reason at all. This is a significant difference from assisted dying laws in many other jurisdictions, and that includes some of the countries whose laws

16:26

Baroness Berger (Labour)

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have been presented to us as comparable to this bill, and as proof that we can have confidence

16:26

Lord Blencathra (Conservative)

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proof that we can have confidence in it. Under New Zealand's End of Life Choice Act 2019, a person must

16:26

Baroness Berger (Labour)

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Life Choice Act 2019, a person must not only have a terminal illness likely to end their life within six likely to end their life within six months, they must also be in an advanced state of irreversible decline in capability and be experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable. In Spain, which we are told is a model for the new voluntary assisted dying panels, the requirement for an assisted death in Spanish law is intolerable suffering.

By contrast, our panel will not have to investigate or even ask why the person has chosen

16:27

AMDT: 44 Baroness Berger (Labour)

this route, as long as they appear to mean it. As long as a person fulfils the other requirements, fulfils the other requirements, medical professionals and the panel will not be expected to ask whether will not be expected to ask whether the person may be motivated not by the disease itself, but by, for the disease itself, but by, for example, the shock and despair that follows a terminal diagnosis, or the stress and anxiety that comes the stress and anxiety that comes with the cost of care, or the sense of guilt of being a burden on family and partners, or the family breakdown that, sadly, can often happen next.

Perhaps the person has also or has previously struggled with suicidal ideation even before they were diagnosed with a terminal illness. None of these examples would rule a person out of eligibility under this bill. I believe that it is a profoundly concerning weakness in the bill's construction, and one which fundamentally undermines the claim that it has the and I quote, the world's strongest safeguards. It does not have one of the most common and obvious safeguards there is, and which rightly exists in other countries.

Indeed, it was in the 2012 Commission on Assisted Dying, chaired by my noble and learned friend Lord Faulkner, that came to the conclusion, and I quote, it is essential that any future system should contain safeguards designed to ensure, as much as possible, that any decision to seek an assisted suicide is a genuinely voluntary and autonomous choice, not influenced by another person's wishes or by constrained social circumstances such as lack of access to adequate end of life care and support. My amendments, therefore, go to the very heart of the balance that the Bill is trying to strike, and which many of us fear may not be possible.

That is, to allow dying people to decide when to end their lives, but without taking any step towards the encouragement or normalisation of suicide. My Lords, this is not a theoretical concern. Make no mistake, the demand for assisted dying for other reasons does exist and will be seen all too clearly if the bill passes as drafted in jurisdictions that have introduced assisted dying without a requirement for a terminal illness at all, or have afterwards expanded beyond it, there are documented cases of people seeking to end their lives not because they were dying, but because they could not access the care, housing or social support they needed to live.

Well, that cannot be the path that we take here. We must ensure that our law is rooted in compassion, yes, but also in moral clarity about the need to prevent suicide. Great strides have been made in doing that in recent years, both within the medical profession and other public services. At the select committee on this bill, we heard about the importance of this from witnesses, including the chief executive of the mental health charity mind and the Royal College of Psychiatrists. We must have confidence that if this bill passes, it will not be at the cost of that vital progress.

My amendments would also serve to strengthen public confidence in this legislation. Many people, including those who support assisted dying in principle, expressed deep unease about the possibility of eligibility criteria under this law being extended over time by explicitly tying eligibility to a person's terminal illness. We reassure the public that this bill is not a step onto a slippery slope, but a specifically defined act of mercy for those who are truly at the end of life. I have heard concerns expressed throughout the Bill's passage that it is intrusive or humiliating to require that a person must prove a particular degree of pain or suffering.

I have listened and my amendments take a different route, asking only that doctors establish that the reason for the request is the terminal illness itself. It is not an. This is not an unreasonable bar to access. It is simply making explicit in the bill that the very reason we have been given for why it is that an assisted death is needed. My Lords, I have spoken often in this House and beyond about the importance of mental health and about the need to treat mental illness with the same seriousness and urgency as physical illness.

This amendment is consistent with that principle. I'm not sure that there can be any more important set of words within this bill than those which which those, and those which define the purpose for which we would allow such a change to a law that has existed for centuries. I urge your Lordships to support my amendments to make this bill true to its purpose, to bring dignity to those whose lives are ending. And I

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commend these amendments to the House. Amendment proposed. Clause one, page one. Line 17. Insert the words as printed on the national list.

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as printed on the national list. My Lords, I rise to speak to amendment 44, so ably introduced by amendment 44, so ably introduced by the noble Baroness Blake Lord Barker, and I thank her for tabling

16:32

Lord Shinkwin (Conservative)

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Barker, and I thank her for tabling it. Today is an especially important day for me because it marks exactly 30 years to the day when I had emergency neurosurgery in a desperate attempt to save my life. Following a terminal diagnosis of only six months. My neurosurgeon couldn't give me odds on survival, never mind recovery. So the outcome was definitely not a done deal. My Lord Sassoon need for this amendment underlines why it's so important that no one assumes this appallingly drafted bill is a done deal by the.

We keep being told by the bill's supporters that this bill is about people who are already dying. If that's the case, I'm assuming the amendment will meet with their enthusiastic support, given that it would make incontrovertibly clear on the face of a bill that a person's motivation for seeking unassisted death is that an illness? Otherwise, as last Friday's debate shows, we took the extremely dangerous situation of other motivations coming into play motivation, such as feeling like a burden, living with a mental disorder including depression or with a disability other than terminal illness.

Last month, when there were Baroness Gray of Tottenham in her powerful speech of 12th of December said, and I quote, we don't live in a society where everyone is equally able to make decisions without being constrained by external influences, whether that's in the form of other people or simply follows from one's own life's circumstances. How right she was. And there was a time when I imagined the noble and learned Lords would have agreed with her.

Given that his own commission ruled that it was essential to ensure decision was, and I quote, not influenced by self-imposed pressures that could result from people feeling themselves to be a burden. It's worth asking the question as to what has changed in that time. Well, the pressures on the NHS have increased. Access to GPS has massively decreased, house prices have rocketed, making their own home making, owning their own home a distant dream for many young people, and thus the inheritance from granny.

Even more valuable. Meanwhile, social costs have gone through the roof, thereby devaluing Granny's legacy. And of course, as your Lordships' House highlighted only two days ago, the insidious impact of social media has had an alarming effect on society and many on some of its values. So noble and learned Lord Moore agree in his closing remarks that, taken together, these factors only serve to make the case even more compelling for there being a specific requirement on the face of the bill that the sole reason people conceit and assisted death is that illness.

If it doesn't, let him say so, because to his credit, in 2012 he was clear about the danger of someone filling a bed. And I admire his honesty and clarity then, but take the opportunity today to be equally honest and clear and confirm that in changing his mind, his moved from viewing burden as a pressure to be safeguarded against, to instead viewing it as a legitimate basis of a rational choice to be facilitated.

Let me say to the noble and learned Lord that I may not agree with him, but I would applaud his determination to address the question directly. My question posed by this amendment can't be touched because it goes to the heart of the bill. Indeed, failing to accept the amendments only makes sense if there is an ulterior motive in rejecting it. So I would be grateful if a noble and learned Lords, when he comes to reply to give your Lordships House a categorical assurance that there is absolutely no intention by the draughters and promoters of the Bill, that anyone should ever be able to cite this bill as the grounds for saying at a later stage, on what basis would we deny that same choice assisted dying to people with depression or those who are chronically ill, for example? Indeed, with the noble and learned Lords Lord Choudrey that accepting this amendment would actually help him, at least in part to dispel the fears of those who suspect that if autonomy rather than motivation is symmetric, that really matters here, then this bill would contain the seeds for removing barriers to a Canada style assisted dying free for all in years to come.

After all, if motivation is irrelevant, how could it not? My Lords, in conclusion, the noble Baroness does your Lordships' House a great service because her simple amendment hits the nail on the head. It also indirectly exposes the battle that is underway for the soul of her great party, its values, not least its commitment to disability rights, for which I have so much respect. Cannot simply be suspended for the duration of this bill.

There are hard choices to be made here and now. My Lords, I hope very much that the noble and learned Lords will recognise the significance of this amendment and

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choose to accept it. My Lords, I put my name to

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My Lords, I put my name to amendment 313, and my concern actually is the whole question of misdiagnosis. My noble friend Lord shrinking has addressed the fact that he was diagnosed with a terminal illness, and that was now some time ago. And one of the

16:40

Lord Hamilton of Epsom (Conservative)

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assumptions running through this bill and through the amendments, and I apologise to my noble friends who put down these amendments, is that the medical diagnosis of somebody approaching death is faultless, and we know from endless examples given by your Lordships in this House that that is not actually the case. There are a large number of incidents when the medics get it completely wrong. And I would like to address at the moment the question of them quite innocently getting it wrong.

I will deal with more malicious misdiagnoses in later amendments, but I think the whole basis on which we are discussing this bill is on the basis that there has been a medical diagnosis, and that this has to hold up as being the sort of the whole basis on which assisted dying takes place. But we know all too often that people live on quite a long time. And the noble Lord Lord McCrea actually made the point that people have lived on with diagnoses as they were going to die after six months.

My wife's uncle, a distinguished diplomat, was given six months to live and died 18 months later. So the so much fault is that the case here, that I think we should be very worried about how much medical diagnosis we're going to lean on as a basis for judging that somebody should be allowed to die. Earlier on in the debate some weeks ago, my noble friend Lord Polak described how he was given six months to live.

Now I know is no longer with us, but I wouldn't describe him as a delicate flower. But. I would also say that he's probably not prone to bouts of sort of depression and that sort of thing either. But it's hypothesised.

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Yes, indeed. Please. I'm very grateful. Just for the avoidance of doubt, for anyone watching these proceedings, the watching these proceedings, the noble Lord Lord Polak is no longer present in the chamber. He is very much still with us.

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much still with us. Lord Harper is absolutely right, because he's still with us. But he's he's he's absent for the he's he's he's absent for the moment. So it might have been that when he was given his diagnosis that he had six months to live, that he had six months to live, that he was told that his final months would be very, very grim indeed and that he would suffer terribly. And he might, if this bill had been in place, have made the decision to actually end his life.

My Lords, that was 32 years ago. And, you know, Lord Polak is actually pretty fit and doing a good job in your Lordships House. So we do have to question medical diagnosis in this case. And I'm very concerned, and I would like to hear from the noble Lord, Lord, Lord Faulkner, what he thinks about the problems of wrong diagnosis, because I'm old enough to remember that there was a time when we had capital punishment in this country and it was abolished.

And one of the reasons why it was abolished was because of the miscarriages of justice and the number of people who were hanged when they were innocent. Now, that was a very serious lever, used to actually get rid of capital punishment. What percentage would the noble Lord, Lord Faulkner, think would be right of misdiagnosis of terminal illness before he thought about whether the whole basis of this bill was to be questioned? Because I don't think we have any statistics.

Maybe he has got some of misdiagnosis, but it does really undermine the whole basis of this bill. If we have doctors who quite innocently are saying we think this person's only got six months to live and then find that they haven't and they live on much longer, and I think this is a matter of tremendous concern to people in this country.

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I give way to noble Lady. For giving way. It might be helpful in the context of this conversation, for noble Lords to be conversation, for noble Lords to be aware that on the data that the Department for Work and Pensions has, when people are in receipt of has, when people are in receipt of a benefit that comes during the six months towards the end of life. On months towards the end of life. On the DWP records, 23% of people who were given a six month prognosis were given a six month prognosis are still alive three years later.

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So if if I, if I understand the lady right, that's 23% of people lady right, that's 23% of people who died well beyond the six months sentence they've been given. That's an extraordinarily large figure, an extraordinarily large figure, and I'm grateful to her for that. And I think that makes us question the whole basis of this bill, which the whole basis of this bill, which is talking about medical diagnosis, is talking about medical diagnosis, giving people a limited life, which turn out to be wrong.

And this should be very, very disturbing. I think if we're going to go ahead on the basis of information that could be wrong in quite as many cases as

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that. Just might be helpful before the noble Lord sits down. He asked about data, and during the select about data, and during the select committee that was held on Lord Joffe's bill on this subject, the Royal College of Pathologists told Royal College of Pathologists told us in evidence that at post-mortem, us in evidence that at post-mortem, 1 in 20 people were found to have died from something different to what was written on the death certificate. And I think that underlines the point that he's making that errors in diagnosis are the fundamental problem happen quite often, and that results in the wrong treatment being given not through malpractice, but just

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because medicine is a very inact science. Very grateful to the noble Lady. And I think that just illustrates And I think that just illustrates my point, that misdiagnosis can very easily be done. And we are very easily be done. And we are putting an enormous input and weight on it in this bill, and it weight on it in this bill, and it can so often be wrong. And I think we should be very disturbed and concerned about that, because I do concerned about that, because I do think that it means that we may be passing legislation which is based

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on very faulty information. To a convenient point to speak to the two amendments in my name in to the two amendments in my name in this group are my amendment 320ZA this group are my amendment 320ZA complements the amendment 339 B and 39 C. I briefly touched on in the last debate by making explicit that non-medical motivations cannot drive an assisted death. It draws a distinct line between medical suffering and social abandonment. International evidence shows that

16:47

Lord Blencathra (Conservative)

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non-medical motivations dominate assisted dying requests. In Oregon, the being a burden is cited by the being a burden is cited by nearly half of all applicants. Parliament must decide whether it Parliament must decide whether it is comfortable legislating for that. This amendment ensures that England and Wales do not drift into a model and Wales do not drift into a model where existential distress, loneliness or, in the words of the noble and learned or sheer misery noble and learned or sheer misery or lack of care become accepted reasons for state facilitated death.

It also responds directly to the Equality and Human Rights Commission, which warned that subtle pressures from lack of services can drive people prematurely towards death. This amendment ensures those pressures are addressed, not endorsed, and my amendment 332 AA operational Operationalises the ask why concession the noble Lord, Lord Faulkner, said he is attracted to a requiring clinicians to ask why a person wants to die, but unless the answer has consequences, the question is meaningless. This amendment ensures that when the answer is I am a burden, or I cannot afford care, or I'm alone, I'm fed up.

I'm miserable. The process pauses and support is provided. It reflects the evidence from the Royal College of Psychiatrists and the British Geriatric Geriatric Society, both of whom emphasise the need for holistic assessment. It ensures that treatable depression and met care needs or social pressures are addressed before an irreversible decision is made. This is safeguarding, my Lords, not obstruction. It ensures that assisted death is not used as a substitute for care. My Lords, my amendments matter because the first of all, we protect genuine choice, a decision driven by lack of heating, housing or social care is not the same decision.

It is not the same as one driven by intractable intractable physical decline. These amendments stop the law becoming a back door response to social failure. Second, I believe there are practical safeguard, not a veto. This is not a blanket ban. It's a procedural pause to address fixable problems, social support benefits, palliative referrals before a final medical judgement is made. And third, my Lords, clinicians need clarity. Doctors must be able to ask why and act on the answer. These amendments give them a clear statutory duty to do so, reducing moral and legal ambiguity.

If the noble and learned Lord Lord Falconer of Thoroton truly believes this bill is about free, informed choice, will he oppose leaving people to die because the state failed to provide basic support? Or will he back these modest, targeted safeguards?

16:50

Lord Markham (Conservative)

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I think the main point here, though, is by definition, you're though, is by definition, you're only eligible for assisted death if you have been diagnosed to be within six months of the end of within six months of the end of your life through a terminal illness. So by definition, that is the reason that you're applying for an assisted death. That is the motivation for doing it. Because clearly these people, it's not like they want to die. Again. We've

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talked to many people I'm sure a lot of people have. They would situation. I'm very sorry. To.

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To. Interrupt, my noble friend, but even the sponsor of the bill, the noble and learned Lord, has been noble and learned Lord, has been very clear in saying that the six very clear in saying that the six month prognosis is a trigger that gives you admission to the process, gives you admission to the process, if you like. It does not have to be the reason, and so it isn't by definition the case that if you have the prognosis, that must be the reason.

There are two quite different concepts.

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No, as I say, these are not people who, you know, want to die. They are people who absolutely want They are people who absolutely want to live. The only reason and the only reason they'd be eligible, but the only reason they are entering

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into this process. I'm I completely sympathise with the noble Lord, Lord Markham's point that they don't want that. These people don't want to die. They want to live. Would he then agree with some of the amendments that I raised last week and spoke on, which is if, for example, they want to die, then they get terminally, then they get diagnosed with terminal illness, that that would be relevant to not allowing them into the process, i.e. that they do want to die.

And then the trigger of terminal illness allows the state sanctioned administration of lethal drugs so that they can commit suicide, which is all of the reasons why people have raised problems about suicide ideation and mental illness. And therefore, I hope that he will back some of the amendments on safeguarding that I raised.

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Yes, of course, noble Ladies talking about a slightly different talking about a slightly different circumstance where there are prior reasons which could be mental health or other reasons why, why, health or other reasons why, why, why that be could be a cause. What we're talking about here is, you know, basically the criteria on know, basically the criteria on which you can first be assessed for this whole bill and assisted dying, which of course, that you have been which of course, that you have been diagnosed in the first place.

And I think to the point that, of course, people might then live longer, might, might experience is, of course, that they're delighted by that, just because they've been assessed as being able to have assisted dying doesn't mean that they will take the medication again. The evidence shows very, very strongly that they will only take the medication right near the end when the pain, the loss of dignity or whatever the reason it is becomes unbearable. So again, my experience is these people would be delighted if it was a misdiagnosis.

And if they're fortunate enough to be living 30 years later. As for some of these examples, they'd be fantastic. And of course they will not have taken the medication. And the point is, they only take it right at the end where there's no other choice, so to speak. So then within that, accepting this is the criteria of people we're talking about. Then of course, there are all sorts of different motivations. Why, when they're unfortunately at the point where they are looking at this death, why they might want to then go ahead with it.

And again, research shows that there are multiple reasons it's impossible to put it down to just one loss of autonomy, less able to engage in enjoyable activities, loss of dignity, loss of control of bodily functions, burden, inadequate pain relief, financial. These are all parts of the reasons. They're all parts of the research. And what you'll find is on average, there's 3 or 4 reasons to do it. So I think it's quite wrong to say no, we're only going to allow you to go ahead with this.

If you've only got that single motivation. I said before, they would rather not be there in the first place, but given that they are in that unfortunate circumstance, surely they should be allowed the choice of why they wish to die.

16:55

Lord Carlile of Berriew (Crossbench)

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So I put my name to the noble Lady Baroness Burgess amendments, and I won't repeat what she said. She opened these amendments with She opened these amendments with superb clarity, characteristic of her contributions to your Lordships House. I have been shocked by what I've just heard from the noble Lord, Lord, Lord Markham, and I would ask him just to reflect on two contributions made earlier in this afternoon's session by my noble friend Lord Mawson, who, from his own experience described what happens in poorer neighbourhoods which he has experienced very directly, in which people face different problems and are more likely to want to die for reasons to which their terminal illness is just an ancillary point.

I've been involved in these debates since I came into your Lordships House. At least I was on the JoffÃ© Bill committee with my noble friend Baroness Finlay. In that committee on that bill, in all the other bills that I can remember since, and particularly in all the case law that I followed over the years, mostly very celebrated cases, the purpose of asking for assisted suicide has been to alleviate, alleviate terrible suffering that has been the sole purpose for demanding a change in the law to alleviate terrible suffering.

And I do not believe that the noble and learned Lord wishes to achieve anything different from that. It's just that it doesn't say in the bill that the purpose of having assisted suicide should be to alleviate terrible suffering. Now, of course, there may be other issues at work in that person's mind when they ask for assisted suicide. We cannot read every synapse in their brain, but we are here to legislate to save people from terrible suffering. If this bill is to pass, and I'm very concerned that this bill should be amended so that the the have it be the capacity, the capability rather to have assisted suicide does not arise as an opportunity to commit suicide.

It should be the the reason to commit suicide should be. I'm sorry I can't see behind my head and I'll give way in a moment. But it should. The absolute cause should be the intolerable suffering who wanted to intervene. Please.

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Thank you. Would the noble Lord. Accept, however, that it would

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Accept, however, that it would be deeply unfair if somebody whose major wish was to end their terminal illness, and the pain and the the intolerable suffering that the the intolerable suffering that was coming with it, was to be denied that right, because they were also concerned about numerous other things. Very few people have a perfect life, even when they're close to death. And to deny that person the right to an assisted death because they might have concerns beyond their suffering,

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would seem to be cruel in the extreme. Difference between what I'm saying and what the what my noble saying and what the what my noble friend is saying. What I'm saying is that people should, if this law is passed, be able to obtain assisted suicide because of intolerable suffering. I'm not seeking to exclude other matters seeking to exclude other matters that might be in their mind, but the cause of asking for assisted the cause of asking for assisted suicide should be that suffering.

And I think that the medical profession and lawyers and judges in particular, if we have the judicial option rather than the panel option, are perfectly capable of reaching a decision on the facts

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that would lead to the appropriate conclusion, I the moment. At which.

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At which. Are you going to say to the noble Lord, I'm sure he will remember that I too, was a member remember that I too, was a member of those earlier select committees, and I'm sure in that context he will remember that the arguments will remember that the arguments and discussions and vagueness, frankly, about how one would ever frankly, about how one would ever define intolerable suffering in a legal sense or in an Act of Parliament, was even more intense than the one that we're having today.

And that that was because there is even more subjectivity about the concept of intolerable suffering than there is about any other.

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I don't actually agree with the noble Lady much as I admire her noble Lady much as I admire her contributions to this house in what she said. I believe that as a legal she said. I believe that as a legal concept, what I'm suggesting is absolutely clear and could be defined properly if we were to use defined properly if we were to use the courts to make the determinations.

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determinations. I do think this is a point which we come to the heart of. The reason why I find this bill so difficult. I know what sort of society I've spent my life trying to produce and work for. It's a society that cares work for. It's a society that cares and cares, particularly for the vulnerable. I was accused by the noble Lady of being patronising the noble Lady of being patronising the other day. Well, if it's patronising to defend the vulnerable then I plead guilty.

17:00

Lord Deben (Conservative)

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I must respond.

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I certainly did not accuse the noble Lord of being patronising. I said that I thought there were said that I thought there were difficulties in health policy when we accepted some of the old and we accepted some of the old and more now old fashioned concepts, which the medical profession seem to be patronising. I was not indeed

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to be patronising. I was not indeed referring to parliamentarians. I won't take it, therefore, as I

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I won't take it, therefore, as I did on the occasion that she mentioned it. But what I want to say to the the house is very simply this. There will be many people in many institutions that will be tempted to look at the price of death as against the price of life. For those who are very seriously ill, there is no doubt at all that in all the area, all the countries that have already enacted laws of this kind, they have all found this problem.

They've all found the problem that the difficulty is that people who have been given about six months to live, even if that is a false diagnosis, there is the tendency to say, well, they're going to die anyway. A number of noble Lords and ladies who support this bill have said that I want a society which cares about those people right to the last moment in which they die. That's what I think we're here to do. I hope that doesn't sound too.

O sentimental. It's actually the difference between kindness and love. Love is something with a backbone which cares for people right to the end of the moment, and which makes sure that they don't feel a burden. Now, we can't do that for everybody. But the trouble with this particular bill is that it doesn't make it as absolute and determined that we do look after people, that we do find out if they feel a burden and help them not to feel a burden.

Any of us who have loved ones who are ill, even if they're not seriously ill, the very first thing that they do is to feel a burden. Burden to their spouse's burden to other people. That's what decent people do. Other decent people spend their time trying to make sure they don't feel a burden. Other decent people try to see what it is that is at the heart of their misery is the phrase that is used. We should be here to try to remove the misery from people in their last year, in their in their last six months, as we should be through the whole of their lives.

And what I have to say to those who are proposing this particular bill is that they seem so committed to get this bill through somehow that we must not, in fact, we must not, in fact, consider what the rest of society is. And I, I know that the noble Lady is hoping to interrupt me. But before she does, let me just say this. I am not one of those conservatives who believe in the kind of free market operation where you don't deal with things at all.

I mean, in that sense, a socialist, I believe in the individual, in society and the whole problem and the whole problem about this emphasis, this emphasis on autonomy is that it isn't acceptable unless you see the individual in society. And the trouble with this bill is that it tempts those who find it more convenient to allow people to kill themselves, because it's more expensive for them to continue to live. I will give way to the noble

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Lords. I wasn't going to interrupt the noble Lord, but his last remark does lead me to interrupt him. I does lead me to interrupt him. I don't think there is anybody who backs this bill, because they think it's more expensive for people to it's more expensive for people to be continued to be treated now. Nor do I think it's the case that those people who back the bill are in some way unaware of the societal some way unaware of the societal context in which people live and die.

We're all aware of that. Moreover, I think some of the comments from those who are opposing the bill or trying to introduce more amendments to it are neglecting the fact that most doctors of course, nobody is perfect, but most doctors are fully aware of their obligations as a member of society and a member of a caring profession. They spend a lot of time trying to help and advise their patients, not just about their immediate medical needs, but about their other needs.

It is certainly the case that most general practitioners will help a patient who is suffering because of poverty. They will find ways in which they can get access to funding. They will find ways to support the patient in terms of their worries about being a burden. So I don't think anybody who supports this bill for one moment suggests that we should accept that a patient who feels they are, they are a burden, should die just for that reason. The reason they do think they should die if they want to is because their suffering is intolerable.

That is what lies behind those who backed this bill's motivation. So I hope the noble Lord will accept that and understand that there is nothing in what we are saying, which suggests that we simply want people to be able to die. And because they need to be autonomous, we want them to have the choice to be able to die, if that is indeed their choice and the circumstances in which they are in are such that their suffering is enormous. And most of us who are actually backing this bill have experienced this in our own lives and seen what happens in these circumstances.

And I have sometimes wondered in listening, and I've done a lot of listening, not much speaking on this bill that some of the people who are raising all these amendments have not had the experience of seeing what seeing what terrible suffering the people who are already diagnosed as

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terminally ill are suffering. Yeah. Well, I agree with everything that the noble Lady said. That's that the noble Lady said. That's not what I was saying. What I was saying was that many people, in saying was that many people, in seeking to get this bill through, are not facing up to the fact that are not facing up to the fact that there are many people in society who will see this as an opportunity to find the better thing for them.

If their old grandmother decides to take her own life. Now, I do say to the noble Lady, some of us have spent many, many years working not as effectively as Lord Mawson, but many, many years working among people who, frankly, are wonderful, have really dealt with huge difficulties in their lives. But we've also found people who would be happy for the death of their grandmother for a matter of a very few pounds. And if their grandmother has a house worth £200,000, then the situation becomes much more clear.

And they know what they want, and they know what the pressure would be. And asking whether people have seen that. I have to say to the noble Lady, I have seen that I have seen it more times than I'd really like to go through with her. And I have to say that that is so. And those of us who have worked all our lives in

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those circumstances and Lord Mawson I think will support me, will recognise that that. Is the case.

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Is the case. Now, all I'm saying about this amendment is that it helps to amendment is that it helps to protect people against that. And it does it by saying that we as a does it by saying that we as a society should be concerned that if somebody thinks they ought to end their own lives, even if they've their own lives, even if they've only got six months to live because their housing is so bad, or because they feel a burden on their family, or that they think the National Health Service shouldn't be spending the money on them.

If that's the case, we ought to be doing what is necessary to remove that reason. If they still, because of intolerable pain, because of that, if they still wish to end their lives, then this bill will be a proper means of doing it. I want to end just by this simple thing. The noble and learned Lord has explained why he doesn't want in the bill itself a reference to intolerable pain and the rest. And I understand that. And that is why the noble Baroness, Lady Berger, has produced this answer, and it is a crucial one, not just because of the sort of society in which we live.

And this is my very last point. But if you do a public opinion poll, what people think this bill is about is about allowing people in intolerable pain to end their lives. That's what they think it's about. And it isn't about that. And what Lady Berger is trying to do is to make sure that it is about that, and that we don't become a society for which this is a cheaper way, or a way in which people can use their influence to gain their own ends.

The best way to add to that support is to support what she says. But it's also a way for us as a house to say to the world, we're not concerned with this assisted suicide for any other reason except as an autonomous choice about real, terrible suffering.

17:11

Baroness Cass (Crossbench)

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Lord Watts. We know that people >> Lord Watts. We know that people may have many of the problems that proponents of the bill have described as reasonable described as reasonable justifications for why someone may want to end their life. They may already be a burden as they see it, or incontinent, or under financial duress, or have pain from arthritis or a whole host of other things that are going on in their life. They may have, you know, fallen out with members of their family.

There's a multitude of things we've heard endlessly about that. And then randomly, they get this ticket that says the ticket that nobody wants, that says that they only have six months to live. Now, prognostic predictions like that are based on averages. And the shocking fact, as we know, is that 50% of people are above average. So there will be a huge range. So if you've been given a six month prognosis, it could be anything from one month to, you know, a 32 years, as we've heard.

So to to then say that is your ticket to be allowed to have an assisted death and then completely disconnect that fact from the reasons for your assisted death makes no sense at all. There is no internal logic in that. And I think that Baroness Burgess amendment is brilliant in getting us past the intolerable suffering to something that is plausible, tangible and really clear. And as I've said previously, the thing that doctors make judgements all the time, the judgements about the six month rule is hugely inaccurate, as I've just described.

But the one thing that the doctor can usefully do is determine whether there is plausible plausibility that the symptoms that are distressing the patient are related to that illness, and they don't have to be the only reason they can have all those other all those other factors going on. But if there is plausibility that there are symptoms relating to that illness, be it pain or breathlessness or incontinence or whatever else it happens to be, that is distressing to that individual, then that seems to me to be acceptable, although I personally I would prefer it to be limited to, to pain and and and and and breathlessness and things that actually aren't amenable or may not be amenable to treatment, but nonetheless, that still gives the doctor some yardstick to determine that this is not just about coercion and even a sort of internally driven coercion, that the patient feels that it's their job to to end their life.

Anything else you're asking for? For somebody to make a judgement that is just not feasible. It's I cannot see and I've said this before, how it is feasible to assess whether the patient is feeling coerced in the way that Baroness Fox described in earlier discussions, just because of the tutting and the head shaking at having to bring something to the patient or the person. Once again, this gives us something which is concrete, it's clear, it's defensible, and I do believe that it is what the public

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believe this bill to be about. 100% support. The motive behind the noble Baroness Brady amendment. And what the noble Baroness Brady and others have just said. But my question is this which is, will it question is this which is, will it make any difference? Because if you know, if you want an assisted death,

17:16

Lord Moore of Etchingham (Non-affiliated)

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know, if you want an assisted death, won't you be able to get it simply by saying that it's related to your terminal illness? What how could, how could how could anything more? You've got a terminal illness. You've got you've got the prognosis. And you will therefore be advised by anybody who wants to assist you in your death, that that's what you must say. And so how is this actually a protection for the problem we're discussing?

17:16

Lord Harper (Conservative)

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This group of amendments, the >> This group of amendments, the two sort of parts of it, if you like, the amendment that I support, that Baroness Berger has brought that Baroness Berger has brought forward is the one that sets out the primary motivation for you. Seeking assisted death is your terminal illness. And I think that is important because otherwise the terminal illness is simply a trigger. And one of the reasons I think it is important and I'm not, by the way, saying that this is the motivation of the sponsor of the bill.

But one of the things that I am very nervous about, he will be aware that many people think that this bill is just a first step. And there are campaigners outside this House that absolutely do think that. And one of the problems with the way it's drafted at the moment is because the terminal illness is simply a trigger. Then it would be very simple if this bill was on the statute book, to simply remove that qualification, and the rest of the structure of the bill would then allow anybody, for any reason, without having a terminal illness under the process in this bill, to seek an assisted suicide.

If you have the amendment in the Baroness Berger suggests, which is that the that the reason why you're seeking an assisted suicide is your terminal illness, then you can't do that, because if you were to remove the terminal illness piece, then actually there would be no motivation. And so you'd have to do a lot more work. So I think those of us that are nervous about this bill as a Trojan horse would be more reassured if that motivation was in place.

The second part to it is that it goes to what Lord Deben said about what the public think this is about. And if you look in the opinion polling about what the public think should be reasons that someone should be able to seek assisted suicide, the powerful reasons that many members not all, but significant number of members of the public support is to relieve suffering and pain. People are broadly compassionate, and they think that's a good idea. What they do not support is people being able to seek assistance to kill themselves because they're poor or for other reasons.

They think that's a terrible reason. And so I think Baroness Berger amendment and others in this group more closely align the way the bill is structured and what it would do with what many members of the public think it should do. The second point I would make is supporting my amendment from my noble friend Lord Blencathra amendment 320 z a, which explicitly says that the purpose of you seeking assisted suicide cannot be various societal factors like your housing and your financial circumstances, and I do think that is important.

The noble and learned Lord Woolf and I had an exchange last week where he made it very clear that he doesn't think or he thinks that if that is, those things are the drivers for you wanting to end your life. He's OK with that. I'm not. And I don't think the public and the polling evidence is that the public's not OK with that either. Choices should be proper choices. And I think Lord Deben set out very well the sort of society that I think people want to see, which is that if people want to end their life because of not to do with their illness, their terminal illness or their pain or their suffering, but because they don't have enough money or they have poor housing, or they have other things that they're not happy about, those things are remediable.

They may be expensive, but they are fixable and we can do something about it. And I want to live in a society where we do something about it, and we make people's lives better. Even if, my Lords, even if it is only for the last few months of their life, I think that's still worth doing. And I think Lord Deben is right. It's he's not saying that the sponsor or the people in this House who support this bill are thinking like this, but he's absolutely right that people make decisions all the time based on weighing up financial consequences.

People have talked about nice today. One of the things that nice does when it assesses approving drugs is it looks at quality adjusted life years against the price of the drug to the health service. It literally weighs up how much valuable quality life are you buying versus how much money are we spending. And my worry is if you don't exclude people wishing to end their lives for these other reasons, we get ourselves in a terrible place where we aren't prepared to spend the money on improving people's lives.

We we rush them towards ending their life in a way that is not necessary. And I think that is a is a big choice for Parliament to make. And there are different views that the noble and learned Lord Bourne Falconer set his view last week. I've set out my Lord Deben set out his and we're in agreement. And that's a decision for the House, and I hope the House will support the amendment my noble friend Lord Blencathra has put down. That will be the House making a decision that you can only seek assisted suicide if it's because of your terminal illness, not because of your other circumstances.

I think that is the right sort of society would be creating. And I think the package of the amendments in this group would improve the bill, and they would also reassure many people who are concerned about the bill to not be concerned about it. And I think that would be helpful for everybody. And I commend them to your Lordships House.

17:22

Baroness Royall of Blaisdon (Labour)

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You just say that. I completely agree with. >> Lord Deben in terms of the society that we're seeking to have. We agree on so many things. We're on different ventures, but we agree on different ventures, but we agree on many things. However, the pre-eminent reason for this bill, pre-eminent reason for this bill, it's a terminal illness for six months. I understand what the noble Lord opposite is saying that one cannot be sure. But we talk about six months and as other noble Lords have said, one might aspire to and one might have access to the drugs so that one can one could take one's life.

If one had a terminal illness and it was thought that it was going to last for six months. But it doesn't mean to say that people are going to use them. I think it's important to realise, to remember that all the time. But six months in a terminal illness, I think that that is a very important thing to keep in the forefront of our minds at all times and.

17:23

Baroness Finlay of Llandaff (Crossbench)

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It is prompted. >> Me to return to the point made by my noble friend Baroness Cass, because the chance of being right because the chance of being right about six months has been estimated at being around 48%. It is just plucked out the air. Really, it depends on the individual and how their body responds to whatever disease it is, and lots of factors that are going on. But there was I was really concerned when the noble Lord, Lord Markham, said that these are people who want to live because then they should be having access to specialist palliative care to maintain their quality of life as high as possible.

And yet we've got

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huge gaps in this country. And I would. I was making the point and I'm

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I was making the point and I'm I'm looking at some people in this category in this very room. I believe they want to live for the rest of their natural life for as long as possible. That's what they really want. They desperately do

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really want. They desperately do not want to be diagnosed with a terminal illness. Well.

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Well. I think no, I have to say, and I have looked after thousands and thousands of patients, and I have never come across somebody who says they want to be terminally ill, they want to have their metastases or whatever. No, people want to live well, but accept that death is a natural part of life. That's quite different to talking about deciding that somebody is going to be given lethal drugs to foreshorten their life. The benefit of these proposed amendments from the noble Lady, Lady Burgess, is that it actually fits completely fair and square with the title of this bill as well, which is it's about terminally ill adults, and it makes it clear that this is about terminal illness and that it can't be masqueraded as anything else.

Now, yes, there will be multiple factors because somebody who is already seriously ill but is content with their life. Of course they're not going to seek assisted suicide. That goes without saying. But the other thing that I do think we need to be clear about is differentiating medication, which is where you give a substance with the intention of achieving an improvement in the person's well-being from this large cocktail of lethal drugs, which we debated previously. And I'm not going to revisit those.

I do also have a concern when we label that all of these patients have got pain and suffering, because the evidence from other countries is that pain and suffering is not the reason, the prime reason that people are going for it. And I see the noble Lady, Lady Jane, nodding. And I remember very well from that select committee that we were on, that we heard repeatedly that there were existential factors, multiple factors that were making somebody's life have so little meaning and so little worth that they felt that they wanted to go for assisted suicide, but we have to put some boundaries around it because we have literally thousands of people in this country who feel exactly that, that their lives are of no worth, they feel suicidal.

And as Lewis Appleby, Professor Louis Appleby, who's the lead suicide prevention adviser to the government, has said, once you say some suicides are acceptable, some self-inflicted deaths are understandable and we actually provide the means to facilitate the self-inflicted death that seems to me so far removed from what we currently do, and from the principle that has always guided us on despairing individuals. It is an enormous change with far reaching implications. So by having these proposed amendments, we actually ring fencing and provide providing some safety barriers, whereas there are literally thousands, sadly, of people in society who are suicidal, which was we heard a lot about it in relation to young people with algorithms on their phones that they get into with social media and so on.

There are an awful lot of people who are profoundly depressed. There are a lot of people in poverty, and when they become ill, that may take them down one further notch. And there are a lot of people who just feel unloved. But we really do have to make sure that this bill sticks to what it claims to do, which is to be about terminal illness.

17:29

Baroness Grey-Thompson (Crossbench)

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In other groups. Last week, I covered issues of why I was concerned over people requesting assisted suicide because they feel assisted suicide because they feel a burden. So I won't seek to rehearse those. But I do think we should care about the other reasons that people's decisions might be impacted, not least because in 2022, Marie Curie said that when someone is given a terminal diagnosis, they're quite often financially impacted by that. So not only do you have the trauma of the diagnosis, there's other things that that happen or fall apart very quickly around you.

And I know members your Lordships' House on on all sides of the chamber have worked on welfare reform, legal aid, punishment and Sentencing Offenders Bill, all things that are designed to put better support around people who may need it. But what I don't understand and can't quite work out. It's great to hear that there are GPS who will offer support in benefit claims and putting other things in place, but where in the process would they be signposted back to the GP? And we know there's a long waiting list quite often for people to get a GP appointment.

Would it be one or both of the two doctors that would actually help somebody with the benefit claim, or how would they signpost or who would they signpost to? And I think that's quite an important part of understanding the process. And just very briefly on misdiagnosis, I've found many, many cases of misdiagnosis around the world. I'm just going to pick three in relation to assisted suicide. Doctor Stephen Child, who's the chair of the New Zealand Medical Association in his evidence in Another place last year, said that 10 to 15% of autopsies show incorrect diagnosis.

You know, that is a number I think that we should be worried about. Canada has a huge number of cases. Just one. A gentleman was in hospital. He had diarrhoea. The nurses were constantly complaining that he smelt in his room. Smelt. He was told he had COPD. He died by injection. The post-mortem found that there was no sign of COPD and closer to home, Peter Sefton Williams last year talked in the media about being diagnosed with MND. He actually signed up to Dignitas and was all preparing all his affairs to go, and then found out that he'd been misdiagnosed.

And actually he had a very treatable condition. So these three cases just show the danger of of trying to pin a six month diagnosis, how difficult it is, but also the danger of misdiagnosis on somebody making a decision. Mr. Sefton Williams was told that he might live five years, but he might live 2 to 6 months. And so, you know, all you'd have to do is find the doctor that would accept the six months if this bill passes and he would be, you know, pushed towards ending his life.

Finally, my Lords, the reason I'm worried about this Bill, I'm pretty sure most of us in this chamber have lost loved ones. I'm concerned because I have lost my parents and I've lost a number of disabled friends, and I'm worried about how they're currently treated in the system as it is. I don't think the system is working to support people as well as it could do, and this bill will just push people who could have a good end of life and could have the right support.

It will push them to think they have no other choice but to sign up for this.

17:32

Lord Kamall (Conservative)

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Oh my Lords, it's been a long day at the end of a long week for day at the end of a long week for many noble Lords, and I seek to make a long speech in that case. But can I just, before I make respond to the debate on these amendments, just thank all staff of the House who have worked these extra hours to ensure that we could be here today and also at this late hour. We really do appreciate appreciate it.

Can I thank the noble Lady Baroness Berger for introducing the amendments in such a clear and more concise manner, and also my noble friend, as my noble friend, Lord Blencathra said, the principle behind this group is very similar to the principle behind the last group in terms of what what's being sought here is that the decisions of those who are terminally ill and have been given a prognosis of six months or less to live, that for these people, the doctors should seek to establish that they're really seeking an assisted death for those reasons.

And those reasons only only for the for the reasons of their terminal condition and not material factors. My noble friend Lord Markham explained why other motivations actually are relevant, or could be relevant, or could be reasons for people seeking to people wishing to die or be seeking assisted death. But then, contrary to that noble Lord Mawson and noble Lord Carlisle referred to misunderstandings and pressures, particularly on people from Black and Asian and other minority ethnic communities. It reminds me of a comment that the noble Lord Lord Rees of Easton made at Second Reading.

A man who spent all his life, you know, working with black communities in Bristol. And he said he was concerned about the impact of this bill on black on black communities. And also, noble Lady Baroness Grey-Thompson has spoken of her own very real experience of people in the system who she is concerned about. If the motivation is not purely the fact that they are terminally ill, and it might be for a fear factors. And I know my noble friend Lord Deben shares the these concerns, can I just gently remind my noble friend Lord Deben that he is not as unique a conservative as he believes he is? In fact, you know, all conservatives want a better society.

In fact, most politicians of all parties go into politics because they want a better society. We're simply on different benches because we disagree on how to achieve that. And conservatives would probably say that. We just say that the society.

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I'm sorry if I've missed if I misled my noble friend, I merely misled my noble friend, I merely meant that you can believe in the individual, but you have to believe in the individual in a society, and in the individual in a society, and you cannot take the extreme view which suggests that the individual

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is kind of on its own. No man is an island. Indeed. In fact, I think many classical liberals and libertarians classical liberals and libertarians do understand about the individual's role in a wider society. But that's not the basis of this debate. And I, I digress too much. So let me return to this group of amendments. I know that a noble Lord, noble and learned Lord Coaker, understands the concerns of those who have raised issues about minority communities and people being stuck in the system, but I also know that the noble Lord Faulkner has already made his view clear about the principle about seeking to exclude some of those other principles.

If I am incorrect, I'm sure the noble Lord will will correct me. So I suspect that we will return to these amendments at Report stage, given the strength of feeling. So, given that, I would like to ask the noble Lord, the Minister, and I understand that noble Lords Minister may not be able to answer these questions now. All the questions now, and we accept that the noble Lord Minister or one of his colleagues will write to us. But we have to understand how the government envisages how a person's motivation beyond their terminal condition could be established, because that's the crux of the matter.

How do you actually establish that if you are going to narrow it only to the fact it's you're only looking they can you can only justify it on grounds of terminal illness and not other motivating factors. And has it. For example, what work has the government done, whether it's done any work or NHS England done in trying to understand that in, in a, in assuming that perhaps they may have to draw up guidance one day, this has the government or anyone in government looked at other countries and how they've handled this issue and whether they do handle this issue, and what would have to change? We spoke earlier about the foundations of the National Health Service.

Perhaps what would have to change in guidance for many of the practitioners, and indeed what training would be required. And my my noble friend Lord Deben is often saying this goes way beyond just this bill. It will affect the Department of Health, it will affect practitioners out there, will affect the legal system. And I think these are questions that we need the government to answer. The government can still take a neutral position, but it has to understand that noble Lords here are seeking to understand the implications for government and the cost of government, and how and how it will change.

So I understand these questions are in depth, and I think and I recognise the noble Lord, the Minister may feel it slightly unfair, and I do not expect all the answers now, but this has been a constant theme throughout the debate and the many days of Committee stage that we need better answers from the government. And it is not a party political point. It's purely we want to see the implications of this on government and actually what extra cost and guidance has to change, has to change.

Before, however, this bill finally turns out and and whatever form it reaches, the statute book, how the government will have to deal with that, because that will, I suspect, for many noble Lords who were torn on this, on this bill, that might be the deciding factor on how they vote at the end of the day.

17:38

Lord Katz (Labour)

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Well, I'd like to begin by thanking noble Lords for their considered debate on motivation for considered debate on motivation for assisted dying. And I would also go into the meat of my comments. I'd certainly like to join the noble Lord Lord Kamall in, firstly, in thanking the House, House clerk, clerks and staff for all their efforts and dedication and allowing us to sit for longer on a Friday and consider these the these weighty issues properly. And I'd also actually like to share his comments about our wider motivations across the house, generally and generally in politics, about wanting a better society.

For what it's worth, I do find myself in agreement with Lord Deben that no man is indeed an island. Whether that makes me a classical liberal or not, I'm not sure the these are probably not. These amendments seek to amend the eligibility criteria for assisted dying to require that the person's wish to, in their own life, is due to their terminal illness, rather than other reasons. I'll keep any detailed comments limited to the amendments on which the government has major legal, technical or operational workability concerns.

Amendments three to 0ZA and 332 AA, tabled by the noble Lord Lord Blencathra seek to prevent people from being eligible for an assisted death if they are motivated by non-medical factors such as loneliness, poverty or lack of services. There are various workability issues with these amendments, which are briefly outlined to aid Lords. My Lords er Lordships House rather consideration. First, it could be challenging to establish whether someone is seeking an assisted death as a result of specified specified factors. Given a person's motivations could be complex.

Furthermore, a wide range of factors could be deemed as non-medical given the term is not defined and the list given is not exhaustive. It's also unclear how either the patient or doctor is meant to proceed if these factors are present. My Lords, I raise no major workability issues with the other amendments in this group, which are rightly a matter for your Lordships' House to decide. However, I'd like to set out their potential effects which which your Lordships' House may wish to consider. The amendments would require a person's terminal illness to be a motivation for them seeking an assisted death, but as drafted, they do not require it to be the only or the primary motivation.

It's arguable that every person seeking an assisted death under the this bill would be doing so in some way because of their terminal illness. So it may be that in practice, the amendments would not impact on who is eligible. The noble Lord Lord Ahmad asked me some some questions. I would genuinely push back to him that I'd say his first question around how the government envisages a motivation, or a process or system for establishing motivation beyond condition be established. Generally, I think this is a policy decision and that's one for the for, for for my noble friend Lord Falconer, the bill's sponsor, and is and those others who support the bill to to establish in terms of his question about any work or research that NHS England has has undertaken, I don't have that answer at my disposal, but I'm very happy to to take it back and and to write to him finally, I would I would just like to mention that none of the amendments in this group have had technical drafting support from officials.

And so the way they're currently drafted means they may not be fully workable, effective or enforceable.

17:41

Lord Falconer of Thoroton (Labour)

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17:55

Baroness Berger (Labour)

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This debate has concluded

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