Live Debate: Lords Chamber

Lords Chamber

Friday 13th March 2026

(began 3 weeks, 1 day ago)

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10:08

Lord Falconer of Thoroton (Labour)

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House House to House to be House to be again House to be again in House to be again in committee House to be again in committee on the terminally ill adults end of life. Bill Lord Falconer of Thoroton Lords. I beg to move that the House do once again resolve itself into a committee on the Bill. The question is that the House do now again resolve itself into a committee upon the Bill, as many of that content, not content. The that content, not content.

The

10:09

Lord Kennedy of Southwark (Labour)

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I don't >> I don't disappoint noble Lords. My Lords, before we begin Committee stage, I would like to make my usual brief remarks. Firstly, I reiterate the thanks on behalf of reiterate the thanks on behalf of the whole House to all staff across the House for facilitating this sitting. I know noble Lords will be aware a huge amount of work that takes place enables us to consider this important business. I will not repeat everything I've said before at length, but I thought it would be helpful to remind the noble Lords a few key points.

I will again look to adjourn proceedings at around 6 p.m. and enable. Lord can seek to bring to an end before that. By moving the motion the house be now resumed. Committee today will begin with the debate on a group of amendments that was adjourned when proceedings concluded on the previous day of committee. Once the deputy on the Woolsack calls the debate on that group amendments, any noble Lord who was here at the start of the proceedings last week, asked to be activated, can participate, but nobody else.

The clerks have helpfully provided a list of all those present, and it was shared with the usual channels last week and again yesterday. I've asked the whips to monitor this and ensure that only those on the list can participate. So please, if you hear at the start of the debate last when we sat, do not attempt to speak and shouting out let them speak is not helpful. My Lords, when the pain is clear, my Lords, can I also say that when we conclude the group today, when we look to finish up at 6:00, it's easy.

We can conclude the group at 6:00 by 6:00 rather than going to a new group. Obviously, if we have to, I will adjourn again in the middle of the group, but it's much cleaner for everybody and we finish with debate and then we can start a new debate the next day. But the class will compile a list of the people speaking in later debates. Ensure we have to. We've got everyone's name, my noble friend Lord Falconer of Thoroton has again set a target for today's Committee stage.

As I've said before, I hope that discipline. The usual courtesies will apply and we can progress towards the target. The whips will facilitate a short 40 minute break for lunch break, and around a point around 1 p.m. for general guidance on how we should proceed conduct ourselves. I highly recommend the companion and particularly paragraphs 4.29 on page six and paragraphs 8.81 and 8.82 on page one for three. Finally, my Lords conversations during the debate are not welcomed. So please, if you can, one other conversation, please leave the chamber and then come back when you finished it with.

I

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think we should move on to the debate. Clause for resume debate on

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Clause for resume debate on

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amendment 142. My Lords, this group, like every

10:11

The Earl of Effingham (Conservative)

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>> My Lords, this group, like every group thus far in the Bill, has been both extensive and in depth. been both extensive and in depth. We have heard from around 19 noble Lords on over 70 amendments. His Majesty's loyal opposition does not believe it would be an effective use of your Lordship's time for us to summarise the excellent contributions made across all benches by many noble Lords. The relevant points have been highlighted and we welcome the opportunity to hear from the noble Baroness, the Minister, Lady Levitt and the noble and learned Lord, Lord Faulkner, to understand their position on the proposals we have all listened to with interest the.

10:12

Baroness Levitt, The Parliamentary Under-Secretary of State for Justice (Labour)

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10:28

Lord Falconer of Thoroton (Labour)

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10:59

Lord Murray of Blidworth (Conservative)

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propose to adopt the style, the enviable style of my noble friend, the Earl of Effingham, and not the Earl of Effingham, and not referred to everybody's speeches, and. I would, however, pick up just and. I would, however, pick up just one point from our discussion on the 27th of February, and that was the 27th of February, and that was in the speech of the noble Lady Baroness Hayter, when she Baroness Hayter, when she criticised my comment in the opening of the group that this was not a life and death decision, that the panel were making.

And I answer that by simply pointing to the contents of clause 17 two of the Bill 17. Two of the bill sets out the checklist of which the panel must be satisfied, and the most pertinent of those are that the person is terminally ill, that the person has a clear, settled and informed wish to end their own life, and that the person made the declaration voluntarily and was not coerced or pressured by any other person into making that declaration.

In my submission, my Lord, it is plainly a decision, the question of life and death that the panel is life and death that the panel is making. I propose to respond to the noble Lord Falconer and the noble Baroness Miller Minister, thematically adopting their own approach. It seems to me there are key three key themes in my amendments. They are the appointment process, whether there should be guidance to the panels and what powers the panels should have.

And I'm very glad that the noble and learned Lord, Lord Falconer, agreed with me that there needed to be an appointment process, but I am afraid I do not share his laissez faire approach, that it all just can be left to the person of the assisted dying Commissioner. It seems to me, my Lords, that it is appropriate for such a significant post to be considered by a formal body, and I do not accept the account given by the government that it's all a bit too administratively difficult for the Jac to consider this.

The Jac is a body set up under the Constitutional Reform Act 2005, and it's governed by Statutory Instrument of 2013. Those are all capable of amendment, and with

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resourcing, it is entirely capable of managing the task that I envisage in my amendments. Here, here, here.

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Here, here, here. Turning then to the question of guidance, there is no provision that there must be guidance to the panels. And it seems to me, unless panels. And it seems to me, unless you have guidance, there is a real risk that panels will be of differing quality and adopt differing quality and adopt different local practices. And this could cause terrible errors, errors with very significant and ultimately irreversible consequences. There must be guidance and there must be guidance made by the commissioner to the panels, and that guidance must be informed by consultation with relevant bodies.

And that is what my amendments achieve. And I'm afraid I don't share the what we might call the good chap theory of assisted death that the noble Lord, Lord Falconer, appears to suggest by having an option to to create guidance to the panels, and then finally, as to powers, criticism was made of me by the noble Baroness, the Minister, and the noble and learned Lord, that I had asked too much in my amendment, asking for the powers of the High Court to be imposed upon the panels, as I made clear in my speech, and as indeed is clear in the member's explanatory statement, my Lords, if you look at the Marshalled List, this was always a probing amendment.

The powers and the noble Lady, the Minister said I hadn't specified which powers. Well, if she'd looked at the member's explanatory statement, she would have seen it's targeted at the powers to require evidence because, as I said in my Second Reading speech, at the moment, these panels have fewer powers than the parking adjudicator of Greater London in in a matter where they're looking at whether or not somebody is being coerced into volunteering to die, the panel can't even ask to see their will.

These powers are an essential addition to the bill if it is to proceed. And with that, I beg to withdraw my amendment.

11:04

Amdt. 143 Baroness Finlay of Llandaff (Crossbench)

Is it your Lordships pleasure? The amendment be withdrawn? Amendment is by leave withdrawn. Amendment is by leave withdrawn. Amendment 143 Baroness Finlay of Llandaff.

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Llandaff. I now rise to speak to this rather large group of amendments, many of which were simply many of which were simply consequential. So I've withdrawn those to focus the debate. I ask noble Lords who may have questions, to kindly allow me to explain the whole process rather than interrupt the sequence. My Lords, we took extensive evidence in our select committee and had many briefings critical of the panel process. As written in the bill, the Royal College of General Practitioners clearly stated that any legislation must ensure that any assisted dying service should be seen as a standalone service and not be deemed core GP work.

They are clear any assisted dying service needs to be separately and adequately resourced, and not in any way result in a deprioritization of core general practice or palliative care services, and the promoters of the Bill themselves have said that the voluntary assisted dying service must be clearly defined and not complicated. The model proposed here would meet those essential criteria and improve safety, providing legitimacy with an expert multidisciplinary panel. Bureaucracy is simplified, avoids burdening family or treating clinicians, and provides statutory separation between assessment and the process of causing death.

The effect of the scheme is to provide clarity by strengthening the process, so the request goes directly through a genuinely multidisciplinary panel involving rigorous assessment, strong conflict of interest rules, clear statutory guidelines, clear norms for the collection of data and in the event of doubt, there is potential court involvement. This creates a higher level of professionalism and greater legitimacy for the person. There's also a clear framework for the panel procedure. Unlike the proposed ADR panels that we previously debated in the bill, these panels are genuinely multidisciplinary across relevant specialities.

The major effect of this is to remove individual doctors, assessing in isolation and the risk of doctor shopping. There is also a new scheme for licensing and regulating assisted death services, as well as strict regulation of the lethal substances used to bring about an assisted death. This would decrease the risk of dispensing errors as the process of dispensing approved lethal substances is closely monitored. These amendments move the provision of accurate information to the patient and the assessment of eligibility upfront in the bill.

The assessment is all undertaken by a defined group with expertise across different disciplines. Clinicians looking after the patient, irrespective of whether they support or do not support the provision of assisted dying, would continue with their duty of care to the patient and family throughout the process. Thus, the patient would continue to have their usual clinicians look after them as always, whilst in parallel they could be assessed for eligibility against the criteria to be established in a statutory code of practice.

My Lords, let me explain. Amendment 143 requires the Independent Commissioner to support the new multidisciplinary panel workings, retain records for at least ten years, support research and report to Parliament. Amendment 266 ensures the panel members independence amendment 192 signposts the person to the panel. Because an assisted death is not a medical treatment, the person can obtain accurate, up to date information, including in one two, in sorry, in two, three, two. How to initiate the process amendments three, three three and 334 describe the panel makeup and its process.

The panel would have a lawyer, a social worker or psychologist, a specialist in end of life care, all of whom would have at least ten years clinical experience, and an administrator, plus a consultant specialist in the disease of the person and, if required, the option to co-opt up to seven members. Their statutory duties relate to licensing or declining the provision of lethal drugs or poisonous substances. They can refer to the High Court if in doubt. Amendment 233 clarifies that two panel members conducting a documented hearing must go to the patient.

New clause amendment 615 explains how the assisted dying service that comes into operation when a person's assisted death has been approved executes its functions in complying with the person's wishes, including the safe transport of dispensed substances. 551 describes a neutral professional of experience who, once an assisted death is approved, can help the patient by ensuring all correct processes are followed. Deal with complications, collect all data and notify relevant persons of the death. This avoids the difficulty of a doctor being tied up waiting for the person to die after ingesting the lethal drugs.

As the Oregon data shows that sometimes this can be prolonged, five, five two and 702 determine a designated regional pharmacy to link to the assisted dying service to improve safety in dispensing and transport of lethal drugs or other poisons, and disposal of any unused substances. Amendment 552A in the name of my noble friend Baroness Hollins improves my amendment 552 by ensuring compliance with regulatory ensuring compliance with regulatory safeguards. 704, 705 and 706 relate to the limits on regulation making powers, and 707 covers devices.

We don't know what these devices are, but they are referred to in the bill. 698 requires all lethal substances to be compliant with MHRA regulations and the Misuse of Drugs Act five, five, six and 643 require the GP to be notified of the process. 654 ensures completeness. Amendment 667760761 and 767 make it clear that any health or social care professional involvement in the assisted death service is separate from their health or social care employment, and their employer must know of their involvement.

This is a separate service that must not jeopardise the care of other patients. However, amendment 710 in the section on Regulation of Approved Substances gives effect to the recommendation from the Delegated Powers and Regulatory Reform Committee on which I sit. Although I should say I am not speaking on behalf of the Committee to remove the most sweeping of the Henry VII's powers in the bill, and I do not consider the Noble and learned law. The sponsor's amendment of my amendment to be adequate.

Others may wish to comment all my remaining 56 amendments in this group are consequential and have been written to ensure there's clarity throughout the Bill as to the effect of these changes. This is

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not vexatious order. Grateful to the noble Baroness for describing her scheme, could for describing her scheme, could she explain to the House what are the eligibility requirements that the eligibility requirements that need to be satisfied in order to give a certificate where one finds them in her amendments? And secondly, could she explain what the role of the High Court is?

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the role of the High Court is? I asked first of all, ask that you could wait until I had completed. Secondly, I apologise to the house if coughing and my voice give up in the process, but so be it. And thirdly, if these amendments were all rewritten into the bill, which is what I tried to do, the noble and learned Lord would see that the eligibility criteria remain as he had put at the front of the bill.

So, my Lords, let me summarise. A person wants to seek an assisted death. They're signposted to the panel for their area. The panel gives them accurate information and if they wish to apply their help to ask for their clinical record to be available to the panel to assess all information. Normally, two panel members would meet the person without pressures, listen to them, assess capacity and if they agree, advise the panel who decide whether to issue a license to end life. The navigator would then make sure that lethal drugs are available to the person at the time of the person's choosing, collect them from the designated pharmacy, deliver and oversee the whole process, documenting it carefully if the person changed their mind, unused drugs would be removed by the navigator.

If the person dies, the navigator would verify, not certify death and ensure all who need to be informed are duly and sensitively informed of the death. But throughout their initial information seeking being assessed, their period of reflection and the assisted death being arranged, their health and social care continues in parallel, not diverted away from its core role in care. Let me illustrate. My Lords. 36 years ago, a GP referred a distraught young man whose prognosis, as estimated by him, the surgeon and oncologist, was about three months, saying he is the most clear cut case for euthanasia I have ever seen in total pain, desperate for lethal drugs with the youngest child at only six weeks old, his care was challenging, particularly in the first fortnight.

11 years after that visit and after many times of complex care, David phoned me. His beautiful young wife was dying of advanced cancer. By then a wheelchair user, he and his three children were with her in the hospice as she died just two days ago. I visited David, who with his three fine adult children who he has brought up on his own despite his disability, said I could speak of this in tribute to him and all his care has taught me.

And they're watching this debate today. I know that they have tuned in. It's a great privilege to be entrusted with such care. That is why an assisted death service must be separated from health care provision, not integrated. These amendments would create a clear, streamlined service with greater transparency and with clear defined oversight that is more easily monitored. They've been written to respond to the request from the Royal College of GPS, the Royal College of Physicians and the Royal College of Psychiatrists and the Association for Palliative Medicine that an assisted death service must be a separate service.

They respond to the call for a recognition that multidisciplinary input into assessment and good governance is essential, and that an assisted death is not a medical treatment. They're based on over 20 years of work by clinicians and academics who have not been opposed to assisted dying, but recognise the dangers of a system which can easily expand to have all the complications and escalation that we have seen. For example, in Canada. These amendments are designed to provide coherence. I beg to move.

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I requested. I waited until the noble Lady was was able to to to make her point.

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The noble Lady has moved for amendment amendment. Proposed clause four, page two, line 39 at

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clause four, page two, line 39 at end. Insert the words on the Marshalled List. And now. OK, I was trying to respond to

11:17

Lord Markham (Conservative)

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>> OK, I was trying to respond to the noble Lady's request not to be intervened during during her what intervened during during her what she had to say so that she could at first. But I did have some questions actually specifically on what she was talking about. And as I say, I was trying to follow her wishes on that and say. And so my concern now is that she won't have the opportunity to answer. OK. So, so thank you. So, so, so specifically around the point and, and I totally appreciate the noble Lady intention in all of this is obviously to try and make it as a robust a process as possible and obviously showed a very moving example there of why she believed it.

But, but my specific question is that surely the people best placed to give evidence and understand the situation on the capacity of the the person involved, whether there is any coercion involved, their own circumstances are the very people that she's suggesting shouldn't be part of that panel, namely the health professionals involved in the doctors. So I'm just again, trying to understand why the noble Lady wouldn't want those professionals involved who are closest to the case involved.

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If I may respond. Unfortunately, I'm not sure that

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Unfortunately, I'm not sure that the noble Lord quite heard me right, because the panels that we were because the panels that we were discussing previously didn't have the treating clinicians on that the treating clinicians on that panel. They were looking at evidence brought to them. And indeed, in the proposal of the indeed, in the proposal of the panel structure that I put down, it would be that panel that would have access to all the patient's notes with the patient's permission, all their investigations and the full assessment of capacity and all other aspects that would be happening in routine practice during the patient's care and concerns over their family, over behaviours during the course of their illness would be documented in the clinical record, and that clinical record would be available to the panel, including the criteria on which the diagnosis was made, which is why I have suggested there needs to be an expert with knowledge of the specific disease of the person who is seeking an assisted death, because there are many rare conditions in medicine.

Common things occur commonly, but rare things are not that uncommon, and it is quite common for there to be a misdiagnosis. So the patient may be making a decision based on a fallacy, believing what they had is, or even what they had been treated for. And we had evidence in a previous select committee that at post-mortem, around 5% of people are found to have died of something different to what had been recorded on the death certificate, suggesting that misdiagnosis is sadly not a very rare occurrence.

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So the specific point I was referring to is the person's health or social care professional cannot participate in any part of the assessment for that person's request for an assisted death. request for an assisted death. That's the point I'm trying to understand. Yes, unfortunately, there are cases of misdiagnosis. The 5% the noble Lady mentioned, but actually the 95% of the time, but actually the 95% of the time, vast majority of these people are the best qualified to to make an assessment on it.

So I'm trying to

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understand why we wouldn't want them involved. Because they won't be involved in the.

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in the. Judgement as to whether the person is eligible for lethal drugs person is eligible for lethal drugs or not eligible for lethal drugs. They are providing their clinical They are providing their clinical expertise and knowledge. It is the

11:21

Baroness Finlay of Llandaff (Crossbench)

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panel who separately, independently through a process that can be completely scrutinised and documented, who would then make that assessment completely independently. It means that the patient's care cannot be contaminated by pressures of the doctor being burnt out, by financial pressures on the system in which that patient is being treated, or even by administrative pressures, because the patient's discharge is becoming difficult, and because there are beds that are needed and there are patients being treated in corridors, which we know is happening all the time, it provides separation and a degree of clarity over the assessment and judgement.

11:22

Baroness Cass (Crossbench)

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Can I make a point of >> Can I make a point of clarification that even whether we take the system proposed by my take the system proposed by my noble friend or the original system with the series of of doctors, it is very unlikely under any circumstance, that the clinician who is providing primary care for the patient will also be in one of those formal roles specified by the bill. And the reason for that is that, as we've discussed, people will need to opt in to take on that kind of role and have very specific training for it.

And given the numbers that are predicted to require an assisted death, that will be quite a small cadre of clinicians. So in practical terms, although I understand the aspiration from the sponsor in the other place and certain members here, that there is this close integration in between the the team providing normal care and those involved in the dying process in practice. I don't see that that would be feasible in in either system. Thank you.

11:23

Baroness Murphy (Crossbench)

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My Lords. I would like to express the the opposite view to express the the opposite view to the noble Lady Findlay that that we should have a separate service, should have a separate service, completely separate. We're going to completely separate. We're going to target and isolate people who are An that they will, with the illness, that we should not move them to another place, that they should be seen and examined there. Yes. It's going to be a separate people, perhaps, who take on this role, and they should be properly qualified and discuss it with the panel and whatever, but it is utterly crucial that we should not separate these people off when they are in the process of dying and reject them.

They should be part of the palliative care provided to them. It almost certainly in other countries, usually happens as part of a palliative care service. That's how it is in Oregon and Washington, and very successfully. So we should not separate them off. We are there to support them during this process. And these little nit picking bits of change to the bill will just make it worse.

11:25

Lord Deben (Conservative)

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11:41

Baroness Jay of Paddington (Labour)

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the other places he has done, but I have had experience both in sitting. Another select committees of your Another select committees of your Lordships' House on this particular matter, not the immediately past one, but others where we have one, but others where we have looked in detail and actually travelled to those places where assisted dying is in place and assisted dying is in place and there is absolutely no evidence that assisted dying, when introduced, does anything other than improve palliative care, because it improves the understanding that people have of discussions about end of life care, of death, of the general issue, which can be debated more openly.

And I would say, and I'm not in a sense, trying to take Baroness Murphy point that noble Lady Baroness Murphy point any further. But I do think one of the things which has concerned us in this committee is that there is so much emphasis in so many of these amendments. On the detailed administration. She used the word nitpicking, which you didn't like, but the very, very small print of administration and so much less focus on those people who are actually going to hope to take advantage of this legislation, the patients, the people who are dying, the people who are reaching the end of their life.

And I have become. I remember in the previous debate, my noble friend Lady Hester said this. I have been rather shocked by the emphasis, for example, on the bureaucracy of the Commission of its structure, etc. etc. which has not emphasised the position of

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those people who are dying. Yeah.

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Yeah. My Lords, I, I would wonder if I could just remind the House of the could just remind the House of the extraordinary common sense of the noble Lady Cass, who pointed out noble Lady Cass, who pointed out the may well be a lack of suitable doctors of one sort or another, and they may have to put up with what

11:43

Baroness Butler-Sloss (Crossbench)

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they may have to put up with what actually is the reality. >> Exactly.

11:43

Baroness Hollins (Crossbench)

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My Lords, I would like to endorse my noble friend Lady endorse my noble friend Lady Findlay's amendments very fully, because I think and I think they would deserve rereading. I think there has been a huge misunderstanding of what she actually described, and this wasn't something drafted on the back of an envelope. This is years of this is years of work thinking about how this could work. Her amendments simplify and strengthen the bill, making the whole process more transparent and more likely to be subject to evidence based improvement in the future.

If an assisted death service is approved and my noble friends amendments may go some way to addressing the continuing concerns of the medical royal colleges, my main amendments in this group, however, concern the regulation of substances proposed for use in assisted dying. I recently co-authored an editorial in BMJ Supportive and palliative Care called Untested Unlicensed Unregulated Prescribing and Oversight Issues in Physician Assisted Dying or Suicide. I thank the noble and learned Lord, Lord Faulkner, for tabling amendments that attempt to address these matters.

My amendment 624A and 708 would amend the noble Lords amendments in this country, drugs intended for clinical use are subject to evaluation and oversight by the Medicines and Healthcare Products Regulatory Authority. The MHRA, which assesses their efficacy, quality and safety before they can be licensed for human use. These frameworks were specifically designed to ensure that drugs used in healthcare meet appropriate evidence and safety standards before they reach patients. I ask the noble and learned Lord why he is reluctant to rely on the established regulatory framework, and instead proposes the development of a separate framework specifically for substances used in assisted dying.

My amendment to the noble Lords amendments, as well as my amendment six, nine nine and 709, propose that the Secretary of State, when specifying a substance in regulations, must have regard to recommendations of the MHRA and that the established Committee is required to report to the MHRA. One possible interpretation for the creation of a parallel regulatory framework is that the substances to be used under the bill are not medicines in the conventional sense, nor part of a standard healthcare intervention and therefore not subject to the usual evidence requirements and regulatory expectations.

I also, if this is the case, it raises an important question about whether such substances properly belong within a healthcare system at all. Doctors within the NHS prescribe treatments that are supported by evidence assessed through established regulatory pathways and embedded within recognised guidelines, such as those produced by the National Institute for Clinical Evidence. It's nice if the substance is proposed for assisted dying are to sit outside such frameworks, then the rationale and indeed the ethics of introducing this practice into the NHS and requiring the involvement of doctors and other clinicians, becomes rather worrying.

I partly address this through my amendment 712 that mandates prescribing standards and amendment 626A that seeks to remove the requirement for a doctor's prescription and enables direct dispensing by a specialist registered pharmacist. If the House takes the view that the MHRA is not currently equipped to regulate substances in this context, then the logical response would be to adapt or expand the MHRA remit so that it can develop a suitable regulatory pathway, something that I propose in my amendment 713A My Lords, it may be helpful to note that for the purposes of veterinary euthanasia, the drugs are subject to formal evaluation and authorisation by the Veterinary Medicines Directorate.

Under the relevant regulations, it seems difficult to justify position in which substances used to end the life of animals are required to meet the usual regulatory standards, while substances intended to end human life would be introduced through a novel and less clearly defined regulatory process. In the House of Commons. My Lords amendments proposing MHRA involvement were resisted on the grounds that such requirements might make the bill more difficult to implement. Expediency and legislative convenience, however, cannot reasonably justify bypassing the usual regulatory framework.

There is also very limited evidence behind the substances used for the purposes of assisted dying. My Lords, the evidence that such drugs reliably produce a peaceful and predictable death remains limited in a number of jurisdictions where these substances are administered orally. The reported time to death varies widely, sometimes extending over many hours or even days. And despite assertions in the media, the truth is that an assisted death is not always peaceful. The limited published evidence, for example, from Oregon in 2023, detailed very common complications in 10% of cases, including vomiting, seizures and instances of procedural failure.

The median time to death was 53 hours. There's an important gap in the evidence regarding the predictability and safety of the drug regimens used for this purpose and addressing these certainties. Uncertainties normally require systematic evidence generation through properly designed studies where randomised controlled clinical trials are considered ethically or practically inappropriate. Alternative approaches such as prospective, observational or structured real world evidence generation studies are commonly used to obtain appropriate data. What cannot be relied upon is an assumption that such evidence will simply emerge over time and be available for the Secretary of State to evaluate if evidence is not currently available, then it must be deliberately gathered through an appropriate research framework.

And this is what I propose. An amendment 713 body best placed to oversee such a process is the MHRA, which already has the expertise and regulatory infrastructure to evaluate drug trials. My amendment 711 would require that the Commission will work collaboratively with the MHRA to establish and maintain a list of approved lethal substances. My Lords, it's been suggested in previous debates that the necessary evidence already exists in other jurisdictions and that the drugs are already licensed and available in the UK, merely lacking authorisation for this particular indication.

But this is simply not true. For example, the barbiturates used in Australia phenobarbital usually is not licensed or available for human use in the United Kingdom, and the drug regimen actually referenced in the government's impact assessment is based on an experimental combination of five drugs, five different drugs that has emerged in certain jurisdictions after the original barbiturate based protocols became difficult to obtain. This combination of drugs was introduced largely out of necessity, rather than through a formal program of drug development.

The available data. My Lords, regarding its efficacy, the pharmacokinetics and the safety remain limited. Reports from these jurisdictions describe significant adverse effects, including prolonged dying and even not dying. Practically speaking, there are no drugs that are both available and licensed in the United Kingdom for the purpose of assisted dying, and if such lethal substances are to be introduced, they would need to be subject to the same evidential standards and regulatory scrutiny that apply to any other drug intended for use in patients.

Finally, my Lords, my amendment 552 seeks to ensure that pharmacies are limited to storing and dispensing approved substances, rather than preparing them. Permitting preparation risks, bypassing established regulatory safeguards designed to ensure the substance's quality, safety and efficacy and substances used for assisted dying should be manufactured in accordance with MHRA requirements, rather than being prepared locally by individual pharmacists.

11:52

Baroness Lawlor (Conservative)

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I'd like to move my amendment to Baroness Hollins amendment 552A, Baroness Hollins amendment 552A, which itself is an amendment to the noble Lady Baroness Finlay 552. I think these are a very good group of amendments and they make for. They avoid the potential conflict of interest about which we've heard. And they make things clear in law. And just in answer to the noble Baroness Murphy and the noble Baroness, I prefer a law made in this House to the gentleman in Whitehall down the line.

Now I'll speak here to my amendments and these three amendments, to which mine is a further amendment five, five, two requires that the provision of the lethal substances through pharmacies is restricted to a limited number of designated pharmacies. It's documented, kept under lock and key, and when unused, disposed of safely. And the noble Baroness Hollins 552, which she has introduced so well and restricts the pharmacies further to only dispensing and storing the the drug, but not preparing it in the premises.

Under MHRA rules. Now what mine does is it prohibits the pharmacies from stockpiling these drugs, but storing any quantity of a lethal substance in the pharmacy, except it must be ordered on a case by case basis. My Lords, at present the Bill has no chain of custody for the secure storage of these lethal drugs, and even though some of those that we know which are used for assisted dying, like Ben's Ben Ben's Benzodia zine, have a black market usage, the measures in these three amendments go some way to addressing this problem of secure storage.

I'd like to draw attention particularly to the role of the MHRA, which is something which is an organisation, the Medicines and Healthcare Products Regulatory Agency. It. Required by Baroness Hollins 552A. It is the body that regulates that licenses, that inspects and enforces the rules for pharmacies and indeed on manufacturers on which I have an amendment later on to section 37. And there already exists in this body a legal framework for looking after those drugs. When they go to pharmacies, the regulations for the Legal framework for distributing and storage.

And they take they're under the law of 20 2012 and the directive to prevent Counterfeit medicines entering the chain. Even the tightest regulatory system is not foolproof. And so other safeguards are needed to protect against theft from the premises to ensure the security of the drug that it isn't counterfeited. And the MRA had a great victory last month in seizing thousands of counterfeit and I suppose, anti-fat drugs, the drugs that people take to help them slim and they had a very, very good operation and they turned up trumps linking a Lincolnshire raid on an illicit drug making factory to one in Nottingham.

And they have police on the job, they work with the police, they can seize, they can check and they can license. And I think that this is why I think, however, we need even greater security because of the thefts from pharmacies are known address and it would be better to limit the storage of these lethal substances in the pharmacies to those which are on a case by case basis ordered. And this don't tell me, doesn't happen. Now, if I have to go to boots for a prescription, sometimes they they have to order it.

And in a matter of assisted suicide, even if there is a delay, it may help the patient reflect further and perhaps have a second opinion.

11:57

Baroness Grey-Thompson (Crossbench)

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My Lords, I think two amendments >> My Lords, I think two amendments in this group 701 and 703 Lord Murray of Blidworth in the earlier group raised, I think, some very group raised, I think, some very valid points on local variation. And I think the method that my noble friend Baroness Finlay has raised seeks to address some of the issues that many of us find with this bill in terms of having a centralised process, I do think we need to find a way to avoid doctor shopping.

And the reality is, you know, medical issues, legal issues, social issues, economic issues are not separate. They all intertwine with each other. And I think what my noble friend suggested is a clearer process and fills some of the gaps because the bill has exists. I do think there's problems with reporting and there needs to be strict data collection. The commissioner can't report what the commissioner doesn't know, and parliament can only regulate through reporting requirements. As the noble Lord Lord Deben raised about palliative care professionals, they're one of the groups that have consistently spoken out against concerns in this bill.

And it was really interesting debate about whether we have a separate service to the NHS. It would be my preference to have something that's unconnected. That does not mean that doctors can for patients, can't communicate and still provide care for somebody who wants to enter this process. But I think we have to think about there may be a number of doctors who, for various conscientious reasons of objection, may not want to actually have this conversation with the doctor.

So my amendments are looking at clinical trials for the drugs and also the regulations of approved substances. I'd be interested in the noble Lords opinion. So I do recognise why a clinical trial for these drugs would be very difficult, but I don't see why. Or there may actually be a case where some people who want to request assisted suicide may be actually be willing to have an enhanced level of study to actually understand how these drugs work on a patient, because I think it is important we understand what drugs can be used.

And in different jurisdictions around the world, there's very different combinations often referred to as cocktail. But in fact, the patient is being given a massive overdose because we don't know enough about how these drugs work. And I think we have to understand how they're mixed. Who mixes them, who sells them, who profits? You know, there are a number of pharmaceutical companies around the world who do not wish their drugs to be used or to be recognised as being used on on death row prisoners because of the adverse effect it might have on the company.

So we've already debated in other groups what happens if the drugs don't work. And I defer to my noble friend Baroness Hollins expertise on the papers that she's written on the subject. But my noble friend Baroness Murphy, I think, raised quite pointedly the fact that primary legislation can change. And the noble and learned Lord Rose said in an earlier debate that we as a Parliament can't tie the hands of any future parliament. But I do think it's important that when we're asking questions about chain of custody, that's not referred to as caught in drugs around, because I think we do need to be really clear what a chain of custody might be.

And in looking at actually how much money is wasted in the NHS through medicine waste, I read a report by NHS Frimley from 2024 that suggested about £300 million a year is wasted through just just drugs being unused. That's about £150 million a year. About £50 million worth of drugs are disposed by care homes. NHS Frimley said they felt they lost about £4 million a year, and many of these issues come to actually overstocking wrongly stocking and not being used in the correct way.

So a centralised process for this makes sense because I don't think any of us would want the drugs to be expired and not have the intended use. We're going to be talking about licensing later and I recognise what the noble Lady, Lady Lawlor says about black market usage. One of the reasons I have many objections to what happens in Oregon is that they're actually allowed to take the drugs home with them, and I think that is incredibly unsafe. I know that's not been.

I hope it's not been suggested here, but I think it's something that we need to consider. And in terms of the issue that my noble friend Baroness Murphy raised about the Code of practice, the guide to making legislation, which is a Cabinet Office manual, which the former first parliamentary counsel, Elizabeth Gardner, signed off, and she was, in fact, the draughter of this bill. It's interesting that the code of practice, it states that it's an authoritative statement of practice to be followed, but typically it differs from legislation and it offers guidance rather than imposing requirements, not hard and fast rules.

And this produces considerable latitude in practical applications. So provisions of the code are not directly enforceable by legal proceedings. So this, my Lords, is why many of us are asking for more detail, because the code of practice gives a significant amount of leeway, and I don't think it's appropriate for a bill of this magnitude. But I would like to understand what the noble and learned Lord Offord sees as the process for deciding what drugs are going to be used. Will they be put into secondary legislation where it can't be amended? What role will the commissioner have? Who will decide? And also, in terms of where device is used in the bill? I think many people who write to me seem to think it's going to be one pill or it's an intravenous injection.

I think we need to be much clearer about what the sponsor of this bill sees as the device's data is not particularly easy to find. But actually, in terms of the drugs and why I think it's so important that we examine this is looking at time of death. And if we look at data from Australia from 2019 to 23, loss of consciousness was reported in less than ten minutes. In 95% of patients. There was one that was quick as 30s 62.8% were reported to have died within less than 30 minutes after ingesting the drugs, 85.9% died with one hour.

That might seem reasonable, but 29 responses reported the death taking more than two hours, seven reported it taking more than six hours and the longest was 11 hours. So this, my Lords, is why the drugs do matter. Alex Greenwich, MP in evidence, said if somebody wants to end their life quickly, voluntary assisted dying through a regulated process is not the option that they're going to take. I presume he was talking about the length of the process in terms of each stage rather than the drugs, but my Lords, we do need to have a better understanding about this, and the model that we've been presented with in this bill is, is just one model.

And I wonder whether this is the best model for us in this country, considering our society, the way our health service works and our relationship with death and dying. There are different models available, and I think we should at least consider if we're going to do something. What's the best model? The standard VAD, which the primary focus is really for suffering. The Swiss model, which is personal autonomy, the German model, which is self-determination, VSED, patient autonomy, palliative sedation, which is symptom relief or a strict regulatory model, which is about safeguards, which has judicial approval and doctors.

What we're being presented with this bill, my Lords, I think, is slightly haphazard. It's decentralised. I don't think it will give the public what they think they're going to get. And a multi-disciplinary panel, I think, gives a clearer view of what the bill claims to do. My Lords, we must avoid doctor shopping. I think all of us would agree that palliative care is incredibly important, and I wish that that had been part of the bill that we could have been debating in more detail.

But, my Lords, I think we have to look at the whole person, and I think this is a model that we

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should at least consider. Before the Nobel. Baroness Stuart concludes her remarks. The Stuart concludes her remarks. The Baroness Casey some really important points that have been made by other noble Lords about the made by other noble Lords about the drugs, and perhaps it's worth sharing with other noble Lords in the context of this debate, as we deliberate these amendments and deliberate these amendments and some amendments that are coming later on, that it was the Delegated Powers and Regulatory Reform Powers and Regulatory Reform Committee of this House that, in its very important report about the extension of delegated powers that have been extended in this bill, is now 48.

There was very specific concerns about substances and drugs and the detail that is missing in this bill. And, in fact, the two specific themes that are relevant are the lack of specification on approved drugs and the lack of regulation of approved substances, because the bill currently uses two delegated powers for this, and this is something that would usually be described on the face of the bill and is instead delegated legislation. And I think that perhaps provides some context about why these amendments have been put forward.

12:07

Lord Empey (Ulster Unionist Party)

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I want to deal with amendments eight, eight, seven A and 888A, and in my name they are probing in my name they are probing amendments. Throughout the process, amendments. Throughout the process, there has been a potential clash between what decisions might be made here and what decisions might be taken in the devolved nations. But in the other place, an amendment was introduced by the sponsor of the bill. As the bill progressed to extend certain parts of this bill to Northern Ireland and to other to Scotland, England and Wales, and my colleagues at the other end tried to put an amendment down to probe why this was done.

Unfortunately, it wasn't taken, so the matter was never really debated. However, if I just remind the House in particular, clause 37 deals with the regulation of approved substance and devices for self-administration, and it says the Secretary of State must, by regulations, make provision about approved substances, and that has the extent of the entire United Kingdom. These regulations also deal with the supply or offers for supply or administration of substances, transportation, storage, handling, disposal of substances, keeping records, it says.

In particular, make provision about the manufacture, importation, preparation or assembly of approved substances, substances or in connection with the monitoring of matters, etc. requiring persons specified in the regulations and specified cases to give information to the Secretary of State. Now things stand. At the moment there is no plan by the Northern Ireland Executive to introduce an assisted dying Bill. There is no private member's bill currently in the chamber, and some of these regulations would actually, in my view, cut across the role that is currently played by devolved Ministers and devolved parliaments.

So what I'm trying to get at and probe, and it doesn't, incidentally, confine the extent to that to clause 37 that deals, in fact, other clauses are to extend the extent of the bill as well. Clause 43 5456 all apply to the whole of the United Kingdom, and I don't understand that. And if the noble and learned Lord could enlighten us, that would be most helpful. As I said, they are probing amendments. And if it is the case that.

Why was that introduced? It wasn't in the original bill. And this is the point that I'm trying to tease out at committee why that extension was made, because as things stand at the moment, there are no plans for assisted dying Bill in Northern Ireland, not from the executive. There's no private member's bill currently, but I totally accept that this Parliament has the right to legislate for the entire United Kingdom, irrespective of devolution. But at the end of the day, if these regulations, if regulations are made under the.

This bill says the Secretary of State must make regulations. There's no argument about it. It must, by regulation, make provision about approved substances. So this is has to happen. And the extent of those that regulations would be. The entire United Kingdom. So whether Northern Ireland wanted this or not, whether Scotland wanted it or not, it's going to happen according to this clause. So why is that the case? If there is no assisted dying available, and if in many cases it would be a devolved matter anyway, why are we regulating for the provision of these substances in all parts of the United Kingdom, even though the availability of assisted dying would not be available? So that's the question I want to know, and I'd be grateful for the Noble and learned laws contribution on the wind up.

Thank you.

12:11

Lord Stevens of Birmingham (Crossbench)

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I just want to speak briefly to two amendments in this group, the first being amendment three, three, first being amendment three, three, four, and in particular, I would hope to draw the attention of the noble Lord noble and learned Lord, Lord Faulkner, the sponsor of the bill to clause three three, sorry, amendment three, 346M and ask him whether he might be inclined to look sympathetically at the proposal which is there. This relates to palliative care. We've had the discussion many times during the committee about the importance of palliative care.

I think that's a shared sense from all sides of this wider debate. And amendment three, three, four, six would require that the assisted dying panel, in its assessment, must ascertain if a person considering seeking an assisted death has experienced the involvement of specialist palliative care teams and if not, whether this was because of availability, unsatisfactory care or patient choice, I would have thought that that should be acceptable to the sponsor of the bill in that, why would you not want to know whether somebody's coming before an assessment panel has had access to palliative specialist palliative care? And if they haven't, whether it's because of the concern that a lot of us have, that palliative care gaps exist right across the country, that will bring about a degree of transparency as to what is actually going on.

And I think in a sense, the difference perhaps, again, between those who are more optimistic and those of us who are less sanguine about the availability of palliative care, just comes from the lack of transparency and the lack of a firm government commitment at this stage to funding unmet need in palliative care. And perhaps by way of analogy, if we look at what's happening in mental health services, the health professionals within mental health services, some of whom are going to be required to support the processes set out in this bill, we only have line of sight as to what is happening on mental health spending, because of an amendment that the House of Lords inserted into the 2022 Health Act that requires the Secretary of State to declare his or her hand for the upcoming year as to what they plan on doing about the share of NHS funding going on mental health.

And we found out yesterday from a written statement by the Health and Social Care Secretary, that his plan is that the share of NHS funding going on mental health services next year should be cut, which is a pretty significant departure from the arrangement that had existed since 2015 onwards. So we have that degree of transparency that's obviously provoked a degree of concern across the NHS, but we have that degree of transparency on mental health. We don't have it in respect of palliative care and amendment 334, six M just provides one little ray of light as to what would actually be going on in this scheme where it's to come into effect.

So that's the First Amendment I draw attention to. The second is amendment 615, which returns to this question as to whether the assisted dying service should be separate from the NHS or part of the NHS, for reasons that I and many others have set out. And I won't repeat. Now, our view is that where assisted dying to become law, it should be outside of the scope of. It is outside the scope of the current NHS and should be established separately. That I know is not the view of the noble and learned Lord.

But I do think that again, since the committee last met and as Baroness Berger has just referred to, we have now had published yesterday a further report from the Delegated Powers and Regulatory Reform Committee, which speaks specifically to this point about the degree of transparency that should be on the face of the bill, about the scheme that the noble and learned Lord is proposing to establish within the NHS. He has helpfully put forward some further detail since we last discussed this matter, but the fact is not to the satisfaction of the Delegated Powers Committee.

It still contains very broad ability to to clause 41 six, so regulations may be made for any provision that can be made by an Act of Parliament, the only constraint being that they may not amend the act itself. This potentially leaves open not what the noble and learned Lord described as skeleton provisions. I would regard them as a a Trojan Horse clause for fundamental change to the National Health Service by the back door, which the Delegated Powers Committee says has not been sufficiently justified to overcome the fundamental objections in provisions of this type.

It goes on to say, quote, delegated powers that can be used to do anything that an Act of Parliament can do are very rare, with the wording currently appearing in just two acts the European Union Withdrawal Act of 2018 and the European Union Future Relationship Act of 2020. So it really does seem surprising that the noble Lord is persisting with this degree of open endedness. Notwithstanding the further changes that he's proposed since we last discussed it. And it does, frankly, put into question what the point will be for Parliament discussing what is likely to be an NHS Bill that will be put forth in the upcoming King's Speech when, regardless of what Parliament decides in respect of the NHS Bill in the next session, actually the mechanism at clause 41 six could subsequently be used to undo all of that anyway, so surely the right thing to do is to specify on the face of this bill what the mechanism is supposed to be.

And then when Parliament subsequently legislates further primary legislation for the NHS, if it wants to make some adjustments to that point, it can do so in the full light of day, right?

12:17

Lord Harper (Conservative)

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Yeah. >> My Lords. >> I rise to talk to this group of amendments I will come on to amendments I will come on to Baroness Finlay exposition of them shortly. I did just want to pick up, because I think it's an important point that Baroness Jay of Paddington raised in. Following on from my noble friend Lord Deben speech. It's perfectly fair point about effectively which end of the telescope you're looking at at this from. And I think she was right to just challenge those of us who are focusing on the safeguards.

It's also important that a bill that is passed by Parliament is workable. But I think there's a reason, if I may just gently say to her why we're focussed the way we are. And it was put extremely well, actually, by Joanne Lamont, who members opposite will know was the leader of the Scottish Labour Party between 2011 and 2014. And this is in the context of of the debate on a different but similar piece of legislation that's going on at the moment in the Scottish Parliament.

And she said in her time as an MSP, she said I came to appreciate the challenge of understanding that something can be of benefit to some, but the unintended consequences for others matter just as much. And we should not just ask how it might help some, but ask what if it means undesirable results for others? And that effectively is the nub of of what we're trying to do here. The proposals of the bill, perfectly understandably, are focussed on those who wish to seek an assisted suicide.

Those of us who are focusing on the safeguards in the bill are worrying about all of those people who may be adversely affected the vulnerable, the disabled, disabled people. Before we fixed the gap in the bill, those with anorexia, although we have now fixed that, although it took a very long time to do so, and I think those are the two perspectives, both of which are valid. And I think that is what the debates in your Lordships House are trying to reconcile in this piece of legislation.

I think the other reason it's very important, and I'm pleased to see my noble friend Lord Markham in his place because he quite rightly, often references public opinion. Now, I happen to think on an issue such as this, it is more important that members of Parliament and members of this House do what they think is right. This is a very important moral question. We should do what we think is right. We should explain why we're doing what we're doing, and then we should allow ourselves to be judged, and people will draw conclusions about your Lordships House on how we conduct ourselves and how we debate this legislation.

But since the proponents of the bill are often happy to quote polling, I think it's worth just putting on the record some recent polling that's been done by Whitestone.

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Insight for Care Not Killing Whitestone Insights as a member of the British Polling Council, and the British Polling Council, and what the key findings of this were, and they're very relevant to this group of amendments, is when you ask the public whether they would support a law enabling patient choice if it risked harm to choice if it risked harm to vulnerable people, 42% oppose such a law and only 35% support it, and more than twice as many respondents strongly prioritised safety over choice rather than choice over safety, which is not the position of the noble and learned Lord Wood, who frequently says to us that the important thing here is autonomy.

And the reason why that polling is important is because that is indeed the job that this House is trying to do. It's about making sure that the legislation has appropriate safeguards in it, so it only ends up being used by those people who exercised a genuine wish to do so, and not anybody else. And that is incredibly important. Having said that, let me just turn to the this group of amendments or the group of amendments put forward by my noble friend Baroness Finlay of Llandaff.

Now, I listened very carefully to what she said. I think she set out a very good, workable proposition about how to ensure there's a genuine multidisciplinary panel that's making a decision that can hear, that's clearly separate from those people providing care. And I think she set out in a very detailed way. I think she explained it very well. Now, labour laws are free to disagree with her, but I don't think anybody could reasonably argue that she hadn't done it in a careful and thoughtful way, informed by her years of clinical experience in palliative care.

So I think it behoves all of us, whether we agree with her or not, to give her proposal due weight. And when the noble and learned Lord Hall Falconer responds, even if he doesn't agree with some of what she said, I hope he will take some time to reflect on the proposal that she's put forward. And even if he doesn't agree with all of it, see if there are some things which he has set out which are worthy of taking forward from his own perspective, even if he can't support all of them.

One of the important things she said, which we've already detected in this debate, is not universally agreed with, but which I strongly support, is this distinction about keeping the provision of assisted suicide separate to the provision of NHS care? And I think that's very important for several reasons. First of all, assisted suicide is not a health care treatment. And I think it's very important that it is therefore kept separate from healthcare provision, partly for the reasons set out, I think very ably by my noble friend Lord Deben, which is if vulnerable people and patients facing a terminal illness and needing palliative care, if they think that at some point the people providing that palliative care are going to try and end their life or encourage them to do so, or put pressure on them to do so, the practical effect of that will be to encourage Will to put them off, seeking palliative care at all.

And my noble friend is right that many people fear if they think there's going to be bad news involved, approaching doctors and healthcare professionals and those involved in healthcare delivery know that many people seek medical treatment at too late, and particularly speaking as a man. Men are particularly bad at going to doctors until it's too late, far worse than than women are. And and that's something we shouldn't be encouraging. We should be trying to make sure people are comfortable seeking support.

So I think it's really important that when they seek palliative care, they're very clear about what it is they're getting and it's not confused. The final point I would want to reference are the amendments brought forward by the noble Lord, Lord Stevens of Birmingham, informed by his enormous experience running the National Health Service. I think there's a there's clearly in this country an enormous amount of support for the principles of the NHS. Whatever the level of performance is at any time.

And it is also clear that the founding principles of the NHS would need to be altered to be able to deliver assisted suicide. I personally think that it would be best not to alter the founding principles of the NHS. To do that, it would certainly be if you're going to do that, that should be an explicit decision of Parliament. It should not be a decision taken by Ministers. And so if it's the wish, as I believe it is from the sponsor of the bill, the noble and learned Lord Falconer, to have this as an NHS service, then it should be explicitly written into the.

Into primary legislation, with the necessary consequential changes to what the NHS does. And that should be a open eyed decision that Parliament takes with all of the consequences that flow from it. And we've debated those, and I won't repeat them here about all the challenges, about whether decisions will then be taken because of funding and and resource reasons, about pushing people down one path rather than another. And we've heard examples on previous debates where that has already happened, things like the Liverpool care pathway.

So I think for for those reasons I support the amendment set out so ably by Baroness Finlay, and I think the amendments put forward by Lord Stevens are very worthy of consideration. The final thing I'd say just in terms of approach, which is point I made earlier and supporting Baroness Berger, is I accept that the noble Lord, the noble and learned Lord Lord Filkin, doesn't agree with everything we say, but I hope he accepts that there are many people, all of the Royal colleges which he referenced.

Having looked at the bill, they don't take a view on the principle, but they do not support this legislation in the form it currently is. And so even if noble and learned Lord isn't minded to support, at least listen to the concerns that other people have got and take these as practical mechanisms to try and improve both the bill and its workability, and I spirit.

12:28

Lord Rees of Ludlow (Crossbench)

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My Lords, before the noble Lord sits down, is he aware of a rather sits down, is he aware of a rather alarming story from Holland which is relevant to the separation of the two services? As he's mentioned, this gentleman witnessed the euthanasia of his mother. The. It was done by an anaesthetist who came in and said to the lady, Now I'm just going to put a needle into your vein and inject this medicine, and you'll go off into a wonderful sleep, and you will have no further worries.

A month later the gentleman was involved in a road traffic accident and he had to have an operation. An emergency operation in that very hospital. He was waiting for the anaesthetist to come in, and he was horrified because it was the same anaesthetist that had dispatched his mother, and the anaesthetist used the same words. I'm just going to put a needle into your vein and give you an injection, and you'll go off into a deep sleep with no worries.

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I'm grateful. I'm grateful to the noble Lord for that piece of information. But I am conscious that because of his intervention, I'm well over time. So I'm going to I'm well over time. So I'm going to conclude my remarks there and allow the House to hear from the next

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speaker in the debate. My Lords, these amendments make

12:30

The Earl of Effingham (Conservative)

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fundamental changes to the process by which a person is able to access by which a person is able to access assistance with ending their life under the bill. It is clear that the noble Baroness, Lady Finlay, has put a great deal of care and thought into these proposals, thought into these proposals, drawing on her decades long, extensive experience in medicine. extensive experience in medicine. The noble Baroness, Lady Hollins, put it so well when she said years of work and thinking of how this will work, have been done by the noble Baroness, Lady Finlay.

Amendment 333 replaces the doctor's assessment with the multidisciplinary panel process, bringing skills and knowledge from both the health sector, the social work sector and the justice sector, including ten years of minimum relevant experience. Our understanding is that the noble Baroness, Lady Finlay, is seeking to strengthen the safeguards for people who are seeking an assisted death, which was also referenced by the noble Lord, Lord Harper. My Lords, we do know from previous groups already debated and indeed in this very group that many noble Lords are profoundly concerned about vulnerable individuals and on the basis of what appears prima facie to be widespread, sentiment in your Lordships House, may we ask if the noble and learned Lord, Lord Faulkner, agrees there is potentially more that can be done to safeguard those vulnerable people and ensure they are not being pressured into seeking assistance under this bill.

If the noble and learned Lord were to acknowledge these concerns and accept relevant amendments, will the noble Baroness, the Minister, Lady Blake, please set out any assessment that the government may have researched regarding the practical solutions required to implement the noble Baroness Lady Finlay's proposals. Points touched on by the noble Baroness, Lady Cass and the noble and learned Baroness Lady Butler-sloss, and will the noble Baroness de Minister, give your Lordships House a sense of the government's view on the balance that they will need to strike between the risks of a vulnerable individual dying in a circumstance where the capacity, understanding or will might be in doubt versus the practicality of delivering an assisted dying service.

12:33

Baroness Blake of Leeds (Labour)

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12:53

Lord Falconer of Thoroton (Labour)

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13:13

Baroness Finlay of Llandaff (Crossbench)

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whether this is within NHS services or whether this is separate to NHS or whether this is separate to NHS services, which has been the request made by the Royal Colleges. request made by the Royal Colleges. And I think it is of concern that that still remains unanswered. And I'm most grateful to the noble Lord I'm most grateful to the noble Lord Lord Stevens for having laid it out quite so clearly and clarified, quite so clearly and clarified, because it isn't only funding, it's about how people behave within a service and what they do.

In terms of the statement about palliative care. I'm sorry, the noble Lord seems to be laughing. Does he find this amusing? No. OK. In terms of the question about palliative care and stating that it is about a good death, palliative care is far, far more when the patient dies. That is an end point of care which has been aimed to improve quality of life right the way through. And I've already provided evidence to this committee that actually an optimum time really should be a minimum of three months of knowing the patient and able to have an input.

And care goes on to those who are bereaved after the death. That is quite different to seeing the the term euthanasia, which was a translation translated into a good death, which is a single point in time. And part of care is used to people having a fluctuating wish to die, used to seeing, seeing people who are in despair, used to having to deal with some very, very complex problems, which was what I tried to illustrate with my patient, who gave permission for me to tell his story.

I, if I may just comment on. I'm I'm aware that this is taking a bit of time to sum up. But this has been a huge group of amendments. My model would not isolate the patient at all, and that's a complete misunderstanding and misreading. The proposal has been that the patient's care would carry on. They would have their clinical team looking after them as their wishes fluctuated in one direction or another, they would still get all the care that they need.

And in parallel to that, they could be assessed. And in parallel to that, they could receive lethal drugs if they wanted to. If I may then turn to the comment from the Delegated Powers and Regulatory Reform Committee, I certainly hope that there will be greater clarification, because that report was quite clear, and I'm grateful to noble, who highlighted that. The Minister, in her response, pointed out the problems in the wording of these amendments. Well, I didn't have any expert drafting advice in writing them.

I had fantastic help from the public bill office. You spent a lot of time with me, but that it then that's not the same as having parliamentary draughtsman. But I felt that it was really important that we tried to look at a scheme that was actually simpler, easier to understand, and met the the request from the Royal Colleges, which others have pointed out in terms of the drugs, if I may turn to that, I'm grateful to the noble Lady Baroness Lawlor for pointing out the issue about dispensing.

Because it seems that there is a range of up to 3% of dispensing errors from community pharmacies. It isn't that dispensing errors don't happen. And her amendments of the other amendments have tried to tighten that up. A dispensing error would be absolutely disastrous if lethal drugs were supplied to a patient who perhaps might have exactly the same name as another patient, or of many other patients. I have to say, in my area, there are a lot of people called David Evans or David Jones or David Williams, and they're often of a very similar age, and it's very easy to get people confused.

So I think that the concerns over tightening up safety are really very valid. In terms of the question over the Secretary of State determining what will be used. I think all the amendments that have been put down have been to try to find out on what basis the Secretary of State will make this decision. I note the noble Lord Lord Winston has referred to a remarkably large amount of literature on the way that these drugs used actually end life. I would be most grateful if he could send me copies of that literature, because I'd have to say in my literature searches, and I believe those are the noble, my noble friend Baroness Hollins.

We haven't found the pharmacological and pharmacokinetic evidence, so it's really important to know how they will that will be decided in terms of devices and substances. It's not even clear whether the substances would improve would include gases. And if they did include gases, whether that would include devices to deliver those gases in a safe way so that other people who were there with the person who was dying through an assisted death, do not inadvertently inhale and become subject to toxic effects from any levels of such gases.

So I think, I think these are really important questions to know how devices will actually be approved and what type of devices they are, and what type of devices they are, and what type of drugs would be used. The. I I'm aware that I'm now standing between lunch and, and people's ability to take perhaps to take in any more. We've had an incredibly wide discussion. This group of amendments was actually pulled together and enlarged because the noble Lord, the sponsor, had wanted to get through more amendments more quickly.

That is precisely what was negotiated with people who had amendments that seemed relevant into this group in order to deal with them in a comprehensive way and avoid the risk of repetition. But with that, and with saying that if we proceed to Report stage, I would like some help in looking at rewriting a model that is different, because I certainly believe that it could be safer. And these amendments were all written in good faith in an attempt to address the various concerns that have come from both sides of this debate and from those who are down the middle as well, and trying to pull together some solution.

But with that, I beg leave to withdraw the amendment.

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Is it your Lordships pleasure that amendment 143 be withdrawn? Amendment is by leave withdrawn. Amendment is by leave withdrawn. Amendment one four for Lord Evans Amendment one four for Lord Evans not moved 144A Baroness Freeman of Steventon not moved 145. Baroness Steventon not moved 145. Baroness Maclean of Redditch not moved 146. Maclean of Redditch not moved 146. Baroness Eaton not moved 146A Lord Morrow not moved 147. Baroness Cass not moved 148. Baroness Cash cas not moved.

The question is that clause five, clause four stamped part of the bill? As many as are of that opinion will say content, of the contrary, not content. the contents have it.

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My Lords. This seems a convenient time to break, so I beg to move. The house

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break, so I beg to move. The house adjourns for 40 minutes until 202. The Committee stands adjourned

13:26

House Adjourned During Pleasure

We We come We come to We come to the We come to the third group today. Amendment 149 in

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clause five Baroness Grey-Thompson. My Lords. The purpose of my amendments in this group is to

14:02

Terminally Ill Adults (End of Life) Bill - committee stage (Resumes)

amendments in this group is to ensure that all patients needs are taken into account, and support is given so that people genuinely have a choice. Amendment 149 and I'm delighted that my noble friend Baroness Campbell of Surbiton will be speaking in this group today is to ensure the subject of assisted to ensure the subject of assisted suicide is not raised within 48 hours of a terminal diagnosis. Perhaps this should be considered a cooling off period. I have been with someone when they've received a devastating diagnosis they were dreading and had considered, but actually neither of us had much after the initial moment of being told.

My Lords, this is about a timing issue that can be seen to be a power imbalance or implied endorsement. Options need to be very carefully discussed and if discussed straight away, it could be considered that the treatment

14:03

Amendment:149 Baroness Grey-Thompson (Crossbench)

might be so awful that assisted suicide is the best option. It might be quicker or easier to talk about this than a complex set of treatment options. To give patients choice, then a multi-agency team assessment should take place to identify current support needs and also ensure that steps are being taken to meet those needs. Also, this amendment is to offer some protection to doctors. If the conversation is discretionary, then there may be a difficult legal dilemma. If it's raised at the initial consultation, it might be seen to be implicit coercion, or if they fail to raise it, they may be concerned.

It might be considered blocking access. There is a case in South Australia where siblings said that when being with their relation and that relation was given VAD, it was the only time doctors had shown empathy or understanding. And that's in the Personal Reflections Report of 2022. 23 The Medical Defence Union, which supports 200,000 healthcare professionals, are deeply concerned about when is the appropriate time to raise it. And it leads us into a grey area of suicide ideation. We fund suicide prevention.

We do as much as we can to prevent someone dying by suicide, and there could be unforeseen consequences. With this bill, as previously debated, it does not guarantee a quick or painless death. But if this process exists, the rate of suicide may even rise. Have they done so in Australia? In the over 65 age group? Also, an assumption that if a terminal diagnosis is given, then it's the process that will be entered, which might not actually be the case. ONS data from 2022 shows that people with terminal conditions can feel suicidal one year after diagnosis for low survival cancers or for COPD.

The suicide rate for patients were was 2.4 times higher and one year after diagnosis. For chronic ischaemic heart conditions, the suicide rate for patients was nearly two times higher than the suicide rate for the matched controls, doctor Price and oral evidence said of those who qualify under this bill, 20% will have a diagnosable depression, 10% will have a wish to hasten death, 4% will have a more persistent wish to hasten death. And in this group, there are 18 times more likely to also feel suicidal.

And the Royal College of Psychiatrists have raised issues where they state doctors do not know how to assess the presence of depression. In a large scale survey of professionals in England and Wales, co-authored by Professor Gareth Owen in 2021, only 6.9% of Non-psychiatric doctors rated themselves as assessing capacity very well. Fazilet Hadi from Disability Rights UK, when she gave evidence, said that when they can't treat us or cure us, they devalue our lives. My Lord. She was referring to disabled people.

The VAD Review Board of the Australian state of Victoria says that doctor initiation may be the reason for increased take up. Previously there was a prohibition on doctors raising it, but that gagging clause has now been removed. J m a j a m a psychiatry paper from 2019 also highlighted the heightened risk during the first week and I quote clinically, our results identify specific cancers associated with significantly elevated risks of suicide, end quote. The combined literature suggests that the first week after diagnosis has the highest risk for suicide falling thereafter.

So it makes sense that those who've received a shock terminal diagnosis are most vulnerable and suggestible and may have low self-worth. Macmillan Cancer Care recommends a holistic needs assessment as part of cancer care. The bill will be better for having this assessment built in and will lead to more patient centred care. It is impossible to have true agency when only one realistic choice is offered. That's why it's crucial that the patient's current support needs are identified after diagnosis. I strongly support the noble Lady Baroness Keeley amendment 155, and feel very strongly that patients should be able to discuss their diagnosis and treatment with no fear of potentially being encouraged, or have this process suggested to them.

In terms of amendment 176, we have covered complications before, and the noble and learned Lord said in the chamber that a discussion should take place before the first set of drugs are taken, and if they don't work, the patient can choose to take a second dose of poison. But what is there to protect the doctor? Will the wishes be written down or witnessed? What should the doctors do if the drugs don't work? Should the doctor have a second dose with them? Will it be a doctor or perhaps a physician assistant? Is euthanasia the next step? My Lords, it could be seen to be the next logical step in expansion.

If 1 or 2 bad deaths are recorded, we might be told that we need to be more compassionate and this is the best way to go. In a Hawaii, a doctor allegedly completed the death of a patient after the woman began choking. It was reported in the Honolulu Star, and that doctor was charged with second degree murder. My Lords, legally, a patient needs to know the effect of the drugs and clause 12 two talks about needs to discuss the complications. But my Lords, we cannot play down the risks.

In Oregon data between 2012 and 2022 showed a complication rate of 11%, and in the Netherlands, one third of cases takes up to 30 hours for a patient to die. My Lords, I've said this before, but assisted suicide is often represented as painless and quick, allowing for calm and meaningful goodbye. But the reality from cases around the world can be far from this. The case of Kurt from Colorado has been previously raised by my noble friend Baroness Finlay. There's been much said in this chamber about the importance of words, and I strongly believe that the word treatment does not cover what we're talking about.

Using treatment to mean a lethal mixture of drugs intended to end life is clearly an attempt to soften the blow of reality, and this is why people are not aware of the frequency of complications and the need to know the wishes of the patient in the event of complications. My Lords, my amendment 200 is very similar to 149, but it's just amending a different part of the bill. And very briefly, I'd like to talk to amendment 200 A and about the unique context around the preliminary discussion, because failure to comply with regulations is appropriately treated as misconduct and subject to existing disciplinary procedures.

I know the noble and learned Lord is not keen to ask someone why they would want assisted suicide, but I do think it should be asked. People don't need to answer, but I think we need to do it to actually understand the process and look at whether there's other ways that we can improve our health service in Victoria in 2023. The reasons for accessing VAD are not recorded, and hence the nature and source of the suffering, which is a criterion for access to VAD, is not known.

So this could help us improve legislation in the future or actually close gaps. The impact evaluation on VAD is undertaken by researchers funded by time competitive grants, which means the results can be piecemeal and data not always accurate. And in 20 2324, ten doctors were the highest caseloads consulted 55% of all VAD cases in Australia as well. The substance is often taken in the absence of health professional, and there are no specific requirements or procedures for gathering or publishing information, or if complications have occurred.

With regards to my amendments. 207 and 207A I've previously quoted Tommy Jessop and his concerns for people with Down's syndrome. My Lord's people with Down's syndrome put great store around people in positions of trust around them and learning and lives deaths report, which was published in January 2026, discussed some of the challenges. The proportion of deaths of people with learning disability classified was 42 40.2% in 2023, and it was 21.8% for the generation in 2022. So almost double.

It demonstrates there are problems in healthcare for people with learning disabilities. 72.7% of adults with learning disability who died in 2023 were reported to have received the reasonable adjustments that they required when they accessed care, but conversely, 27.3% were reported to have needed at least one reasonable adjustment that they were not provided with Lord Spellar already. Deficiencies in our system. Disabled people are discouraged by ableist attitudes in our culture. In 2024, Autism Alliance reported that 91% of autistic people feel that society does not accept or only sometimes accepts them.

So that's the reason, my Lord, I've widened in the definition that we should be looking to support from a Guardian or independent person. My Lords, many families are loving and caring, but we have to recognise there are some who aren't, and we should ensure that people have the right protection and support around

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them. My Lords, I beg to move. Amendment proposed in clause

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Amendment proposed in clause five, page three, line five at end. Insert the words as printed in the Marshalled List. My Lords, I rise to move my amendment in this group to move my amendment in this group at 200 B, which inserts a new clause which would say that care professionals are not permitted to professionals are not permitted to raise assistance and from the avoidance of doubt, the amendment says that anyone who is engaged in patient care may not raise, suggest, encourage or initiate consideration of the subject of the provision of assistance under this act.

My Lords, there are four main reasons why I put forward this amendment. First of all, I think that in terms of the initiation or discussion of the subject, it gives clarity to those who are in the medical profession and those in the care professionals. It gives an absolute level of legal certainty. Now we know what other parts of the bill. There will be a sort of a clear position as regards to what actions will be taken by

14:13

Lord Weir of Ballyholme (Democratic Unionist Party)

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medical professionals when it comes to the administration of the assisted death. But it is also assisted death. But it is also important that we have a a clear legal position when it comes to the the front end of the process. And that is not simply to give assurance that there is clarity in the law. But I think for anyone who the law. But I think for anyone who is involved in the care profession, I think that gives them comfort and I think that gives them comfort and certainty as well, because if I was, for instance, involved in a care profession, I would want to know with a level of certainty what I'm entitled to do and what I'm not entitled to do.

And I think that that gives a level of of support to those people. Secondly, it is very much in the spirit of trying to create a a distinction between healthcare and the provision of assisted death. And in doing so, I think there is a concern that has been raised on a number of occasions within this House as to the extent to which assisted death mix alters, if you like, the perception of the National Health Service and alters the mission statement, if you like, of the National Health Service.

Now, this amendment in and of itself does not solve all those problems, but at least it goes some way to having that level of protection of the the National Health Service, I would say the National Health Service, which is very much been the jewel in the crown of this society, probably the most significant piece of legislation which a Labour government ever put through. And it is important that we do actually look at the implications of that. And I'm drawing, I think I remember remarks made in an earlier group, I think, by Lord Empey, who said that if you like moving outside the bubble of this chamber, we've also actually got to work out how people on the ground will perceive the existence of of assisted dying, particularly if it is located within the the health service.

And indeed, there is a fear that the perception out there will be that someone going to their doctor, will they be steered in the direction of an assisted death? Will they be receiving care? And indeed, because in our society, the way word of mouth gets on, I think that is a real danger in terms of the health provision that we can do. So having that level of distinction is important. Thirdly, I think it is one of quite a number of amendments that are required within this bill to provide some level of safeguards to try and address the concerns of the many disabled groups that are out there.

It is no surprise, and I think people do need to actually think why, amongst the the dozens upon dozens of groups that are representative of disabled, there's not a single one which is in support of this piece of legislation. And there are widespread fears and concerns that are there. Now. I think that while quite often when we are talking about provisions for the disabled, it'll be very honeyed words within this chamber. There is a danger that the concerns of the disabled.

We we treat them in a certain blasÃ© fashion. I think it is very difficult, I think, for any of us to put our minds or put ourselves into the minds of those with severe disabilities. Let me say that once you're disabled, particularly if you have a visible disability that looks at you differently, it treats you differently. It speaks to you differently. As many in the chamber will know for the last three years as due to a partial disability, when I. Some of the times I'll be able to walk about just without any aid, but if I'm going any distance, I have to use an electric wheelchair.

I should say perhaps electric because I don't have the. The same level of fitness as Baroness Grey-Thompson on that basis. But I know, and I see members of the public will look at me and perceive me differently when I'm in a wheelchair than when I'm not. I should say, as an aside, that last summer, whenever we had a few of those, those days which are rare in this country of warm sunshine, and I was about outside in a pair of sunglasses, I did get the pitying looks of some people with a look at that poor man.

Not only is he disabled in the wheelchair, he's obviously blind as well, although I do not know. That might have been more of a commentary on my my wheelchair driving, but the reality is that that there are deep fears and concerns out there amongst the amongst disabled people. And it is not simply. Well, I think that one of the biggest concerns that many of us have with this bill is over the issue of coercion. It is not simply the very clear cut form of coercion of family members pushing a person into an assisted death.

It is a much more subtle process. It is the concern that disabled people will be made to feel a burden, that the only route out for them is an assisted death and accumulating within that, if they feel that they are getting those suggestions or indeed raised in conversations by medical professionals, then I think that that puts additional pressure on them. And particularly if we look at those with suicidal ideation, again, being able to pick up remarks and suggestions can lead people down a path to which they don't have to go.

And finally, I think the the key reason for this is also that it preserves the idea of autonomy. Now, in terms of the key principles of this bill, one of them initially was to deal with the situation of pain and suffering. And there's been well rehearsed arguments about why that is disappeared completely off the face of the bill. And so for the proponents of this bill, the key argument, the golden thread that was run through it, is the autonomy of the individual.

If we are genuinely to respect the autonomy of the individual, then the initiation of any process of assisted death has to come from the person themselves, not. It's not simply the protection against coercion, but also ensuring that it is not initiated or suggested by others. So I look forward to the response of the bill's sponsor in relation to this. I say look forward. I say that perhaps more in hope than expectation, given some of the responses, but I look forward to the rest of the debate here.

14:20

Lord Shinkwin (Conservative)

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Anybody else intervenes? I should have said at the beginning should have said at the beginning of this group of amendments that Baroness Campbell of Surbiton and Lord Shinkwin will be taking part remotely, so I apologise to both of them for forgetting that at the beginning, my Lord's Lord Shinkwin is taking part remotely, and I invite the noble Lord to speak.

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My thoughts. I advise to speak

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My thoughts. I advise to speak to amendments 162194 and 858 in my name, which I should make clear that I do not intend to move. Amendment 162 proposes that where a Amendment 162 proposes that where a person has down syndrome or learning disability, a registered learning disability, a registered medical practitioner must not initiate, suggest or raise the matter of assisted dying with that person. My Lords, this is consistent with two findings of a new poll by Whitestone Insights, to which my little friend Lord Harper referred in the previous trip.

It shows that, firstly, 84% of people believe assisted dying should only be initiated by the patient, and that figure rises to 91% among people aged over 75. It also shows that 86% of people support additional safeguards for people with Down's syndrome, autism and learning disabilities. Ten Ross of the National Down Syndrome Policy Group told the Select Committee on the bill that, and I quote, those with learning disabilities may place great weight on the doctor's suggestion and be unduly influenced towards choosing an assisted death.

And I quote the acquiescence bias risk from people with down syndrome is extraordinary. My Lords, we've talked extensively about the huge risks of coercion caused by this poorly drafted and unsafe bill. As our forensic scrutiny has highlighted, these cannot be overstated for some of the most vulnerable members of our society, including people with Down's syndrome or learning disabilities. The Noble and learned laws has complained about the number of amendments that have been tabled, but bizarrely did so without any acknowledgement that this reflects the very poor state of this unsafe bill when it came to Lordships House.

It is regrettable that the Noble and learned laws, in his consistently dismissive responses is sabotaging noble Lords, carefully considered and reasonable attempts to mitigate the worst effects of his badly drafted bill. That is the purpose of amendment 162, its consequential amendments eight, five eight and of 194, none of which I would have needed to table if this bill was safe. Amendment one, nine, four and 208. In the name of my little friend Baroness Maclean of Redditch, who cannot be president present today.

Which my receptors I regulations to make provision about the training, qualifications and experience that a registered medical practitioner must have if they are to exercise their professional judgement. Under sections two three. At the moment, despite the sensitivity of these conversations, not least with people who, because of down syndrome, are predisposed to agree with what they're told and unable to compute the gravity of finality of choice for an assisted death. And the fact that a conversation to be the first step on the pathway to end that person's life with lethal drugs.

Despite all this, there are no minimum requirements in terms of either training or experience my laws in such a situation in which the bill grants every doctor legal protection if they exercise their professional judgement to discuss assisted death with a person. Is it not essential that there are minimum requirements to qualify for this protection? Surely the question is as to how they could not meet minimum training or experience to deal with such delicate, sensitive situations, especially those involving people with down syndrome and learning disabilities.

I cannot understand why anyone should think that they don't unless there is another agenda at play here, one that prioritises over everything else. Making access to an assisted death as easy as possible and thus unencumbered by safeguards such as those which my amendments would provide, particularly to those with down syndrome or learning disabilities. Because these disabilities would place them in an invidious, viciously vulnerable situation. Mr. Moss told the select committee that such training should be mandatory.

He also cited a shocking statistic which underlines the point that ban the number Baroness Penn Baroness Grey-Thompson made earlier of the extent of existing discriminatory outcomes and evidence of health inequalities, and this has been revised only two months ago. In a corrected version of 2025. L d r report. And the statistic is this just over 40% of people with learning disabilities die from avoidable causes. My doubt is now without this bill, surely we need to consider how much worse the bill would make.

That deeply unsettling statistic. Mr. Ross also told the select committee my quote there is a real fear among people with down syndrome that I've spoken to that this bill will further target their lives. I wonder, is noble and learned Lord Moore really going to ignore their fear? Because I have to say that that is not the Labour Party that I and many other people know and respect. And my books. While dismissing the case, I made intermittent on six of February relating to people with congenital lifelong conditions like mine.

The Noble and learned laws expressed sympathy. I'm afraid, and I quote to my fate, which is a bit ominous, although perhaps inadvertently accurate in the context of this bill, I dare say I should be grateful for such touching thoughtfulness, although I'm not sure his sympathy with either me or in relation to these amendments. A person with Down's syndrome or a learning disability. Any protection from the deadly provisions of this deeply flawed bill. My thoughts in closing, I readily acknowledge that translating warm words of sympathy into effective safeguards might defeat even the most able of advocates.

So perhaps I could offer a more practical solution in the form of these amendments. I hope the noble and learned Lord Moore will accept them. I beg to move.

14:30

Baroness Campbell of Surbiton (Crossbench)

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My Lord Reay. Baroness Campbell is also taking part remotely, and I invite the noble Baroness to speak. >> My Lords, I've added my name to

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My Lords, I've added my name to a number one for nine in the name of my noble friend Baroness Grey-Thompson and I also support the principle underpinning amendments. One 5151 and 154 all of which aim to prevent a medical practitioner from initiating discussions on assisted dying under clause five of the Bill. My Lords, like the noble Lord Lord Shinkwin, I thoroughly agree that doctors must not be permitted to initiate conversations about assisted dying to patients, and I will tell you why.

To do so would be in breach. It would be to breach their fundamental duty of care to their patients. At the very point when the patient may well be at their most fragile, newly diagnosed and frightened about what the future

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holds. It would not be a neutral

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It would not be a neutral clinical act. It is an intervention laden with power, meaning and consequence. The very suggestion of assisted death from a doctor. At such times risks being heard not as such times risks being heard not as an option but a judgement. My Lords, it was not long ago, during the scariest time of the Covid 19 pandemic, that disabled people were contacted by their GPS to allow permission for DNR notices to be placed on their medical records, should they be hospitalised after contracting the virus.

Disabled people were horrified and many contacted me and other parliamentarians to know why they were being treated differently to non-disabled people, they said. It felt as though catching Covid would be a death sentence. Thankfully, the Secretary of State for health rectified the issue, reminding doctors that their actions were in contravention contravention of the Equality Act and the Human Rights Act. But the damage was already done. Disabled people who relied on their doctors for their health and well-being felt betrayed and unworthy of a life saving treatment.

If a medical practitioner raises the possibility of an assisted death, the patient's feeling of security and trust will be damaged in the same way as they were during the pandemic. Your Lordships have often heard me say that I count my blessings every day because my doctors support and celebrate my life. However ill I become, I feel secure knowing they will do their absolute best. However grim my prognosis may be. Reliance on that assurance is critical to the well-being of patients, especially those with long term disabilities.

If assisted dying is to become an option, it must be one that is strictly patient initiated, tightly defined and clearly demarcated from ordinary clinical care. It must sit within a system that prioritises palliative care, practical support and the affirmation of life. Otherwise, it will be seen as the simplest and most straightforward option for the patient, their family and friends, the NHS and society as a whole. My Lords, the doctor patient relationship is inherently unequal and never more so than after a terminal or life limiting diagnosis.

When a doctor introduces the possibility of assisted dying, however delicately phrased, it carries weight. For many patients, particularly those who already feel themselves to be burdensome, costly, or devalued, the message risks being internalised as a subtle signal that their lives are no longer worth living. We must also confront the reality of acute vulnerability, a diagnosis of serious, serious illness often brings shock, despair and temporary suicidal thoughts feelings that with time and treatment and compassionate support, frequently pass.

This is why I support my noble friend Baroness Grey-Thompson in her amendment 149, which seeks to address this. My Lords depression, unmanaged pain, fear and loneliness are not unusual bedfellows for those people with a terminal diagnosis. Medical practitioners are not specialists in disentangling these states.

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My Lords, if we are serious about safeguarding autonomy, then about safeguarding autonomy, then our first duty is to ensure that people are offered care too. Hope and practical support. Not an and practical support. Not an expedited exit at a time when they expedited exit at a time when they feel most afraid. So I hope the noble and learned Lord will recognise this and come back with his own amendments that Report stage to ensure the subject of assisted dying is only raised by the patient and never by a medical practitioner.

I would be very pleased to meet with him between now and reports to explain further why this is so essential for the legislation to be safe in practice. Thank you.

14:36

Baroness Blackstone (Labour)

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I rise with some. >> Trepidation to speak. >> Since I realised how passionately the previous speakers think about what they've said. And think about what they've said. And the first small point I want to make the Baroness Blower Baroness Brady Campbell referred to a report stated we're not going to have a Report stage because we've taken so long in dealing with all the many, many amendments that have been put down. But leaving that on one side, I think we have to realise that doctors main objection and main main object is to try to alleviate suffering.

And this is what those of us who are backing this bill believe it does. It will alleviate suffering and sometimes terrible suffering and torment by allowing people to choose the time of their death when they're already dying. We must not forget this if we accept that this is the role of doctors and this is what they try to do in their professional work, we must allow them to discuss at an appropriate point in their judgement, all the possible options that are available to the dying person.

Now, if this bill became legal and was enacted, one of the options would be an assisted death if they had reached that point. So I think to say that a doctor in a close relationship with his or her patient is unable to raise this as a possible option would be entirely wrong. And I do advise everybody, if they haven't done so already, to look at what the BMA says about this. They have specifically briefed against prohibiting doctors from initiating discussion about assisted dying under this bill, warning that it will be detrimental to patient care.

I accept this piece of advice by the BMA, and I think it's a view that many doctors and some in this chamber too, would actually adhere to and agree. So I very much hope that this these this group of amendments would not be accepted. It doesn't mean that the patient at the end is not the one who makes the decision about whether to request an assisted death, of course he or she does, but it just becomes one of the options that is available to them.

And that is an option that I believe we should allow them to be aware of. Mr Speaker one 5156 166, and 205 to which I have put my name and in support of other amendments in this group, my Lords has drafted the bill would permit a discussion with about assisted dying with the patient before any requirement to discuss expert palliative care and Baroness Bi Baroness Blackstone said that, you know, it would be irresponsible not to allow this. In Australia and New Zealand, doctors are not permitted to initiate such discussions as drafted.

Doctors in Australia are now allowed to do so. The law has been changed there. I accept Baroness Hayman, but they certainly thought it was a bad idea and I know that there is further discussion in, I think, southern Australia about the issue. Now, if I may go on as drafted, the Bill would permit discussion before any discussion about assisted dying, before discussion about palliative care. And I think it's it would come as something of a shock.

14:40

Baroness O'Loan (Crossbench)

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Was that there was an act in Victoria, Australia, after the five year review of the operation of the act, the government recommended act, the government recommended that the prohibition on raising it be removed as it was found to be impeding access and undermining patient centred care. The Royal Australian College of GPS welcomed the recommendation as a sensible step and the law was changed.

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Just fine. No problem. I think it would come as a shock if a doctor came to one's bedside and doctor came to one's bedside and said, in these circumstances you may wish to consider an assisted death experience would tell us that death experience would tell us that a patient might not hear much more of any discussions about treatment and palliative care, given the and palliative care, given the shock and the already vulnerable state. Can the noble Lord, the Minister, explain why the bill is Minister, explain why the bill is drafted as it is in this context, permitting a discussion about assisted dying without requiring a previous discussion about palliative care? And can the noble Lord be noble and learned? Lord, assure your Lordships House that there will be a genuine choice.

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The noble Baroness will know that clause five specifically says that clause five specifically says that if a registered medical practitioner raises the question of assisted deaths, he must also assisted deaths, he must also explain and discuss with that person all appropriate palliative person all appropriate palliative hospice or other care that is available. Accordingly, such a preliminary discussion about assisted death must not be conducted in isolation of, among other things, palliative care. So I'm not sure the basis on which the noble Baroness is saying that that should come before, rather than at the same time.

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It should come before, because that clause five was drafted, as you read out to the House, says you read out to the House, says it's to be part of a discussion about assisted death. And what I am suggesting to the House is that if suggesting to the House is that if a doctor mentions assisted death, that will focus one's mind in a way, that will focus one's mind in a way, in a way which may. Cause distress, shock and all sorts of things.

Another problem, this issue of the doctor raising the issue. Despite that, the patient, despite the fact the patient has given no indication he wants to talk about it. My Lords, this bill is said to be a matter of autonomy, and it cannot be denied that there is an unequal relationship between patient and doctor doctor's perceived as knowing and acting in the interests of the patient, and under the Constitution of the National Health Service, it provided that it is there to. To improve our health and well-being, supporting us to keep mentally and physical well, well, to get better when we are ill and when we cannot fully recover.

To stay as well as we can to the end of our lives. Now, even where a patient may have autonomy, where a doctor to initiate a discussion about assisted dying, he or she would fundamentally undermine patient autonomy. Offering assisted suicide is not the same as offering palliative care, cancer treatment or any other care. These are all directed to the treatment of a living person. Assisted suicide is about killing the person. When doctors raise assisted suicide or assisted dying, patients may interpret this as an implicit recommendation or indeed a judgement about the value of their life, not a neutral option.

And that undermines agency. A choice influenced by authority, fear or deference is not a free choice, and there is a huge risk of a doctor exercising undue influence and exposing patients to pressure at the most vulnerable point in their lives. I believe I've heard the noble and learned Lord Faulks acknowledged that doctors do hold exceptional authority over patients, and I think he should reflect on that. The solution to these problems in amendments. One 5151 indeed. 154 therefore, amend clause five two by providing no discussion with the patient until the patient has said they want the discussion.

Amendment 156 would delete clause five two and is consistent with the other amendments. Amendments one, five nine and 160 clarify the meaning of the bill to state specifically what is to be discussed and the death of the person sitting lying in a bed before the doctor. Not any other matter. All these amendments bring clarity and additional protection. Amendments 157 and 164 would protect the patient even further by providing that where a person has told their GP they don't want a discussion about assisted dying, that should be recorded in their notes and should provide an audit trail of the wish of the patient, which must then be complied with by any registered medical practitioner.

Another problem as drafted, the bill will allow any doctor to erase assisted dying with any patient, regardless of whether they're under their care at the time or where. For example, a locum doctor has temporary care of a patient, even for one day. The solution, I think, suggested in amendments one five, five, 156 and 157 would preclude any doctor from raising the issue of the patient, who has previously considered assisted dying and rejected it, or who has opted out. Further amendments would ensure that doctors will only be legally permitted to raise assisted dying with people who are generally genuinely under their care, not with any person they encounter and the various solutions offered in amendments 158 require that the doctor must have known the patient for six months.

Could the Noble and learned law confirm that the provision currently in clause five do allow any doctor to raise the option of ending the patient's life if they feel it's appropriate to do so in their professional judgement? And can you also confirm that, as drafted, the bill is not limited to the patient's GP treating consultant specialists and that there are no restrictions on the settings in which a doctor might do this, or in the presence of whom a

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doctor might do this, allowing any Abegglen. The noble Lady. R am I right in

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The noble Lady. R am I right in understanding that her amendments are designed to achieve the situation where someone is actually experiencing and receiving the best palliative care? Before the palliative care? Before the discussion takes place? Otherwise, as the Most Reverend Primate, the Archbishop of Canterbury said, any choice that you exercise could be illusory unless you're in that situation.

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I thank the noble Baroness for her very helpful intervention. her very helpful intervention. There is a further problem, my Lords. As drafted, there is nothing to prevent any other health to prevent any other health professional from raising the issue of assisted dying with a patient, a nurse, a health visitor, a physio. nurse, a health visitor, a physio. Sometimes patients form stronger relationships with these people than with doctors because they see than with doctors because they see more of them.

It's essential, therefore, that there is no possibility of a warm up conversation being initiated by a professional to ease the ground for the doctor when he wants to make his approach. It may be said this would not happen, but we have seen ample evidence of the situations in which cost savings to be secured by freeing up beds and ending treatment, are regarded as justification for assisted death. And we have, of course, seen the situations in which a person who has suffered an amputation, has a terminal cancer, seeks a wheelchair and is told the waiting list is two years, but assisted dying can be provided tomorrow.

My Lords, any situation in which assisted dying is discussed for the first time must be strictly patiently. Initiative initiated, tightly confined and must take place through a clearly defined process. Amendment 205 to which I put my name and 207207A and other amendments in the group will prevent any discussion about assisted suicide with a person who has a learning difficulty or autism without a family member, guardian or independent person present. The effect of this would be to do what all professional and caring organisations do when dealing with, or engaging with people with such disabilities.

I support the amendments in this group. B17346457512, which seeks to protect those who experience feelings of suicidal ideation, which may be transient. And what about the doctors, my Lords, the MDU, which represents over 200,000 healthcare professionals, is deeply concerned about the proposals in the bill. The MOU. The MDU points out that the position whereby doctors are not required to raise it, but are still permitted to do so, is a worst of both worlds for doctors because they would be liable to complaints in either situation.

If the doctor doesn't raise it, a complaint can be made against them for not having done so, and if they do raise it, a complaint can be made against them. As the MD points out, such proceedings can take a toll on doctors. The time taken, the emotional toll, the pre-procedural concerns. This cannot be overstated. My Lords, this is one of the many unintended consequences emanating from this clause. As it's currently drafted. The clause requires substantial amendment to make it safe.

14:49

Lord Goodman of Wycombe (Conservative)

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For my amendment 151, which is >> For my amendment 151, which is supported by Lord Carlile, Baroness Fox and Baroness Hollins, was also Fox and Baroness Hollins, was also referred to approvingly by Baroness Campbell in her remarks earlier, and my amendment would prohibit medical professionals from raising assisted dying as an option unless explicitly requested by the patient. I'll be very brief in introducing this amendment by pointing out to the House that it goes to the heart of a juxtaposition which is suggested by the bill, which is that on the one hand, we have an increasingly large, frail, vulnerable, often elderly population who may not have the full autonomy that the sponsor of the bill suggests.

On the other, we have a National Health Service that, by the nature of events, is almost always underfunded or feels it will be underfunded. What happens if you put those two things together? The answer to that is that inevitably, there is a pressure to cut costs and present the cheaper option to the patient who's seeking guidance. Now, I've read very carefully the words that the sponsor has written into the bill in section five, and it is true that on paper, the patient must be offered the option of palliative care, as well as the option of an assisted death.

But I am concerned in these circumstances of financial restriction of the patient being steered in a certain direction. I will not regale the House with horror stories from abroad, usually from Canada, about where precisely this has taken place. Were I to do that, the sponsor of the bill and others would quite rightly point out that there are safeguards in this bill that are not present in Canada, although I would also point out in return that safeguards can be whittled away over time.

And I say nothing in making that point to the detriment of the sponsor of the bill. I'm sure he doesn't mean that to happen, but people can come back over time with amendments and changes to legislation. So I want to step back from this amendment and look at it really in this way. I believe assisted dying is intrinsically problematic. And if this bill ever got further, I would vote against it at Third Reading. But my concern while we're here is to improve the bill.

If we aren't to have a bill, I want it to be in the best condition. Or rather, I should perhaps aim the least bad condition possible and nobody will know. There is nothing in this bill that alters the basic architecture and structure of what the sponsor of the bill has proposed. Nothing in relation to the first or the second doctor or the panel or proxies or the regime for regulating substances of any of that. The amendment does nothing whatsoever to prevent anyone from seeking an assisted death.

All it does is to prevent a medical professional from raising it. Therefore, I would suggest to the noble Lord Bourne sponsor of the bill that if he wants to make some progress with it, he might accept this amendment or one of the many others in this group to a similar end, and I look forward to hearing him when he replies. But whether he does accept it or whether he doesn't, I think this amendment rights a safeguard into the bill that isn't there, and I recommend it to the House.

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My Lord. The noble Lord, for. In three minutes and 35 seconds. Although I disagreed with his Although I disagreed with his conclusion, he managed to summarise the arguments both ways and the evidence brilliantly. In such a

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evidence brilliantly. In such a short period of time. Yes. To follow the noble. My noble

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To follow the noble. My noble friend Lord Goodman, 151. I'd like friend Lord Goodman, 151. I'd like to add a a word and propose my amendment 153A, which goes further

14:53

Baroness Lawlor (Conservative)

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to stipulate that a medical practitioner not only may not raise practitioner not only may not raise the subject with the patient, but a person unless the person has raised person unless the person has raised it first in an in-person appointment requested specifically appointment requested specifically for that purpose. And we've spoken today about the position of trust, today about the position of trust, which the doctor enjoys his trusted by the patient. He's trusted by our society. He's paid for by the taxpayer who trusts him or her.

And that trust is breached if the position is used, not for the the treatment of a patient's symptoms or to help manage them or to benefit the patient, but to suggest the patient instead should consider killing themselves. The doctor who is trusted to find the best medical treatment for pneumonia, blood pressure, heart disease becomes an agent who leads to the medicalized death for the patient with a poison, which is self-administered as if it were just an ordinary curative medicine.

Moreover, as the bill stands, the requirement to discuss possible side effects and complications, which we know happen in other jurisdictions is not there, perhaps we might also consider why doctors are in this position of trust. They are because they have special knowledge, not only knowledge of medicine and its treatment, but access to medications. And they are especially trusted when the patient is very ill, very frail, terminally ill, perhaps already feeling a burden to those who are looking after the patient.

If we permit the doctor to raise the subject of assisted dying to those who are so suffering, we leave the door wide open to the abuse of power. It need not be deliberate abuse. The doctor may only be raising a possibility, which they think the patient. I wonder if I could just ask.

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The noble Baroness Lawlor whether she's aware that of all the countries in Europe where doctors countries in Europe where doctors are most trusted, it's the Netherlands and consider what their Netherlands and consider what their legislation is, how closely, often the relationship is between the doctor and the patient who is in doctor and the patient who is in receipt of assisted death. I am not advocating their legislation, but I'm saying of all the people, all the countries that have assisted dying, actually they are most trusted.

The doctors are most trusted in the Netherlands.

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The noble Lady. But may I point out that the Netherlands has many out that the Netherlands has many significant problems to do with various aspects of its medical various aspects of its medical legalisation of certain actions and operations, and in fact, I won't go into them. But other countries are into them. But other countries are suffering from a fallout of what is happening, especially those on a happening, especially those on a rail service from Amsterdam. And if we leave the door wide open, it can happen.

And even because a doctor may only be raising the possibility, but a patient may be more swayed by a doctor's opinion than their own. Indeed, where no pressure is intended, the pressure may be there nonetheless, and so the position of trust can only survive if the doctor recognises the normal rule is limited to supporting the health of the living, helping the patient to live life to the fullest possible by managing an illness or its symptoms, or coping through the ups and downs of treatment.

Participating in assisting suicide for those doctors who agree to do so is an extraordinary non doctorly role, which they should enter into only at the self-initiated request of the patient could I.

14:58

Baroness Hayman (Crossbench)

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Say that I've found some of this discussion quite difficult to compute with my own very limited compute with my own very limited and not doctor experience of end of life care and with relatives who have been dying. And the noble Lady, Lady Lord Dear spoke as if there was a very binary division between assisted dying care and palliative care. And yet the cases that I've been involved with and seen very closely have been of people very much, very definitely very frail, very at the end of their lives and where the range of options they wanted to talk about were not simply pain relief.

The whole time, no one has mentioned the right of people to exercise autonomy, to stop eating and starve themselves to death. Does the doctor not consider what happens in those circumstances and talk about options? Then the the option, of course, to turn off life support the option. My mother refused to have any blood transfusions. Doctor talked her through how that would reduce her life expectancy, but seemed to me to be a whole range of circumstances that you would want a doctor to be able to talk to the patient about.

And it is not simply we can offer you any only talk to you about this is the palliative care available and only if you've heard that seen it, chosen about it, can we then talk to you about something different, which is about

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assisting your death. And it seems to me. To the noble Lady, as I

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To the noble Lady, as I understand it, she's talking about various possible options. So would she think it would be a good idea she think it would be a good idea if the doctor were free to advise

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the patient to stop eating? I think it's very important that

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I think it's very important that the doctor should listen to the wishes of the patient, and I certainly think a doctor should be should not be able to force feed a

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patient in those circumstances. My amendment 169 is a very

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My amendment 169 is a very modest one. It simply proposes that if this bill proceeds, that before any doctor raises the possibility of assisted dying, the patient should first receive a should first receive a psychological assessment from an appropriately qualified specialist. This is not an onerous hurdle. It This is not an onerous hurdle. It is a basic and sensible safeguard. As many Lords have raised before me. When people are approaching the end of their lives, they are often in a very vulnerable state.

Feeling of sadness, anxiety or despair are not unusual, and even the most resilient of individual is affected. That vulnerability can become much more acute when a. When patients are told they have a terminal illness and perhaps only six months to live, such news can be profoundly shocking and can offer often trigger despair and even suicidal thoughts. The evidence reflects this reality. Research, drawing on data from the Office of National Statistics, King's College London and the University of Manchester, shows that the risk of suicide rises significantly in the first six months after diagnosis.

In other words, the period immediately following diagnosis is often when patients are the most fragile. Psychologically, this is precisely why we must proceed with great care before introducing the possibility of assisted dying. It seems only prudent to understand the patient's mental state. Without a proper psychological assessment, we cannot know whether patients are coping as well as they appear, or whether they may be struggling with depression and even suicidal thoughts. Studies suggest that 20 up to 40% of patients with advanced advanced cancer experience, clinical depression doctor Rachel Clarke, a palliative care physician, warned the Commons Public Bill committee exactly about the situation and that raising the question of assisted dying can unintentionally place pressure on a vulnerable patient.

Autonomy is often far more fragile and complex than we assume. When someone has just devastated received devastated news. Even a careful framed question may be interpreted in ways we never intended. Both the Royal College of Physician and the Royal College of Psychiatrists, as well as palliative care and disability groups, have warned that vulnerable patients are not adequately prepared protected by this bill. As it currently stands, my Lords, ordinary doctors are not usually trained to make complex psychological assessment.

According to the government's own impact assessment, doctors involved in these early conversations may receive as little as 90 minutes of e-learning and one hour of an online interactive session. Surely that is unlikely to equip them to recognise subtle depressions or suicidal ideas. Ideation. Feelings in patients who are already known to be at great risk. My son is a consultant physician at the largest psych hospital in Berlin. For many years, he has worked on the front line, treating patients in acute crisis and teaching junior doctors how to recognise mental illness.

His view is very clear depression can be remarkably easy to miss if you're not a specialist. We assume every human has free will, but this will be impeded by severe depression. People suffering from severe depression may appear calm, rational and composed. They may even seem cheerful. Yet internally

15:05

Baroness Meyer (Conservative)

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they may be struggling with profound hopelessness and suicidal profound hopelessness and suicidal thoughts that impair their judgement and decision making. judgement and decision making. Research published in The Lancet has shown that general practitioners detect depressions practitioners detect depressions only in 50% of the cases. This is not a criticism of them. It simply reflects the fact that recognition that recognising depression, especially in people with serious physical illness, requires time, training and specialist experience in the context of assisted dying, this matters enormously.

A misdiagnosis diagnosis is not a harmless mistake. It can have fatal consequences for a patient whose suicidal thoughts must be might be treatable, and whose desire to die may have only been temporary. For that reason, many psychiatrists psychiatrists are cost. The United Kingdom in Europe believe that a specialist psychological assessment should come at the very beginning of the process. It is careful. It is a careful, humane and responsible safeguard and settled decision, not untreated despair at a moment of profound vulnerability.

If we fail to make that assessment, first, we risk confusing a treatable cry for help with a settled and autonomous and autonomous decision to die, to proceed without that knowledge is unsafe, unethical, and legally questionable. As many Lords noble Lords have raised before me. Baroness Finlay, one of the most authoritative medical voices in the Lords, has warned, and I quote, without proper psychiatric assessment, a request to die may reflect treatable depression rather than a settled wish to end life.

I very much hope that the noble and learned. Lord Falconer will take into account these worries and

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accept my amendment. For amendments. Towards the end of this group

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Towards the end of this group are amendments 31734, six, 457 and 512, and they're all in identical terms. And they're designed to terms. And they're designed to ensure that a person seeking a state assisted death is not acting state assisted death is not acting out of a temporary feeling of fear, panic or anxiety in relation to panic or anxiety in relation to their diagnosis and prognosis. I'm very grateful for the support of the noble Lady Baroness Fox and the

15:08

Lord Carter of Haslemere (Crossbench)

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noble Lord Lord Farmer. I can testify that when a person is told they've got a terminal illness with they've got a terminal illness with only a year or so at best to live, it's difficult to think rationally. It doesn't occur to you that will often be a wholly inaccurate often be a wholly inaccurate prognosis, or that specialist palliative care can deal with most patients. My amendments, therefore, seek to ensure that the assessing doctors are satisfied that a person seeking a state assisted death is not acting from such feelings of panic.

The noble Lord, the sponsor, may say in response that the bill already requires the doctor to ascertain whether the person has a clear, settled wish to end their own life. However, it seems to me that a person can have such a clear and settled wish as a temporary result of fear, panic or anxiety. So these amendments seek to raise the threshold at which an assessing doctor can be satisfied that the person has such a clear and settled wish.

It's at moments like that when people are at their most vulnerable, but great care needs to be taken to ensure they don't opt for something and go down a path which, on deeper and longer reflection, they might decide is wholly unnecessary or inappropriate for them. Yes, in theory they can change their minds later, but many people might feel reluctant for all sorts of reasons to reverse their decision once they're on that track. So the initial discussions with the assessing doctor are critically important.

A full specialist palliative care assessment, an amendment I previously tabled in committee but was rejected by the noble Lord, the sponsor. Forgive me, would. A full palliative specialist palliative care assessment would help to ensure that they're not acting out of despair, fear, anxiety or panic, since it would put a pause on the whole process and ensure their wish to end their life was properly informed, as required by the Bill. Both these sorts of amendments strike me as obviously desirable in a bill of this nature, and I urge the noble Lord, the sponsor, to avoid the need for having to bring them back at report.

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My Lords, I stand to speak on amendments 158163 in my name, and also 157 and 164 in the name of my noble friend Lord Ahmed, who cannot noble friend Lord Ahmed, who cannot be with us here today. My Lords. be with us here today. My Lords. 157 in my noble friend Lord Ahmed's name seeks to ensure that a doctor name seeks to ensure that a doctor may not raise assisted suicide with patient who has opted out. 158 in my name.

This refers to what the bill appears to permit any doctor to raise, ending a patient's life, even if they have no prior relationship with the patient. This amendment specifies that a preliminary discussion can only take place with a registered medical practitioner who has known the patient for a maximum of six months, and 164 in my noble friend

15:11

Lord Evans of Rainow (Conservative)

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Lord Ahmed's name. If a person has informed their general practitioner this. They do not wish to discuss this. They do not wish to discuss the subject of the provision of assistance in accordance with this act. That fact must be added to their medical records, and a registered medical practitioner must not discuss that with them. My Lords, Lord Deben observation made a very powerful point in the a very powerful point in the previous group, where he said, based on his experience as a constituency MP, that many members of the public are worried by doctors and hospitals.

So when we debate medical issues in this House and put legislation onto the statute book, it does worry very, very great numbers of the population. And it reminded me of my grandma grandmother, who ten years ago died. And she had a theory. She lived till she was 97, but she had a theory. If she went into hospital, you didn't come alive. And when I went to see her in East Cheshire Hospice, an outstanding hospice, at the age of 97, she grabbed hold of my arm and said, what did I tell you? They're trying to kill me.

Get me out of this place! But she died a very dignified death. Similarly, with my 90 year old mother, a outstanding GP, family GP service that knew our family, we knew, knew the GPS, good service from the local NHS, outstanding palliative care and again an outstanding hospice and East Cheshire Hospice. So the glue that helped my family members to have a dignified death was that of a loving family. And on a previous day on on this debate from Lord Harper made a very powerful point about it's OK if you have a loving family networks around you to take care of you and think of your interests when interacting with doctors and hospitals, but Lord Harper referred to those people who are poor, lonely, and ill, and without that loving network around them to look after them.

And there is a case study that happened recently, which is very close to the Lordships house. Noble friend was admitted to a regional general hospital with sepsis, a very, very ill friend indeed. And the one of the issues that Lord Goodman was mentioning about the NHS and the pressures on the NHS, whether it's through funding or indeed at times of stress, such as when the junior doctors are on strike. And there was an assessment made of my noble friend that they needed to be operated on urgently life saving operation.

But because of the junior doctors strike, they were unable to get the necessary staffing for the operation period. So the decision was made that they could not operate on my noble friend. My friend's daughter was distraught with this, as you can imagine. So she contacted the whips office and asked if they could help. Well, the Lordships house is full of many, many eminent clinicians, and a member of the Lordships House was able to find an operating crew that could operate on our noble friend, my noble friend in London.

All they had to do was extract it from the NHS hospital in the regions, bring it down to the private hospital hospital in London, which was duly done, but they could be could not operate on my noble friend because she was dehydrated. The decision had been made in that regional hospital to not continue with with food and liquids. The good news is that rehydrated they operated. And my noble friend, I'm very happy to say he made a full recovery and to this day makes a huge contribution to this house from our front bench.

Now our Lords, what's that got to do with this bill? Well, what I would say is the dangers of this system permits any doctor to raise ending the patient's life. That does not require other options to be provided, and the doctor need have no knowledge of the patient, further intensifying the risk of quick judgements or bias or dismissiveness. NHS failure or strikes mean no other options available in this instance. On the NHS, the doctor had no knowledge of the patient or the doctor saw was a frail old lady, perhaps coming to the end of her life, which was an absolute fact.

A government Minister and in their judgement, with all the biases that are part of human nature, would they have said the same thing? That they could not get the operation operating team together if it was a child with sepsis, that they wouldn't have moved heaven and earth to make that operation happen. The doctors proposed that the only way forward was dehydration and let my friend die in this, in their professional judgement, this is the best option because the doctor did not know who the patient was.

Only through a massive advocacy and a powerful network of noble Lords and noble friends managed to save my noble friend's life. But the bill would allow a very similar situations options to be constrained by NHS failure or government decisions, not to fund treatment or to just logistics. Any doctor could raise the option and explain that there's really nothing else that can be done immediately. Ask them whether they want to sign the declaration immediately to the first assessment, or arrange for someone else to do put them on the conveyor belt to the second assessment seven days later, followed immediately by the panel and the reflection period reduced to 48 hours.

A timeline of just nine days to save your loved one who has been told that there is no other option.

15:17

Baroness O'Loan (Crossbench)

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When to take this opportunity to. >> Entrusted order. >> The noble Lord, Lord Faulkner said in response to my statement that. Assisted dying was not something that doctors could suggest in Australia, the government of Australia, State of Victoria Health website says it is against the law for medical or other health practitioner to suggest voluntary assisted dying as an end of life option to one of their patients. A medical practitioner cannot talk about voluntary assisted dying unless a person asks them to first.

And if I could take you then to New Zealand

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and to the health New Zealand. Yes. What I was saying was that

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Yes. What I was saying was that was the position. There was NA5 year review in Victoria and the law was changed. Well.

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Well. It's not changed on the government's contemporaneous today's website. And then if I go today's website. And then if I go to New Zealand, it says that a to New Zealand, it says that a doctor cannot. The doctor cannot advise or discuss assisted dying with you unless you ask for it first. So those are both government websites. Today. I accept that there may be changes due. I accept that they may come, but not in. As far as I can see.

Lord Sewell. When a doctor.

15:19

Baroness Hollins (Crossbench)

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The very person entrusted to preserve life and to relieve preserve life and to relieve suffering raises the possibility of assisted dying. It is no longer a assisted dying. It is no longer a neutral act. For some people, particularly those who are depressed, isolated, or overwhelmed. depressed, isolated, or overwhelmed. The mere introduction of the possibility of an assisted death risks planting the idea that this course is rational or even expected, and in an inherently unequal doctor patient relationship, suggestion easily becomes perceived as a recommendation.

There's no requirement for an independent advocate, somebody to sit beside the patient, helping them process and grasp what is being said. And we're leaving some of the most consequential conversations a person can ever have to take place in isolation, without or within an asymmetrical, authoritarian relationship. There's no requirement for the discussion to take place by someone with specialist expertise. A registered medical practitioner could be a local doctor a location hasn't ever met before. Foundation year doctor in their early years of practice, someone with no training in palliative care, someone with no experience of autism or learning disability.

And yet they are the people that may introduce a conversation that can seriously alter the trajectory of her life. I think that no clinician should be allowed to initiate such a conversation. It should arise only if a patient independently raises it themselves, and even then, the doctor's role should be limited to acknowledging the request and directing the patient to an independent body, while remaining firmly focussed on diagnosis, treatment and the provision of appropriate and timely palliative care as needed. Assisted dying must not be presented as an equivalent option alongside treatment, support and comfort.

To do so risks the medical service being seen as one that no longer values preserving and improving life, but rather one that enables the end of life. The Royal College of GPS have stated that the role of a GP should be limited to signposting patients, to a designated specialist service, if, and only if, the patient raises the subject. And the Royal College of Psychiatrists this week wrote to me expressing their continuing concern, and I quote their view that all applicants should receive a holistic multidisciplinary assessment at the preliminary discussion stage, including for mental health needs.

In other words, much more like the panel, a multidisciplinary panel proposed in the previous group by my noble friend, Lady Findlay. Therefore, I suggest that clause five and in consequence also clause six should consequence also clause six should not stand part of this bill. I

15:22

Baroness Monckton of Dallington Forest (Conservative)

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speak to amendment 205, which is in my name, as well as those the noble Lord Lord Carlile and the noble Lord Lord Carlile and the noble Baroness Baroness O'Loan. I declare my interest as founder of Team my interest as founder of Team Dominica and as a mother of a young woman with Down Syndrome. I'll be brief with. Several of my points brief with. Several of my points have already been covered by other noble Lords. My amendment is simple noble Lords. My amendment is simple and proportionate.

It reflects the concern I raised at Second Reading that it's incomprehensible to me that people with learning disabilities would not be allowed a family member, or, in the absence of a family member, a learning disability nurse or a qualified practitioner to be with them. When a doctor initiates the conversation about assisted suicide chronologically, people with learning disabilities may be adults, but many are still children, and they lack understanding of abstract principles. It is true that clause five, subsection two, specifies that a doctor must exercise their professional judgement to decide if and when it is appropriate to discuss assisted suicide.

I am not satisfied that this provision is sufficiently strong. My amendment provides an additional layer of protection for this vulnerable group, many of whom will have a limited understanding of the concept of death and dying, and therefore would be panicked and frightened. And this combination of fear and lack of understanding would be emotionally absolutely devastating. There is also, as we've heard, and I see this in my own daughter, a desire to please, which is a way of seeking to belong.

And she is also terrified of doctors, hospitals, dentists, anything medical. I dare not imagine what it could be like for anyone with a learning disability in the situation. Having a conversation about killing themselves without a family member present, and probably in front of a doctor who they may never even have met. Yes, the bill requires that the there is mental capacity and a clear and settled and informed wish to die, but assessing capacity for people with learning difficulties is complicated on so many levels, and I can't begin to imagine how it would be done.

Would it be an easy read leaflet with diagrams and it doesn't even bear thinking about. I acknowledge, and I know this will come up, that not all families are perfect, and that malign family dynamics are a reality. But I would suggest that the greater threat would come from a process that fails to accommodate the specific vulnerabilities of people with learning disabilities. I find this lack of understanding extraordinary, but then people with learning disabilities are so often ignored and forgotten.

As my noble friend Lord Harper has already pointed out, in Covid, people with learning disabilities had do not resuscitate notices put at the end of their beds. Then came the clinical Frailty scale, nine categories from one fit to nine terminally ill. The guidance was to deny life saving treatment for those in categories 7 to 9. My daughter fell into category seven, thank God when she got Covid, we didn't have to send her to hospital. In the present case, in this present bill, this discrimination may be about saving money.

The government's own impact assessment on this bill has revealed a particular cost saving £2,323 if an independent advocate is not used. It's easy to work out cost, but much harder to measure values and the value of a human life. Before I end, I would like to thank all parents who written to me about this bill, some of whom are actually too scared to die themselves because they don't know what on earth would happen to their adult children. And these are parents who have spent a lifetime fighting sometimes, one mother wrote to me as she digested the implications of this bill for her own child.

It's easier to cry about the small things. My own daughter has taught me a different way of looking at the world. She's taught me to live more fully. She's taught me to be courageous. She has given me the strength to fight for people with learning disabilities so that they're not defined by being different. Their story is our story. We have a shared humanity and an absolute duty of care for this most vulnerable group from the beginning of their lives to the end, and it is on their behalf that I stand in your Lordships House and ask you to support my amendment.

I beg to move.

15:27

Lord Rook (Labour)

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My Lords, I rise to speak to three amendments in my name amendments 154210 and 211. I also wish to support the amendments of my noble friend Baroness Goudie 202208 and 209. As she is unable to be in her place today. All that said, I will endeavour to be brief. Together, these amendments address two questions that I believe unite noble Lords across the House, namely, how we protect vulnerable people from coercion and how we safeguard young people preventing coercion.

Amendment 154 establishes a simple but essential safeguard. Assisted dying should be patient initiated. A doctor or other health professional should not raise the subject unless the patient has done so first. The proposed legislation rests heavily on patient choice and the absence of coercion or pressure. If freedom from pressure is the legal foundation of this bill, then the design of the process must minimise avoidable influence. Doctor Matthew Dory, of the Association for Palliative Medicine, cautioned the Commons committee that if clinicians introduce the subject of assisted dying, vulnerable patients may reasonably perceive that as an endorsement or recommendation, particularly given the power imbalance that is already in place.

We have rightly heard how much agency and patient choice play a role in these debates, but if an assisted death is truly a matter of patient choice, why allow the authority figure in the room to introduce the option? The bill already makes clear that there is no duty on doctors to raise assisted dying, and if there is no duty and if preventing coercion is central, why not make that safeguard explicit on the face of the bill? So I ask the noble Lord Lord Falconer of Thoroton if the bill's case rests on patient choice in the absence of pressure, why resist a clear rule that this conversation must always be initiated by the patient themselves? Secondly, protecting young people.

Amendments 210 and 211. These seek to strengthen safeguards where young people are concerned. I have previously supported amendments proposing that we raise the minimum age for assisted dying to 25, based on neuroscientific evidence that the brain continues to develop into the mid 20s. However, if that is not possible, it is essential that clause clause six protects younger people. Clause six prohibits raising assisted dying with a person under 18. That is welcome. But what happens if that is breached? Amendment 210 provides that such a breach must be referred to the General Medical Council without consequence, a statutory prohibition risks becoming merely symbolic.

Statutory prohibitions normally carry consequence, and clarity here protects both the patient and the clinician. Supporters of the bill may suggest that existing professional regulation covers this, but if that is so, then placing referral clearly on the face of the bill should pose no difficulty and would increase clarity and safety. So I ask the noble Lord what enforcement mechanism will operate if clause six is breached? What sanction will follow if a clinician fails to uphold this safeguard? Amendment 211 addresses a different scenario where a minor raises assisted dying themselves.

Here, the bill is silent about what must follow. Yet silence in safeguarding creates inconsistency and risk. Doctor Annabelle Price told the Commons committee that around 20% of those who might qualify under the bill could have diagnosable depression, and that those expressing a wish to hasten their death are far more likely to feel suicidal. Professor Louise Appleby's work likewise shows that suicidal risk and spike in the immediate aftermath of a serious diagnosis before stabilising with support. It is a tragic fact in our country that suicide is now one of the leading causes of death for young people.

So when a child expresses a wish to die, our national response is about safeguarding. It's about compassion, it's about referral. It's about care and support. My amendment, therefore provides clarity for clinicians. If a minor raises assisted dying, the doctor must refuse to discuss it beyond explaining that the person is ineligible and the interaction must be recorded and the young person must be referred for mental health support. In other words, when a minor expresses a wish to die, we should treat that not merely as an inquiry about their eligibility but as a serious safeguarding event.

Finally, I support the amendments tabled by my noble friend Baroness Goudie. Amendment 202 ensures the prohibition applies not merely to raising assisted dying, but also to discussing it. Without that clarification, the boundary risks becoming semantic rather than substantive. Amendment 208 makes clear that the protection applies even if a child initiates the conversation vulnerabilities does not disappear simply because the young person speaks first, and amendment 209 recognises that influence does not come only from clinicians. Adults in positions of authority, guardians, carers, educators all carry significant weight, and safeguarding must be consistent across all those parties.

If we accept that minors are vulnerable to influence, why confine the prohibition to clinicians alone through these different amendments? And with this I close. There is a single thread. If this truly is to be a safe bill, the final legislation must minimise coercion and protect the vulnerable. Above all, it must fulfil the commitment of its sponsors, namely to ensure that a citizen's decision to choose an assisted death is always voluntary, and that the state's obligation to safeguard the most vulnerable is always upheld.

I commend these amendments to the House.

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I rise to speak to probing Amendment 200 C in my name, which Amendment 200 C in my name, which prohibits people from raising assistance in taking your own life with children and deals with the with children and deals with the method by which the issue of assisted dying can be raised. With someone under 18, it should not someone under 18, it should not particularly be raised online. It seeks to extend clause six of the seeks to extend clause six of the bill, but I do firstly want to note my support for amendment 210 that the noble Lord, Lord Rooker, has just outlined in terms of consequences for breaching clause six.

Further, I wish to support amendments 157 and 164 in the name of my noble friend Lord Ahmed and moved by my noble friend Lord Evans. It's entirely sensible to enable people to opt out of being offered such an assisted suicide service. The bill seems to have no limit, nor is it probably possible to place a limit on the number of times assisted suicide could be raised with the patient, so surely there seems to be. It is consistent with autonomy to give the patient the right to opt out, even if one is only thinking of a GP surgery.

The number of GPS or nurses you see. And if each of those people raises it with you, that could possibly even border on harassment. I think conceptually it's just an extension of the freedom of conscience that we give to organisations and clinicians to opt out of the service. I hate to think that even dealing with a GP surgery, it could perhaps become even part of patches which. The means by which. Which leads me on to the means by which issues can be raised, which has radically changed and why.

My amendment includes online. I'm grateful to the noble and learned Lord for filing comprehensive amendments in relation to advertising, but the issue of raising it with someone under 18 is, I believe, different. So I'd like assurance from the noble and learned Lord that this use of social media, for instance, of someone sending TikTok or something like that about assisted suicide, is covered by clause six. That. That example may seem straightforward, but once again, it brings into focus the analogue nature of the bill.

If ChatGPT, for instance, in response to a question which it mishears tells an under 18 year old all about assisted dying on the bill, is that covered by the prohibition on advertising amendments that the noble and learned Lord has raised raised? Could a bot or algorithm operate without direct human intervention and raise the issue of assisted dying with a child? Noble Lords will be aware, and I think the noble Lady, Lady Berger, has spoken much of the cases that are currently being taken against ChatGPT.

I think it's OpenAI is actually the litigant is being sued for giving suicidal information to young people who have incredibly, sadly, acted on that information. So has the noble and learned Lord spoken with technology experts about the bill to ensure that all the. These situations have been fully considered as. I don't believe on my reading that they are covered by the prohibition on advertising. As I say, advertising and raising it with someone do seem to be two different concepts. My Lords, I use the word person in the amendment, not just healthcare professional, as there are numerous situations and relationships where children might have assisted dying raised with them, obviously school or college.

But does the noble and learned Lord Singh envisage that there will be guidance in this regard? And which one of the many delegated powers would be used under this bill? What about youth groups, faith groups, sports clubs, carers, school, transport? Parents do need to know who is allowed to raise this potentially life and death issue with their children. Assisted dying law will shape, we believe, how children will understand the value placed on life, disability and dependence. Vulnerable children may internalise the message that society is more willing to facilitate their death, rather than fund their long term care and inclusion.

The concern my Lords of parents and carers around how this issue is raised with children could make the issue of teaching, namely sex education in schools, look uncontroversial. Although the scope of this amendment is wide and I have said it is proving at least it is clear as the last clause six and clause 56 are not. No health care professional is in the title of clause six. Then it says no registered medical practitioner or other healthcare professional within the clause.

This is a

15:38

Baroness Berridge (Conservative)

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mixture of the definition of health professional. That's in clause 56 professional. That's in clause 56 of the bill and you usually, when you have an interpretation clause stating a definition like health professional, then you would expect that term to be consistently within that term to be consistently within the bill. Nowadays, all you have to do is control F to find every example and ensure that there is example and ensure that there is consistency throughout the legislation. Due to this mix of use of terminology, our physios are included in these definitions and therefore within clause six, although I accept that clause six was added in the Commons, I am disappointed that the noble Lord sponsor has not got ahead of the curve here and laid his own amendment.

My final point, my Lords, is for clarification as to whether the registered medical practitioner in clause five can be a private GP or private healthcare professional, because of course, people may also have a financial interest as we believe there can be private providers of assisted dying services. It may be that, am I correct in that understanding, and I presume that the noble and learned Lord Wood want to ensure that there is no conflict of interest or incentive in that matter. It may be that that matter has been covered in the developments under the law.

Since the Medicinal Devices report. However, because of the lack of pre-legislative scrutiny, it is not clear. And I'd be grateful if the Noble and learned law could clarify that matter. Please.

15:40

Baroness Keeley (Labour)

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55 which is different to the >> 55 which is different to the amendments in the name of noble Lord Ahmed on patients who opt out. My amendment ensures that when a My amendment ensures that when a person has previously cancelled the process of obtaining assisted dying, having considered it as an option and then rejected it, they can continue to discuss their terminal illness freely with their medical practitioner without being pressed to reconsider assistance to end their life. Now, as we're hearing, we have had a great deal of evidence on this issue.

In their written evidence, the Association for Palliative Medicine of Great Britain and Ireland observed, and I quote them, doctors influenced decisions made by their patients in conscious and unconscious ways and are themselves shaped by their personal and professional life experiences. If the patient clearly rejects assisted dying, they may suspect that other treatments suggested by this doctor are driven by an agenda to shorten their lives, or may otherwise result in that. This could result in patients opting not to engage with palliative care, or to the loss of trust in a medical practitioner or in the medical profession at a crucial time in people's lives.

There is a clear danger here. If a patient has already considered and rejected assisted dying and their doctor raises it again, it may appear as though the doctor is pursuing an agenda to shorten that person's life, that risk to trust at the very moment when trust is most needed, should not be created by the legislation before us. I also want to refer to evidence given to the Commons by Doctor Vicky Hibbert, an NHS speciality doctor in psychiatry with extensive professional and personal experience of suicidal ideation.

She expressed serious concerns about the impact of the bill on suicide prevention work and highlighted that the voices of people with lived experience of suicidal ideation were not heard in oral evidence sessions. So, speaking about terminally ill people who may experience thoughts of not wanting to be alive, Doctor Ebert writes, and I quote, her thoughts are wanting to die. Have a known association with being given a cancer diagnosis or learning of being terminally ill. Suicidal ideation may have arisen as part of the response to a new diagnosis with a terminal prognosis.

It may therefore be the part of an adjustment. Reaction adjustment disorder often settles without professional intervention. If it persists, additional support may be beneficial. Assisted suicide should not be facilitated. My amendment 155, therefore, seeks to ensure that a doctor may not raise assisted dying with a patient whose medical records show they have previously cancelled a first or second declaration. When somebody has already walked back from that decision, the law should protect them from renewed pressure. Not intentional or not. Finally, I want to quote from a recent article by Jim McManus, national director of health and wellbeing at Public Health Wales, writing in a personal capacity, and I quote him no end of life decision happens in a vacuum.

Choices are shaped by many things and sometimes these are inequality, unmet need, patchy palliative care and the grinding pressures of an overstretched NHS. People expressing a wish to die may be experiencing treatable depression, loneliness or feelings of being a burden. The Royal College of Psychiatrists has raised concerns that the bill's safeguards are insufficient to protect people in exactly these vulnerable states. My Lords Amendment 155 is a small but vital safeguard, ensuring that when someone has stepped back from assisted dying, that decision is respected.

At such a vulnerable moment, no patient should face renewed pressure. Our priority must be to protect, trust and uphold compassionate, high quality care at the end of life.

15:43

Baroness Fox of Buckley (Non-affiliated)

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Lords, what influenced me to >> Lords, what influenced me to look positively at a number of amendments in this group and also to move amendment 150, was, in fact, that some jurisdictions that have assisted dying legislation explicitly prohibits doctors from initiating assisted dying discussions. And I know that there was a bit of a row earlier about Australia, South Australia and New Zealand. But the truth is, people who have this legislation thought that it was important to say that if a doctor raised this with the patient, it would breach professional misconduct.

And in fact, South Australia even used the wordings must not even suggest. It's quite hard. And I think that's very interesting. Whatever the. And and an indication of the fact that this group of amendments has got importance for us all, because, in other words, it can't be assumed to be either filibustering or messing around, because actually we're exciting places that have assisted dying and they think this is a very good, important safeguard, or there's at least worth debating.

And I think one of the reasons why they do that is because of the issue, which I know is very close to the noble and learned Lord Moore, which is all about autonomy, because the concern is that if a doctor initiates discussions about assisted dying, then it undermines that very principle of those supporters of the bill, which is to ensure the decision regarding assistance to end your own life. Is yours taken freely, patient initiated. I was rather surprised, actually, to hear the noble Lady Baroness Blackstone cite the BMA in this instance.

I was thinking what happened to the patient centric approach. We've now got the kind of BMA versus what patients should. If a patient wants an assisted death, good, they can initiate the discussion. Not good. I mean good if they want to, to raise it themselves. It's an autonomous decision. And I just think we've got to be honest about something which is not discussed enough in this, which is socially and culturally. There is an imbalance of power when you have a doctor patient relationship.

Now, I think what sometimes happens in this House is because we're surrounded by many brilliant medical experts, and then we're all their peers and we're all peers. We sometimes behave as though we're we don't hold back from challenging each other. We're all equals. But I don't know about the rest of you, but when I go to the doctors as a patient, I suddenly become a quivering wreck. I feel very much the less equal partner. Like millions of us.

I mean, the noble Lord Lord Deben made the point that people are frightened of doctors. I don't think it's that. I think it's a kind of old fashioned deference and or that it's a relationship of dependence. After all, you're saying the doctor because you're ill. And specifically in this instance, it would be terminally ill, but you're very poorly. I'm very, very poorly. Your sense of agency is at its weakest. We feel fragile and vulnerable. And that's one of the reasons why I added my name to the noble Lord.

Lord Carter of Haslemere is very important. Amendments. The doctor is who we are looking to as an expert, who we're dependent on for treatment and advice, and for their expertise and help. And that award's considerable moral social authority to the doctor and considerable influence over an ill person's medical decision. So, to be honest, if a doctor raises assisted dying, patients may interpret that as an implicit recommendation about, well, for example, what faces them in handling the illness.

I mean, is it a suggestion that the suffering will be intolerable if a doctor raises it? Even it might be a comment on the value of one's life at this phase in in your life, patients could well hear this. As the noble Lady Baroness Campbell of Surbiton explained something like, you're better off dead. And that might be the worst case. But even if we heard it as we recommend, if you go to the doctor, they say, have you thought about assisted dying? You think, oh my goodness, they're recommending it.

It's certainly not an impartial intervention because doctors typically don't suggest courses of action that they believe are harmful. So when it's raised, we'd understandably assume it's a suggestion in our best interest. And I think that causes real problems. I'd just like to commend, by the way, if that's true in general, I would like to suggest that the points made by the noble Baroness Monckton of Darlington so movingly, passionately, powerfully put is is that those people who have down syndrome, who want to keep people happy, if they hear that suggestion, I'm putting it very badly.

It's it's an abomination that that's even there on the on the possibility list. I really would like to hear the noble and learned Lord at least concede that point. If nothing else today,

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that would be worth coming for. Yeah. Because it was it was so moving

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Because it was it was so moving to hear the contribution from Baroness Monckton and everything that she said. And obviously the points that others have made about points that others have made about the words that people may hear, including people with learning disabilities. And I was reflecting on the evidence that we heard at on the evidence that we heard at the select committee from the National Down Syndrome Policy Group. And it's not just the words that people may hear, it's also what they see in front of them in particular, which was really striking.

I hadn't thought about was the uniform of someone that may be in front of you, the doctor that's having that conversation, and even the even the uniform could suggest a position of authority and something that someone with a learning disability should show acquiescence to. And I thought that should be that's something for us to consider in the light of all these really important amendments.

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Thank you. I think that was very helpful. So when I say a uniform, I helpful. So when I say a uniform, I get a bit quivery as well. I listen, I don't want as we've gathered, I don't want as we've gathered, doctors, we're obviously at a time in the day, right? I don't want in the day, right? I don't want doctors to, to initiate raising assisted dying at all as a healthcare option. But if they do, I don't want there to be any linguistic whitewashing.

If I can just quote, unusually, Sarah Wooten here, who's the chief executive of Dignity in Dying, she wrote in her book Last Rites, and I quote, we have to move away from idealised, sanitised nursery rhyme accounts of what death can be like towards truthful, no BS. I've I've abbreviated it and nobody has plain spoken explanations of what could happen. Surely these words, which are very powerful, I think, should also apply to conversations about assisted dying or assisted suicide.

And let's ensure that if a doctor is to raise it with patients, then they shouldn't. There shouldn't be any attempt to hide behind idealised, sanitised nursery rhyme accounts of what assisted death would be like. And I think that's why I was particularly keen to emulate this no BS approach, which is why I put my added my name to amendment 160 in the name of the noble Lady Baroness Lawlor. That ensures that in any discussion a doctor initiates, they make it clear what's being suggested, i.e.

this is about ending this person's life. I mean, it's it's, you know, if a doctor says to you, would you like a dignified life, a dignified death, that might all sound very appealing if they say, would you like me to give you a lethal drug? That means that you can take your own life. It might suddenly feel a bit different. And I do think that we do need genuinely to say what it is we're talking about it. And I think there's similar concern raised in the noble Baroness Fraser of Craigmaddie 167 is also very important, and the doctor does not hide behind opaque language and euphemism that avoids spelling out clearly what the doctor is suggesting and offering.

From the first preliminary step to the end of some to the ending of someone's life by, as I said, by basically helping a patient take their own life. And then just the final point I wanted to make was, I really do think that we're saving the doctors here, doctors starting suggest that you can end people's lives. It's going to completely change the relationship between doctors and patients. And one of the things I thought was, I mean, first of all, you're forcing a doctor to think, is it in the best interest of this patient to die with my help, through the ingestion of a lethal substance that must have messed up the mind of a doctor who's trained to keep life going as much as possible.

But I did think it would actually erode healthcare relationships moving forward in terms of trust. Because, say, for example, your doctor suggested assisted dying and you said, no. I mean, then you kind of have to go back and face the same doctor. I mean, I'm not entirely convinced I'd be confident in the medical practitioner who had maybe told me I'd be better off dead to then say, can you help me extend my life a bit longer? I might want to doctor shop, as they say.

15:53

Lord Moore of Etchingham (Non-affiliated)

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Imagining the noble Baroness Lane-Fox as a quivering wreck. But but but if it's if it's if that's but but if it's if it's if that's how she feels. Well, you can imagine what it's like for most of us when we face our doctors. So I think the point is made very strongly. And there's so many good amendments here, and I can't possibly refer to any of them, to all of them, but I just I think I want to drive home by force of comparison, a point that arises from two things that were said, one by the noble Lord Rook and one by noble Baroness Hollins no longer in her place.

Lord Foulkes said that there is no duty under the bill to raise assisted dying. I think that's that's obviously true, and it's very important to pursue what that implies. And Lady Hollins said that to raise assisted dying by raising assisted dying, a doctor is not performing a neutral act. So I think the question we have to ask is what is going on when the doctor proposes assisted dying? And I'm saying I think that if it's not a neutral act, it's an ideological act, and that is not something that's appropriate for a professional.

And I would like to draw a comparison which may illustrate that the government keeps promising, and I think it will will introduce a bill to ban conversion therapy. And the objection to conversion therapy is that it's a form of coercion of the weak, and it's a form of exploitation, and it's a form of forcing an ideology upon people, which is not which is considered to be wrong and and exploiting their feeling of weakness. And I think this is the danger we face here.

Now, of course, many noble Lords will object, and they'll be right that conversion therapists are quacks, whereas doctors are real doctors. But in my view, that makes it even more important that they, the doctors, stick to their professional obligations and don't start advocating things which they happen to believe are right. If we think about it that way, we will see just how important these amendments are. I speak to a couple of amendments that I have in this group, but could I start by responding to what the noble Lord Lord Moore of Etchingham just said? I think he misconceives his

15:56

Lord Moylan (Conservative)

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opponents, and indeed, if I may say so, our opponents, because they don't regard the offer of assisted don't regard the offer of assisted suicide as an ideological act, but simply as the offer of of a simply as the offer of of a different medical treatment. And and this is one of the great divides between us, that there are divides between us, that there are those of us who will not accept that offering to kill somebody or to assist them in killing themselves can constitute a medical treatment.

So I say that purely preliminary and almost without relevance to what I'm going to come to, which is amendment 166, which I just speak to very briefly. This is such a minor and technical amendment, and it arises from the fact that the bill creates because it has this elaborate bureaucratic sort of process, it creates lots of decision points. And if you need a decision map, you have a very complicated one as you as you pass down through it. And there's one here in clause five, which is which needs correcting or it needs improving at least, which is that it says in, in subsection three that where a person in England or Wales indicates to a registered medical practitioner their wish to seek assistance to end their own life, the registered medical practitioner may, but isn't required to conduct a preliminary discussion.

Now. Preliminary discussion is a technical term in the bill. It is something which is. It is a key which opens up the path to assisted suicide. It's not just any old discussion that happens to come early. It's it is a technical term now. Now, the registered medical practitioner may at that point have the preliminary discussion, but they don't have to. But if they don't have to, then clause six makes clear. Subsection six makes clear what they have to do, which is to refer somebody to a place where they can get information about how they can have a preliminary discussion.

But my point is, the person asking to have the person making the inquiry about assisted suicide doesn't actually have to be ill. They might be asking and quite wrongly asking that they would like to end their life without coming within the scope of the bill at all. So I'm simply suggesting to avoid the poor doctor being driven off on these two impossible and irrelevant courses that we add to subsection three after the words in England or Wales, that we add the words, who has had a terminal? Find it very quickly? Who has been diagnosed with a terminal illness.

Now, I thought that's something that the noble and learned Lord would be willing to add in the interests of clarity, and to try and straighten out some of the complexities that the bill, through its complications, has created. If I turn to amendment 152, amendment 152 does something that many other amendments in this group seek to do, and it prevents it prohibits a doctor from initiating or another health professional from initiating a discussion about assisted suicide. And so many speeches have been made already about why this is a valuable thing to do, that I am not going to attempt to repeat them.

Indeed, even the story about my late father that I was going to tell you has been trumped by the very moving stories from my noble friend Lord Evans of Rainow about his mother and his grandmother. So really, everything that I wanted to say has been said. I think the only thing I can say is that one learns that in Canada they regard it. Doctors regard it as a professional obligation to raise assisted suicide because it's regarded as a medical treatment.

So you have the the possibility of lying in your hospital bed, having just received a terminal diagnosis and having 4 or 5 different doctors walk into the room in the course of the day, each one of them suggesting assisted suicide. Q I mean, Morecambe and Wise would have made a fantastic sketch out of it. When you when you think about it, that at least we could avoid if we had an amendment which prohibited them from doing so quite explicitly. I think what I've learned from the debate is that there really is a divide between those who are, what shall I say, those who are confident, people who are confident that they can make their own decisions, that they'll be in charge of events, that they can choose their own end, exercising their autonomy at a time that is suitable for them.

And those of us perhaps on the other side, who want to give a voice to the great mass of people, we would say, who are, if not necessarily quivering wrecks when they go to their doctor. But like my noble friend Lord Deben said, are frightened of the doctor, have some or of the doctor tend to give what might be excessive respect to what the doctor says, who find themselves being driven in a certain direction and not necessarily the one they would autonomously choose.

Ultimately, if we ever get to a vote on this bill, that is the choice. And that is that is where the House has to decide which side it wants to be on. Of those who that small number, I would suggest, who are confident, and the very large number who are not confident about themselves when faced with medical issues. And finally, I will say in response to what the noble Baroness, Lady Heyman, said in her intervention earlier that she spoke as if there wasn't already at least 3000 years of philosophy and moral theology devoted to the difficult issues she raised.

So we we know that nobody is obliged to accept medication that keeps them alive artificially if they decide that's not the right thing for them. Nobody is obliged to accept more blood transfusions

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than. Grateful to the noble Lord. I

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Grateful to the noble Lord. I think I was particularly. Trying to get to the point of the doctor's role. I understand what he says, and he's quite right that what I and he's quite right that what I was trying to advocate, if you like, was that doctors should be able to was that doctors should be able to have conversations with their patients about care, not just medical treatment, which I think is the phrase he was using before.

And to look holistically about what that dying person wants and needs and to be able to take to respond to their desire not to have any more pain, not to have any more drugs, not to have any more treatment, and that the doctor should be able to talk freely about all those options. And in my view of the world, that would include medically assisted dying. But I

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think there is a spectrum there. Indeed a spectrum, and the doctor should be able to speak. But doctor should be able to speak. But as I say, we have 3000 years of thought given to this. And part. thought given to this. And part. What has resulted from that is a firm conviction that while some medications that do you good may also do harm, and that the doctor also do harm, and that the doctor has to make careful judgements about that, that the active killing of a patient, the actual administration of substances with a view solely to bringing about death is morally abhorrent, and it may not be morally abhorrent to the noble Baroness, but she has to understand the novelty, the violence that she is doing to our inherited moral framework.

When she says so, no, let me finish. When she when when she puts that forward, when she says that to her, it is one, it is simply one option. It is not one option. It is crossing a line. I'm sorry, Lady Murphy. Sorry.

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Well. Moral. I want to speak to that morally abhorrent is quite distressing. I'm a doctor. I've distressing. I'm a doctor. I've been a doctor for 50 years. I've worked with dying people quite regularly in hospital, particularly regularly in hospital, particularly in general hospitals. And I do find that the notion that the doctors that the notion that the doctors all find this abhorrent is utterly wrong. We know that at least half wrong. We know that at least half support the principles of this bill and can recognise it is something that they would like to support.

I'm not talking about the medical royal colleges. They take one line. In fact, most of them are neutral about the principle. But the reality is not, as the noble Lord Moylan is describing. And certainly I don't feel the way he does. And I find it very offensive when somebody says it's morally abhorrent, it's not morally abhorrent to help people when they're desperately suffering and to respond during a conversation to

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what they're talking about, what they're asking for. Do you hear.

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Do you hear. The answer that I am saying? That we have 3000 years of a moral framework in which it is morally abhorrent, and I am not here. I am abhorrent, and I am not here. I am not here primarily to protect the sensitivities and the feelings of sensitivities and the feelings of doctors. I'm saying how what a violent novelty this is that we are embarking upon if we go down this route. Lady Heyman, I'm sorry.

16:06

Lord McCrea of Magherafelt and Cookstown (Democratic Unionist Party)

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As legislators. >> My Lord Stoneham, there are a. >> Number of key objectives outlined in the amendments that we have been discussing for some time have been discussing for some time now, and they are worthy of our most serious consideration. I suppose the burden of the amendment suppose the burden of the amendment is that doctors should be prohibited from initiating discussion about assisted dying, because if they were permitted to do so, it would fundamentally undermine the long established patient doctor contract and could expose vulnerable patients to undue pressure or influence at a time when they are fragile, a fragile moment in their lives.

Now, the raising of the issue of assisted dying surely must be strictly initiated by a patient, and any discussion of the issue must be embedded in a manner that prioritises palliative or other support. Care over death. If doctors were permitted to initiate the issue of assisted dying, patients could rightly interpret this as an implicit recommendation on behalf of the medical profession, and could be seen as a choice influenced by authority or even fear, and not by a free choice.

It must be acknowledged that doctors have, within society an exceptional moral and social authority, and a person who feels vulnerable or marginalised or feels devalued, can easily be susceptible to pressure and influence. If the recommendation or the initiation of the issue of assisted dying comes from their doctor. Now, the moment of diagnosis of a terminal illness or a life limiting illness is an earth shattering moment to most people within society. And as a Minister of religion, over 50 years, I have been with thousands of such people.

Whenever they have received that diagnosis, that they have a terminal illness, they feel shattered. They feel absolutely broken. And I can tell you that that leads to a multiplicity of emotions, that immediate shock of hearing those words and having loved ones, many loved ones who have faced that moment, and friends without immediate shock can turn into depression. And even for a period, it can turn into suicidal thoughts, feeling it's all over anyhow.

And therefore let me get out. However, we all know that from personal experience, or I think certainly many of us know that these thoughts at that earth shattering moment can dissolve over time whenever they are surrounded with love, whenever they are aided by a loving conversation or their personal faith, or supported within the family or within the community context. Indeed, the initial devastation I have seen turned dramatically into a quiet confidence, into a determination to fight for life, to live a fulfilling life even though they're in the midst of adversity.

That is something to be cherished. That is something to be praised at the moment of despair. When a terminal diagnosis is given, how improper it would be for any doctor to raise or to suggest the issue of assisted dying as a more sympathetic way out of their pain, or would be a free exit from life. Sadly, the personal deep doctor patient relationship is no longer the reality that it used to be, and in actual fact, in multi doctor practices, you may never see the same doctor again for months or even years.

They don't really know you as they used to know you, and to pretend that somehow it is the old way. It's not reality, it's living in a different world and therefore no personal knowledge of that patient is often held by a particular doctor. Any deep understanding of their mental health, their family life context, societal pressures, financial pressures that that person may be experiencing is negligible. And yet it's the moment of crisis in the life.

Now, during previous debates, some noble Lords and ladies have been rebuked for using the term assisted suicide instead of assisted dying. For assisted dying terminology not masked the reality of what we are discussing. Normalising discussions about ending life before the natural appointed or the God appointed time surely risks reframing suicide as a legitimate medical response to pain or distress, which is outside the scope of this bill. Or at least that's what we're told.

Allowing, but not requiring, doctors to raise assisted dying with their patient gives me no comfort, but rather, I feel would lead to medical professionals being open to criticism or challenge. It will no doubt lead to inconsistency among professionals. Will patients seek to move from one general practice to another because the doctor that they're moving to supports them in assisted dying? Will they have to move because their doctor, their GP, has a sincerely held conviction about the sanctity of life and will not participate in the practice of assisting a person to die.

When a doctor is permitted to discuss assisted dying with a patient, surely it cannot just be any registered medical practitioner. And perhaps for clarification, can I ask the noble and learned Lord Farmer? Can he confirm that the provision in clause five is not limited to the patient's GP? But treating consultants, specialists or doctors with a minimum relationship with the patient or none that they are not restricted. To give this advice, can he also confirm that there are no restrictions on the setting in which a doctor might give this advice? In a hospital ward, an outpatient clinic, or where? If so, how is it professional that someone with little or no knowledge of the patient's history, mental state, etc.

with no care relationship with that person is permitted to raise ending the life of a patient the doctor involved does not require to be caring for the patient, the person, but their knowledge can be based on a glance at a chart, a computer screen, or a person's appearance. Surely that can't be a thoughtful, caring way in a health service. Doctor Neil Hurst, MP and the public Bill Committee said the reality of clinical practice is there are consultant consultations within consultation, and he said the committee needed to trust the judgement of clinicians who know their patients well.

And one final thing discrimination against disabled groups. Faisal Hadi, who is the Disabled Rights UK, and I quote, we often find that doctors, because they cannot treat or cure us, do they value our lives? We have disabled people who have actually had the suggested to them or their families that their lives are expendable, when actually those people have got a lot of years to give. We also know that when you cannot. Yes, I'm finishing this with a statement and just a couple of sentences.

We also know that when you acquire a disability, which most people do, it's absolutely frightening. If doctors are not on our side because they are thinking, should we mention the fact that they could have an assisted death that poses a big cultural issue for the NHS, but also for us having confidence in the NHS?

16:17

Baroness Stedman-Scott (Conservative)

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I rise. >> To speak to probing. >> Amendment number 161. >> In my name. This amendment asks

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In my name. This amendment asks the simple but profoundly important question that should registered medical practitioners be granted a blanket legal protection to raise the possibility of ending any person's life? Or should that protection be carefully and responsibly limited to patients already in their care? At the heart of this debate lies the issue of safety and trust. The relationship between a patient and their doctor is not a casual exchange. It is, and hopefully is, a deeply personal, often vulnerable bond built on confidence, continuity and professional responsibility.

When someone receives a terminal diagnosis, they're not merely confronting medical facts. They're confronting fear, uncertainty and the fragility of their remaining time. In that moment, words matter immensely to grant blanket legal protection to any registered medical practitioner, regardless of whether they have an established clinical relationship with the individual, risks undermining that trust. It risks introducing the possibility that a suggestion about ending life could come from a professional who does not know the patient's history, values, mental state, family circumstances or vulnerable vulnerabilities.

Amendment 161 does not seek to obstruct lawful medical practice. It does not deny terminally ill adults the autonomy this bill intends to provide. Rather, it seeks to ensure that conversations about assisted dying occur in the right context within a relationship where the doctor knows the patient, understands their condition and is responsible for their ongoing care, we must consider the subtle power imbalance inherent in clinical settings. A doctor's words carry authority. Look at the effect they have on the Baroness Cox at times.

For a patient who is elderly, disabled, isolated, or feeling like a burden, even a carefully phrased suggestion can carry unintended weight. If such a conversation is initiated by a practitioner with no established duty of care, we risk normalising a culture in which ending life becomes broadly available, broadly available option, rather than a carefully safeguarded patient led request. Limiting legal protection to practitioners involved in a patient's case care and case strengthened safeguards. It ensures that any discussion arises from clinical knowledge, not abstract eligibility.

It reinforces accountability. It reduces the risk of inappropriate suggestion, and it protects vulnerable people from feeling steered towards a decision at a moment of profound weakness. Autonomy is meaningful only when it is protected from subtle coercion, even unintentional coercion. By supporting amendment 161, we are not diminishing choice. We are strengthening the ethical framework in which that choice is exercised in matters of life and death, precision matters, boundaries matter, and safeguards matter. Amendment 161, I hope, offers a proportionate, reasonable and ethically sound safeguard.

It preserves trust in the medical profession. It protects vulnerable patients, and it ensures that if such conversations occur, they do so within the context of established clinical responsibility. And for those reasons, I urge the House to seriously consider the intent and spirit behind amendment 161.

16:21

Baroness Cass (Crossbench)

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Say to. >> Say to. >> The Baroness Fox. >> That my mother. >> Held doctors in great esteem and

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Held doctors in great esteem and reverence until the day that I and my rowdy friends qualified. And then the whole mystique was exploded overnight. But the serious point is that I'm, I'm, I'm really still very mystified by clause five, because it remains to me completely unclear who is having this preliminary discussion. And even if we safeguard against the doctor raising the subject of assisted dying without it being initiated by the patient, nonetheless, this this clause is still really opaque about who this person is.

If fortuitously, the patient has a good relationship with their GP and is able to raise the matter and to have a full discussion, then they may be able to cover all of the things that are listed in this clause diagnosis, prognosis, palliative care, hospice, available treatment and so on. But if it is not their GP, then who is the medical practitioner supposed to direct them to? Unlike the coordinating and the independent doctor, they do not have the right written into this bill to access the patient's records or make inquiries of the person who is looking after them.

So I'm really unclear about how they're supposed to discharge all these duties. And also, it doesn't really reflect reality. If somebody is starting to think about possibly seeking an assisted death, they might ask one part of their GP, another aspect of their priest, another aspect of their next of kin, and they will gradually form a view. But to lay it down in statute seems to me to be putting an additional hurdle in patient's way. And surely at the time when they really want to ask about the detail of assisted death and what it might entail and what the feasibility is, the person to seek advice from then is the coordinating doctor or the first doctor within the voluntary assisted dying service, who will have had the training and will have some knowledge to be able to say with confidence what that individual should expect.

So I strongly support my noble friend Baroness Hollins view that clause five does not stand part of the bill, because it seems to be a complete muddle that we have been discussing various aspects of for

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some time now. So I think the debate we've had

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So I think the debate we've had for the last 2.5 hours show this House in a very positive light, House in a very positive light, because the debate we've had goes to the very essence of what some of to the very essence of what some of us who are sceptical of the bill believe is probably the most crucial issue, how the bill will crucial issue, how the bill will potentially impact on the very most vulnerable people in society and in passing.

Can I say how moved I was by the wonderful speech of the powerful and emotional speech of my noble friend at Baroness Monckton, and indeed the speech from and the amendment in the name of my noble friend Lord Shinkwin. My Lords. Noble Lords, might ask a rhetorical question why are we spending so much time in this particular group? And may I offer an anecdote to your Lordships as to why I think it is important that we have spent this time talking about people with disabilities, people with learning disabilities, and particularly people with Down's syndrome.

In the summer of 2024, my 91 year old father was admitted to our hospital

16:25

Lord Jackson of Peterborough (Conservative)

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and spent a number of hours in euphemistically called ambulatory care, which is the back of an ambulance, before being able to access a trolley for a number of access a trolley for a number of hours. And he was, as it happens, terminally ill. He died a few weeks terminally ill. He died a few weeks after with bladder cancer that had metastasised to the rest of his body, but he didn't have a diagnosis of terminal illness. And when I reached the hospital, there was his belongings on the.

Adjacent to where he was and at the bottom of the Sainsbury's carrier bag with all his personal belongings, was a do not resuscitate form filled in. In fact, I think it was what they call, again, euphemistically a respectful and. It had been countersigned by a doctor without any discussion with myself and my two brothers. Now none of us are shrinking violets as your noble. Your Lordships. No, my brother's a decorated police officer, and my other brother is a world leading scientist and a professor of psychology.

We're all quite smart people. But this form had been completed without any discussion with the family. And indeed it was alleged that my father had capacity to sign that form and agreed to it. Being countersigned by a doctor. And that's a very significant development. And I found myself having to front up a difficult conversation with the clinicians in accident and emergency and the geriatrician that was on duty on that day. And the point was, I thought to myself, what if my father had a learning disability? What if he couldn't read or write properly? What if he was anxious about dealing with bureaucracy and dealing with professional people, and how much more difficult it would have been if he didn't have a family, if he didn't have three sons watching him, watching out for him, protecting his interests.

How much difficulty would there have been in him challenging the professional bonafides and authority of a clinician, a medic, well educated, articulate, someone that knows their profession and that, my Lords, I, I, I would posit to you is the reason we've spent so much time on debating these issues, because it's not for the people like my father, who, as it happens, as I say, was terminally ill. It's for the many people who do have great difficulty, who already in a position where they're sad, they're lonely, they're depressed, they're bereft, they're distraught at a at a prognosis and a diagnosis of a terminal illness.

And for those people, they need assistance in primary legislation to protect their interests. And they need that because no one else would otherwise look out for them. That is not to say that those doctors were in breach of the Hippocratic Oath. They weren't compassionate and empathetic and caring and feeling for my father and many thousands of other people in similar situations, particularly old people. But nevertheless, they're busy, they're stressed. And that form was filled

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in in good faith. I give way to the noble Lord. Noble Lord, giving way. Would he

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Noble Lord, giving way. Would he not accept from me that in the modern NHS, not the NHS of five years ago, ten years ago or 20 years ago, but in the patient, in the back of the ambulance for hours outside the thing, then into a corridor before they get into a corridor before they get into a ward. That patient might only see a consultant on the ward round once or twice a week for a few minutes, if they're lucky, and they may not see the same consultant again for weeks, and that that fundamental change in the nature of our health service over the recent years, with the huge additional pressure and demand, makes all these protections

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all the more important. As usual, the noble Lord makes a very apposite point and reinforces very apposite point and reinforces the arguments I made. That time is pressing on, so I will just develop pressing on, so I will just develop slightly my support. If I can beg the indulgence of your Lordships the indulgence of your Lordships House with Lord Shinkwin the points he raised right at the beginning of he raised right at the beginning of this debate. The danger that terminally ill patients, accustomed to trusting medics who care for them, will sense that they should do what their doctor is telling them, when they are only suggesting the option of assisted suicide is greatly heightened.

Where, for instance, learning disabilities are in the mix. My noble friend made reference to Ken Ross and he was quite right. Ken Ross for the National Down Syndrome Policy Group. And specifically, he said people with down syndrome have a very complex and unique speech and communication profile. They are highly suggestible. Even someone wearing a uniform could suggest a position of authority to them, and something that they should show acquiescence to the acquiescence bias. As mentioned by my noble friend from people with down syndrome is extraordinary.

They could have a seeded view around what they think that person wants to hear and talk about, without fully understanding the position. I assume by ceded view, my Lords Minister Ross means that the idea is planted in their mind by a doctor mentioning assisted suicide, that this is what that doctor would prefer. Others more expert might put me right. Another similar points were made by my noble friend Baroness Monckton in her superb speech about the dangers of someone such as her daughter Domenica, who has down syndrome, being advised by a doctor new to her that a terminal condition might mean it's best to have her life ended, that without any legal obligation to discuss this with parents, other family members or someone independent, as Baroness Grey-Thompson amendments propose.

As she said, fear, terror and a total lack of comprehension would sit alongside her daughter's highly suggestible disposition. The Commons, in fairness, did ensure the bill now has extra safeguards for those with learning disabilities, but these are focussed on training and an advocate from the first declaration, far further down the road than from the preliminary discussion. And actually, if I may say, the experience in Australia is that training around the specific bespoke issue of coercion is very limited and that needs to be looked at.

And perhaps the noble and learned Lord may address that in his concluding remarks. This is when framing effects will occur and the starting point for vulnerable people misunderstanding options or feeling pressure. By the time an advocate is in place, the person they are working for might have a fixed idea which the advocate will not want to ride roughshod over. The bill therefore needs strengthening in clause five to address this inconsistency, which is a key concern of experts in learning difficulties.

Hence, for the question that maybe some noble Lords are asking the need for prohibition, particularly where down syndrome and learning disabilities are in play, because these patients might be the ones most likely to provoke cost concerns, but least likely to discern that this motivation, and not their best interests, is the main reason for raising the possibility of assisted suicide. And I have to say that is in a minority of cases, and I'm not making that point about the vast majority of clinicians.

So, my Lords, in conclusion, it is for these reasons that I strongly support amendment one, six, two and others in this group.

16:34

Baroness Finlay of Llandaff (Crossbench)

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That's in this group. And we've had a lot of comments about the real world, about what's actually going on now today out there in healthcare. And I think it would be very interesting to hear how the noble and learned Lord, Lord noble and learned Lord, Lord Faulkner, responds to all the criticisms and the way that the inherent dangers in clause five have been highlighted. But my amendment 201 concerns children. A little boy with advanced malignancies said to me, I'm going to die when my goldfish dies, and went on to talk through what he wanted when he was dying and how he would play football in heaven with another boy who died recently, not long after his goldfish was found floating, my strenuous attempts to resuscitate his goldfish failed, and he gently died soon after.

But today, that was some years ago. Children also live off the internet, not just off what they hear from other children. And they know about the debate of this bill. Some raise it in line with the Lord sessions. So if a child is asking questions about this, they have to be able to express their fears if they're already ill. And they often speak with remarkable frankness. Children's awareness is phenomenal. They deserve gentle, honest planning of their care. That also explains why they're ineligible for assisted suicide, hence my wording.

But I would suggest that the wording by the noble Lord Lord Rook provides much clearer guidelines. The mind for clinicians involved to allow them to listen, but in no way to hint that the child is going to be eligible. My Lord's assisted suicide is not a medical treatment. It falls outside McCulloch and and Montgomery rulings. Hence my amendment. 159. As has been said, if a doctor raises assisted death unprompted, the implication is this is something you should consider a tacitly implication.

This might be your best option. And as I may address the comments by the noble Lady Baroness Hayman, it is just as it is now a doctor's duty of care to sensitively explore you with open questions and careful listening, to discuss whatever the person wishes to discuss at their initiation. That is, patient autonomy and control. Mencap. The Association for Palliative Medicine and the Royal College of Psychiatrists, have all warned how patients trust gives doctors a dangerous ability to steer decisions.

If the suggestion comes from the doctor, listening with undivided attention is crucial in gentle, honest communication, in the pace of fashion, in the face of patient's anguish. Patients hang on to our every word, so suggesting it is an option, signpost them in that direction. It abandons suicide prevention duties under the Mental Health Act and the state's duty. Under article two of the European Convention on Human Rights. The amendments overall have a common theme of trying to put the autonomy of the patient paramount in these discussions, able to raise the assisted death and their own time, at their own pace, at their instigation.

I hope that these

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amendments will be taken heed. I rise briefly because I want to

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I rise briefly because I want to thank my noble friend, Lord Jackson and my noble friend Baroness Monckton, whose speech was quite Monckton, whose speech was quite spectacular indeed for raising the spectacular indeed for raising the example of NRS, because I think that's a very good example when we're talking about who can raise the preliminary, who can raise assisted dying in preliminary

16:38

Baroness Fraser of Craigmaddie (Conservative)

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discussions. And I just want to give a very brief illustration of when my father was in hospital and five different medical professionals came into his room and took out his family aside to and took out his family aside to try and get him to sign up to a DNR. And he he didn't really want to. I And he he didn't really want to. I mean, it might have philosophically been the right medical thing to do, but he wasn't in the right place.

He didn't want to be asked, and he certainly didn't want to be asked five times by five different medical professionals. And I have to say, it left a rather bitter taste in our mouths because when we were able to to take, you know, to quietly as a family, have that discussion with my father, we did have a DNR, and I count the fact that we were fortunate to have that time rather than he had something, you know, put at the end of his bed with the Sainsbury's bag.

So I think this group of amendments is really important. Whichever one I mean, you know, they're all so they're all so similar in just saying we need some guidance as to who can raise the discussion, under what circumstances. And if we really do believe patient autonomy is important, then I believe

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something should come from this group of amendments and should be on the face of the bill. Thank you.

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Thank you. Clause six. Has been opposed by. My noble friend Lord Moylan.

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My noble friend Lord Moylan. Because of other aspects amendments tabled. I very much support clause six staying in the support clause six staying in the bill in terms of. It's the one amendment at report where there was a significant majority in favour in a significant majority in favour in the Commons, and in particular, I found it astonishing that anyone could even consider raising this with a child. And indeed, it disappointed me that the sponsor of the bill in the Commons actually voted against that amendment.

But I'm relieved it got through. I think also it's worth pointing out to the committee that there is slightly different wording between six and clause five, particularly subsection one, which my noble friend Lord Moylan amendment 152 addresses by making sure other health professional is included, not just regarding medical practitioner, what my noble friend Baroness Fraser has just referred to. I've also seen multiple times and I have to say it is very irritating, especially when somebody's being taken home to die, that against their wishes, DNR had been put in place by medical practitioners and then had to be rescinded again.

So it's somewhat frustrating in that regard. In terms of my noble friend Lord Goodman has was succinct. I think that's partly the training of a journalist. It may mean two years of quiet, contemplative reaction when he considered his vocation in a particular abbey on the Isle of Wight. But in terms of one of the

16:41

Baroness Coffey (Conservative)

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points, I just briefly wanted to raise, the noble Baroness Baroness Blackstone referred to the BMA. I'm Blackstone referred to the BMA. I'm conscious they're a trade union for doctors and they do a lot of work on their behalf, but they are not clinical body in that regard. But they did point out, and this their concerns about without it, it would create uncertainty, legal risks for create uncertainty, legal risks for doctors. And they in their evidence, they go into more detail on that.

However, in contrast, the Medical Defence Union's written evidence to the Commons Select Committee and by the way, the MDU is an organisation that specialises in providing indemnity and other issues in terms of legal issues regarding doctors, they came up with a different thing, saying that basically the MDT is concerned the legislation is drafted, leaves doctors who do it at greater risk of complaints and then subsequent legal things. So, my Lords, I think overall, trying to get away from, as has also been pointed out, at what point would this ever be raised? I do support more generally the approach that I do understand that if a doctor is asked about this, of course that should be open to a response unless they don't wish to do so.

And part of some of the clause five covers that. But overall, I think that initiation should not be in the hands of the medical practitioner. And we come on later in further clauses to debate the recording of such discussions. My Lord, I want to focus my remarks on two points.

16:43

Lord Harper (Conservative)

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One is. Addington speech was very powerful, and I strongly support what she said about proper safeguards for people with learning disabilities. And she's got an amendment which deals with that. But but I really wanted to just test the thinking here because I think there's a there's a view here, and this is where I settled on whether you should whether medical professionals should be able to raise things proactively or not. And the thing I was thinking through, and I'd be interested in what the noble Lord noble and learned Lord, Lord Falconer thinks is this bill is obviously about putting in place a process which, first of all, about legalising assistance to help someone take their own life, but also to put a process in place.

And those are two separate things. But I was also thinking about the thing that is currently lawful, which is that someone is able to take their own life if they don't require assistance. But I don't know whether it's just me, but if you were diagnosed with a terminal illness and you suggested to a medical practitioner that you were thinking of taking your own life, if this bill wasn't in force, as far as I understand it, and there are many in this House that can correct me, but that medical practitioner has a duty under the various suicide prevention strategies that exist, to take steps to try and prevent you from taking your own life.

They're absolutely not supposed to try and help you. They're supposed to try and stop you up to and including using provisions in the Mental Health Act to stop you. And so I think, therefore, it would be extraordinary if we were to permit medical professionals, if we were to enable assistance to be provided, to raise the subject proactively of someone taking their own life when that hasn't been raised by the person themselves. That seems to me the more consistent approach, because otherwise we have a very strange approach where where a medical practitioner will be able to medical professional will be able to raise with somebody proactively using the provisions in this bill, should it become law to provide medical assistance to end their own life.

But I think I think I'm right in understanding that they wouldn't be we wouldn't we still wouldn't think it appropriate under the suicide prevention strategies and duties that exist for medical professionals. We wouldn't think it appropriate. And I don't think the noble and learned Lord is suggesting this. He'll be able to say so when he winds up. I don't think anyone is suggesting that it would be appropriate for a medical practitioner to proactively suggest that someone ends their own life without assistance and goes off and does it themselves, and he's nodding assent to that proposition.

So I think there's a the reason why I raise this, it has been raised before my noble friend Baroness Berridge has raised it, and other noble Lords have. But I don't think we've ever had a very clear answer about how we reconcile the provisions of this Bill on assisted suicide and the long standing. Very important duties that we have on not just medical professionals, but many other professionals in this government and previous governments suicide prevention strategies. And I think we do have to resolve that issue because otherwise we put and my noble friend Baroness Coffey set this out when she quoted the medical Defence unit.

Otherwise, we put the professionals who we are. We would be asking if this bill were to become law, who would be asking to implement it? We put them in an absolutely invidious position where we give them conflicting legal and professional duties, which we then expect them to reconcile at considerable risks to themselves. And I think the cleanest way of doing this is that we say that they can only respond to the patient when the patient themselves raises this issue.

I think it's reasonable that if a patient goes to their medical professional and asks them a question, I think it's reasonable that that expert answers it in some way, either the content themselves or directs them to somewhere where they can get that information. I think it would be not helpful if that expert were to refuse to engage, because that would simply drive the person off to some other forum. And as my noble friend Baroness Berridge says, often to an on dangerous online forum, but I don't think it's appropriate that they raise it proactively.

And as I said, I do think it also raises this issue about what we expect of medical professionals, about people who want to take their own life without assistance and what they should do in those circumstances, because I still don't understand how we are reconciling those two things. And I don't understand how a medical professional can have a duty to prevent someone taking their own life in other circumstances, but in these circumstances, they are expected to facilitate it.

And I still don't understand how we are reconciling that either, both from a moral, professional or legal context. So I'd be grateful if the noble and learned Lord Wood set out how he reconciles that when he responds to this excellent and very helpful group of amendments. amendments.

16:48

Earl Howe (Conservative)

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From noble Lords on all sides of >> From noble Lords on all sides of the House seeking to prevent medical practitioners from initiating a conversation about initiating a conversation about assisted dying with a patient, demonstrates how strongly noble Lords feel about this issue. So, as a minimum, it's clear that many noble Lords don't feel that the current drafting is sufficient. And although we've heard some counterarguments during this debate, I think it is now incumbent on the noble and learned Lord, Lord Faulkner, to set out in some detail his reasons for allowing registered medical practitioners to be able to initiate these discussions.

Following on from that, I think there was one particularly moving contribution to this debate, and that was the speech from my noble friend, Lady Monckton, the case she made from her own family perspective in support of my noble friend Lord Shinkwin amendment 162, to prohibit the topic of assisted dying, being raised with someone with down syndrome or learning difficulty disability was one I found especially powerful, and I hope that noble and learned Lord will acknowledge that this is a particularly sensitive aspect of the issue that needs to be addressed.

There are two additional issues I'd like to pick up. I was particularly interested in the noble Baroness Grey-Thompson amendment, which requires the minimum 48, a minimum 48 hour delay between diagnosis and any conversation about assisted dying. Given the shock that a patient will feel when receiving a diagnosis that could make them eligible under this bill, it does seem right and appropriate that they be given the space and time to process the news before facing the question of potentially ending their own life.

Is the noble and learned Lord, Lord Faulkner, willing to consider how that degree of sensitivity might be incorporated into the bill, or, failing that, into guidance to ensure patients who've received some of the worst news they will ever hear, do not immediately feel the need to address a choice as momentous and emotive as whether they wish to end their own life. Finally, I do feel the amendments in respect of persons aged under 18 are worthy of the noble and learned Lord Rose careful consideration.

This bill is designed to create a legal right for those over 18, not for children. Surely it does follow that the provisions of the act shouldn't be raised with children, and I therefore hope the noble and learned Lord will consider carefully the protections for children which the Bill could

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usefully incorporate. Well. Said Lord Howell.

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Said Lord Howell. My Lord, I would like to thank all noble Lords who have all noble Lords who have contributed to this very important debate today. As usual, I will keep my comments limited to amendments on which the government has major legal, technical or operational legal, technical or operational workability concerns. To begin with, I turn to amendment 149, tabled by the noble Lady Baroness Grey-Thompson. Key concepts within the amendment are unclear, so it will be difficult to assess whether the duties have been discharged.

For example, it is not clear who must coordinate and undertake the suggested multi-agency assessment of support needs and who is responsible for ensuring that those needs are fully funded. It may

16:52

Government Spokes. Baroness Blake of Leeds (Labour)

therefore be impossible to demonstrate that these criteria have been met. Amendment 152, have been met. Amendment 152, tabled by the noble Lord Lord Moylan, seeks to prohibit Moylan, seeks to prohibit registered medical practitioners or any other health professionals from raising the subject of provision of raising the subject of provision of assistance under the Bill. If passed, this would be inconsistent with the discretion currently with the discretion currently afforded to registered medical practitioner in clause five, paragraph two, which makes it clear that a registered medical practitioner may exercise their professional judgement to decide if and when it is appropriate to discuss the matter.

This amendment would therefore create conflicting duties and may lead to confusion about whether a registered medical practitioner can raise the issue of

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assisted dying. Let's briefly and I took no interest to other members of the interest to other members of the House, but it's surprising that with all the legal advice offered to her, she hasn't noticed that to her, she hasn't noticed that there is a consequential amendment in my name. In the same group which in my name. In the same group which I referred to, which deletes subsection two. Since I too have subsection two. Since I too have spotted there is an inconsistency

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and I've dealt with it. Well. Can I thank the noble Lord

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Well. Can I thank the noble Lord for his comments and move forward? But I still think in the context it But I still think in the context it is worth raising these matters to is worth raising these matters to avoid any confusion. Amendment 162, tabled by the noble Lord Lord Shinkwin, would mean that a registered medical practitioner could not raise assisted dying with with any person with a learning disability, including people with Down's syndrome, unless they raise the subject themselves.

This restriction would apply to all persons with a learning disability, including where the person has the capacity to make a decision to end their own life. The purpose of amendments to 105 207 207 A tabled by the noble Baroness Baroness Monckton and Baroness Grey-Thompson, appears to be to prevent a healthcare professional from raising the subject of the provision of assistance with a person who has a learning disability or autism, unless that person has a family member, independent person or guardian present under amendment 207 a, both the family member and an independent person would need to be present.

These amendments do not draw any distinction between varying levels of individual needs. As drafted, a registered medical practitioner would be required in all cases that the person does not have autism or a learning disability before raising the subject of an assisted death. Unless a family member or independent person is present. Turning to amendment 200 and see tabled by the noble Lady Baroness Berridge, this would mean that no person, whether online or otherwise, could raise provision of assistance for those with those under the age of 18.

Amendment 209, tabled by my noble friend Baroness Goudie, prohibits any adult with a duty of care or responsibility for a person under 18, including but not limited to, guardians, social workers, educators or carers. From raising the subject of assisted dying with such a person, and I quote, these amendments would be extremely difficult to enforce due to their breadth and ambiguity. They may, for example, prohibit parents or guardians from discussing the broad issue of assisted dying with their children.

Finally, I would bring to the noble Lords attention that amendments discussed here, including 149 162, 200 C, 205, 207, 207, A and 209 could give rise to legal challenge on our grounds. In particular, challenges brought under articles eight, ten and 14. These amendments would require reasonable and objective justification in order to comply with each obligations. I make no comment on the other amendments in this group. However, as noble Lords will be aware, the amendments have not had technical drafting support from officials.

Therefore, further revision and corresponding amendments may be needed to provide consistent and coherent terminology throughout the bill.

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My Lords, for the benefit of the House, I should let people know that when we. My noble friend Lord

16:57

Falconer of Thoroton. I do intend then to bring the house to a conclusion. I think it'd be wiser to start the next group next week to start the next group next week rather than halfway through it, and all the problems about I was in, I wasn't here, so we'll be bringing wasn't here, so we'll be bringing colleagues in the next group. It won't be called to next week.

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won't be called to next week. Could I pay tribute to the noble Lord Lord Jackson of Peterborough

16:58

Lord Falconer of Thoroton (Labour)

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17:18

Baroness Grey-Thompson (Crossbench)

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My Lords. >> My Lords. >> I'd like to thank all those. >> Who have contributed to the debate, this group of amendments on debate, this group of amendments on raising, as in conversation and preliminary discussion, including preliminary discussion, including training. I thank the noble Lady Minister for her response to my amendments. But in given the government response and the question about funding lays open, I think the bigger question of the whole bill that many of us are grappling with about who pays for this and what that final bill may be.

Now, the debate's gone in a slightly different direction than I expected, and I thought it was interesting that the noble earned noble and learned Lord Doyle Faulkner differentiated in his response between non-disabled and disabled people. Independent advocates is going to come up in a later group, but I think it's really important that actually it's understood as part of this group when we're talking about learning disabilities, that it actually may be very difficult for someone with a learning disability to understand what an independent advocate is, what their role is.

They may say they don't need it and not actually understand what they're saying yes or no to, but we'll cover that next week. I'm slightly worried that there may or may not be guidance from the GMC and or the Secretary of State. I'd be very interested in discussing that with the noble and learned Lord, away from this chamber. And this is where we probably disagree. So those who support this bill will say about Victoria, it gives greater access. I say it's it's a slippery slope.

It actually is making it easier for a wider group of people to, to enter this process. We've covered in previous amendments the use of language person with a disability is not used in the Equality Act. And I'd hoped through my previous debates, there was some understanding of it and why organisations, often for disabled people, are worried about this bill. It's not just about the contents of the bill, it's about the language of the bill. Organisations, often for disabled people, use the social model.

I won't go through that again, but the language they choose to use is disabled people. The noble Lord Lord Weir has apologised for having to leave, but he started raising about the issue about how disabled people are treated. I'm going to raise a difficult question, not to anyone in particular, but to the whole chamber. It's rhetorical. How many new laws does chamber have ever felt sorry for me because I'm a wheelchair user, my previous career as an athlete negated some of that feeling because if you like sport, then compete in the Great Britain is a privilege.

Which of course it is. But in my second career, I considered the way that I'm treated every single week. I'm a long way from my sporting career now, but if I'm rushing to a meeting, luckily I don't get too much these days. It's not a race. I know I'm not in my racing chair. I'm not wearing Lycra. I'm not sure. Sometimes when people say this, they think they're being kind or sweet or funny. I didn't have a traumatic or dramatic accident.

I was a wheelchair user from a very young age. There's a few points in my life where I've had three spinal surgeries, where I experienced terrible pain, but I'm healthy, and I think the points that the noble Lord Lord Weir raised around the different view that doctors have of people. I've talked before, my husband had a traumatic accident at 21. He broke his back. He was nine months in hospital. Many people assumed it irreparably changed his life. It didn't.

He went on to complete his PhD. He changed sports. He went from cycling to wheelchair racing. He met me. But the way he was treated and is treated is very different from whether he's walking with his crutches or if he occasionally uses a wheelchair. If he's walking, people like to think he's had a skiing accident or something quite cool, but when he's in his wheelchair, people talk down to him, and his colleagues have completely forgotten that he's got a PhD and have talked to him differently.

He had a stroke in 2020. I was really worried about him going into hospital because I wasn't sure of the outcome. But I had calls with doctors telling me about the impact of the stroke. And this is where, you know, the Noble and learned law talks about the doctors need to know all the information. It is really clear in his patient notes that he had a spinal cord injury, but the doctors rang me to tell me both of his legs were really badly affected.

And it's like, well, that would be the spinal cord injury. They then told me his grip strength was really good. Well, 30 years of doing wheelchair racing and cycling and walking with crutches would make that happen, but they had no idea what his grip strength was like before he had the stroke. So actually the information they were giving both of us was, was not very helpful at all. So, you know, all our experience of healthcare is very different. I had a doctor in a spinal unit ask me, how did you catch spina bifida? I laughed.

I think at the time I've been asked it several times. I think the first time I was in my early 20s, I said I caught it with a butterfly net. And yeah, humour doesn't always go down very well, either in the chamber or outside. But I was really shocked that a doctor in a spinal unit was asking me how I caught a congenital disability. Every time I go to the hospital, because my scoliosis, my internal organs are all in rather strange places in my body.

Every time I go for a kidney scan, I'm asked, do you have one kidney? I have two kidneys. Look at the notes. Are you sure? Yeah. Haven't had an operation to remove one of my kidneys. And every time you are measuring what you say because you don't want to offend doctors, you don't want to be rude, you don't want to be flippant. And I said, I've got two kidneys. My right kidney is somewhere up under my arm. It can't be there. Yeah. Look at my notes.

Right. Eventually they find my kidney somewhere up underneath my right arm. And this is the frustration that disabled people feel because it's it's lovely to say that doctors will read all the notes and will understand it, but actually something as basic as I have two kidneys is, is often misunderstood. So I challenge you. Lordships chamber. Have you ever pitied me? Do you think I'm brave? Do you ever think, well, at least it's not me. AM I brave as a wheelchair user or brave because I was an athlete? How many people consider that? Because of my impairment, I suffer now.

I apologise when I sighed when the noble and learned Lord talked about suffering of disabled people, my phone started pinging. I can't read out any of the responses of the messages I've had to that all the languages on parliamentary. But this is why disabled people are scared because the assumption is that we suffer. I do not suffer. Disabled people are worried. This is why they are fighting this bill. It is not kind. It's not sweet. It's not been understanding. It's not being compassionate.

We are constantly having to try and fit into a non-disabled version and idea of what people think of us. And if we dare challenge that, then we've got a chip on our shoulder and one of those funny disabled people who just doesn't understand, you know, that we're meant to, you know, just deal with people being kind to us. We have to deal with being patted on the head, literally and figuratively. It's happened once to me in this building. I was with a colleague. It was a peer who did it to me.

I was with a colleague who was a wheelchair user. We were chatting about a bill that we were working on. The peer came up to us and said, are you having a nice time in that town? Yes. We said, yeah, actually we're debating the bill that we're working on at the moment. The peer ruffled my hair. This is patronising. This is ableist. It is not kind. So I'd like to ask the noble and learned Lord, how do you assume that people like me suffer? I'm really squeamish about the word and that is why so many people are frightened because of the assumptions that are constantly made.

So I want to take my challenge further. How do you see disabled people who might be on the streets? Are we deserving and undeserving disabled people? Well, that happens between Paralympians and Paralympians. My noble friend Baroness Campbell of Surbiton talked in her speech about DNR being put on healthy disabled people. And because of the nature of how people speaking remotely are able to contribute the both Baroness Campbell of Surbiton and Lord Shinkwin are not able to come back into the debate.

But my noble friend Baroness Campbell wants to make it clear that she has to rely on doctors for everything in terms of our well-being. It is a huge amount of trust that you put in these people, and my noble friend has been in hospital many times, and it's important to listen to her voice about her experience of what it's like just again, and I will keep raising this in terms of how I'm able to contribute in debates. I can sit in one place, well, three places in the chamber.

I can't sit with my colleagues, those speaking remotely can't come back and ask any questions. There's been one time in the time I've been here when five wheelchair users wanted to speak in a debate. We had to tag team in and out of the chamber. How many other noble colleagues have had to do that? So my noble friend Baroness Campbell wanted to reiterate the unequal nature of the system. She also wanted to draw attention to a BMA survey, which was looking at results of doctors and med students who are disabled or have long term health conditions, and this was published on the 3rd of December 2025.

The author, Natasha Wilcox, is deaf, and it raised the ableism that exists in that profession. And the assumption, I think, is that the barriers were from patients, but actually their deep rooted issues with the experience of doctors who are disabled. And there's a huge amount of prejudice that comes from other doctors. The noble Lord Lord Shinkwin, again, was not able to come back in, but wanted to raise a couple of points. And he did ask me to say that the noble and learned Lord didn't answer any of his questions and would be happy if he could write to him.

If you treat your disabled colleagues with prejudice and contempt, then this is referring to the BMA survey. Again, how do doctors treat disabled patients? Because the equity of treatment of staff and patients are inextricably linked. And we've talked before about anybody who has a terminal condition is disabled, but you don't have to be disabled. It doesn't work the other way around. But legislation the Department of Work and Pensions frequently links sick and disabled. And again, this is why disabled people are really worried.

So we have to question our own biases in the chamber and actually question the biases of the system that disabled people will be going into. And so, you know, groups often for disabled people are not reassured by the words of the noble and learned Lord. Unlike others. I would like to thank Baroness Monckton for her speech. It is not easy to stand up and talk about something so personal. And as a daughter and a mother, I find talking about my parents much easier than talking about my daughter.

But how can we live in a world where, well, first of all, somebody with down syndrome gets a clinical frailty scale of seven? What's going on with that? But how can we live in a world where people are frightened to go to hospital because of what the doctor is going to say to them? And I was contacted by a friend who's a scooter user who also has a clinical clinical frailty scale of seven. They thought their scale was three and the shock that they experienced when they told that's the level they were on, and they contribute massively towards society.

And my friend said he thought his life had value, but suddenly a process is telling you that you have no value. And he said it makes you feel a bit rubbish when you realise that this government values your life as a seven, not a three. And he also went on to say that if assisted suicide existed, then he feels he would be in big trouble. I don't think my noble friend is. Murphy is in her place, so I will follow up outside about what she said about the percentage of doctors that support this.

In February 2025, the Royal College of GPS polling, only 33.7% said they should support the principle of assisted dying, 47.6% said they should oppose it. But it is worth noting the Royal College of Pharmacists, while 54% support the principle of assisted suicide, that dropped to 38%. When asked about this bill. Conscious Time Lords. But there's a lot to cover in this group. The noble Lady, Baroness Blackstone Fox and Coffee talked about the the BMA, and I think that's a really interesting point.

They gave two reasons in their written evidence. One was likely to be detrimental to patient care, and the second would also create uncertainty and legal risks for doctors. So I think that goes a little bit further than noble Lady, Baroness Blackstone said. I've covered the gagging clause. I think we still haven't got to the bottom of the definition. The medical personnel, which was raised by the noble Lady Baroness Berridge and my noble friend Baroness Cass Lord's terminal diagnosis has a significant pressure on someone's mental health.

Currently, suicidal thoughts are given protection or support, and the UK national lead on suicide prevention, Professor Louis Appleby, in research with palliative care expert Katherine Sleeman, raises that increase in suicidal risk. But Jamila Hussein, doctor Jamila Hussein and committee evidence said palliative care staff experienced racism and patients from ethnic minorities experienced worse outcomes in healthcare. So the timing of the discussion is very important as much as how it's raised and the words that are used. And while I think this has been a really interesting debate, I still don't think we've got to the bottom of many issues that these amendments address.

But at this

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stage, I beg leave to withdraw my amendment. Is it your pleasure that this amendment.

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amendment. Be withdrawn? Amendment is by leave withdrawn. Amendment 150 Baroness Fox of Amendment 150 Baroness Fox of Buckley not moved. Amendment 151 Lord Goodman of Wycombe not moved Lord Goodman of Wycombe not moved 152 Lord Moylan not moved. Sorry. Oh, sorry.

17:34

Deputy Chair of Committees. Baroness Barker (Liberal Democrat)

So we should tidy up when we get

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to amendment 165 on the next, right? One five. OK. Sorry. Amendment 153. Lord Frost not moved. Amendment 153A Baroness Lawlor not moved 154. Lord Rook not moved 155. Baroness Keeley not moved. Amendment 156. Lord Goodman of Amendment 156. Lord Goodman of Wycombe not moved. Amendment 157. Lord Ahmad of Wimbledon not moved 158. Lord Evans of Rainow not moved 159. Baroness Finlay of Llandaff not moved 160. Baroness Lawlor not moved 161.

Baroness Stedman-Scott not moved. Baroness May 162 Lord Shinkwin not moved 1163. Lord Evans of Rainow not moved 164. Lord Ahmad

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of Wimbledon not moved. Lord Touhig to move the house. Do now resume.

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Do now resume. Question is that the house be resumed? As many of that opinion should say, content contrary, not

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content. The contents have it. Lord Sentamu the House to now adjourn.

This debate has concluded

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