Terminally Ill Adults (End of Life) Bill

Baroness Blackstone Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Dodds of Duncairn (DUP)]

Some noble Lords are becoming exasperated or resentful about the time that we are taking to consider these important amendments today. I say gently that, had some of these issues been dealt with in a different way in the other place, we would not have to spend the time we are spending in this House dealing with them. When we consider the number of days in Committee that we spend on important Bills that come before us—sometimes 11 or 12 days in Committee and another three, four or five days on Report—it is not unreasonable that we spend at least a few hours to consider matters of life and death.

These amendments relating to coercion are at the heart of some of the concerns that many people have about the Bill. Coercion is central to the concerns. We have heard about financial and emotional abuse, about external influences, people feeling a burden and wanting to relieve themselves of that burden. These are critical issues—they are real issues. Those of us who have served as Members of Parliament, who have worked in the community and who have dealt with real people in real communities understand and know the reality of what we are talking about.

It can be easy to dismiss these issues sometimes. We sometimes see people speak on television who are very strong and confident, with lots of family support and resources around them. But I was struck today by the words of the noble Lord, Lord Deben: we must speak up for the vulnerable. I came across many vulnerable people in my work as an MP in one of the most deprived areas of Belfast, and they suffered in great loneliness and financially straitened circumstances. They felt pressure in today’s environment, where suicide is something that people undergo. In this situation, will the safeguards being introduced be stronger than what we have today?

A new regime is being set up whereby, for the first time, the state and all its resources will be made available to assist another person to end their life. That is a very different set of circumstances. All the pressures and influences that vulnerable people come under today will be massively increased and amplified when this new law comes into place—if it does.

It is very important that we take the time to consider these matters. I support the amendments in this group, to a greater or lesser extent, and very much agree with the sentiments argued by the noble Baroness, Lady Fox, about encouragement. That is something that needs to be in the Bill if we are to provide all the necessary safeguards. Whether you are for the Bill or against it in principle, surely we need the most robust and strongest possible safeguards against coercion, pressure, encouragement or otherwise.

[Baroness Blackstone (Lab)]

My Lords—

[Lord Shinkwin (Con)]

My Lords—

[Baroness Blackstone (Lab)]

We have given an enormous amount of time to looking at safeguards. The noble Lord just totally denied that and said that we have to begin all over again. We do not. This debate has regrettably been characterised by too few of the speakers giving any consideration at all to the important, tough safeguards already decided in the House of Commons. I will not go through them now, in the interests of time, because I that know my noble and learned friend Lord Falconer will, when he responds to this debate.

[Lord Shinkwin (Con)]

My Lords—

Terminally Ill Adults (End of Life) Bill

Baroness Blackstone Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Markham (Con)]

My Lords, it is clear, I think, that we all want the same thing here. Whatever one’s feelings about it generally, if this Bill is passed, we want to make sure that the person is in the right position—I do not use either “capability” or “ability”—to make a decision on whether to take part in assisted dying.

We all want the same thing, so what we have to decide is whether we believe that the existing framework, the Mental Capacity Act, can work here. I have heard a body of evidence that says it can. I respect in particular the evidence from Sir Chris Whitty, who, as Chief Medical Officer, is probably our highest adviser in the land in the medical space. He believes that it can do it. I also respect the opinions of the psychiatrists who have written in and said that, in their professional opinion, they are able to use the Mental Capacity Act to assess whether a person is in the right position to take part in assisted dying. So, as the noble Baroness, Lady Andrews, and others have made out, we have a body of evidence and 20 years of experience showing that the Mental Capacity Act can work and is already acting in very similar situations.

One can argue whether these two things are exactly the same, but they are pretty similar: both involve life-and-death situations, such as “do not resuscitate” orders, people deciding not to eat or drink any more, and people with motor neurone disease asking to come off ventilators. These are all very similar situations that, today, are decided under the Mental Capacity Act. So we have a system that is being used and which our best adviser says works, and we are setting an unknown definition against that. If we set about asking, “What do we mean by ‘ability’?”, we would probably all come up with very different answers. This would be untried and tested; it may take years, if not decades, to find something, against something that exists today. It would be very confusing: when do you use the Mental Capacity Act and when do you use this new definition?

Again, we all want the same thing: for the person to be in the right position. Our highest expert in the land says that the Mental Capacity Act can do it, and a number of psychiatrists are also saying that they can make the assessment under it. To my mind, that is what we should be considering.

[Baroness Blackstone (Lab)]

My Lords, I agree entirely with what the noble Lord, Lord Markham, just said. We have a tried and tested way of measuring people’s capacity, but we do not have a single tried and tested way of measuring people’s ability. That is a very broad concept, and anybody who has worked in education at any level will say with absolute certainty that it would be unwise to replace what is currently in this Bill with “ability”. There is no definition of it—it can cover a vast variety of different kinds of ability—and finding an adequate test could take years.

[Baroness Berridge (Con)]

My Lords, I declare my interest: I received a personal donation from Dr Etherton to fund research support. Normally, I would agree with the noble Lord, Lord Pannick, in relation both to legal terms that are not defined and to moving to something that is ill defined; he will find, in the later groups of amendments with which I am involved, that this is a key concern that I have had.

The amendment in the name of the noble Baroness, Lady Finlay, talks about “ability”. I have struggled with that, for the same reasons as the noble Lord, Lord Pannick, but I have been persuaded that there is something in this. I served on your Lordships’ Select Committee. One of the benefits of serving on those Select Committees is that you sometimes get to meet your hero. Professor Sir Chris Whitty sat in front of us as the highest expert in the land, but when he gave evidence to the Commons Select Committee he had to write afterwards because he had misunderstood something and had to clarify it. It was after the Third Reading vote, I think. His letter was put in our pack and made public; I thank the noble and learned Lord, Lord Falconer, for nodding. One has to consider the fact that even he got it wrong.

We also heard from Professor Alex Ruck Keene, who is an honorary KC, who trains practitioners in how to apply this test. We heard that, although it might be common and used up and down the land, there is a considerable body of evidence that practitioners are struggling to apply it in what he calls the 15% of cases that are complex. I think this is the kind of case outlined by the noble and learned Baroness, Lady Butler-Sloss.

The committee’s time constraints meant that I was not able to put that evidence to Professor Sir Chris Whitty, as Members’ questions are limited, but I put the following to him because it is sometimes helpful for us to think about the practical realities. The MCA would bring with it its other parts, not just the capacity test. There is a presumption if, for example, an 18 and a half year-old who has had a life-limiting condition all their life is being assessed and the doctor doubts whether that young person has capacity that they have capacity—as far as I understand Professor Ruck Keene. We have to take that evidence into account. There has been some discussion about the royal colleges, but as political parties we know that some people will peel off from the corporate view. We need to take seriously that the royal colleges are not supportive of the Bill. While Professor Sir Chris Whitty might—

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as chair of the Royal College of Obstetricians and Gynaecologists. I have followed what the different royal colleges are saying and it is not true to say that they are opposed to the Bill in general. Most of them are neutral, one or two are in favour and one or two are against.

[Baroness Berridge (Con)]

As people around me are saying, I do not think I said that. They are neutral. The royal colleges have said that they have problems with the Bill, but they have been neutral on the principle, save for the Royal College of General Practitioners. I am sorry; I stand corrected on that. They are neutral, as is the Association for Palliative Medicine, which is not a royal college.

When one looks at the evidence that we took, of course individuals from within that group would come along whom we had to call. It was right that we did that, but one looks at a corporate view. I enormously respect Professor Sir Chris Whitty, but I heard his evidence on this and he was not the highest expert in the land. He was humble enough to write to correct himself, as he had misunderstood the Mental Capacity Act when he gave evidence in the Commons.

Terminally Ill Adults (End of Life) Bill

Baroness Blackstone Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, I have spoken in favour of assisted dying in previous debates in this House, and that is still my position. Therefore, I am grateful to Kim Leadbeater MP for her work in steering the Bill through the Commons. We must not forget that the elected House has supported it; our task is to scrutinise, not reject it.

Like my noble friend Lady Thornton, I was concerned at proposals last week for a Select Committee, which might undermine the agreed timetable for such scrutiny in Committee. After so many years considering assisted dying, whether in Select Committees or Private Members’ Bills, it is now important that we complete the process. Therefore, I am grateful that my noble friend Lady Berger has agreed to a committee that is limited in scope and time, allowing the Bill to go through all stages before this Session ends.

With a view to improving the Bill, I welcome the opportunity to look into procedures and safeguards, calling evidence from experts. I am impressed by many of the contributions made so far, including some speeches from those not in support of the Bill. However, I regret the language used sometimes, such as references to the “killing Bill” or the “assisted suicide Bill”. Because of my personal experience, I am affronted by this.

When my former husband, in hospice care, was dying of stomach cancer at the age of 44, in agonising pain, with terrible nausea, too, he desperately wanted it to “come to an end”, as he put it, and asked for my help. I tried to persuade his carers to speed up his death, but failed. Is this “killing”? Was his wish to die “suicide”? Surely not. He loved life and had not wanted to die, but he was dying and, when life became truly unbearable, he longed for death. Because of the law, I could not help him end his torture.

As legislators, we have a duty to consider public opinion. Rigorous surveys all report high support for the Bill, ranging from 73% to 80%. The Nuffield Council on Bioethics set up a citizens’ jury on assisted dying earlier this year. Support for law change actually grew over the eight weeks of deliberations, when participants heard views from all sides. There are also large majorities in favour of assisted dying among Christians and those of other faiths, as well as disabled people.

Some speeches have referred rightly to the inadequacies of the status quo. Prosecutions of people who admit to helping a close relative die usually end in juries refusing to convict. Laws should not remain on the statute books where this is the case. Currently, there is no safeguarding when people end their lives at Dignitas, nor when unregulated and drastic ways of ending life, such as starvation, take place. Those who oppose the Bill need to address the problems of the status quo. We need more palliative care, yes, but it cannot always end the horrors of agonising deaths.

I end with two pleas. First, allow our fellow human beings greater autonomy over how they die; it is for them to decide and not for others, whether for faith or other reasons, to impose their views. Secondly, be truly compassionate in sparing terrible suffering as death approaches, allowing those who choose to die sooner to do so.

Preterm Birth Committee Report

Baroness Blackstone Excerpts

Friday 6th June 2025 Lords Chamber

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the trust of the Royal College of Obstetricians and Gynaecologists. I have another interest in that I am the grandmother of preterm twins born at 29 weeks’ gestation. They are an example of the success of the NHS in providing excellent care—they are now professional women with postgraduate as well as undergraduate qualifications.

I thank the excellent chair of the committee, the noble Lord, Lord Patel. I am also very grateful to the Government for the many positive replies they have provided for the committee in their response to the recommendations. There are, however, several issues where an update on progress would be valuable, and one or two where more detail would be helpful to build on somewhat vague promises.

The two important issues I want to raise concern staffing and research. I begin with the first of those. Undoubtedly, good outcomes in reducing the percentage of preterm births and in improving the care of infants and small children who are born prematurely, as well as supporting their parents, depend on better staffing. The services involved are complex and require first-class co-ordination between different professionals to be truly effective. I ask the Minister to answer a specific question concerning the need for adequate numbers of doctors where there are serious pressures on existing staff and those pressures reduce the quality of care. As part of a workforce planning exercise, the DHSC commissioned the RCOG to accurately quantify the number of obstetricians needed in maternity units in England. A tool was developed to enable trusts to compare their staffing levels with national averages, taking into account their local context, including the complexity of their case load. The department received the findings, including an estimate of the number of obstetricians needed, in 2023. Continuation of that work is now urgent but, so far, the DHSC has failed to confirm the next stage of the project—can it do so now?

For the Saving Babies’ Lives Care Bundle, properly staffed preterm birth prevention clinics are needed, with access to regional centres where that is not possible. Further training is needed for the specialist staff required in developing cross-specialty leadership, which includes internal and foetal medicine, as well as neonatal care and anaesthetics. Employers need to be resourced to free up specialist staff to get in-service training and to build a supportive learning culture.

There is also a crucial shortage of perinatal pathologists, who are needed to examine possible causes of preterm birth, as was referred to by my noble friend Lord Winston. We need to undertake placental histology of women who have given birth at less than 32 weeks’ gestation. Even when that service is provided, there is a lack of specialist postnatal clinics to follow up on the results. Can this be rectified?

So far, I have focused on doctors but, of course, nurses and midwives are also crucial, as others have said. So I welcome the current three-year delivery plan to boost the midwifery workforce. Perhaps the DHSC could start to consider what it will do when the three years is up next year. I also welcome greater attention being given to the retention of nurses and midwives through more flexible working arrangements. I first became aware of the acute shortage of neonatal nurses when I chaired the Great Ormond Street Hospital board—that was several years ago, yet the shortages continue. Perhaps the Minister can explain what the Government meant in practical terms when they said in their reply to the committee report that they would

“refresh the NHS workforce plan”.

Like other speakers, I also refer the Minister to the Royal College of Midwives’ survey findings that final-year midwifery students lack confidence that they will find work as a midwife when they finish their course. It really is puzzling given the apparent shortage of midwives and the large amounts of overtime they currently work. Can workforce planning in this area be improved?

I turn to research. It is recognised that the causes of preterm birth and its prevention are not as widely understood, as was set out so well by my noble friend Lord Winston. Without funding for more research, that will continue. I recognise that the call for more research is happening in many areas of medicine—it is widespread—but the costs of prematurity, especially when it is extreme, are enormous. Better research could produce savings for the NHS in the long term, as well as benefiting families. For high-quality research to succeed, more attention should be given to developing digital systems to improve data collection. The variation in digital systems across the country prevents the creation of a comprehensive national database of birth outcomes and their relationship to demographic characteristics. Without that, we cannot do the good research that is now needed.

Lastly, I will touch on socioeconomic and ethnic questions. It is well known that higher rates of preterm birth are linked to socioeconomic deprivation. Of course, policies way beyond healthcare are needed to address inequality. However, specific steps are needed to support women who are poor when they become pregnant; these include public health measures to tackle the advertising and promotion of unhealthy food, alcohol and tobacco. Prenatal and postnatal monitoring are especially important for women from deprived communities, to reduce the incidence and mitigate the effects of preterm birth.

Measures such as parental accommodation on neonatal units, although valuable for all parents, are particularly important for the socially deprived. This, of course, was mentioned by the noble Baroness, Lady Wyld. Can the Minister confirm that the necessary investment is in the Government’s plans for this purpose? This is just one way to help families who are suffering acute stress as a result of preterm birth.

I will end with a little anecdote. No one so far in this debate has mentioned siblings. After my premature twin granddaughters were born, I looked after their older sister, who was two and a half years old. I took her to visit my brother and his family. While no one was looking, she bit the baby in the pram. I think she was giving us a little message: “I’m distressed too. I’ve been displaced and I don’t like babies”. We need to end stories such as this.

Women’s Health Strategy

Baroness Blackstone Excerpts

Tuesday 4th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with the noble Baroness. It is a disgrace that there is such a huge inequality in maternity care. Maternal mortality rates are some 2.3 times higher for black women and 1.4 times higher for Asian women, while those living in the most deprived areas have a maternal mortality rate nearly twice as high as that for those who live in the least deprived areas. That cannot be acceptable in 2025. I am glad that we have taken a number of actions to ensure that trusts who fail on maternity care are robustly supported. We will set an explicit target to close black and Asian maternal mortality gaps. Trusts are also required to publish a suitable plan to tackle this and to put it into action. It is a challenge, but not one that we shy away from.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. What is the Government’s timetable for a revised or updated version of the women’s health strategy? Can the Minister also assure the House that there will be adequate funding for its implementation when it is brought in?

[Baroness Merron (Lab)]

Let me assure my noble friend and other noble Lords that there are no plans to cancel the women’s health strategy. I know my noble friend did not say that, but it is very important to put that on record. We continue to implement it; for example, since I have been in post, through measures such as supporting pregnancy loss through a full rollout of baby loss certificates, introducing menopause support in the workplace, and boosting women’s participation in research and clinical trials. As I said, our priorities for delivering the strategy will be through the 10-year plan. Funding decisions will be announced in due course.

Musculoskeletal Health

Baroness Blackstone Excerpts

Thursday 30th January 2025 Lords Chamber

[Baroness Donaghy (Lab)]

My Lords—

[Baroness Blackstone (Lab)]

My Lords—

[Lord Pannick (CB)]

My Lords—

Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates

Baroness Blackstone Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.

[Baroness Blackstone (Lab)]

My Lords, I declare my interest as set out in the register. Given the complexity of the causes of these unacceptable mortality rates, what is the Minister’s department doing to ensure that there is a cross-government approach to ending the maternal mortality gap?

[Baroness Merron (Lab)]

My noble friend is quite right: this is a cross-government matter. There are complex reasons why black, Asian or minority-ethnic people are suffering far worse than those who are white. They include socio-economic factors such as deprivation and health inequalities being felt across the whole range. It is not going to be possible to solve this without cross-government co-operation. I look forward to working with my ministerial colleagues to put it right.