Terminally Ill Adults (End of Life) Bill

Debate between Baroness Cass and Lord Jackson of Peterborough

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Cass (CB)]

My Lords, I say to the noble Baroness, Lady Fox, that my mother 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.

My serious point is that I am still mystified by Clause 5, because it remains completely unclear who is having this preliminary discussion. Even if we safeguard against the doctor raising the subject of assisted dying without it being initiated by the patient, none the less this clause is still 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 have a full discussion, they may be able to cover all the things that are listed in this clause—diagnosis, prognosis, palliative care, hospice, available treatments and so on—but, if it is not their GP, who is the medical practitioner supposed to direct them to? Unlike the co-ordinating doctor and the independent doctor, they do not have the right written into the Bill to access the patient’s records or make inquiries of the person who is looking after them, so I am unclear about how they are supposed to discharge all these duties.

Also, it does not reflect reality. If somebody is starting to think about possibly seeking an assisted death, they may ask their GP about one part, their priest about another aspect, their next of kin about another aspect, and they will gradually form a view. But to lay it down in statute seems to be putting an additional hurdle in the patient’s way. Surely, at the time when they want to ask about the detail of assisted death, what it might entail and its feasibility, the person to seek advice from is the co-ordinating 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 the individual should expect. So I strongly support my noble friend Lady Hollins’s view that Clause 5 should not stand part of the Bill, because it seems to be a complete muddle that we have been discussing various aspects of for some time now.

[Lord Jackson of Peterborough (Con)]

My Lords, I think the debate that we have had for the last two and a half hours shows this House in a very positive light. It goes to the very essence of what some of us who are sceptical about the Bill believe to be the most crucial issue: how the Bill will impact the most vulnerable people in society. I say in passing how moved I was by the wonderfully powerful and emotional speech from my noble friend Lady Monckton, as well as by my noble friend Lord Shinkwin’s speech on his amendment.

Noble Lords might ask a rhetorical question: why are we spending so much time on this particular group? I will offer an anecdote to your Lordships on why it is important that we have spent this time talking about people with disabilities and learning disabilities, and particularly people with Down syndrome. In the summer of 2024, my 91 year-old father was admitted to Peterborough hospital and spent a number of hours in what is euphemistically called “ambulatory care”—which is the back of an ambulance—before being able to access a trolley for a number of hours. As it happens, he was terminally ill. He died a few weeks later from bladder cancer that had metastasised to the rest of his body, but he did not have a diagnosis of terminal illness.

When I reached the hospital, his belongings were adjacent to where he was. At the bottom of the Sainsbury’s carrier bag that held all his personal belongings was a “Do not resuscitate” form that had been filled in. In fact, I think it was what they call—again, euphemistically—a “respect form”. It had been countersigned by a doctor without any discussion with myself or my two brothers. As your Lordships know, none of us are shrinking violets. My brother is a decorated police officer and my other brother is a world-leading scientist and a professor of psychology. We are all quite smart people, but this form had been completed without any discussion with the family.

Indeed, it was alleged that my father had had capacity to sign that form and had agreed to it being countersigned by a doctor. That was a very significant development. I found myself having to front up a difficult conversation with the clinicians in accident and emergency and the geriatrician who was on duty that day. I thought to myself: what if my father had a learning disability? What if he could not read or write properly? What if he was anxious about dealing with bureaucracy and professional people? I thought about how much more difficult it would have been if he did not have a family: if he had not had three sons watching out for him and protecting his interests. How much difficulty would there have been in him challenging the professional bona fides and authority of a clinician—a medic who is well educated and articulate and knows their profession.

I posit that that is the reason we have spent so much time debating these issues. It is not for people such as my father, who, as I say, was terminally ill, but for the many people who have great difficulty: people who are already in a position where they are sad, lonely, depressed, bereft and distraught after a diagnosis of a terminal illness. Those people need assistance in primary legislation to protect their interests, because otherwise no one else will look out for them. That is not to say that those doctors were in breach of the Hippocratic oath, or that they were not compassionate, empathetic, caring and feeling for my father and many thousands of other people in similar situations, particularly old people. Nevertheless, they are busy and stressed and that form was filled in in good faith.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Cass and Lord Jackson of Peterborough

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Cass (CB)]

My Lords, I rise very briefly to draw attention to Amendment 928 in the name of my noble friend Lady Hollins, who cannot be in her place today. There are two ways of getting additional expertise: one is through consultation and the other is through having additional experts on the panel. Her amendment provides for having a safeguarding expert, a physician and a clinical psychologist on the panel, and she sets out the qualifications for each of those individuals. That would give a greater pool of expertise that could be selected from, appropriate to the needs of the particular person whose circumstances were being considered.

[Lord Jackson of Peterborough (Con)]

My Lords, I will focus my remarks on Amendment 462B, in my name, and support Amendments 463, 464 and 465, to which I have attached my name. Like my noble friend Lord Murray of Blidworth, this is the first opportunity I have had to contribute to this Committee’s deliberations and, like him, I last spoke on Second Reading.

The amendment requires a public notice to be issued 28 days before the panel intends to sit, which would enable members of the public to attend and potentially engage with the proceedings. I want to say in advance that this a probing amendment. I understand further work would need to be done, probably through regulations, to specify what any notice must entail and consider any further matters around privacy. I am open as to whether 28 days is the right notice period. Amendment 439, in the name of my noble friend Lady Maclean of Redditch, does a good job of addressing many of these concerns, in a way that aligns closely with existing practice directions in the Court of Protection.

However, those caveats aside, I trust that this amendment probes an important point. Schedule 2.6 states that:

“Panels are to determine referrals in public”,


but the public nature of the panel is surely illusory if interested parties are not notified that a panel hearing is taking place. How would anyone know when and where to turn up? I do not think we can gloss over this as a minor omission. Giving evidence to the House’s Select Committee, at page 143 the Law Society listed this issue among the things it is “really concerned about”. As it explains, it is unclear at the moment where the panels will be held and how people will know about them. That needs to be clarified and further information needs to be provided.

The point was also well made by the late Sir James Munby, the former president of the Family Division, whose comments continue to have an important influence on our deliberations. He described the Bill’s silence on a notification mechanism as “an astonishing omission”. He went on:

“Quite apart from all the other reasons why it might be thought desirable to make such provision in the Bill, the participation of others is necessary if the process is to have that degree of rigour which is essential if it is to be capable of identifying and preventing possible abuses, and in particular be adequate to detect what may be very subtle external pressures, and if it is to command public confidence”.


He was absolutely right. Supporters of the Bill have talked about how they intend this proposed law to bring end-of-life decisions “out of the shadows”. However, as drafted, the Bill provides for individuals to die in secrecy with the intentional assistance of the state. We cannot ignore the impact that this secrecy will have on the grief of families who hear that their loved one has died by assisted suicide only after the event, particularly if they possess relevant facts such as evidence of coercion or mental illness. The Committee may be aware of the tragic death last year of Maureen Slough from Cavan, Ireland. Her family reported their devastation at being informed of their mother’s assisted suicide via a WhatsApp message from a Swiss clinic. The same message also informed them that her ashes would arrive by post. The circumstances behind Ms Slough’s death were even more tragic. First, her brother, a UK solicitor, said Maureen had provided the clinic with “letters of complaint to medical authorities in Ireland in respect of bogus medical conditions” which the clinic allegedly used to support her application. Secondly, the clinic claimed to have received what appears to have been a forged letter from her daughter Megan, acknowledging her mother’s plans. These details, together with the fact that Ms Slough had long struggled with mental illness, suggest that there were potential red flags which may have been identified had the family been duly notified.

While supporters of the Bill may argue that the panel process is designed precisely to avert this kind of situation, I respectfully ask how we can be so sure. Remember that the panel operates on only a civil level of proof—in other words, on probability. To use an example from Ms Slough’s story, it is likely that the panel would have concluded, without hearing Megan’s claim that she did not write it, that the letter was more likely to be a forgery and so warrant further investigation. Perhaps so, but we cannot be sure and that is the problem.

We must also consider the importance of notification in light of the Bill providing no clear mechanism for families to intervene at a later stage once an eligibility certificate has been granted. To refer again to the late Sir James Munby, in his very eloquent words,

“the Amended Bill is entirely silent as to how the panel is to deal with the kind of issue exemplified by the Canadian case of AY v NB … where the patient’s partner intervened and obtained an interim injunction because of concerns about what was happening. What if the patient’s partner and relatives, excluded from participation in the panel process, discover, only after the panel has granted a certificate … facts of the kind which in AY v NB prompted an eleventh-hour intervention by the Canadian judge?”

This is a major hole in the Bill and, as it stands, if interested parties are to intervene, it must be at the panel stage and they must be informed of the panel meeting so that they can apply to submit evidence as necessary.

Finally, I want to address concerns that some noble Lords may have around the amendment’s requirement to publish the names of people referred to the panel and the potential impact this may have on privacy. I have thought long and hard about this. As I alluded to before, there is great merit in the proposal by my noble friend Lady Maclean in Amendment 439. However, one weakness is that it requires the commissioner to notify any other person properly interested in the welfare of the person. There is no clear way of establishing who they might be. How is the commissioner to know which friends to contact? One may just have vital information. Therefore, there is a benefit in requiring a more general notice.

I also observe that there are times where public interest is so great that it outweighs privacy concerns. Marriage, as a public institution, is a good example of this. I based the amendment on its notification requirements. In that context, the interest that we all have in defending that public institution means that a general notice is issued so that anyone can come forward with evidence of coercion or any other legal impediment. In considering public interest, we need to appreciate what is going on here.

In the words of my noble friend Lady May of Maidenhead at Second Reading, this Bill gives the state a licence to kill. Whatever our views on the subject, in handing the state this power there is surely great public interest in demanding maximum oversight and safeguards. The panel process should not be seen as totally analogous to the situation in the Court of Protection, where greater anonymity protections would normally apply. It is important to note that most cases in the Court of Protection involve patients who clearly lack capacity and have not consented to the process. Instead, cases usually involve best interest disputes between families and medics. However, in this process it is a basic requirement that the patient be able to consent.

In closing, I add this. Even if the House desires a more anonymised process, we need to debate the details of it. What restrictions would there be on media reporting? Who would determine the circumstances in which these restrictions apply? Perhaps the noble and learned Lord, the sponsor, can address these issues in his remarks. Without answers to these and other questions, the Bill risks the assisted suicide process being more shadowy and less transparent than would apply in cases in the Court of Protection. I do not think that this is acceptable.