Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Friday 16th January 2026 Lords Chamber

[Lord Blencathra (Con)]

I want to speak briefly in firm support of this suite of amendments, because they do not obstruct compassion but restore clarity and protect the vulnerable. As many noble Lords have said, the Bill leaves crucial decisions to discretion and delegated guidance. As my noble friend Lord Deben said, it is not precise.

Where I slightly disagree with my noble friend Lord Harper is that I am worried not about the judges moving the goalposts on the main Act of Parliament but because I believe that there will be more than 40 regulations, of which we have seen neither hide nor hare. We will not even see a draft before the Bill becomes law, and every single one of those regulations will be wide open to judicial review. That is where the judges will not have to move goalposts but have to fill in gaps on issues that neither House of Parliament has considered. They will have to decide whether the goalposts are for rugby or football, which neither House will have determined. I am deeply concerned that the Bill is not precise enough on the details that noble Lords have specified.

That imprecision leaves a big legal vacuum, where the most sensitive judgments about life and death can be initiated or driven by others, where serious mental illness can be overlooked and where people in care homes or in poverty can be pushed towards an irrevocable choice without robust, statutory safeguards. The amendments in this group are practical, proportionate and targeted fixes to those gaps.

First, the amendments make it clear that only the person themselves may initiate a request and that lasting powers of attorney cannot be used to start the process. That is essential, and I believe the noble and learned Lord, Lord Falconer of Thoroton, agrees. If he does, let us put it in the Bill. The law must not be ambiguous about agency of any sort. Where the law is silent, pressure and expediency will fill the silence. We have seen in other jurisdictions how a third party can accelerate a fatal outcome; the Bill must not replicate that risk.

Secondly, the amendments addressing severe mental health are not an attack on autonomy; they are recognition of clinical reality. A person can meet the narrow legal test of capacity while still having a treatable or episodic mental disorder that drives suicidal ideation. Excluding those with a history or pattern of suicidality from eligibility, or at least requiring a specialist psychiatric assessment, protects people whose wish to die is a symptom rather than a settled, autonomous decision.

Thirdly, the Bill must provide an independent, neutral route for information. Many doctors will rightly decline to participate. Patients must not be left to navigate a black box where the only signpost is a clinician who may be unwilling or conflicted. An independent local service or register would ensure that information was unbiased and accessible, and that the pathway into assessment was not covertly steered by those with other motives.

Fourthly, care home residents deserve heightened safeguards. Undiagnosed dementia and fluctuating capacity are common in residential settings. A single visiting doctor cannot reliably detect these risks in one brief encounter. Requiring a specialist assessment for care home residents is a modest, necessary step to prevent tragic mistakes.

These amendments would not create delay for those who are clearly eligible. They would create clear, statutory thresholds and processes so that clinicians, patients and families knew where they stood. They would reduce litigation risk, prevent inconsistent local practice, and ensure that the law aligned with the seriousness of the act that it permitted. If this House is to legislate for assisted dying, we must do so with precision. These amendments are not obstructionist; they are the scaffolding of a safe, humane system. I urge noble Lords to support them so that the Bill protects autonomy while safeguarding those most at risk of being failed by ambiguity, poverty or untreated mental illness.

I conclude in a more inadequate way than my noble friend Lord Deben did, on the point that he also made to the noble and learned Lord, Lord Falconer. If he cannot produce an assurance of amendments on the Bill that will implement some of the concerns of the royal colleges and of the three Select Committees of this House, some will be left with the impression that his strategy is not to accept amendments but to beg for more time and drive through the Bill, line by line unamended. That would be unacceptable. I hope that that is not the noble and learned Lord’s intention, but he could reassure us all by coming forward with revisions to the Bill and amendments that seek to implement the safeguards for which many organisations outside the House have been calling.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to three amendments in this group—Amendment 38, in the name of my noble friend Lady O’Loan, to which my name is attached, and Amendments 39 and 68. Amendment 38 seeks to address the challenges of those who have bipolar disorder, borderline personality disorder or other conditions associated with episodic suicide ideation, who face a higher baseline risk of self-harm and suicide. Research indicates that suicidal thoughts and behaviours are significantly more prevalent among people with these diagnoses, even without terminal illness, as reported by NICE in 2022 and Public Health England in 2021. Critically, evidence also shows that suicidal ideation tends to increase following a terminal diagnosis, so without the safeguard of this amendment, the Bill risks enabling assisted dying decisions to be influenced by pre-existing mental health vulnerabilities exacerbated by the receipt of a terminal diagnosis.

I support calls in the Chamber today to look at the benefits system. It is a really complicated process, whether you have a terminal diagnosis or not. It is important to learn from other jurisdictions. The 2024 Oregon official report cited that 9% of those who requested to end their lives did so for financial reasons and 42% requested it because they were felt a burden. I think it has already been quoted that in 2011, the noble and learned Lord, Lord Falconer, with the Demos report, said that no remedial mental health condition should be eligible for assisted suicide. I do not expect an answer in the Chamber on this question this afternoon because it might take a long time—I am very happy to meet outside—but I am interested to understand what has changed from his view in 2011 to thinking that this would work in the Bill now.

Many of the amendments talk about a settled wish. I could almost see how somebody could try to justify that, for someone with a terminal condition and suicide ideation, requesting assisted dying might be a form of suicide prevention. I feel like I am tying myself in knots with this argument, but I think when we hear the argument that people are already dying, we need protection for those groups of individuals. The noble Baroness, Lady Jay, who I do not think is in her place—I am sorry, I do not have my glasses on—raised evidence given in the Select Committee and talked about paternalism. My personal experience is that I do not see much paternalism in the health service. What I do see is an awful lot of ableism, and I think that if we are talking about paternalism, we should be talking about ableism as well. From a disabled person’s perspective, this recognises the intersection between disability, chronic illness and mental health vulnerability.

The panel has already been raised in the Chamber this afternoon. The panel is a really important part of the eligibility determination and deciding whether somebody can go forward. I think that one of the only things that the noble Lord, Lord Winston, and I could agree on today is that words are important. This relates to the place of the panel. I draw your Lordships’ attention to the clarification statement that was issued by the Association for Palliative Medicine this week. Because words are important, I am going to read it. It states:

“In Friday’s … debate (9/1/26), Lord Falconer cited, and misrepresented, expert evidence presented to the Terminals Ill Adults committee last year by the Association for Palliative Medicine … Crucially, panel members would not be required to meet the patient. They would, therefore, have no individual clinical perspective to bring to bear on the person applying for an assisted death. This renders the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.


This is why these amendments are even more important in terms of what we are trying to do.

I have previously discussed suicide among unpaid carers and the pressure on them. In Canada, there is a case of a man who had carer burnout and arranged for an urgent assessment for his wife. She died that day. That is listed in the Ontario coroner’s report. There is also written evidence to show that two men who had caring responsibilities for their partners ended up doing a mercy killing, which is often, strangely, very sympathetically portrayed in the media.

Amendment 39, in my name, is about recognising where an assisted death could take place and who will be most directly affected. The settings that could be affected include care homes or nursing homes—communities that care for those living with dementia, frailty, disability or advanced illness, where dependency is a condition of daily life rather than an exception.

It is important to recognise that a significant proportion of people living with dementia or cognitive impairment remain undiagnosed until the later stages of the disease. On average, people with dementia live with symptoms for three and a half years before receiving a diagnosis. Current NHS England and Alzheimer’s Society data show that only about two-thirds of those with dementia receive a formal diagnosis. The diagnosis rate in Wales is even lower. This further underscores the need for a specialist clinical assessment before any conclusion about capacity is reached. If one in three people with dementia are never diagnosed, one in three potential applicants under the Bill may have an unrecognised impairment in capacity. This is not a margin of error that any legislator can reasonably accept.

A recent report by the whistleblower charity Compassion in Care further illustrates the heightened vulnerability of care home residents. Based on evidence submitted by over 1,000 care workers who called the charity’s helpline to express their concerns about the Terminally Ill Adults (End of Life) Bill, the most predominant issue raised in 97% of cases was that of fluctuating capacity, which is common among those residing in care homes. The British Geriatrics Society, which gave evidence during the Select Committee, estimates the prevalence of delirium among care and nursing home residents to be as high as 60%.

Amendment 68 is about protecting autonomy. It would ensure that the right to request assistance to end one’s life remains solely with the individual who is terminally ill. It would prevent any surrogate, family member or medical professional making that decision on their behalf. By explicitly prohibiting third-party decisions, we safeguard vulnerable individuals from coercion or misinterpretation of their wishes.

Finally, I would like to ask the noble and learned Lord a few questions. How will he specifically seek to protect those who are in care homes or who may be vulnerable? How will the Bill protect those individuals who have had previous suicide ideation? Where does the Bill seek to understand the intersection of those with suicide ideation who then receive a terminal diagnosis and whether this is a genuine, settled wish? How, through the Bill, will we be able to offer protection to those who have a previous history of self-harm?

[Lord Empey (UUP)]

My Lords, following on from the proposal in Amendment 39, from the noble Baroness, Lady Grey-Thompson, one of the issues that perhaps is not fully appreciated or understood—it is only if you have actually witnessed it that you get the full implications—is delirium brought about by a combination of medications that are applied. One particular medication can clash with another and can produce a situation which appears almost like dementia, but the patient is not suffering from dementia but delirium. The noble Baroness, Lady Grey-Thompson, expressed that very well.

The noble Baroness, Lady Berger, spoke to Amendment 31. Again, it seems an elementary thing but, whether a person is sufficiently capable at the relevant point in time and is not suffering from delirium and/or dementia is best judged by the clinician who knows and works with the patient, rather than somebody with a white coat who is dashing in and out of a ward room and trying to assess the person on the hoof.

Like the noble Lord, Lord Deben, and others who spoke earlier, I do not like this Bill. However, as I said at Second Reading, like everybody else in this room I am a legislator. We have a role above and beyond our personal prejudices and beliefs.

I must say to the noble and learned Lord, Lord Falconer of Thoroton, that, as the noble Lord, Lord Deben, mentioned, a lot of issues have come up in the past few weeks. Last week, we had the series of amendments that were ably put forward by the noble Lord, Lord Carlile, which dealt with a very serious issue. The week before, we had five separate issues dealing with prisoners, pregnant women, et cetera, and we have had other issues. I know we are only part way through Committee, but if the noble and learned Lord wants the House to compress the process, rather than have to reiterate all this on Report, then I think it would make a difference to how people approach the rest of this legislation if he brought forward coherent amendments that address the issues that have been raised.

I do not mean to be unkind, but there is no point in him getting up every Friday like Stonewall Jackson and saying, basically, “I’m right and you’re wrong”. There is a difference of opinion—a chasm, in many respects—over a lot of these issues. To be brutal about it, we need to see the colour of his money. I hope that would allow us to go forward, but unless we deal with these fundamental, basic issues then we will have a very long slog indeed.

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[Lord Harper (Con)]

My Lords, I will touch on Amendments 30, 56 and 57, the latter two to which I have attached my name. Before I launch into my arguments, it is, if I may say so, a delight for me to see the noble Baroness, Lady Campbell of Surbiton, in her place after an unavoidable absence. She and I worked very closely when I was shadow Minister for Disabled People. I found her insight and lived experience, and her willingness to spend time with me on improving my knowledge of disability, extraordinarily helpful. I was grateful to her for the time that she was willing to spend. I am pleased to see her here in this important debate.

The latter contribution I thought was helpful. It goes to the heart of two issues: what the Bill is about and whether the promoters of the Bill are being entirely straightforward about what it is about. The Bill is called the Terminally Ill Adults (End of Life) Bill, and the primary requirement is that you have a terminal diagnosis. The arguments made for it are almost entirely around preventing people suffering or having physical pain. However, as has been pointed out, that is currently not anywhere a requirement in the legislation.

Sometimes supporters of the Bill do not make that argument. Instead, they focus on autonomy, as the noble Baroness, Lady Jay of Paddington, did this morning, or on choice, as the noble and learned Lord, Lord Falconer, did in response to my challenging him on someone’s financial circumstances. We should be very straightforward. If the promoters of this Bill are arguing that it is entirely about somebody’s choice, they should be very straightforward about it. They should not argue that people have to be suffering and that this is about relieving it—which, as my noble friend Lady Fox said, is what compassionate and kind people think is the motivation for this legislation. If they think it should be open to anybody regardless of motivation, they should say so. It is very helpful when some of them are prepared to say that, because it makes what this is about more straightforward.

This goes to the heart of why many of us have concerns. We know this will get challenged in the courts and be expanded, because that has happened everywhere else. As I said earlier, the Minister keeps telling us about the human rights provisions. They will absolutely be used, if not to change what is in the Bill, to widen and challenge the regulations made under it. That is why so many of us want more safeguards on the face of it and not left to statutory instruments, which we know judges are very happy to change and strike down.

It will get expanded, so the proposed new clauses we have put down about the motivations are important. If it is about choice, it has to be a real choice. For people to have genuine choices, they cannot be forced by circumstance into making them. I was exercised with the noble and learned Lord, Lord Falconer, earlier because somebody might have enormous pressures on them—financial, housing, feeling like a burden or, as others have said, wishing financial resources to go their families. Some think those are perfectly fine reasons for somebody to have an assisted suicide. I do not, and I think most members of the public do not think those are reasons for somebody to kill themselves or seek to have others help kill them. We should just be honest about it. If noble Lords think that is fine, they should say so and we will see whether that argument carries water.

People are not making that argument; it is about whether you are suffering. If noble Lords think that is the critical matter, they should put it in the Bill and make it so that you can get assistance with your suicide only if you are suffering and in pain, and that is the reason for your seeking this course of action. If it is one of the other things, we should rule it out. If you are not prepared to rule it out, it becomes clearer what this is really about.

That goes to the point made by my noble friend Lord Shinkwin and why so many of us have concerns. The remarks I made at Second Reading are absolutely highlighted by these amendments. Not a single organisation of or for disabled people supports this legislation, because they are concerned about two things. As my noble friend said, they are concerned that, because so many disabled people are made to feel that they are a burden or, because of the costs of their disability, have financial or housing pressures that others do not have, they will feel forced into seeking an assisted suicide when that is not really what they want. Secondly, they are concerned that, if society decides that it is okay for you to get help in ending your life because you feel you are a burden or do not want to cause problems for other people, that fundamentally changes how society treats and looks after disabled people. Instead of wanting them to live well and have great lives, and being prepared to find the resources for them to do so, we would rather they were not here. That is the message they are getting.

These groups of amendments make it very clear that this legislation is about alleviating suffering and pain; it is not about the other things. That is why I strongly support these amendments and I hope that, in his response, the noble and learned Lord, Lord Falconer, will recognise that those are the reasons why so many people take a different view from him, If he limited the provisions of the Bill to people who are in pain or suffering, it would reassure the many disabled people in this country who are terrified that the passage of this legislation will fundamentally alter their lives for the worse.

[Baroness Grey-Thompson (CB)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Harper; when he was a Minister, we had many interesting discussions, although they were possibly not as collaborative as those with my noble friend Lady Campbell. This group talks about motivation and I am sure we are going to be told that these people have terminal conditions and they are dying anyway. We have to understand, however, that there may be a number of other motivations that are part of this.

The noble Lord, Lord Harper, as a non-disabled person—I assume—highlighted many of the reasons why disabled people are very worried about this Bill. We look at what happens in other jurisdictions around the world, including Oregon, Washington, Belgium and Holland. Australia is one of the newer jurisdictions, having recently changed the law, and it has surprisingly high figures on the number of people who request assisted dying because they feel they are a burden. In western Australia in 2022-23, 35.3% of people who requested an assisted death did so because they felt they were a burden. In 2023-24, that figure was 32.2%.

We have to understand that, unfortunately, in the UK currently, the health and social care system is broken for many people. The fact that a person might not be able to get good social care, a job or access to work could add layer on layer to a reason why someone might request an assisted death.

I am told that it is not for disabled people, and I am not suggesting we draw up a list of every single condition of people who would qualify or not. I have spoken many times in the Chamber about how people assumed I would want to change the law because someone with my condition would probably rather be dead than alive. My condition is spina bifida. I assume that I would not be eligible for an assisted death because of that, but, if I got a pressure sore, I would very easily and quickly fit it into that six-month diagnosis.

I have lost many friends through pressure sores, one of whom I was in school with. She also had spina bifida and had a pressure sore on the base of her spine, and one problem with it developing so rapidly was that she did not feel it: she was paralysed and did not realise she had it. It was discovered by the smell. As soon as it was discovered, a number of people around suddenly started talking very differently about that young woman’s life: about how, basically, she would be better off dead, because it was never going to heal.

This is why disabled people are so fearful. If the law changes, it does not matter whether there is one doctor or two in the assessment process—which I do not believe is anywhere near strong enough currently. There will always be ableist doctors out there who would very quickly think and agree that we would be better off not being around.

Let us look at other jurisdictions and the number of people there who choose to end their lives. When I talk to people outside, they assume we are talking about cancer and leukaemia, not lots of other conditions. But in Belgium, for example, the official figures from last year show that 54% of people who requested an assisted death had cancer; 26.8%, however, had polypathology. Now, I am not a medic, so that sounds like an interesting combination of conditions. Actually, though, what is included in those figures is being tired of life.

This comes back to the debate we had in the previous group about the equality impact assessment. That is based on the first 10 years of Oregon, where the numbers were very low because there was no social media and people did not know about it. This provides more evidence of why the Government need to reconsider looking at the impact assessment to actually understand the numbers that might be involved. The noble Lord, Lord Harper, is absolutely right: we need to be honest about what we are doing here, not wrapping it up in euphemisms and easy soundbites. I have said consistently that, when you do an interview about the Bill, it is not easy to lay down every single reason in four minutes as to why a number of people have many concerns with the Bill.

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[Lord Falconer of Thoroton (Lab)]

I hope I have been clear about not liking the amendments as they are and that I am keen to see whether what the noble Baronesses, Lady Smith of Newnham and Lady Fox, said can be incorporated somewhere in the Bill. It may well connect with things we have said already. I hope I have made my position clear.

[Baroness Grey-Thompson (CB)]

My Lords, I feel a sense of disquiet listening to the noble and learned Lord’s response, especially when he talked about privilege. I have a huge amount of privilege in my life. If I need a new wheelchair, I can buy one. I can put a lift in my house. I can buy a car and pay for the hand controls. When I need a van with a tail lift, I can pay for that. Is he really saying that lack of privilege plays no part in somebody choosing to end their life?

[Lord Falconer of Thoroton (Lab)]

I am saying that everybody should have the choice. The way that one makes the choice is inevitably determined by how one got to the point where one had to make it. It is an impossible question. Why do we all make choices? They are all affected. Some people make them because they are richer or poorer than others, but I am not in favour of drawing financial distinctions. I hope that, in the light of my remarks, the noble Baroness— I cannot remember who started this—will withdraw her amendment.

--- Later in debate ---

[Lord Gove (Con)]

My Lords, I will take just a minute or two. Words matter. In America, in legislation similar to that which we are entertaining, it is known as “medically assisted suicide”. Similar terminology is used in Switzerland. Those are both jurisdictions that have informed this debate. Recently, in the British Medical Journal, a physician who works in Scotland made this compelling point:

“The phrase ‘assisted dying’ creates confusion and is poorly understood … just 43% of respondents”


in opinion polling

“thought ‘assisted dying’ involved the provision of lethal drugs to end somebody’s life”.

Fewer than half of the public understood what was meant by this legislation. He went on:

“The majority believed the term meant withdrawing life-prolonging treatment or providing hospice-type care”.


If so many of the public have the wrong view of this legislation, how can it possibly not be of assistance for us to use plain language on a matter of such moment?

[Baroness Grey-Thompson (CB)]

My Lords—

[Noble Lords]

Front Bench!

[Lord Kennedy of Southwark (Lab Co-op)]

As I said earlier, it is absolutely fine to break mid-group on these amendments.

[Baroness Grey-Thompson (CB)]

My Lords, thank you. If there is one place where language matters, it is in the Bill before us. As a young disabled person, I used to interchangeably use “person with a disability” and “disabled person” and did not understand the importance of that. In later amendments, I will argue that “disabled person” is much better phraseology to use.

Language is the dress of thought. We are all spending many hours working on this Bill, but, if the outside world does not understand what is meant by “assisted dying”, we could be in a situation where somebody with learning disabilities or who uses British Sign Language, who has not spent as much time as we have interrogating the Bill in every single session, might not understand what they are signing up to. Personally, I would prefer something around “died by suicide”—that is something else that can be finessed as we go through the Bill.

The BMJ published an article that showed how poorly understood the phrase “assisted dying” was. This highlights the problem that we are facing: the phrase is poorly understood and creates confusion. Just 43% of respondents thought that “assisted dying” involved

“the provision of lethal drugs to end somebody’s life. The majority believed the term meant withdrawing life-prolonging treatment or providing hospice-type care”.

That is something we must consider. The noble Lord, Lord Winston, talked about how the Bill should be largely workable. It should be workable, but it should also be safe. Part of that safety is about the public understanding what they might be signing up to.

In other groups, we have talked about doctors and medics, and I have many in my family. There is nothing more medic-like than using very long words and things that the public do not necessarily understand. Not everybody is an expert patient. We must be clear about what we mean in the Bill. We should stop hiding behind phrases that people may choose to use. To be clear, I have used the term “assisted dying”, because I try to be very thoughtful of the people who do not like “assisted suicide”. However, I have used “assisted suicide” today, and I will from now on, because that is what the Bill is going to do to the people who sign up to it.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I will speak, given that we are going to continue until 5.30 pm and the noble Baroness, Lady Fox, has mentioned me. The problem with removing the word “dying” is that it does not give to the public the absolutely key bit of information, which is that these people are dying anyway. We are talking only about people who are dying. That is what the Bill is about: people who have less than six months to live. They are dying. We may have a theological belief that we are all dying, and that each day we get nearer to that, but let us put that to one side.

The removal of the word “dying” would be the worst way to tell people what this Bill is about. The Bill is not about assisted suicide for someone who just decides that they want to commit suicide or have a suicide death—I do not like the word “commit”. It is not about people who suddenly say that they want to commit suicide because of this, that or the other. We are talking only about a cohort of people who are dying; remove that from the Bill and it is less likely to be understood.

Rare Cancers Bill

Baroness Grey-Thompson Excerpts

Friday 16th January 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I thank the noble Baroness, Lady Elliott of Whitburn Bay, for bringing this Bill to the Chamber today and I pay tribute to two Members who are no longer with us, Baroness McDonagh and Baroness Jowell, who both had a huge impact on my career.

For about the last year, I have been working with Ceri and Frances Menai-Davis and their campaign to highlight the challenges that face families who have a terminally ill child. Their website, It’s Never You, clearly highlights many of the issues. Their son Hugh had rhabdomyosarcoma, a rare cancer affecting muscles attached to bone, which spread throughout his abdomen. He was diagnosed in late 2020 and passed away in September 2021 at the age of six, after undergoing intensive treatment including radiotherapy. His parents described receiving the diagnosis and the trauma they experienced as being thrown into an ice bath with a concrete weight tied around your feet. Through my work with them, I have an amendment to the Children’s Wellbeing and Schools Bill, which may be debated on Monday, asking for more research to find the true extent and impact that rare cancers have on families and seeking to require the Secretary of State to report to Parliament on the barriers preventing parents being at the bedside of critically ill children.

The Journal of Pediatric Psychology and the Lancet Psychiatry have said that 30% to 50% of parents with critically ill children meet the diagnostic threshold for PTSD. The BMJ Open has said that parents are more likely to experience anxiety, depression and suicidal thoughts, and mothers have a 50% increase in mortality. While there is no current target for research or funding allocation to be spent on paediatric cancer research, it appears that only 3% of current national spend is put into this area because it is rare, but we have heard in your Lordships’ Chamber today that these cancers are far from rare. We have to look beyond seeing it as a market to see how we can truly help people. I would like to see a minimum annual research target being set for rare childhood cancers, and progress being published.

I strongly support this Bill, especially the creation of a national speciality lead, and I hope we can do that at pace. The impact of the Bill will be felt by so many, not just those with a cancer diagnosis but their families as well. We have heard that a number of organisations support the Bill. Cancer Research UK and others have highlighted how many fewer treatment options there are for those with rare cancers. Also, brain cancer patients have been in touch with me to say that they need far more support. This week Ceri and Frances Menai-Davis hosted an event in Parliament, and they now campaign under the banner Parents Deserve Better. Yes, they do, and this Bill will help with that.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.

[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendment 21, tabled in my name, from personal experience. The richness of the debate today shows that, even in your Lordships’ Chamber, we all have completely different experiences of how we access a GP practice.

I tabled this amendment partly from personal experience, trying to look at how we provide continuous care to a patient. As for my own experience, I am disabled, not sick, but I have had some very interesting experiences of interacting with doctors. Fairly recently, I was asked by a doctor how I caught spina bifida and had to explain to him that it was congenital. As for my husband’s experience of the healthcare system, he had a spinal cord injury in 1984 and, at a recent visit, was continually asked whether it was in 1884 that he had his accident—I know he looks good for his age, but not that good. This is not to be flippant, which I have been accused of before. It is actually to try to ensure that we have proper continuity of care for a person who wishes to end their life.

My amendment is also grounded in coercion detection and the limitations of any capacity assessment. When I tabled it, I was thinking that perhaps a GP could provide extra knowledge to contribute to the decision that was made. But then I heard of the experience of my noble friend Lady Falkner, which is absolutely appalling. It shows that there is far more work we need to do, not just on the National Health Service but on making sure we provide the right care. The noble Lord, Lord Deben, talked about the NHS we wish to have. Well, this might be a chance to think about the NHS we wish to have.

I take this opportunity to welcome my new noble friend Lady Gerada and the experience she brings to the Chamber. I have to say that it has left me slightly more confused. I have amendments on data recording, which we will be debating later. Her comments show that data recording and sharing is really important. The part I got a bit confused about was that, if there is a named clinician as part of that process, does that not ultimately feed in to the points that have been made today? I would welcome the chance to discuss that with her outside the Chamber.

Continuity of care is really important, and how it relates to improved patient outcomes. In 2012, 56.7% of patients had a preferred GP, but that is declining. There is a link between your preferred GP and being able to access that GP. The decline has happened regardless of baseline continuity, rural or urban location or level of deprivation. Providing a better experience to patients will make those final weeks and months better for them. The Royal College of General Practitioners published excellent work in 2021 on why the patient’s relationship with their general practitioner is so important. Research on coercion and undue influence demonstrates that standard capacity assessments, while necessary, are not currently sufficient to identify subtle forms of coercion. That is why I tabled an amendment.

In response to the comments of my noble friend Lord Pannick, about what happens if a GP dies, I am happy to be corrected, but I thought the provision in the Bill about your doctor dying would cover a general practitioner as well as any other doctor involved in the process.

What we are talking about here are really complex decisions. Consulting an established GP or GP practice might mean that they possess the nuanced knowledge which would help somebody make a choice. The requirement that GPs confirm that they have a good understanding of the individual’s personal circumstances represents, to me, a better form of safeguard, ensuring that this knowledge actually exists. We cannot assume anything during this process. The assessment should provide abuse detection capacity unavailable in other types of consultations. For individuals whose care is family dependent, the home visit element—which I had, not so long ago—can play an important part in identifying coercion. If the debate has raised nothing else today, it is that this is a really complicated issue which needs much further work.

[Lord Markham (Con)]

My Lords, perhaps I may just ask a question on that. Everyone believes a GP should be able to conscientiously object. But, in all of this, I have not heard an answer to what happens in that circumstance. Surely, we need a circumstance, as happens today, involving a team-based approach, as the noble Baroness, Lady Gerada, said. Otherwise, you could have formed a great relationship with a GP who then conscientiously objects—which we think is absolutely suitable—withdraws himself or herself from the situation and can no longer take part in it. Surely a team-based approach is the better approach.

[Baroness Grey-Thompson (CB)]

The comments made by my noble friend Lady Gerada explaining the team-based approach seem very sensible in terms of providing that continuity of care. I am very lucky that I see the same GP every time I go; it is interesting to understand that not everybody experiences that. I am not absolutely welded to it being a single GP. For me, it is about ensuring that we have continuity of care and the right support for an individual, and doing it in the right way that enables them to make the best choice, while not experiencing any coercion in making that decision. The more frequent contact means that a GP or a practice may be able to understand some of the really difficult family complications that we absolutely know go on.

Many noble colleagues who worked on the then Domestic Abuse Bill will see that coercion can be very subtle and understated and happens in numerous different ways. We have a duty to make this Bill the safest Bill in the world. The noble and learned Lord will say that it is. We slightly disagree on it being the safest Bill in the world, but we have a duty to make it safer.

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Moved by

[Baroness Grey-Thompson]

22: Clause 1, page 1, line 12, at end insert—
“(e) is not a serving prisoner, and(f) is not detained by a hospital order,”

[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendments 22, 24, 30C, 308, 347 and 458. I tabled these amendments after looking at data from other jurisdictions and listening to debates in another place. These amendments are probing. I want to be clear that they are here to invite debate not on the death penalty, abortion rights or who can become pregnant but merely on the groups and how they are impacted by the Bill.

With regard to my amendments on prisoners, those on remand and defendants on bail, there could be seen to be a conflict between prisoners’ rights to autonomy and the state’s duty to administer punishment. I was privileged to visit a young offender institution recently with the Duke of Edinburgh’s Award, which I chair. It is always very interesting to visit prisoners in young offender institutions and see the life that they live. UK staff are trained to spot prisoners who are at risk of bullying, suicide or self-harm. But I would like to understand—including in the context of what the right reverend Prelate the Bishop of Gloucester raised about prisoners’ access to primary care—how this would work in practice and which doctors would be allowed to have a conversation with prisoners.

Those deprived of liberty can be very vulnerable and prone to suicide. As we have heard, they could also experience a lack of care and palliative care. Yoann Della Croce argues that while prisoners in Switzerland should have the same level of care as the general population, assisted dying is a liberty that should not be extended to prisoners.

There are many international examples. Peter Vogt, a prisoner with kidney and heart disease in Switzerland, applied for euthanasia in 2023 due to physical and mental suffering, citing a life of “vegetating behind walls”. As of August 2020, three prisoners in Canadian federal prisons had received MAID. The process for these cases is complex, involving unique barriers such as bureaucratic hurdles and concerns about voluntariness and confidentiality in correctional settings.

This issue is not without controversy. Quadriplegic Marin Eugen Sabau requested euthanasia in 2022 after being shot and paralysed by police while being arrested. Due to the Spanish Government’s wording of the assistive Bill around incurable and unbearable permanent conditions, he was successful in requesting euthanasia. After initiating procedures in July 2022, and approval by the guarantee and evaluation commission of Catalonia, the process was suspended as a result of private and public prosecutors filing several appeals. Despite this, these were dismissed and the man’s euthanasia was carried out a month later.

In Belgium, Frank Van Den Bleeken asked for approval for euthanasia. It was initially granted, but the decision was later reversed. Similarly, in 2018, a Swiss inmate made a request to die through the EXIT society, because of an incurable lung disease and mental illness, arguing that refusing him access to assistance constituted psychological torture.

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[Baroness Grey-Thompson (CB)]

My Lords, I thank all noble Lords for this thoughtful and considered debate. As ever in your Lordships’ Chamber, the debate did not go quite the way I was expecting. This has been quite a catch-all group trying to cover a number of very complicated issues. I thank the noble Lord, Lord Kamall, for summing up. I will not seek to sum up all the contributions, but I will pick up a few points.

The noble Baroness, Lady Berridge, asked me about pregnancy. There is very little data on the numbers and one of the challenges is that recording and reporting are very different in different jurisdictions. In somewhere such as Oregon, where the data is destroyed a year after death, it is hard to follow up and interrogate the information. Many jurisdictions around the world do not require a pregnancy test, but that puts a lot more pressure on doctors as it is then up to them to assume or guess whether or not a woman is pregnant. Whether she is showing or not, do they accept the request for assisted dying? It is really worrying for those doctors, because if it is later found out that the woman was pregnant in jurisdictions where there is a penalty for the doctors, they might find themselves less likely to want to carry out an assisted death.

[Lord Winston (Lab)]

Does the noble Baroness not accept that there are certain cancers that will give a positive pregnancy test and also be killing the patient, in a very serious condition?

[Baroness Grey-Thompson (CB)]

I thank the noble Lord; I will cover that later in my summing up, if that is okay, but I will come to back it. What happens in other jurisdictions makes it really difficult for doctors, which means that we need clarity in this Bill about what would happen in those situations.

Many noble Lords discussed the vulnerability of prisoners. This debate has shown that it is not that simple. I have visited many prisons and young offender institutions over the years and they are all very different places. I have met many people who have hope and some who do not. The noble Lord, Lord Deben, articulated my thoughts on the circumstances in which prisoners find themselves very well.

I debated long and hard whether to use this example. The noble Lord, Lord Farmer, talked about moral hazard. There is the case in Australia of Daniel Hume, who was six years into a 30-year sentence for paedophilia. He had a terminal condition and exercised his right to die. His daughter said that she and other victims felt robbed by him being able to access assisted dying. This highlights the complexity of the issues we are dealing with. I hope I am a kind person—I believe in rehabilitation for prisoners—but these are not easy things that we are trying to sort out or get to the bottom of. I have very complicated views on all these issues, as I know many noble Lords do. It is absolutely something that we have to come back to.

I was probably expecting the answer from the Minister on Articles 8 and 14. I am not convinced that we have Article 2 quite right. I thank the noble Lord, Lord Winston, for his intervention and I would be very happy to take his advice. I tried to keep my opening speech very close to 10 minutes, rather than the 15 minutes I am allowed, so there are lots of areas I was unable to discuss in my opening speech. I accept what the noble Lord said—he has far more experience of pregnancy than I do—but that just throws another complication into the mix in respect of what we are trying to sort out. I will welcome his advice on rewording my amendments, should I choose to come back with them.

I would like to thank the noble and learned Lord, as well as the honourable Member for Batley and Spen, who I am meeting next week to discuss some of my amendments. I hope that we can get a bit more clarity in that meeting on the amendments we are discussing. I thank the noble Lord, Lord Mackinlay, for his intervention. I think there is a line—I am sorry, I am jumping back to pregnancy—when it comes to what we do and at what point we do it. I believe that the noble and learned Lord and I have agreed to disagree on the safeguards in the Bill.

I would like to make a correction. I am serious about my amendments, although I could have worded them better. I did not intend for men to have a pregnancy test, and I did not intend to get into a debate about age and the pregnancy test. The reason why I tabled the amendment on a pregnancy test was to allow women to understand all the implications of what they are getting into and to be able to make a choice. They may or may not choose to do something differently with that information.

I thank all noble Lords who have contributed to the debate this afternoon. With that in mind, I beg leave to withdraw my amendment.

Amendment 22 withdrawn.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, my Amendment 420 could sit beside Amendment 419 from my noble and learned friend Lord Falconer, but it has not been put in this group. This group is labelled “drafting changes” but, as we have just heard, the effect they would have goes further than that. I have tabled Amendment 420, to be discussed in a later group, to address a concern that the grounds on which a co-ordinating doctor can drop out are already too wide, but I see that the amendments in this group from my noble and learned friend Lord Falconer compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later, because your Lordships’ Committee needs to be aware of the concern I am seeking to raise, which the noble Baroness, Lady Coffey, also has.

My Amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be acceptable for the state not to be concerned that the doctor is unwilling. As the noble Baroness, Lady Coffey, has highlighted in her Amendment 420A, the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the co-ordinating doctor by excluding the word “unwilling”, which Amendments 420 and 420A both address.

It would be helpful if my noble and learned friend Lord Falconer could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience and one who is unwilling due to suspicion? Without a requirement to record the specific reasons for unwillingness, is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member’s influence, surely the system needs to capture that specific hesitation before a new doctor is appointed. Will my noble and learned friend Lord Falconer specify what circumstances cross the line where the state should be more curious about why the doctor is unwilling?

[Baroness Grey-Thompson (CB)]

My Lords, I originally requested that later amendments that I have on disability language, as defined under the Equality Act, be moved into this group, but they were not. I think it is important that we have a chance to debate them as well. Language is the dress of thought, and “person with a disability” is not language that is used in the Equality Act. However, if the noble Baroness, Lady Coffey, seemed to misunderstand these amendments, I think I have misunderstood them as well.

I am particularly concerned about Amendments 290, 366 and 931 around domestic abuse and coercive control, which I have spoken about in other debates. I believe that these amendments go beyond mere drafting changes. The wording as it now exists waters down what the training around domestic abuse is likely to be. For example, it could be a course on physical or sexual abuse, but that does not necessarily mean that it is as comprehensive as I believe it needs to be. I am conscious of time, but I would be interested to know whether the noble and learned Lord or the sponsor in another place, the honourable Member for Spen Valley, has spoken to the honourable Member for Lowestoft, Jess Asato, about the impact of these amendments on her work. It important that we understand the context of what we thought was coming from the Commons and what these changes might mean to the Bill.

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[Lord Falconer of Thoroton (Lab)]

I do not need to withdraw the amendment, because if the noble Lord objects to it, I will not press it in Committee. It depends on what we get to when we get to Report. What I am saying is that, at the moment, I cannot see the difference. I am more than happy to talk to him before Report. If there are valid points, let us put them in. However, at the moment, it looks to me to offer just as good, if not better, protection.

[Baroness Grey-Thompson (CB)]

I would not be able to accept the amendment as tabled because I have numerous other amendments on disability, language, BSL, different levels of interpretation and Makaton that are all important when having these conversations. Following the offer that the noble and learned Lord made to the noble Lord, Lord Shinkwin, I would be delighted to join the meeting as well, to see how the noble and learned Lord’s amendments can be improved to move further down the road. What we are trying to do is to make sure that people go into this decision-making process clearly understanding the decision they are taking.

[Baroness Hollins (CB)]

If such a meeting were to take place, I would be delighted to ask the noble and learned Lord to consider the alternative wording I proposed when I spoke to the amendment.

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[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

My Lords, while we are on the subject of interventions, I remind the Committee that a Member who is speaking may be interrupted with a brief question of clarification. A Member may justifiably refuse to give way. Let us try to stick to the people who have their names on the amendments and make progress.

[Baroness Grey-Thompson (CB)]

My Lords, my Amendments 13 and 309 are probing amendments. I recognise that the 60 months and the 12 months in my two amendments do not quite tally, but they were tabled at quite different times.

Amendment 309 is quite simple. It looks to open a discussion and seeks to protect asylum seekers, immigrants without indefinite leave to remain, and anyone in the asylum system.

On Amendment 13, it was very interesting to listen to the noble Lord, Lord Lansley. I recognise that 60 months will have raised some eyebrows. It was my clumsy attempt to talk about death tourism and look at how we can provide consistency within the Bill. One of the reasons that we are consistently given for needing the Bill is that those who can afford it can go to Dignitas, which promotes inequality. However, if we do not get this section of the Bill right, that inequality will still exist.

My noble friend Lady Finlay raised some important points on where someone is able to die, and I have other amendments on certification of those areas. This needs more thought because, in many of the letters I receive, individuals who want the law to change talk about wanting to end their lives at a time and place of their choosing. They may get roughly the time that they want, but they may not get the place.

We have been talking about people living in different countries. The latest statistic that I can find online is that at any one point there are between 4.5 million and 5.5 million British people living abroad, and they need clarification about how the Bill could affect them.

I am concerned about the possibility of different processes existing in different parts of the UK and the Crown dependencies, because it could be possible that, if you have money, you could purchase or rent a small property in another jurisdiction to enable you to access this. That might be totally fine, but people need to understand what this is going to bring, and that inequality could still exist.

The phenomenon of death tourism represents a documented concern internationally. The Isle of Man explicitly incorporated a five-year residency requirement into its assisted dying legislation, following recommendations from scrutiny committees examining the Bill’s clauses. That is why I picked 60 months. However, we have to be careful that we are not turning jurisdictions into destinations for accessing end-of-life services. Such relocation could create several problems. It might indicate that the person’s wish to die is not deeply rooted in their established community context. It could create practical and ethical difficulties for healthcare systems, which are unprepared to provide end of life to transient populations. It also raises questions about whether individuals are making decisions in isolation from their established support networks.

Whatever we end up with in terms of what residency looks like, we have to take into account what has happened in other jurisdictions. I was pleased that the noble and learned Lord said in the previous debate that in the Bill the age will not drop below 18. It is important that we get the residency right, because in other jurisdictions over time it has changed. In 2014, Belgium removed any age restriction and Vermont lifted its residency requirements in May 2023. At least 26 people have travelled to Vermont to die who were not resident there. Vermont is a tiny US state, but that represented nearly 25% of reported assisted deaths in the state from May 2023 through to June 2024, as listed in Vermont Department of Health data.

In Oregon, the same thing has happened: the residency requirement has been lifted, and around 6% of those choosing to end their lives in Oregon have been from out of state, according to official Oregon Health Authority reports. The oncologist Charles Blanke, whose clinic in Portland is devoted to end-of-life care, has said Oregon’s total is likely an undercount and he expects the numbers to grow.

Adequate residency duration enables meaningful healthcare relationships to develop, and I have amendments on relationships with GPs in a later group. For me, it is about providing appropriate healthcare and the right information. It is about being able to look at patterns of depression, changing wishes, family dynamics and coercion, which we have already debated. It is about providing stability and the authenticity of the person’s desire for assisted dying. It is also about whether the correct palliative and psychosocial support is there.

I do not think 60 months is the right number, but we have to be careful and clear about what will happen in terms of people being able to access this service. Finally, longitudinal research on end-of-life preferences demonstrates significant variability in expressed wishes over time. That is why we have to be really clear that we get this right.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Lord for the intervention but, if he will permit me, I would like to finish. We can imagine many different sorts of conversation. If noble Lords would like to hear more examples, I am sure they will ask for them.

None of these possibilities is ruled out by the Bill as it stands. They would not be considered an instance of coercion or pressure. Nor will it be possible when this Bill becomes law to investigate with due legal process whether someone has been instrumental in inducing a person to assisted suicide, provided they are covered by the terms of the Bill. Clause 34 outlaws dishonesty, coercion and pressure, and Clause 35 the destruction of documentation or the falsification of what purports to be a declaration, but the Bill does not address other means of inducing someone to opt for assisted dying. Under Clause 32, criminal liability for providing assistance will be removed from the Suicide Act 1961; as will civil liability under Clause 33, which stipulates that

“providing assistance to a person to end their own life in accordance with this Act”

or assisting a person to end their life while performing a function under the Act does not of itself give rise to any civil liability.

Moreover, the Coroners and Justice Act 2009—the duty to investigate certain deaths—will be amended so that the reference to unnatural deaths does not include a death caused by the self-administration by the deceased of an approved substance within the meaning of this Bill. Similar changes will be made in respect of arrangements for medical certificates under the new regulations and for Schedule 1 on suspension of investigations. These changes mean that there will be no effective way of investigating improper behaviour after an assisted death has taken place. The Bill already, in effect, recognises this problem by making absence of coercion and pressure a condition for eligibility for someone to be given assistance to die under its provisions. It opens the possibility to object to an assisted suicide going forward on the grounds that the person about to die has been coerced or pressured.

Furthermore, Clause 10(2) gives the first doctor—the co-ordinating doctor—the duty of ascertaining that the person concerned has not been coerced or pressured. We have heard from the noble Baroness, Lady Finlay, and others who have great professional experience in looking after people with terminal and other grave illnesses how difficult it is to establish coercion. It is often very difficult to establish coercion. It is true that the Bill wants to establish coercion—or so it alleges—but, as has been argued, the grounds are too narrowly defined.

A person in a poor mental state, because of their terminal diagnosis, is especially likely to be open to suggestions from other people, especially figures of authority such as their doctor, or their own family, whom they want to believe are thinking only of them. If we want to be sure that the decision to have assistance to die is genuinely their own, it is not enough just to rule out coercion or pressure. We need also to outlaw subtler, more insidious, but no less effective forms of persuasion. There is a danger that, if the Bill includes, as it does now, just a prohibition on coercion and pressure, the inference will be drawn that any form of encouragement or inducement, so long as it is not coercion or pressure, is allowed. Surely that is not what the proponents of the Bill would want.

The noble and learned Lord the sponsor and his co-sponsor are putting forward the Bill under the banner of giving dying people more choice over what happens to them, and providing greater freedom. Surely, in pure consistency with this underlying purpose, they must be intent on ensuring that the irrevocable choice a person makes to undergo assisted suicide is genuinely that person’s free choice, and therefore must support the amendment I am proposing, and indeed the amendments that others are proposing.

I hope that we can go even further. If my amendment is adopted, a further provision could be added to Clause 10(2), making it the duty of the co-ordinating doctor to ascertain not just that there was not coercion or pressure but that the idea of assisted suicide was not suggested to the person by another party.

[Baroness Grey-Thompson (CB)]

My Lords, I have three amendments in this group—Amendments 52, 58 and 181—which seek to explore coercion and ensure that people are free from undue influence, including social, economic and care-related pressures—not only active coercion, which is very difficult to prove. These amendments also seek to understand the reasons why someone would choose to end their life, so that we can look at how we might improve further NHS services or use that in important debates on reforming the welfare system.

It was raised on the first day in Committee that definition is important, and I believe that much further work needs to be done on the definition of “pressure” and how it becomes a strict liability. However, we find that it is very hard to gather data. We have been told that there is no evidence of coercion in other countries, but Ellen Wiebe et al, in a paper on the reasons why people request assisted dying, highlighted some of these very important issues.

In 2018, Dr Wiebe’s team looked at 250 deaths in Canada and noted that data was collected differently across different jurisdictions. Of the 250 deaths, six charts had no reasons; 56 gave one reason; some of the charts gave three or four reasons, but only two reasons were coded. This does not show the whole picture of why people are choosing to end their life on top of having a terminal condition. Looking to other jurisdictions, in Belgium, legal requirements were more frequently not met in unreported cases of assisted dying than in reported cases, and we still do not really know how it is practised. In Oregon, the data and the records are destroyed a year after someone has died.

Admitting coercion is highly unlikely to occur, so that is why we need a robust process of identifying it so that it can be acted upon. I look forward to debates in other groups on the role of the coroner in this. It is hard to find studies on coercion—I spent a lot of time trying—but it is possible to find a huge number of individual cases. In Canada, Lisa Feldstein was with a patient when the patient was pushed towards assisted dying. The person who suggested it did not realise that Ms Feldstein was a lawyer. Heather Hancock, a woman with cerebral palsy, was told by medical professionals while she was in hospital that she was not living but merely existing. I wonder how that made her feel.

Again in Canada, slideshows of MAID have been shown to healthy patients, which would make you think as your condition deteriorates that you do not have any other options apart from ending your life. In Australia, in November this year, three people were arrested after a man was found dead with euthanasia drugs in his system, and the police believed he was part of a suicide encouragement ring. Ruth Posner ended her life abroad with her husband; a friend spoke publicly about Ruth’s emotionally controlling husband and did not believe it was a free choice. But the difficulty is that, once you are dead, it is really hard to prove. As the noble Baroness, Lady Berridge, raised, the Bill does not take into account the impact of social media.

In New Zealand, doctors are told to do their best to detect how pressure may be placed on a patient, but this is completely unclear as to their duties and does not stand as a safeguard. This is listed in the review of the End of Life Choice Act 2019 in the report published on 19 June this year. In Washington state, physicians are rarely there when lethal drugs are ingested, which makes it nearly impossible to ensure that the patient’s decision is free from last-minute coercion, impairment or doubt. In Holland, it was found that GPs in an interview study felt pressured by emotional blackmail, family influence, time constraints or systematic pressures when processing assisted dying requests. As mentioned before, real-world data from Oregon shows that the top reported reasons for assisted death are loss of autonomy, loss of enjoyable activities, loss of dignity and being a perceived burden—not uncontrolled pain, which is missing from the Bill.

At the Select Committee evidence sessions, the honourable Stephen Kinnock, the Minister for Care, was asked about protecting vulnerable people, but the panel has no power to ensure that unmet needs are supported, such as increased care hours, adaptive technology and palliative input. We should ensure that the law does not default to death as a substitute for deficient services, which is an ethical red line repeatedly emphasised by disability advocates and UN experts reviewing permissive regimes. Best practice guidance from jurisdictions with assisted dying frameworks highlights the importance of exploring whether enhanced external support might address these factors, and it should be the case that the approval process checks them.

What is presented as a voluntary choice may in fact be a choice made under hidden pressure. The Australian Care Alliance research shows that the training for voluntariness and assessing absence of coercion was a two minute and 10 second video, with slides that take approximately two minutes and 50 seconds to read. Qualitative reporting in Canada shows disabled applicants citing inadequate housing or lack of care rather than unmanageable pain.

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[Lord Falconer of Thoroton (Lab)]

I completely appreciate what the noble Baroness is saying. She is, in effect, repeating what she said with such force and articulateness before. My answer to that is that there will be some professional people, and Clause 5 recognises this, who think the person is saying, “I just can’t bear this, I want this to end”. Would it be inappropriate in those circumstances for a professional person, in the context of all the other options, to raise it? In my view, it would not be, and in my view, it would be completely wrong to say that if you did raise it in those circumstances, that person, the patient, would be barred from ever having an assisted death.

On Amendment 58, the lead amender—not every other amender—said that coercion or pressure should include

“intentional or indirect structural disadvantage including poverty or lack of care”.

We are all agreed that coercion and pressure on an individual by another individual is not to be allowed. Where the reason that you want an assisted death is because in your mind you are influenced by your circumstances—for example, because you are poor—should you be barred from having an assisted death because of your poverty? In my view, you should not be. What the two doctors on the panel have to be satisfied about is that it is your own decision.

[Baroness Grey-Thompson (CB)]

This partly follows on from the comments of the noble Baroness, Lady Fox. The noble and learned Lord mentioned in his previous answer to one of my amendments that the doctors would be able to investigate. I think many of us still do not understand how that investigation would take place. In terms of understanding the standard of proof, Minister Sarah Sackman in another place said it would be on a civil standard. So, in terms of balance of probability, is the noble and learned Lord saying that the doctor has to be only 51% certain that there is no coercion for the panel to carry on and for an assisted death to be granted?

[Lord Falconer of Thoroton (Lab)]

They have to be satisfied that the person is not being coerced. That means that they have to do the appropriate inquiries. If, for example, as the noble Lord was saying, they do not understand the community, then they cannot be satisfied. If, for example, they do not know enough about it, they cannot be satisfied. Every case will depend upon its individual circumstances. They will have to do what is required in relation to it.

Amendment 118, in the name of the noble Lord, Lord Hunt, proposes that if you have a close relative who has been convicted of fraud or you are living with somebody who has been convicted of fraud, there has to be an independent financial assessment. That means that if your child, grown up by this time, has committed a fraud, there has to be an independent financial assessment of your circumstances before you can have an assisted death. I am strongly against the idea that if a relative of yours committed such an offence, that would mean there would have to be a yet further layer that you have to go through. There are still all those protections.

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[Lord Falconer of Thoroton (Lab)]

On my noble friend’s first question, I have not dismissed all the amendments; I have accepted that we should look at some of them, and very many of the ones I am not accepting are because they are already covered in the Bill. I am rejecting some of them on the basis that I do not think they are practical. When my noble friend talked about the donor, I think he was talking about, for example, somebody who may benefit from the will of the patient. Indeed, that was a point raised by the noble Lord, Lord Farmer. Very often, the person who most supports you in relation to this is the person you love most and who is going to benefit under your will. So, very frequently the person who has taken a loved one to Switzerland is the person who is then going to inherit under their will. That does not make them bad, and I would most certainly not exclude people who benefit from the will of the person who dies because they have helped them in this respect. It seems to me to not properly recognise the importance of human relations in relation to this.

I have dealt with the point of the noble Lord, Lord Farmer, about the will. His second point was that, if you had a friend who was convicted of a criminal offence involving financial fraud of some sort, you should not be able to have an assisted death unless there is an investigation of your financial position. Well, if I reject the point from my noble friend Lord Hunt in relation to a close relative or the person you speak with, then I think, for the reasons I have given, it also does not apply in relation to a friend.

In Amendment 181, the noble Baroness, Lady Grey-Thompson, proposes that the doctor must ask why and seek specific confirmation that a decision is not coerced. There is no specific requirement for that in the Bill: it is for the two doctors to determine what they think the right course is. If they felt that they could not reach a decision without asking why, or without asking, “Are you being coerced?”, they would have to ask that. But there is no prohibition. It is, as the noble Lord, Lord Pannick, said, a decision for the two doctors and the panel to decide, in each case, what is the best way to reach a conclusion as to whether this person is being coerced. That is the question that all these things are addressing.

[Baroness Grey-Thompson (CB)]

So, the two doctors could ask an entirely different set of questions to each person who is requesting to end their life?

[Lord Falconer of Thoroton (Lab)]

It will depend on the circumstances. If, for example, the doctor had a very severe doubt about whether somebody was being coerced, I would expect them to ask very many questions about their domestic circumstances. Suppose, however, it was somebody who was clearly not, on the face of it, at the slightest risk of coercion—a person of 60 in the full flush of his or her pomp, as it were—and who had said, right from the outset, “I can’t bear the thought of this illness”, and the idea that this person has been coerced is not really plausible, then I would expect the doctor to be asking different questions from the sorts of questions that they would be asking if the circumstances of somebody’s home life were completely different. It would obviously depend on what you knew as the doctor, or had found out as the panel, about the circumstances of the individual.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Mackinlay of Richborough (Con)]

My Lords, I am in favour of the amendments from my noble friend Lady Coffey. This has been a fascinating debate about the issues that we have with the devolution settlements across our United Kingdom. It is not only about the issues across the English-Welsh border, which have been so ably demonstrated and described by my noble friend Lord Harper, who has experience in this matter from the other place, but we have other strange dynamics going on in this country on the English border over into Scotland, where things are very different. There are other differences between England and Northern Ireland. We are not proposing to usurp the settlement with Scotland or to usurp the settlement with Northern Ireland.

I am quite interested to hear, at the appropriate time, whether the noble and learned Lord, Lord Falconer, will declare whether he is no longer quite so keen on the old devolution settlements that I can but assume he was part of during the Government that he served in, in that it is not quite as convenient now in this Bill to do the things required by those devolution settlements.

I was interested to hear the comments from the noble Lord, Lord Weir, because the Northern Ireland arrangement has a further dynamic, between Northern Ireland and the Republic of Ireland, where there is, again, a swapping over and a commonality of health provision, and it is quite commonplace that people come and go.

The matter of abortion was also raised. That has had a different dynamic across our United Kingdom over many years. My voting record in the House of Commons will show that I took no part in the rather heated debate on abortion that happened some years ago. I abstained because I appreciated that the devolution settlement was a matter for the Northern Ireland Assembly to come to its own conclusions on.

We have to ask ourselves what this Bill is. Is it a criminal justice Bill? We have 42 Henry VIII powers, exercisable by Ministers, so the Bill before us is not actually the Bill that will affect people’s lives; that will be written later because this Bill has so many of those Henry VIII powers in it. Many of those powers, as I described at Second Reading, should not really be there. We should not be having Henry VIII powers to create criminal matters under statutory instruments and delegated legislation; that is just not the way we do things.

So is this a criminal justice Bill? I do not think it is, because it has now morphed very much into a health Bill. It seeks to amend the NHS Act. I think it is the intent of many of the Bill’s supporters that it is the NHS that does these things: advise, provide the medical staff and do the deed. I do not know which chemical might be used. It may be barbiturates in England; it might be heaven knows what in Scotland. These are serious matters.

Is this a medical Bill? I believe that it is. Because it has morphed increasingly into a medical Bill, whether or not we agree with the devolution settlements, we have to respect them. As my noble friend Lord Harper highlighted very clearly, this is the danger of a Private Member’s Bill that is so interwoven with and entrenched in the complications of a devolution settlement. Whether you are for or against this Bill, or whatever, these are complex matters. These are matters of a different potential life or death, depending on which border you are close to in this United Kingdom. This is a matter of health in Wales.

Looking back to Covid, I know that it is a period we all rather like to forget, unpleasant as it was. At that time, I and my noble friend Lord Harper—I am sorry to keep mentioning him—were somewhat active in the space. Do noble Lords remember? These were matters of life and death; I mean, Covid was deemed to be. I was not quite so keen on the measures and voted against them all, but they were deemed to be measures of life and death; that is why they were so draconian.

I remember very clearly that I came up with what I called the Wilkinson conundrum. It is not a good conundrum now, because Wilkinson has subsequently gone into liquidation, but I made the point that because Wilkinson sold everything—fresh fruit and vegetables, tins of beans, and pots and pans—it was allowed to open. The lunacy was that the independent trader next door who sold only pots and pans was not allowed to open. We did that for whatever reason—it was deemed to be a matter of life and death—but Wales did something entirely different. In Wales, Wilkinson had to hide the pots and pans; one could buy beans and everything else, but a cover had to be put over the pots and pans. In matters of life and death, we allowed Wales to have its way.

This is most seriously a matter of life and death. We have a devolution settlement, and it has to be respected.

[Baroness Grey-Thompson (CB)]

My Lords, I declare my interests in this debate: I chair Sport Wales, which is an arm’s-length body of the Welsh Government; I am the president of the LGA; and I am a director of Living and Dying Well. I also spoke recently at a fundraiser event for a hospice in Wales.

A fundamental part of why we are here is to debate legislation, including looking at how this Bill might impact various parts of the UK—most specifically, England and Wales. I am concerned that we could end up with vastly different systems in England and Wales. Generally, there is a lack of understanding on devolution. In sport, I seem to spend quite a lot of time in meetings asking, “What about devolution?”, and we have to be careful about what we do in Westminster and what should be a matter for Wales when the health service is devolved.

--- Later in debate ---

[Baroness Coffey (Con)]

I am very interested in that, because the response that I have had from the Minister is that nobody should be working on this beyond the Bill team, so nobody should be working on implementation. What the noble Baroness says is very interesting.

[Baroness Grey-Thompson (CB)]

I thank the noble Baroness. At the Lady Mayor’s parade, a member of the public introduced himself and told me that this is what he was doing. We agreed to disagree on the outcome of the Bill. Slightly patronisingly, he followed this up by saying how wonderful he thought I was and to keep going.

I did not mean to make a point that was amusing to the Chamber, as this is far from amusing, but these are the details that we need to understand. Is there far more going on behind the scenes? Is the presumption that very few amendments will be accepted, as happened in another place, or are the supporters of this Bill really open to making it better? I have tabled the second-highest number of amendments; my competitive edge fails in this example, as my noble friend Lady Finlay is about 30 amendments ahead of me. My amendments are to improve the Bill. Many are slight drafting changes, changes of words, which are to improve this Bill. That is our role. That is what we must remember. We have to improve this Bill. We have to make it workable.

Coming back to the point of this grouping, we have to make it work for England and Wales and we have to remember, as people who work in Westminster, that we have a responsibility to the people of Wales and should not step into areas that are not for us to step into.

[Lord Wolfson of Tredegar (Con)]

My Lords, this is the first debate in Committee on this important Bill so I hope that the Committee will allow me to take a minute or two to set out the approach of the Official Opposition. As my noble friend Lord Kamall and I said at Second Reading, the Official Opposition have no collective view on this Bill. Although each Member of the Opposition Front Bench will have their own view on the Bill, we will support noble Lords across the House in their scrutiny of the Bill. We will also table a small number of additional amendments where we feel that parts of the Bill need probing further. We will not seek to delay the passage of the Bill, nor will we seek to hold up progress in Committee. Instead, we will seriously engage in detailed scrutiny of the Bill so that we can collectively deliver the best possible piece of legislation.

In that regard, I respectfully pay tribute to the noble and learned Lord, Lord Falconer of Thoroton, for demonstrating his openness to improving the Bill already by tabling amendments that we hope to get to today and which reflect concerns that have been raised by noble Lords. I speak for all my colleagues on the Opposition Front Bench when I say that I look forward to working with him to ensure that we send a better Bill back to the other place.

The amendments in this group relate to the territorial extent of the Bill. My noble friend Lady Coffey is seeking to remove references to Wales in the Bill so that it would apply only to England. While I am not entirely persuaded that making this an England-only Bill is necessary per se, these amendments raise important questions about devolution. The core question for the noble and learned Lord, Lord Falconer of Thoroton, is why the Bill does not apply to the whole of the United Kingdom on the one hand or only to England on the other.

At the heart of this is, as the noble and learned Lord, Lord Thomas of Cwmgiedd, said—although various Acts of Parliament may put us to sleep, a speech by the noble and learned Lord never does; I was listening very carefully—that these amendments speak to the devolution settlement that we work with and the inconsistencies and confusions of that settlement. The noble and learned Lord used the word “complexity”. It is extremely complex. In this area, we have the problem that criminal law is not devolved to Wales whereas health is devolved. To pick up the point made by the noble and learned Lord, with which I respectfully agree, declaring the appropriate interest, Wales should not be regarded as inferior to Scotland. That is a point of general application.

The Scottish Parliament, as noble Lords know, is currently considering its own legislation on this topic. I hope that noble Lords have picked up that the Scottish Bill is significantly different in key ways—most markedly in the definition of terminal illness. In Scotland, it lacks the “six months to live” test which, whatever view we take, is at the heart of the Bill before us. The definition of terminal illness in the Scottish Bill is:

“For the purposes of this Act, a person is terminally ill if they have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death”.


I am not quite sure about “premature” in that context in all cases, but that is what the text says.

Leaving aside the point that those resident in one part of the United Kingdom will therefore have different rights to assistance under the law from those in another region of the United Kingdom should both Bills pass, I see the point that my noble friend Lady Coffey is making. If the people of Scotland may choose whether to have a law for terminally ill adults who wish to end their lives, why—I ask rhetorically, so to speak, looking forward to the response of the noble and learned Lord, Lord Falconer—should people in Wales not have the same choice? This is the key question that the noble and learned Lord has been presented with by this group of amendments.

--- Later in debate ---

[Baroness Merron (Lab)]

I will certainly look into the matter that the noble Baroness raised and would be pleased to write to her. However, the first point I wanted to make here was about engagement with the Welsh Government. Of course, Ministers themselves have not met with the Welsh Government in relation to this Bill, as again would be expected, as it is not a government Bill. I know that the sponsors have met with the Welsh Government to discuss the policy intent and to negotiate which clauses require a legislative consent Motion.

The sponsors are also leading engagement with Scotland and Northern Ireland while—on the point made earlier by the noble Lord, Lord Harper, and others—UK government officials are providing technical support to support the sponsor and are engaging with Welsh government officials to discuss technical matters in relation to clauses that require a legislative consent Motion or those to which Wales has requested that further changes are made. Officials have regular meetings; they can be as frequent as weekly, as was the case at some points over the last few months.

[Baroness Grey-Thompson (CB)]

The noble Baroness mentioned that the role of Ministers is to ensure that the Bill is legally robust, effective and workable, but surely safety has to play some part in that as well.

[Baroness Merron (Lab)]

I am sure it would be expected that safety is absolutely paramount. The point I am making—and I look forward to hearing from my noble and learned friend—is that our position in government here is not to deal with matters of policy. As I have said, we are restricted to areas to which any Government would be restricted.

We will absolutely work with the Welsh Government, NHS England and the NHS in Wales to understand the impact of any changes to the law and the provision of healthcare services in Wales, during the coming stages of the Bill.

--- Later in debate ---

[Baroness Hollins (CB)]

My Lords, I want to add a correction for the noble Lord, Lord Winston. The Royal College of Psychiatrists voted on the principle and it was a 50:50 split. The issue of this Bill is different. The college has taken the view, after a great deal of consultation, that it does not support the Bill.

[Baroness Grey-Thompson (CB)]

My Lords, may I clarify that? I have just checked the information. My noble friend is correct in what she says, in that the support was 50:50, but the majority of respondents—64%—opposed expanding eligibility and 65% of them were not confident that consent could act as an adequate safeguard against unfree choices, such as those resulting from coercion or psychopathology.

[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.

--- Later in debate ---

[Lord Goodman of Wycombe (Con)]

My Lords, in debating ability and capacity, I will speak briefly as a member not only of the Delegated Powers Committee that considered the Bill but of the Select Committee that also did so. Noble Lords have heard differing views from members of the Select Committee about the various goings on that took place there, but I am sure we can all agree that we heard some very fine evidence.

All I wish to do in intervening here is to quote what Professor Alex Ruck Keene, whom my noble friend Lady Berridge referred to earlier, said about capacity and the role of psychiatrists, as it is extremely relevant to the debate on this clause. He said:

“The point I am trying to make is that, if you simply say, ‘Apply the MCA. Apply the principle of the presumption of capacity. Support the person to have capacity to decide their own life’, I anticipate, if you asked very many psychiatrists, they would go, ‘How am I supposed to think about that?’ That is for a very specific reason. For psychiatrists, most of the time, their job is to secure life. Their job is suicide prevention”.


He concluded:

“We need to know—and one of my real concerns is—how this Bill sits in the wider landscape of the law. I need to be able to tell, because I am going to be one of the people writing the books here and giving the training. I need to be able to say, with absolute crystal clarity, to a psychiatrist, ‘This is the point where you are not in the suicide prevention zone, and if you do not do all steps necessary to try to secure this person’s life, you could be prosecuted or you could be charged in various different ways or be civilly liable’. I need to be able to say, with crystal clarity, ‘You’re no longer in that zone; you’re now in the zone of the Terminally Ill Adults (End of Life) Bill’”.


I quote the professor simply to draw to the Committee’s attention once again the complexity of the issues before us. Although “ability” may be flawed and legally powerless, as the noble Lord, Lord Pannick, suggested, “capacity” is deeply problematic in the context of the Bill.

[Baroness Grey-Thompson (CB)]

My Lords, there is probably one thing we can all agree on today: everyone’s frustration with the process of evidence giving. I was hugely frustrated when the committee in another place was looking for evidence but deaf and disabled people’s organisations were not able to give evidence, despite making up 25% of the population.

I hope that I speak on behalf of the whole House when I say how sad it is that my noble friend Lady Campbell of Surbiton is not able to be in her place. She has experience in politics and in the House of Lords of extensively debating capacity, on what became the Domestic Abuse Act and in previous debates on assisted dying. I would urge anyone who has time to look at her contributions on capacity.

My noble friend is an individual who, I am afraid to say, in her 66 years, has been deemed terminal more times, probably, than most of us in the Chamber combined. She has had her capacity challenged probably an equal number of times. I remember a few years ago, when I had not long been in your Lordships’ House, when my noble friend was in hospital and several of us had phone calls to say that we needed to get to the hospital right away because they were challenging her capacity. Her husband was told that she was not able to make decisions on her care because she was delusional. Why was she delusional? Because she had told the doctors that she was a Member of the House of Lords. The response was, “She can’t be in the House of Lords—she’s disabled”. I cannot remember whether her husband got away with taking her pass in; there was talk about having to take her seal in to prove that she was in the House of Lords. But this highlights some of the issues with mental capacity assessment.

I have had personal experience of it. When my father was ill and the doctors found out I had lasting power of attorney, I was taken to one side to argue that he should have a different set of treatment. He had the capacity and ability to decide what he wanted. In this case, he had to have his leg amputated, and he was told that, as a wheelchair user, he would have no quality of life—they said that to me. If there was one thing I could do for my father, I could get him a wheelchair.

More recently, I have had an experience with my husband. At the end of 2020, he had a blood clot on the brain stem—he had a stroke, and he was blue-lighted to hospital. It was a dreadful experience. My daughter was in her first year at university and had to be called home. We did not think he was going to make it, and we were not allowed into the hospital. I was frequently told by the medics that he had no capacity to make a decision on his treatment. My husband said, “Look at the notes”; I said, “Look at the notes”. What they were arguing over in terms of his capacity was his ability to walk. Looking at the notes was really important, because his lack of ability to walk was nothing to do with the fact that he had a stroke; it was due to the fact that he had had a spinal cord injury in 1984 when he crashed his pedal bike into the back of a double-decker bus.

I understand what the Chamber is saying. I have personal experience where I think the Mental Capacity Act has been used in the wrong way. We have to find a way of making it work so we are able to take care of capacity. Like others, I am not entirely sure that “ability” is the right word. I understand what I mean by “ability”; I have amendments later on around the ability to understand decisions. I have one on British Sign Language because of the case of a deaf man who was told by a nurse who could only fingerspell that he had HIV when he did not—he thought for two days that he had HIV—and I have another amendment around people with learning disabilities. So maybe “ability” is not the right word.

My noble friend Lord Pannick talks about legal definitions, and I also have a number of very minor amendments which look at a better legal definition of disabled people. Perhaps we can take this away, work on it and do something. As the noble and learned Baroness, Lady Scotland, said, we have to make it work. We have to look at the Mental Capacity Act through the prism of the Bill, not in terms of what it was designed to do.

[Baroness Coffey (Con)]

The importance of the amendment in the name of the noble Baroness, Lady Finlay of Llandaff, is that, as has already been well described, there are genuine concerns about the appropriateness of the Mental Capacity Act 2005 as it stands. I think also that there has been more interest at this point because, so far, it has not been deemed to be in scope to put an amendment down to amend the Mental Capacity Act 2005—although I noticed that my noble friend Lord Goodman managed to get something in, so I congratulate him on that. That is why it is taking more time to consider aspects of this. I hear a noise—I thought it might have been someone shouting “Order!”, but perhaps it was excitement elsewhere.

I am just conscious that it is without doubt that, in the consideration in the Commons, Professor Sir Chris Whitty—who used to be one of my Permanent Secretaries when I was at the Department of Health and Social Care—suggested that the Mental Capacity Act had a higher test for basically a life or death decision, and then of course changed that evidence. However, I accept that he said, in evidence given orally to the Select Committee in this House, that having something that people are used to using is important. So one of the things that we need to judge is recognising the role of the Royal College of Psychiatrists—admittedly, it is not the Chief Medical Officer—and take its words seriously.

I was somewhat shocked by the words of the noble Baroness, Lady Murphy. I do not know if she ever used the Mental Capacity Act in her time as a professional. I know she is experienced in this in terms of psychiatry, but I was pretty horrified by the words she just used in this Chamber about the witness.

Tobacco and Vapes Bill

Baroness Grey-Thompson Excerpts

Committee stage
Monday 3rd November 2025 Grand Committee

[Baroness Fox of Buckley (Non-Afl)]

The point I am making is that it is true that the majority of smokers do not sit around and discuss whether filters have a benefit to their health. I am quite sure that, had you asked me in that survey, I would not have had a clue. You would then say that I was being conned into using a filter. However, I would be indifferent because that is not the basis on which people smoke, either with or without filters. I am particularly bemused by the idea that, as a woman, if I saw a white filter, I would immediately think “purity” and be forced to smoke a white-filtered cigarette. I mean, goodness me—have we all gone mad?

I want to talk also about the idea of health warnings on actual cigarettes, which, again, is completely disruptive to product design and so on. It is completely petty. Sometimes, I feel as though the public health people have done everything and anything they possibly can and have run out of things to do, so they are now down to the narrowest possible thing: the cigarette itself.

It is interesting that this idea is aimed especially at young people who might be given one cigarette at a party; and that people seem to be saying that, if only such people saw that written warning, it would be enough to stop them. Were we ever young? Were we ever at a party? Did we ever read anything on the side of a cigarette that stopped us? The point I am making is that, as it happens, the majority of young people know that smoking is bad for you; many young people even give adults like me lectures on how smoking is bad for you. The idea of a written warning is not, I think, very helpful.

I just wonder what the health warning would say. Would it say, “Tobacco kills you”? What is it going to say? I have had an idea. Public perceptions on the difference between smoking and vaping are at their all-time worst. Only a minority of current adult smokers—29%—are able to recognise accurately that vaping is less harmful than smoking. So I have an idea: if we are going to have a message on the side of individual cigarettes, perhaps we could say, “Vaping is cheaper and less harmful than smoking”. That is a good message. Why do we not say that? We could even say, “Vaping is good for you”. The point I am making is that that is not where we should be putting messages; we have heard confused messages in this Committee so far.

My final thought is on the success of Canada and Australia in dealing with smoking, which has been cited and thrown into the conversation. Let us look at what is actually happening and today’s front-page headlines in Australia. The only success of Canada and Australia has been the huge growth of a black market in cigarettes and vapes. It is a disaster. Many people in public health are now saying, “Maybe we went too far”. So, before we start emulating them, maybe we should take different lessons. The front page of the Australian newspaper The Age today is about the fact that people are panicking about what they have inadvertently done. This group of amendments is the kind of thing that could lead us in completely the wrong direction.

[Baroness Grey-Thompson (CB)]

My Lords, I wish to speak to Amendment 34 in the name of the noble Earl, Lord Russell, to which I and the noble Baroness, Lady Walmsley, have added our names. I declare an interest as the president of the Local Government Association. I thank ASH—Action on Smoking and Health—for its briefing, in which it laid out these amendments clearly. It supports the amendments in the name of the noble Baroness, Lady Bennett of Manor Castle, though not the one in my name; however, it raises some really interesting points around what we are trying to do and how far we need to go.

It is important to raise the issue of greenwashing and to look at better solutions than the one we currently have. Although this amendment does not go as far as some want, it is a step forward. I came to this amendment, which looks at the equivalent number of plastic straws that are in each cigarette—it is two plastic straws—because I worked on the impact of the ban on plastic straws on disabled people. Disabled people were vilified for daring still to want to use plastic straws, whereas people who smoke do not seem to have that same level of pressure against them.

The noble Baroness, Lady Fox, always makes really interesting speeches and asks really interesting questions. Are we doing this from the point of view of public health, the environment or littering? I would say, “All of them”. As somebody who has never smoked—I question how interesting any of the parties I went to as a teenager were—I presumed that filters were safer. It is only when you do the research that you realise that people have been deceived into thinking that they are safer than they actually are. The number of butts that are littered worldwide—4.5 trillion—is absolutely horrendous; it is the equivalent of 1.69 billion pounds of toxic trash. Look at the impact on the UK: a minimum of 3.9 million butts are littered every day. I am also interested in the fact that cleaning up these cigarette butts costs local authorities around £40 million a year; I think that that money could be spent far better in different ways.

[Lord Patel (CB)]

My Lords, I will speak briefly in support of the amendments in the name of the noble Earl, Lord Russell, and the noble Baroness, Lady Bennett of Manor Castle. The point I am making is slightly different. If I had my way, I would ban cigarette sales completely, but I know we are not going to get that far in a hurry.

As the noble Earl, Lord Russell, said, the filters are made of cellulose acetate that is converted into plastic. They are promoted as a health benefit in the sense that people think they filter out harmful tar, nicotine and carcinogens, which they do not. They are of no benefit. Filters also make people more addicted, because they make the cigarette smoke temperature lower and feel smoother, so I am told. People therefore take deeper breaths and become more addicted to the substances they inhale, because there is a higher concentration of them. They are actually more harmful, despite being promoted as less harmful than just cigarettes on their own.

Tobacco and Vapes Bill

Baroness Grey-Thompson Excerpts

Committee stage
Thursday 30th October 2025 Grand Committee

[Lord Kamall (Con)]

My Lords, I speak to the group of amendments in my name and that of my noble friend Lord Howe, supported by the noble Baroness, Lady Grey-Thompson, to whom I am grateful. Together, these amendments seek to prohibit the manufacture, sale and supply of high-strength oral nicotine products—those containing more than 20 milligrams of nicotine per portion—and empower HMRC officers to seize and detain such products before they reach consumers.

The reason for these probing amendments can be summarised by a BBC article in July which told the story of Finn, a 17 year-old who started using nicotine pouches after getting bored of vaping. What began as curiosity quickly became addiction. He described how he and his friends would use pouches so strong—some claiming to contain 150 milligrams of nicotine each—that they would vomit or become physically immobilised. At school, he hid them under his lip, until one day he turned “bright green” in class and had to run out of the room. His mouth, he said, was “shredded to bits”.

This is not an isolated case. Recent data suggests that use among 16 to 24 year-olds has risen sharply in recent years, a deeply worrying trend. These pouches come in bright tins, flavoured with mango ice or bubble gum, and are marketed as clean, safe, and discreet. In reality, some of these products are many times stronger than a cigarette and far more addictive. This is a form of nicotine ingestion which is socially acceptable and often unnoticeable. Children can and do consume these products, sometimes even in class.

The point is not that nicotine pouches have no legitimate role at all. For adult smokers trying to quit, properly regulated products can have a place as part of the harm reduction strategy and a pathway off smoking. Although the Minister knows that my classical, liberal views mean that I am generally against banning things I do not like, what we have at present is the sale of nicotine products that are so strong that dentists have reported that they can burn gums, cause lesions and even expose the roots of teeth.

For these reasons, more reputable manufacturers already limit their products to under 20 milligrams per pouch. They also want a market that encourages and rewards responsible production, and which acts against rogue operators flooding the market with dangerously high-strength pouches. These probing amendments suggest a possible, sensible and enforceable ceiling that would align with good industry practice and give clarity to both regulators and retailers.

However, prohibiting the manufacture and sale of these products is only part of the solution. Unless enforcement agencies have the statutory power to act, those prohibitions risk becoming little more than words on a page. That is why our amendment to Clause 88 proposes that HMRC officers should be explicitly empowered to seize and detain high-strength nicotine pouches, preventing them entering the market in the first place. I know that the Government have indicated that they recognise the need for action in this area; this amendment probes the Government on how they intend to address concerns over these high-nicotine products.

Do the Government think that we should rely on downstream enforcement after these products have already reached young people? That is my first question for the Minister. My second question is: do the Government agree with the sentiment of the amendment on the need to address this issue at the border, where these goods are entering the country in large quantities, especially by giving HMRC the clear legal authority to do so? Thirdly, do the Government see the need for immediate action, or will they require a series of future consultations? Finally—I know that I am asking a lot of questions—do the Government believe that it is more effective to have a firm and immediate statutory assurance in this Bill, in order both to allow these products to be controlled and to give enforcement agencies the clarity that they need to act?

These amendments can be seen an opportunity to protect people, in particular young people, before they become addicted instead of punishing them afterwards. It is about ensuring that, if these products are so dangerous, they should not be able simply to be bought over the counter or ordered online. I recognise that all tobacco products may to some extent be classified as dangerous—or, at the very least, as not good for you— but the products at which these probing amendments are aimed are particularly dangerous. I am, therefore, interested in the Minister’s answers; in the Government’s position on high-nicotine pouches; and in how the Government intend to address the concerns here, as exemplified by Finn’s story. I beg to move.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak on Amendments 13 to 15. I apologise for not adding my name to Amendments 139 and 140, but I strongly support them.

I added my name to this group of amendments because I did not know an awful lot about oral nicotine. I was talking to a group of university students about my strong dislike of vaping. They introduced me to the subject and told me—they were at several different universities—that many university students use vapes almost continuously for lots of different reasons.

A lot of my concerns are around the impact on young people. Growing up, I remember the TV adverts that showed all the damage that smoking would do to your lungs, with images such as the pouring out of a glass of tar, but I am not sure that young people necessarily understand the impact that vaping will have on them. I am concerned about the high levels of nicotine in these products, but I am also concerned about the potential for vaping to lead to addiction and cardiovascular issues such as increased blood pressure.

I have read the same report as the noble Lord, Lord Kamall. It mentions young people talking about using vapes until they vomit. The report talks about a young man, Finn, using vapes and says that they immobilise the individual—especially when they use two or three in one go—which is not at all the intended consequence of them. Finn goes on to say:

“You feel this burning sensation against your gums, and then you get the hit”.


As the noble Lord, Lord Kamall, said, these products have impacts on oral health, including gum disease and gum recession. Vaping is also linked to an increased risk of certain cancers, such as oral, pancreatic and oesophageal cancers. It can also have, potentially, a negative effect on adolescent brain development.

My problem with these products is that they are so easy to hide. The fact that children in school are able to use these products should be cause for concern, because young people are talking about sweating, salivating and struggling to concentrate. These products that should not be anywhere around young people. There is also a lot of discussion about how they can be used as a gateway to vaping or smoking. There is a lot of debate around how vaping and smoking are meant to be helping each other, but I have concerns about that as well.

Tobacco and Vapes Bill

Baroness Grey-Thompson Excerpts

Committee stage
Monday 27th October 2025 Grand Committee

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, we are running out of time. If we want to finish the group, we will have to finish by 8 pm—otherwise, we will have to break midway through. It is up to noble Lords whether they want to keep their comments to a minimum so that we can finish this group.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak very briefly to Amendment 193, to which my name is added. I thank the noble Lord, Lord Young of Cookham, for explaining its aim so well. I also support Amendment 4 from the noble Lord, Lord Bethell, and declare an interest as president of the LGA and chair of Sport Wales.

With my background in sport, I know that there has been a lot of nudge behaviour in stopping smoking. Some really good work has been done in Wales on smoke-free sport, and the Football Association of Wales has done work on banning smoking around youth games. However, this does not go far enough. I must apologise, as I am working on this and the Infrastructure and Planning Bill, and I have just come out of a debate on how to ensure that we have good physical activity and improve the health of the nation. The adverse impact of smoking on the health of the nation is partly why I am speaking on this Bill.

I am slightly surprised by some of the briefings that I have received, which seem to be more content with vaping than I expected. I am constantly told that it is much better than smoking, but it is hardly healthy. I have never smoked or vaped, so I probably do not come at it with the fervour of a reformed smoker, but I believe that a great deal of harm has been done by smoking and vaping. I shall discuss some of that in later groups. While smoking cessation services have gone some way, they do not go far enough. This amendment is part of a concerted effort to move forward. The way to do it is through a new clause that very clearly lays out the road map so that we can move towards a smoke-free United Kingdom.

Tobacco and Vapes Bill

Baroness Grey-Thompson Excerpts

2nd reading
Wednesday 23rd April 2025 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I support many aspects of the Bill. I strongly dislike both smoking and vaping. I grew up in a house where both my parents smoked. My mother used it for hunger suppression and weight management. My father smoked just because people did. They both stopped later in life as the detriment to health was more widely realised.

I am delighted that my noble friend Lord Stevens of Birmingham raised Cancer Research UK. Smoking is the leading cause of health inequalities in the UK and accounts for half the difference in life expectancy between the richest and poorest in society. Some would argue that vaping is okay and not as harmful as smoking. The UK Vaping Industry Association briefing stated that vapes continue to drive smoking to historic lows. The association states that Public Health England has shown that vaping is

“at least 95% less harmful than smoking”

and that the NHS Better Health guidelines affirm that while vaping is not without risk, it is

“substantially less harmful than smoking”.

It might be better, slightly, but it is hardly good for you, as early smoking ads would suggest.

As an athlete, I never directly smoked. When I was competing, I spent most of my time avoiding anywhere that anybody smoked. One of the reasons I really dislike vaping is that I do not seem to be able to walk around anywhere without being vaped on or over. Vaping allows for nicotine to be more prevalent in the air, allowing for inhalation by third parties. I can try to be as healthy as possible—I can eat well and I can exercise—but ultimately I am inhaling vape smoke. I am pleased that a couple of noble Lords have raised cannabis, because I seem to spend quite a lot of my life swerving along the street trying to avoid that as well. I am no longer an athlete, but it is still on the banned list for athletes. The fact that it is so available should be cause for concern.

I realise that I am sounding old and grumpy. Quite a lot of things irritate me, but one of the things that irritate me quite a lot is people who pretend that they are not vaping while trying to hide it. People vape in places where they would never normally smoke, such as on buses. I am certain that I have smelt vape smoke in this very building. Being British, all I do is tut loudly. I am worried that vaping is seen as an alternative to smoking.

I accept that the initial reason for vapes and e-cigarettes was to provide a safer alternative, but the evidence has shown that the introduction of vapes has led to the gradual increase of vaping among children and minors. There are loads of statistics out there—72% of 11 to 17 year-olds report that they are exposed to some form of vape promotion. The main source has been in shops, at 55%, while online it is 29%. In March and April 2023, the proportion of children experimenting with vaping had grown 50% year on year, from one in 13 to one in nine. Young people who had used an e-cigarette were seven times more likely to become smokers one year later. The reasons that young people give are anxiety, stress and depression, but nicotine addiction just links these symptoms. We end up being in a Catch-22 situation.

Beyond my personal dislike, we have to look at environmental issues around smoking and vaping. Cigarette butts are currently made of cellulose acetate, which is synthetic plastic. We spent a lot of time in this building banning straws. Each cigarette butt contains around two straws’ worth of plastic. Globally, 6 trillion cigarettes are smoked each year, with 4.5 trillion butts being littered. Even in the UK, around 3.9 million cigarette butts are littered.

Wildlife and Countryside Link reported more than a million disposable vapes going into incineration or landfill every week. When I go to lots of sporting events, I see disposable vapes and vapes littered everywhere; the only thing that horrifies me more is the number of nitrous oxide cartridges that I see.

I am supportive of this Bill. Committee will be very interesting. I know we are going to get on to some contentious issues around smoking around hospitals. I would ban it from all entrances, but I realise that is possibly not possible. The noble Baroness, Lady Thornton, talked about the impact of smoking on her family, and it has probably impacted every single person in this building. I support any Bill that supports a smoke and vape-free future.