Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I was going to speak to Amendment 146, in the name of my noble friend Lady Eaton, to which I have added my name. It concerns care homes and a duty on the commissioner to identify and monitor emerging risk and report systemic risk to the Secretary of State so that preventive steps can be taken. However, as the noble Baroness, Lady O’Loan, has so ably introduced it, I simply convey the apologies from my noble friend Lady Eaton, who sent them last night.

The other amendments that I support in this group—Amendments 436, 439 and 913—I will not go into, in the interests of parity. The last one is about conflict of interest. The others seek to put a duty on the commissioners to serve as an extra safeguard, so that the exercise of the commissioner will not simply be to tick boxes but to request further paperwork if necessary, or that the families will be notified, as in the amendment tabled by my noble friend Lady Maclean. That can act as a trigger for a discussion with the families and perhaps prevent the coercion which can happen.

Amendment 913 seeks to prevent those involved with organisations promoting assisted dying, whether as volunteers or employees, being a commissioner, a deputy commissioner or on the staff. There is a conflict of interest if those who have a responsibility for seeing that procedures for assisted suicide are not abused should themselves be actively committed to the cause of promoting assisted suicide. The conflict of interest is so self-evident. I imagine that it is an oversight that a clause to this effect was not included in the original Bill. Perhaps the noble and learned Lord, the sponsor, could comment on that and tell us whether he envisages a conflict of interest and how best we can prevent it.

I associate myself with the very strong expression of support for the noble Baroness, Lady Finlay, who tabled Amendment 913. The support was to give sympathy against the attack on one of the leading medical authorities in this country—a specialist in palliative care who has put her knowledge, expertise and time at the service of those most in need of palliative care. She has done so with her time and her knowledge. Not only that but she has served this country in all kinds of ways: teaching students, seeing patients and building up her profession, which is one of the most important specialisms in medicine. She also gives such service to this House, giving her time selflessly, with her knowledgeable contributions and in sitting on the Woolsack, night after night. We owe her an enormous debt of gratitude, not only in this Chamber but in the whole country.

[Baroness Grey-Thompson (CB)]

My Lords, I have two amendments in this group, the first of which is Amendment 125. I am concerned because the Bill as it stands leaves the responsibility of appointing the commissioner to the Prime Minister alone, with no guarantee of the usual safeguards that are applied to public appointments. As a Cross-Bencher and someone who has been through the independent process— I owe my seat in the Chamber to that process— I believe it is vital.

In October 2025, the Cabinet Office released an updated Governance Code on Public Appointments. The first two requirements are for integrity and openness: Ministers must declare and resolve any interests and relationships, and the processes for making public appointments should be open and transparent. My amendment seeks to bring more transparency and openness, but would leave the final decision with the Prime Minister—once, of course, they have consulted with Welsh Ministers.

There are no such requirements in the Bill for this, just that the commissioner must hold, or have held, office as a judge of the Supreme Court, the Court of Appeal or the High Court. That is a reasonable assumption. However, there is no requirement for the commissioner to declare and resolve any interests and relationships or for the appointment process to be open and transparent. We have to declare virtually everything that we do, so it is not inappropriate that the commissioner should have to do so as well.

I strongly agree with the noble Lord, Lord Deben. That person has to command respect. However, the reason I am asking for this is also to safeguard the individual. We see in the amendments today that the Bill is weak on data and reporting provisions.

My noble friend Lady Finlay raised what has happened in New Zealand. Simon O’Connor, a former New Zealand MP, described some troubling incidents there around the two doctors. Dr Dana Wensley resigned due to her concerns regarding serious problems with the committee’s ability to oversee the implementation of assisted suicide and euthanasia. Dr Wensley is an ethicist. Dr Jane Greville, a palliative care specialist, was pushed out, it is thought, because she was raising too many concerns about the operation of the new law. Both Dr Greville and Dr Wensley went public and stated that the committee’s oversight of the law was so limited that wrongful deaths could go undetected. They cited being extremely concerned about how little information they received relating to patient death, leaving them feeling constrained to the point of irrelevance. They both said that the system was so broken that they would not have been able to identify if somebody had wrongly died.

What happens if normal standards are not followed? We can compare it to someone with significant shares in a drug company being able to decide what drugs the National Health Service could use. As others have said, the assisted dying commissioner will have tremendous oversight. They can make appointments to the list of persons eligible to sit on the assisted dying review panels. They can make arrangements in relation to panels, determine applications for reconsideration and monitor the operation of the Act. This role should be defined by Parliament, not by their own ideas. I would like the noble and learned Lord to give assurance that this appointment process will be looked at to see how we can ensure that the Nolan principles for public appointments will be adhered to.

Looking at the possible scenarios, this individual could be called into a meeting with the Chief Medical Officer to discuss the future of palliative care. They will hold a great deal of power in their hands.

At the Lords Select Committee, Justice Minister Sarah Sackman confirmed that there would be no support to engage or challenge the commissioner. I am very interested in the noble and learned Lord’s view on whether legal aid would be possible to do this. In the case of exceptional funding in coroners’ cases, we might have to be in the position where a person is dead before they get any support to challenge the decision that was taken.

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[Baroness Grey-Thompson (CB)]

My Lords, the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, raised some interesting points in this group of amendments. I do not have the noble Lord’s experience of local councils—I declare that I am president of the LGA, but that is largely an honorary role—but I have a lot of experience of wheelchair services. I also declare that I am president of the Wheelchair Alliance.

A service that should be incredibly easy to provide has become one of the most complex parts of NHS funding. In the good old days, when I was a child, there were two choices of chair: a small one and a large one. These days, because we want to provide better wheelchairs for people, which is a good thing, the commissioning and provision of those services has become complicated, and in different areas different prices are paid for exactly the same chair. My concern is that, if we cannot do that for something as simple as wheelchair services, how are we going to do it for this process? Many wheelchairs should be provided within 18 weeks, but I know cases where it has taken years to provide a chair for a child. We should learn from previous experience.

Some noble Lords have mentioned the potential competition that could come from funding for this service and the challenges for palliative care. However, the consensus among several professional bodies, including the Royal College of General Practitioners and the Association for Palliative Medicine, is that assisted dying should have distinct funding. Others have mentioned the way that palliative care is currently funded in the UK, but Nancy Preston, who gave oral evidence as well as written evidence co-written with a professor at Lancaster, Suzanne Ost, expressed concern that it would communicate the wrong symbolic message.

I am one of the seven Peers who were in the Observer for my number of amendments. I am receiving lots of emails telling me I need to uphold the will of the people, but I am not sure the people have been asked how they would like to reprioritise the funding of the NHS. I accept that lot of people think the service is needed, but are they being given the choice of what else they might lose? The comments by Stephen Kinnock, who said there needs to be reprioritisation, were interesting. We need to be really clear what we are going to lose out on. The noble Lord, Lord Markham, made some interesting points about savings and cost, but for me that is more about how you schedule the payments and work through it.

I am more concerned about the comments made by the noble Baroness, Lady Finlay, about the incentive to encourage people to go down this route. In Belgium, the service is paid for through the national health and the doctors receive a fee of €180. The cost of the procedure in Canada is $2,327, and it is estimated that they spend about $22.3 million a year to put this service in place. They save $149 million, but for provincial healthcare that is a negligible saving—it is 0.08% of their budget.

Stephen Kinnock talked about doctors receiving a reasonable expense. I have raised the issue of “reasonable” in terms of the Equality Act before. What actually is it reasonable for a doctor to be paid? In Australia, 27% of the doctors were unpaid while 32% got direct state government reimbursement, but a conversation is going on there at the moment about whether clinicians should have to be altruistic to provide this service. Doctors are already talking about having a standardised price for a voluntary assisted dying assessment of $860 as an out-of-pocket expense. That is important because a lot of assumptions are being made about where this service is going to be provided. The reality is that if we are going to give people a choice, we need to give them a real choice.

This is probably going to come up in later groups as well, but I have also noticed a shift in the language, which originally talked about doctors and now we are talking about medical practitioners. Does this mean it could be physician assistants? Could it be nurses? Could someone else be trained to do this? Could there be a career path in this service? Might people think this a good step in their career? The reality is that somebody always pays: the question is just who and when.

[Lord Empey (UUP)]

My Lords, to some extent this group of amendments goes to the core of a lot of the potential downsides of this Bill because, whether we like it or not, it is going to be a source of coercion.

If we go back a few weeks to the issue that was drawn to our attention by the noble Lord, Lord Stevens, concerning the role and the purpose of the National Health Service, clearly, that would need to be changed because we are talking here about a mechanism for ending life rather than a service that does its best to preserve life. To anybody who has had to spend a lot of time around hospitals—be it as a consumer of, or a relative of a consumer of, NHS services; or if you have had any role in government, even at regional level, dealing with health services—it is inconceivable that looking at the balance sheet is not going to be an issue for a clinician and a trust. That is the nature of the beast if you are the finance director of a trust and it is over budget, as they nearly all are. In Canada, we see that some people are boasting about the money they have saved by providing assisted deaths. I do not believe for one moment that that factor can be airbrushed out of this equation as far as this legislation is concerned. While I do not necessarily accept or agree with every amendment in this group, it draws our attention to the principles at stake.

It is in those circumstances that we have got into the habit in this debate of euphemisms. We call one thing by a certain name, but we know it actually means something else. In that regard, I draw the attention of the Committee to a debate on assisted dying that took place during the last iteration of this Bill, proposed by Lady Meacher, on 22 October 2021. This is the point I want to try to get across. Incidentally, that Bill had 13 clauses and 10 pages, compared to the 59 clauses and 51 pages we are looking at today. After Lady Meacher proposed her Bill at Second Reading, the noble Lord, Lord Winston, who I think is not in his place, spoke. He said that the Bill should refer to “euthanasia” rather than “assisted dying” as the Bill’s title did not represent what was intended. He went on to provide the Greek definition of what the word “euthanasia” means.

These amendments go to the core of a couple of issues. The first is the rationale behind the National Health Service in the first place, and how it would be changed and turned if it is carrying out a service which is anything but—

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[Baroness Finlay of Llandaff (CB)]

I have already spoken to Amendment 459 and am finishing off speaking to it.

I will move on to Amendments 475 and 939 in Schedule 2. There is concern over the operation of the panels and safeguarding responsibilities, just in terms of the information that comes forward. Someone with relevant information would be allowed to come forward to the panel with appropriate evidence and be afforded whistleblower protection, in the type of situation described by the noble Baroness, Lady Berger, where there is a new person on the scene who others may feel has malintent, for one reason or another.

In the Bill’s current model, medical assessments that have previously gone to the panel will not be monitored contemporaneously. They could be poorly reported, they will not be reviewed and this could hide errors, unconscious bias and discrimination. The role of the panel will be to issue a certificate. In Amendment 493, I have suggested that the certificate should have validity for six months and, in the event that the person has a longer prognosis—we have many examples of that—it is renewable rather than having to start the process again because they have outlived their prognosis.

However, the appeal mechanism to a panel seems to be one-sided. The person can appeal against a refusal to give them a certificate, but there does not seem to be a mechanism for appeal. My Amendment 499 seeks to allow information to be brought to the panel that it may not have known about when it gave a certificate. This may relate to domestic abuse that had been hidden, to coercion or pressure, to any information that the diagnosis may have been wrong, to recent emotional or psychological trauma, or to depression or metabolic disturbance which might have impaired capacity.

Amendment 932 is a very practical one concerning the provision and distribution of panels around England and Wales. It has not been made clear how many panels there would be or that there needs to be fair distribution. I have suggested a minimum of three per region in England and a minimum of three in Wales. For the geography, topography and population, I think three would work for Wales. However, areas of England with high population density, or very large rural areas, would probably need more to enable the panel to visit the patient face to face for an assessment. It is completely inappropriate to expect a patient to go to see a panel when they are already ill or to rely on remote consultation rather than having the ability for face-to-face discussion. Those face-to-face discussions must be subject to the confidentiality that you would expect in any medical consultation. I hope that we will not be suggesting that this would be publicly available.

I suggest that, as has been said, these panels came in two-thirds of the way through and a panel can take testimony from others. However, in terms of getting information about the person, as the Minister of State for Courts and Legal Services said in Committee on this Bill:

“It is not a court or a tribunal … They can make the request, but they cannot compel someone to attend”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 12/3/25; col. 1102.]

[Baroness Grey-Thompson (CB)]

My Lords, I want to pick up on a couple of points that have been debated this afternoon, and those raised by the noble Lord, Weir, on the impact on disabled people. I seem to have completely failed in all the debates to get across the fear that disabled people feel with this Bill being debated.

Jennyfer Hatch in Canada had Ehlers-Danlos syndrome, experienced organ failure and was approved for MAID. It made me think of the letter that the Minister, the noble Baroness, Lady Merron, wrote to the noble Lord, Lord Moylan, this week, about the combination of illnesses that would qualify a person for this service. That is why disabled people are so worried. The combination of their disability and other conditions would make them eligible, even though we have been told that there is nothing to worry about. Can the Minister confirm what I understand the noble Baroness, Lady Merron, said when she wrote to us: that a combination of impairments would enable somebody to enter?

I strongly support the amendment from the noble Baroness, Lady Keeley. That is really important because in another case from Oregon, Joan Lucas, who had ALS, was approved for this service; her children filled out the form. There was no question about it; they just took it and she was approved, which is quite worrying.

I thought the debate on somebody dying by suicide was really interesting, and I am going to use “assisted dying” in this context. One of the reasons we are told we cannot use “dying by suicide” is because dying by suicide and this process are completely different. I am not really sure that we can have it both ways. We need to give a little more thought to that.

I get quite upset when we are constantly told that people are dying anyway. I apologise to the noble Baroness, Lady Hayter, but we have to find a better form of words. People may be dying, but the process and the experience they have as they go through that might vary considerably. Sometimes the language that we use in the Chamber can be quite dismissive of the amendments that we are trying to bring to make the Bill safer. We still never seem to hear the word “safe”, we just hear “workable” all the time.

My amendment in this group, Amendment 924, is about protecting older people and being able to make sure that any abuse or risk of coercion can be assessed. It is really about how the panels gather this information. It has already been mentioned that the British Association of Social Workers has said that the safeguarding is not enough. Hourglass has said that one in five of over-65s has experienced abuse, and on 15 June last year, which was World Elder Abuse Awareness Day, there were calls from numerous organisations to do more. The British Psychological Society has said that elder abuse is a “hidden epidemic”, and the scope is huge: it can be physical, emotional, financial or sexual; there is also neglect and self-neglect.

While the Domestic Abuse Act 2021 gives a framework, challenges persist of social isolation, caregiver abuse, power dynamics and, again, financial abuse. The role of professionals and how they report back on this is really important. I absolutely understand what my noble friend Lady Hayman is saying about not making the system overly complicated, but we have to find a holistic way of supporting people.

SafeLives has said that older people experience abuse before seeking help for twice as long as those who are under 61. Last year Age UK reported the fact that older people are overlooked by policymakers, service providers and programmes that are designed to support victims and survivors. Until 2021, people over 75 were not even asked about their experience of domestic abuse, so the lack of data means that there is an assumption about who is being abused. The ONS introduced new survey questions, which render comparison nearly impossible. Of course, the perpetrator of the abuse could be an adult child. What we found out is that women are at higher risk from their partners and men are at higher risk from adult children. Many organisations have talked about the need for professional support, which is really important.

When I am sitting in the Chamber and we talk about people becoming older at the age of 61, I wonder what the average age of the House of Lords is. I believe it is still 71, and everyone is incredibly active, but this is not the real world—on so many levels, it is not.

[Noble Lords]

Oh!

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[Baroness Grey-Thompson (CB)]

Sorry, I did not mean to be funny.

We are using old data or data that is incomplete. The data I found, which is from 2017-18, showed that 139,500 women and 74,300 men aged 60 to 74 experienced domestic abuse. Those are huge numbers. Hourglass estimates that 2.7 million older people experience abuse, and in Australia, the Royal Commission into Aged Care Quality and Safety said that 39.2% of older people experience neglect and emotional and physical abuse.

I am very sorry that my noble friend Lady Hollins is unable to be here today, because her experience of assessing patients—the thousands of patients she has worked with—would be quite important. We were told by the honourable Member for Spen Valley, Ms Leadbeater, that there would be detailed conversations, so not to worry. But I question what those detailed conversations will look like. My husband and I have very different views on what a detailed conversation is.

To cover the issue of panels briefly, I have no experience of such panels; the only experience of panels that I have is for Olympic and Paralympic selection, which is very different. But you are talking about someone’s life in sport, and potentially their career can be ended by a decision—although I am in no way conflating those two things. But in that process an athlete who has not been selected is able to appeal only the process and not the decision. That is a really important thing, because most athletes never understand what they are trying to appeal to get to go to a major Games. So it needs to be very clearly understood what that appeal process should look like.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Empey (UUP)]

My Lords, I am indebted to the noble Lord, Lord Carlile, for bringing to a head one of the critical issues in this legislation. As one of the diminishing number of people in this House who is not a lawyer, I say that we have to find our way through this labyrinthine structure where we have chambers and all sorts of things. Without legal experience, it is difficult even as a legislator to navigate through this.

The point I want to make at the outset is that this significant piece of legislation started off in the other place with the legal process as a fundamental part of the architecture. That was subsequently changed more than half way through its process in the other place, and now we are trying to re-inject it into the system. I would ask the sponsor and indeed the Minister to respond to this. There are so many issues that have been raised already this morning about the consequences of making this change, for which we have absolutely no information whatever.

I remind colleagues that, on our last Friday, there were five separate issues—I repeat, five—to which no response or answer was provided. They were: the issue between England and Wales, the issue between England and Scotland, the issue of pregnant women, the issue of homeless people, and the issue of prisoners. There is no clarity on any of that.

The noble Lord, Lord Carlile, and his co-signatories are attempting in these amendments to at least make the legislation, as the noble Baroness, Lady Finlay, said, less unsafe. The stage we are at in this legislation is probably 75% or 80% of the way through the process and, as with a Meccano set, we are still bolting bits on and taking bits off.

All of this could have been avoided if we had had the proper process of a Royal Commission and a government Bill. This is Heath Robinson-type legislation on such a serious issue. I have to say to the sponsors that, instead of battling this out for the next few months, they would be far better to go to the Government and ask them to appoint a commission and get on with it. Then we would not have to fight our way through this morass.

Not being a legal person myself, I ask the noble Lord, Lord Carlile—given the pressures that we understand are applied to the courts and the Family Division—whether there is a case for the creation of a special chamber for people who are dedicated to this, with the training that would be required. Or, with the pressures that the family court is under, could it be that comparatively junior people end up being designated to hear these cases? Because you are talking about a huge gap in knowledge and experience on a life and death issue.

Maybe these questions cannot be answered now—maybe we will get answers when we come to Report—but the fact is that we are having to ask all these questions and we have no information, no numbers and nothing in front of us. I do not believe that that is a coherent and sensible way to go forward.

The noble and right reverend Lord, Lord Harries of Pentregarth, made a very valid point about the general public’s confidence in who makes such decisions. While I can see the merits, as the noble Lord, Lord Pannick, pointed out, of having a panel with different disciplines, the fact of the matter is that persons who are on that panel have to be appointed by somebody. Is there confidence in the people who appoint them? The court system, however, has a level of public confidence miles above any alternative.

All of these things need to be sorted out. They should have been sorted out before we had this debate today and they have not been. That is where we are. I think that the noble Lord, Lord Carlile, is attempting to put a foundation under this legislation. Leaving issues of principle out of it for the moment—we are legislators and sometimes we have to do things that we do not want to do personally—we are obliged to undertake this process. I assume that he is trying to put a foundation underneath this legislation that would command confidence among the general public, or at least a higher level of confidence than, I suspect, the panel process has. The fact that we have had this change and this flip-flop is very concerning.

I conclude by asking the noble Lord, and indeed, necessarily, the Minister: if these amendments were to be accepted by the sponsor, what would be the Government’s response? The noble Lords, Lord Harper and Lord Gove, have raised this, as have others. I understand that Ministers are in a difficult position. They are technically dealing with a Private Member’s Bill, whatever some of us think about that. Without having knowledge of what the state is going to do, we are legislating for the state to intervene to allow a person to end their life, which is against other legislation that we have already passed. So it is important that the Government should let us know what their responses will be in these various scenarios and I do hope that, when we come to the wind-up of this debate, we will get some clarity.

[Baroness Grey-Thompson (CB)]

My Lords, I speak to Amendment 67 in my name, in which I have sought to bring back the role of the High Court judge. The complexity of this group of amendments is shown here, but I thought that it could be done with one amendment rather than the number of amendments that my noble friend Lord Carlile had to table.

I think that this debate shows many different things. Not least, we have heard quotes about how the noble and learned Lord, Lord Falconer, has changed his mind over time. Others in the Chamber have done so as well, depending on the situation and the specific piece of legislation.

We need to give much more consideration to how this Bill will work in practice; this is one of the fundamental issues. I was disappointed when the High Court judge was removed from the process, because that had given me a level of reassurance. I felt that it gave authority and integrity to the process.

On where we are now, as other noble Lords have said, the toing and froing of this part of the Bill is very difficult. In another place, two-thirds of the debates on the Bill took place with the High Court judge as part of the process. If the noble and learned Lord was minded to bring that back in, it would yet again change a huge part of the Bill.

I thank the noble and learned Lord for meeting me before Christmas, when we had a very interesting discussion on one of the areas I am very concerned about, which is coercion, specifically coercion of disabled people. I am not minded to think that the panel is strong enough to cope with not just the number of cases that they may have to deal with but actually being able to spot some of the things that we have talked about. I have amendments on coercion; I also have amendments on the appointment process of those panel members, which I will not debate now. I know that the noble and learned Lord and I disagree on whether this is the safest Bill in the world. This is not the time for me to ask who has provided independent verification of that, apart from the Bill’s sponsors, but one thing we have to talk about is how we can make the Bill safe.

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[Baroness Berridge (Con)]

The noble Baroness used the phrase “moral pressure”. I mentioned in my speech that this is a fundamental change. If Clause 3 has gone, not by way of clause stand part, then actually, “pressure” has now gone from the test here. We now have “undue influence or coercion”, not “dishonesty, coercion and pressure”. Does she have any view—I mentioned domestic abuse victims—on whether that makes any change to the safety of the Bill for disabled people?

[Baroness Grey-Thompson (CB)]

Oh, absolutely: I think pressure is something incredibly important that we have to assess. Certainly, from the huge number of disabled people I have spoken to, pressure comes in many different ways, and it is very difficult to detect. If we do not take that seriously, I think people will be coerced into thinking that this is their only option, rather than that they have a range of options. That is picked up in some of my other amendments, but I thank the noble Baroness for her intervention.

We talked about the equality impact assessment. We need to look at the impacts on the Crown Court, on health and education committees and on children with SEND, and I think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for the Bill. I am minded to support my noble friend Lord Carlile, because I think that what he proposes is much better than the panel currently in the Bill.

Mindful of time, I will leave my last comment to the Medical Defence Union, the leading indemnifiers of UK doctors, which gave evidence to the Commons Bill Committee:

“The involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted”—


noble Lords should understand that this was the context when the evidence was given—

“No ‘independent panel’, however so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this Bill to provide the very best for their patients at the most delicate moment of their duty of care”.


This is one group we have not really heard a lot from, and we should be minded of its role in the system as well.

[Earl Howe (Con)]

My Lords, as sizeable as this group of amendments is, the key proposals embodied within it can be described in relatively brief terms. The Committee therefore owes its gratitude to the noble Lord, Lord Carlile, for having given exactly that kind of helpful summary in his opening speech, which set our debate going on a good track. In thanking him for that, what has emerged most clearly to me in this debate is the far-reaching nature of the change to the architecture of the Bill represented by his proposals. In addition, were his proposals to be adopted in their totality, they would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death.

In combination, those two consequences inevitably open up a range of questions, as we have heard, about how these proposals would work, not just in theory but most particularly in practice. We have, for example, heard questions about the capacity of the family court, about its funding and about the extent of the opportunity costs which the family court would need to sustain. The noble and learned Baroness, Lady Butler-Sloss, and my noble and learned friend Lord Garnier gave us considerable reassurance on some of those issues, as did the noble Lord, Lord Carlile, himself. However, the questions that have been asked are of fundamental significance and I think the Committee should hear from the Minister how the Government view the practical effect of the proposals and their workability.

On the principle of the proposals of the noble Lord, Lord Carlile, we have heard some powerful points in their favour: for example, the established powers vested in the court; the analogous decisions which courts already have to make; the ability of the court to arrive at a reasoned judgment and to be a court of record; the fact that the court-based appeal system is well understood; and indeed the level of public confidence which the court already enjoys.

I would venture to add another, which is that the role for the court envisaged by the noble Lord, Lord Carlile, would be a substantive judicial role, in contrast to the role originally envisaged in the first iteration of the Bill. That came over to me, at least, as more of a tick-box exercise than an exercise of judicial judgment.

However, what I look forward to hearing from the noble and learned Lord, Lord Falconer, are his views on the strand of this debate brought out most ably by the noble Lord, Lord Pannick, my noble friend Lady Berridge and my noble and learned friend Lord Garnier: how he has assessed the merits of the proposals of the noble Lord, Lord Carlile, in comparison to the proposals set out in the Bill. He is on record, some years ago, as having favoured a court-based approach in this area of the law. If his view is that, on balance, he now favours the panel process, as set out in the Bill, what considerations have led him to that conclusion?

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[Lord Falconer of Thoroton (Lab)]

I do not understand that proposition. It seems to me that the panel is able to take that into account just as well as the court—and, indeed, I think the panel would probably be better able to assess it. I am not sure I accept that proposition.

[Baroness Grey-Thompson (CB)]

My Lords, when this was debated in another place, that argument was made, and the Association for Palliative Medicine wrote formally to correct the record. In the statement, the APM clarified that the Bill does not align with the standard multiprofessional team decision-making process. The noble and learned Lord mentioned Dr Cox, who argued that the Bill’s model of two independent doctors working alone was inadequate, and that assessments should be carried out within the multiprofessional team model to strengthen the Bill. On that discrepancy, the APM and MPs noted that although the Bill introduces a panel of psychiatrists and social workers at the end of the process, that does not equate to multiprofessional assessment at the beginning—the assessment stage that Dr Cox was advocating for. That is really important. The Association for Palliative Medicine wrote formally to correct the record following the debate in the other place. If the noble and learned Lord does not want to respond to that point right now, I am very happy for him to write to me, but I think it is important for that to be on the record in this Chamber, as a by-product of what happened in another place.

[Lord Falconer of Thoroton (Lab)]

The reason why I quoted Dr Cox of the Association for Palliative Medicine was that she specifically said that it is better to approach this issue through a multidisciplinary process rather than by placing it on the shoulders of the two doctors and the High Court judge. The panel approach reflects that approach. That is why I quoted it. I do not think I need to write to say that. It was part of the evidence that was saying, “Have not one pair of eyes to judge, but three pairs of eyes”.

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[Noble Lords]

Front Bench!

[Baroness Grey-Thompson (CB)]

My Lords, I have five amendments in this group and I beg noble Lords’ indulgence—I will get through them as quickly as I possibly can. I have tabled Amendments 179, 182 and 185 and I am a signatory to Amendments 262 and 263. We have talked a lot about choice, and I believe that patients should have real choice, not partial choice, which is why I have tabled amendments that focus on specialist palliative care.

In another place, the Public Bill Committee accepted Amendment 108 in the name of Polly Billington requiring doctors to offer palliative care support, but this could almost be a case of, “This is what you could have won”. Without a guarantee of that support being made accessible, it does not offer patients the choice that they may be expecting. We have seen cases such as Canada, where they are told, “Yes, you can have this, but we’re not going to fund it”. If the Bill is to be the best in the world, we genuinely have to offer patients every choice that is available. On the previous group, we talked about cost. We were not able to cost this up, but if patients feel that they have no choice but to end their life, we are stripping choice away from them.

Amendments 179, 182 and 185 are in my name. The Bill does not require a medical practitioner to ensure the patient has access to specialist care for their consideration. During the conversations, I believe it is important that the patient is automatically referred to specialist care, ensuring that they have a real choice about the treatment that they may choose to have. It is very important that my Amendment 179 goes beyond what the Bill says, which is just offering to refer, and says they must be referred. Until you are in that situation where you have been given a terminal diagnosis, even if you have a family member who is going through it, it can be slightly different when it is you. How does a patient know about all the different treatment options unless they are given them in a way where they have the time to understand them?

Amendment 182 is about needs being assessed by an appropriate health or social care professional, and proposed new subsection (5A)(b) states that patients must

“be provided with palliative and end of life care in line with their assessed needs”.

We should not be doing this as a case of, “This is what you could have won”—I apologise, but I cannot think a better way of saying it—but we see that in other jurisdictions, such as Canada, you are told, “You can have it, but we’re not funding it”. That puts patients in a really difficult and impossible situation. Amendment 185 also refers to the specialist support that I think is important.

My Amendments 262 and 263 are amendments to Amendment 261 in the name of the noble Baroness, Lady Ritchie. They would add the specialist part of it. I am struck by the number of people I have spoken to who say they have had access to palliative care, but when I have interrogated it, it turns out that they have had access to some medical support. It might be a district nurse, but it does not necessarily mean somebody who has had specialist training. That is incredibly important.

I have lost both my parents. I thought my mother had access to good palliative care, and this is a sense of guilt that I and others feel. It was only when my father was dying that I realised what that could and should look like. They died eight years apart in the same hospital. You would have expected a similar level of treatment and support, but it was very far from that. My father was involved. He had a multidisciplinary team. There was lots of information that we were given time to understand. He was given time to understand what the situation might be.

One of my concerns with the Bill, and why it is so important that the specialist element is there, is that when we were having discussions about my father, we were told he was approaching end of life. We were told that it was very serious, we could let him slip away and that was what we should encourage to happen. That is what he was encouraged to think about. This is why I have real concerns with many parts of the Bill. At that point in my father’s life, he had had his foot amputated. He was told that he would not have a normal life and that he would not be able to live in the same house. It was the house I grew up in, and it was vaguely adapted. He was told it would not be possible to get a wheelchair. If there was one thing I could do for my father, it would have been to get him a really good wheelchair.

This comes back to one real issue I have with the substance of the Bill: how it could be misused by families who are not caring, loving or kind, or by doctors under huge pressure who encourage people to consider ending their life. It is important that the full gamut of options is available, so that individuals can make genuinely open choices about how they choose to end their lives.