Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Blencathra

Committee stage
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?

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Blencathra

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.

Planning and Infrastructure Bill

Debate between Baroness Grey-Thompson and Lord Blencathra

Report stage
Wednesday 22nd October 2025 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I rise very briefly to support the amendment in the name of the noble Lord, Lord Borwick. I am absolutely delighted that he has tabled it. As a disabled person, I have to say that the guidance on accessible charging is not worth very much, as it has not made an impact on my ability to move to an electric car. I totally agree about the barriers that the noble Lord mentioned of raised kerbs, gravel or, indeed, poorly lit charging stations, or even lack of accessible bays.

To use a charging station, I need to be able to open the door of my car to the widest possible point. My chair comes apart—the wheels come off, and the frame and the wheels sit on my front seat—and I do not want to damage any other cars while I am getting in and out. It does not take me much longer than a non-disabled person to do so, but when I tried, very hard, several times to move to an electric vehicle it proved impossible.

The first time I tried, I was close to signing the paperwork but had a look around my local area. There was no accessible charging station within at least 30 miles of my house, which was not particularly useful. The advice from the garage was that perhaps I should just take someone with me wherever I went, and they could get in and out of the car to charge it for me.

The problems go deeper than that. As we are seeing charging stations develop, they are taking over accessible bays. One time I was sat in a queue at a service station—admittedly, it was at a busy time—and looked at how much longer it would take me to charge my car, because I need a wider bay. It was a significant amount of time, compared to my place in the queue. What I am worried about is the impact this is going to have if we do not do something now for disabled people.

I recognise that there are probably changes coming to the Motability scheme. I do not have a Motability car, but I do receive personal independence payments. There are an increasing number of electric vehicles on Motability’s books, and Motability is removing cars that a lot of disabled people can drive. This is cutting down people’s choices and options. There is also a lack of wheelchair-accessible vehicles that are electric and allow a tailgate lift, so if someone has an electric wheelchair, that policy is shutting down their options and making things really difficult.

I recently visited Newport, and I offer some praise to Newport Council. It has done an amazing job of providing not just accessible charging stations but lots of different options in its car parks. This is a real model that we should take forward. The council has looked at the guidance, recognised that it is not going to help disabled people, and gone above and beyond. But that is one council; sadly, there are gaps all over the rest of the country. Ultimately, I do not want disabled people to be blamed for not caring about the environment, as they were when plastic straws were banned. Disabled people experienced a massive backlash: they were told they were going to be murdering turtles and dolphins, but plastic straws were the only means by which many people could drink. We can already see that disabled people have been accused of not caring about the environment and not making the switch. Rather, they want to but are unable to do so.

With that in mind, I strongly support the amendment. We have to do something to make it possible for disabled people to switch to electric vehicles.

[Lord Blencathra (Con)]

My Lords, I support Amendments 53, 54 and 55 but express some concern about Amendment 52. My noble friend Lord Moylan is absolutely right to call for an impact assessment before local authorities go overboard with removing non-electric car spaces in an obsessive drive for electric vehicle charging points. There are 2.6 million plug-in cars in the UK, including hybrids and fully electric— 5% of the total. But there are 33 million petrol and diesel cars in the UK. AutoTrader issued a report in July this year, stating that the current sales trajectory of new electric cars would see just 45% market share by 2030, well below the 80% projected and mandated target set by the Government. Personally, I prefer to trust AutoTrader’s expert analysis rather than government wish-list projections.

What are the Government’s projections? They believe there could be between 8 million and 12 million hybrid vehicles and electric cars by 2030 if uptake aligns with their targets. By 2040, the number could reach 25 million according to the Local Government Association. Some projections, aligned with the UK’s net-zero goals, estimate up to 37.4 million electric vehicles by 2050 if we go flat out on net zero. So we might have 11 million hybrid cars if—I repeat, if—the uptake aligns with government targets. But we see that those targets are 100% out already, just as the Government’s heat pump projections are about 500% out. In the nicest possible way, it is all wishful thinking.

But the big danger here—and this is where my noble friends’ amendments are spot on—is the Local Government Association’s projection of 25 million electric cars by 2040. Where on earth does the LGA get this information from? What does it know about forecasting electric car uptake? The only ones who can do that are car manufacturers, dealers, others in the trade who have their finger on the pulse of buyer motivation, and those who understand battery replacement costs, Chinese cheap car penetration, trade-in values and so on. If local authorities take up the Local Government Association’s projection and take it seriously—as they are likely to do—we will see twice as many non-electric car parking spaces ripped out, and we will have electric car places instead, so that projection will be wrong.

I simply ask noble Lords to cast their minds back to 2020, when everyone thought that electric vehicles were the bee’s knees and would rapidly replace petrol and diesel cars. In 2019, the Department for Transport forecast that there would be 1.5 million electric cars by the end of 2020. In fact, at the end of 2020 there were approximately 431,000 ultra-low emission vehicles, and that includes battery-electric and fully electric. That is one-third of the Government’s projection. What would have happened if local authorities had had the money and resources to implement that flawed projection? Thank goodness they did not have the money to do it; otherwise, they would have removed thousands of conventional car parking spaces and installed three times more electric charging points than there were cars. That is why it is essential that local authorities follow the measure in my noble friend’s amendments.

We must have a parking impact assessment before permitting EV charging points that would replace general use parking, and businesses and residents must have the power to request a review when EV installations reduce conventional parking. We have seen local authorities ride roughshod over local residents, closing roads and imposing ridiculously low speed restrictions, but I have no doubt that many will ignore the needs of petrol car drivers in the fanatical pursuit of electric cars.

I also strongly support my noble friend Lord Borwick’s Amendment 55. I congratulate him on all the work he has done with London cabs over the years to make them accessible. I and thousands of other people in London would not be able to move anywhere around this city were it not for the ramps that he insisted be built into London cabs; the new, longer ramps are just superb. Most charging points that I have seen seem to be about one metre above the payment. Theoretically, they should be accessible for disabled motorists, but many charging points are not usable for motorists with wheelchair-adapted vehicles. I congratulate my noble friend Lady Grey-Thompson on her excellent speech setting out many of the deficiencies she has faced.

In 2018, it was calculated that about 400,000 vehicles had been adapted or converted for wheelchair users, but that includes drivers and passengers. It is a relatively small number in comparison to the 30 million other vehicles on the road. However, if you are a wheelchair user, there first needs to be a dropped kerb. Imagine that you are a wheelchair user, a driver, in a car: there are only two ways to use it. You either get a ramp at the back to get out and in, or a little hoist to get out of the driver’s seat. The first decision you have to make if you see an electric charging point is whether to drive up in such a way that you are exiting on to the street and taking a risk there, or whether to turn the vehicle round so that the driver’s seat is next to the kerb. In the latter case, there needs to be a dropped kerb nearby so that you can get out of the vehicle and on to the pavement. I am not suggesting that every charging point must have a dropped kerb, but there needs to be one nearby. Then, the charging plug must not face the street or car, since the wheelchair user cannot get round to that side to use it. It is not rocket science. It is not expensive to make sure that all plug-in points either face the pavement or are at right-angles to it, or at least do not face the street.

While I have no solution for the scenario where the plug for the car is in the middle of the bonnet or the boot and the wheelchair user can plug in okay, but then cannot get on to the pavement to plug in at the other end, the latest statistics show that most plugs on cars are at the rear. Some 37% of electric vehicles in the UK are configured with the plug at the right rear; the left rear is the second most common location, found on 31% of vehicles. The left front is less common still, accounting for 18% of vehicles. The wheelchair user therefore has to get to the left rear, the right rear or the front to plug in, and then has to get on to the pavement to plug into the socket there. I therefore believe that my noble friend Lord Borwick is absolutely right. If the Government do not make this simple concession, I hope that he will push his amendment to the vote.

Finally, I flag my concern at the mention of cross-pavement charging points. Suffice it to say that, in my short journeys to the House of Lords in my trusty chariot, I battle daily with e-bikes and scooters dumped or parked anywhere on the pavement. Then one contends with temporary construction work, which necessitates cables and pipes crossing the pavement. To be fair, in nearly every case, the construction companies cover them up with temporary cable ramps or protectors but, in about 50% of the cases, they are so high, lumpy and protruding that I cannot get a wheelchair over and sometimes get grounded trying to cross them. However, these construction companies know the law and they try to safeguard pedestrians.