Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Friday 9th January 2026 Lords Chamber

I look forward to hearing from the noble Lord, Lord Carlile, and, as I said earlier, from the family Justice Minister, if she is in her place.

[Baroness Hollins (CB)]

My Lords, I have added my name to several of my noble friend’s amendments and I would like to congratulate him on finding a solution that could allow the Bill to meet one of the sponsors’ original aspirations. The impact of Amendments 25 and 120 are many. One that may be attractive to the Committee would be that it would considerably shorten the Bill, as several clauses would be removed and hours of debate would probably become unnecessary.

The Bill states that it will

“allow adults who are terminally ill … to request and be provided with assistance to end their own life”

and refers to eligibility for

“lawful assistance to voluntarily end their own life”.

The Oxford Concise Medical Dictionary defines suicide as

“deliberately causing one’s own death”

and assisting suicide as

“the act of helping a patient to commit suicide by giving them the means … to do so”.

The Office for National Statistics similarly defines suicides as

“deaths resulting from intentional self-harm for persons aged 10 and over”.

Clause 32 on the criminal liability for providing assistance explicitly references the Suicide Act 1961, providing that assistance carried out in accordance with this Bill will be exempt from that Act’s offence of assisting suicide. This reinforces that the subject of the legislation under consideration is assisted suicide.

I am aware that many people would prefer the term “assisted dying” because of the stigma associated with the term “suicide”. The Bill rather contradicts itself by adopting the term “assisted dying” while attempting to modify these other statutory provisions that concern assisted suicide. That creates both conceptual and legal ambiguity. If Parliament is being asked to authorise assisted suicide, then it follows that such decisions fall within the proper domain of the courts. For that reason, among others, I support my noble Lord, Lord Carlile’s amendment that would replace the assisted dying review panel with a court-supervised process.

Amendment 120 appropriately moves decision-making from the medical to the legal sphere. Assisted dying is not a medical treatment; it is an act with profound societal implications, and it therefore requires, I suggest, judicial rather than clinical oversight. For that reason, I believe that it does not belong in the National Health Service. Under the proposed model, doctors would continue to provide expert medical evidence confirming diagnosis and prognosis, but the final authorisation would rest with a judge. That judicial scrutiny provides a stronger safeguard against errors, and enhances transparency and public confidence in the system by placing responsibility for these irreversible decisions in the courts, where I believe they properly belong.

Concerns about capacity in the courts, or potential delay and cost, do not outweigh the need for robust safeguards when decisions of life and death are involved. The appropriate response is to streamline court processes, not to lower the level of scrutiny. The same issues of capacity in taking on a new stream of work would, of course, apply in the NHS. A judge would provide a more independent assessment of an individual application than a panel, which is likely to comprise people who have chosen to do that work and have no track record of dealing with issues such as undue influence. It is regrettable that the other place abandoned judicial oversight in favour of an assisted dying review panel and commissioner, thus seriously weakening the safeguards that were originally envisaged. The assisted dying review panel is not, in its current form, fit for purpose. Its composition does not provide sufficient safeguards for vulnerable individuals, and there is insufficient clarity on how it includes expertise in palliative care, safeguarding and decision-making capacity. A court model would be preferable; without it, the panel would need to be substantially strengthened.

I also strongly believe that, without guaranteed access to a comprehensive multi-disciplinary specialist assessment of palliative, psychological and social care needs, neither judicial scrutiny nor an expert panel would be able reliably to identify inappropriate requests for an assisted death. Those preliminary assessments are the most essential safeguards to ensure that treatable sources of distress, or modifiable psychosocial factors, are considered before an informed decision can be made, both by the individual concerned and by the decision-makers. We will debate specialist multi-disciplinary assessments in the next group of amendments, and I look forward to returning to that.

I also support the amendments tabled by my noble friend Lord Carlile that seek to broaden the scope of safeguards referred to in Clause 1. At present, the Bill limits those safeguards to Clauses 8 to 30, which cover only the procedural steps. My noble friend’s amendments would extend the safeguard requirements to the whole of the Bill, ensuring that every substantive provision—not just the procedural elements—must be complied with before assistance to die can be lawfully provided.

I also support my noble friend’s Amendment 69 to strengthen the definition of “a terminal illness”. The amendment clarifies that a terminal illness must be

“an inevitably progressive disease which cannot be halted”.

The inclusion of “halted” is important; it ensures that eligibility is limited to conditions for which the disease trajectory cannot be stabilised or slowed through available interventions.

[Baroness Berridge (Con)]

My Lords, I will speak briefly to two of the amendments in this group. I am grateful to the noble Lord, Lord Carlile, for meeting me in relation to his proposals under Amendment 120.

This group also contains related Amendment 116, which would introduce the capacity test that the noble Lord expects the court to use. Within that amendment, in the clear and settled intention part of that capacity test, is the introduction of the phrase “undue influence or coercion”. That test is different from the rest of the Bill, which uses “dishonesty, coercion or pressure”. I am sure that the noble Lord is aware, as he has outlined, that undue influence has a particular meaning in civil law and is presumed within certain relationships.

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[Baroness Brown of Silvertown (Lab)]

My Lords, my Amendment 51 and others would require the providers of assisted dying services to ensure that all persons seeking such services have discussed the range of end-of-life options available to them with a palliative care specialist.

The Government and proponents of the Bill have promised that end-of-life care will not suffer in order to accommodate assisted dying. I have significant reservations about whether this would be possible, and I fear a push factor, particularly for those who are vulnerable, those who are without family and, to be absolutely frank, those who are poor and cannot fund their own care. When done right, as we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one’s death. Equitable access to options for end-of-life care must be a cornerstone for this Bill, which is why I have laid these amendments. I want to ensure, as far as humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life and to specialist teams to manage the symptoms and pain and to provide dignity.

This Committee must accept that equal access to these services, as for many public services, is not guaranteed and is rarely delivered. I give just one example, due to time. A Liverpool resident with the terrible asbestos-related mesothelioma cancer can undergo a specialist injection that has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are so few specialists trained to take this work on. Therefore, access is obviously limited.

Clauses 5 and 12 require doctors to have discussions about disease prognosis, treatments and symptomatic alleviation with patients. Clause 5 includes an offer to refer them to a specialist. Although these are important discussions, which must be had, they have to be conducted by somebody properly trained and experienced in such matters. For conditions that are specialist care cases, such as motor neurone disease, most doctors will have minimal involvement in the management of that condition and will likely not have the skills and training to adequately fulfil the duties that the Bill places on them. A specialist referral is absolutely necessary to that ensure patients are able to reach an informed decision about their care with somebody who properly understands the disease, how that disease will progress and what can be put in place to alleviate their distress and pain.

A person seeking assisted dying will be worried about their future, losing their independence and dignity and placing a huge burden on their families. A dedicated palliative care specialist would have the expertise, skill and training to provide the highest level of information and support, tailored to the individual needs of each patient, and have specialist knowledge of the condition that the patient is experiencing. Clause 1 requires that a person

“has a clear, settled and informed wish to end their own life”.

I believe that you can ensure a settled and informed wish and reach an informed decision only after properly exploring all available care and treatment options with dedicated palliative care specialists and having those options available to you. My amendment would therefore create a duty on all people involved in the provision of assisted dying services to ensure that those discussions have occurred, covering care options including symptom management and home care provision.

I welcome the amendments tabled by other colleagues that would ensure a dedicated palliative care assessment is part of the assisted dying process and I believe that my amendment can work alongside theirs. My amendment would also cover consultations with palliative care specialists that occur prior to a person seeking assisted dying, providing they cover the criteria outlined in the amendment. You can reach a clear, informed decision to end your own life only after having the advice and support to truly be able to weigh your options. That guarantee should absolutely be in the Bill.

[Baroness Hollins (CB)]

My Lords, when I first read this Bill, I realised that there was something important missing—a first stage, if you like. This group of amendments is probably one of the most important to address before the Bill can really make progress. Ther Bill, in its drafting, has perhaps failed to recognise the provisions of the Health and Care Act 2022, which my noble friend Lady Finlay referred to, with regard to the new obligations on integrated care boards to commission for the palliative care needs of their local populations.

There are several amendments in my name in this group. I have also added mine to my noble friend Lady Finlay’s amendment. The most important amendment is Amendment 221, and I will try to explain some of the rationale. The amendments are intended to ensure that specialist multidisciplinary palliative care is a mandatory, properly resourced and integral part of any assisted dying pathway. The central purpose is quite simple: it is that no person should progress towards assisted dying until their palliative, psychological and wider social care needs have been fully assessed and understood and, where appropriate, addressed. The medical royal colleges have endorsed this request.

Not all doctors are trained or equipped to provide comprehensive information about prognosis, symptom control or the full range of palliative care options at the end of life. This is not the remit of general practitioners or general physicians, nor should such complex and sensitive discussions be taking place in routine medical settings. For that reason, I disagree with the preliminary discussion clauses and the clauses about first and second declarations in the Bill as currently drafted. Instead, I propose that once a terminally ill person requests an assisted death under this Act, they must be referred for

“a multidisciplinary specialist palliative care assessment”

alongside a psychological assessment within established palliative care services. Given the urgency that often accompanies such requests, this assessment should be completed within seven days of referral. To ensure that any subsequent decision is genuinely informed, the individual must then be offered access to appropriate palliative care and psychological support

“within 48 hours of the assessment being completed”.

A person should not be eligible to proceed until their needs have been assessed, and the treatment and support options have been made available. That is why I propose that, before an application can proceed, there must be written confirmation from a consultant in palliative care medicine that all relevant specialist palliative and end-of-life care options have been discussed, offered and, where appropriate, tried.

Medicine routinely works in this careful, stepwise manner. It is entirely consistent with good clinical care that evidence-based palliative care should be fully explored before considering the irreversible act of ending a life. I have heard discussion in the media suggesting that these amendments would mean that people would be forced to have palliative care against their will. No, that is not their intention; the intention is twofold. First, it is to make sure that patients can make an informed decision. Secondly, it is to ensure that specialist palliative care services are available for people who want them, and that people are not choosing an assisted death because the NHS is not commissioning for the palliative care needs of the population.

Obviously, specialist palliative care itself needs to be properly defined, funded and made universally available and accessible. It is far more than the prescription of high-dose medications at the end of life. It is an active, multidisciplinary approach that supports patients and families at home, in hospital, in care homes and in hospices. That is why defining specialist palliative care, as set out in one of the amendments before us, is so important.

At present, access to such care is inconsistent and heavily dependent on charitable funding. Before introducing assisted dying on a national scale, we must ensure equitable access to high-quality specialist palliative care across the country. As part of the multidisciplinary palliative care assessment, I propose that every individual applying for assisted dying should be considered for NHS Continuing Healthcare through the fast-track funding process. This is an existing, well-established process, although perhaps not well understood within primary care or perhaps even within your Lordships’ House.

Continuing healthcare provides fully funded health and social care support, including assistance with medication, mobility and activities of daily living, but it can be slow to arrange. However, the fast-track pathway exists precisely to ensure that people with rapidly deteriorating or terminal conditions can access this support within 48 hours of their request. It works in practice. It is already there; the architecture already exists.

This can make an enormous difference, enabling people to choose their place of care, arrange nursing support, secure equipment or home oxygen, and relieving families of both emotional and financial burdens at a critical time. Encouraging fast-track access to continuing healthcare within the Bill would ensure that individuals receive timely, holistic support and are not driven towards assisted dying by unmet care needs. Furthermore, patients approved for fast-tracked continuing healthcare funding are more likely to have an accurate prognosis of six months or less. Taken together, these amendments would place specialist palliative care where it belongs: at the centre of end-of-life decision-making, ensuring dignity, compassion and genuine informed choice.