Terminally Ill Adults (End of Life) Bill

Debate between Baroness Hollins and Lord Shinkwin

Committee stage
Friday 27th March 2026 Lords Chamber

[Lord Shinkwin (Con) [V]]

My Lords, I make it clear at the outset that I do not intend to press my Amendment 193. I also support the other amendments in this group and look forward to learning and listening, as I am sure the noble and learned Lord does, before I wind up at the end of the debate on this group.

The modest and reasonable nature of my Amendment 193 belies its significance. It is crucial to ensuring transparency and thus trust—the trust of the patients, their families, the medical profession in the widest sense, any relevant legal and regulatory bodies, and, of course, the public. In practical terms, the amendment would require:

“If a registered medical practitioner or other health professional raises the subject of the provision of assistance in accordance with this Act with a person, or if a person raises the subject with a registered medical practitioner or other health professional, it must be considered a preliminary discussion and the discussion must be recorded”.


This is therefore very much a “to be or not to be” amendment, because the noble and learned Lord’s response to it will show whether he wants the assisted dying regime that his Bill would create to operate transparently or in the shadows. It will show whether he recognises that transparency is crucial to engendering at least a modicum of trust in the assisted dying process he proposes, or whether he has something to hide and would much rather plough on regardless.

As a lifelong NHS patient who receives a copy of any post-appointment letter sent by my orthopaedic surgeon to my GP as a matter of course, I find it not just positively Neanderthal but pretty sinister that such a pivotal exchange as a preliminary discussion about assisted dying would not be recorded in a way that explicitly involves the patient after the conversation as well as during it—and that it would implicitly not apply beyond a practitioner from the “person’s GP practice”, to quote the Bill. Surely this begs the question of why any registered medical practitioner or other health professional involved—or indeed the patient—would not want there to be a record of what was said and, furthermore, for that to be made available to both the patient and appropriate stakeholders, such as but not only their GP, within the set timeframe, as provided by amendments in this group that other noble Lords will speak to.

We are assured by Kim Leadbeater in the other place that this Bill provides for the safest assisted dying regime in the world. I beg to differ, but it is good to know none the less that she acknowledges the need for the question of its safety to be addressed. This amendment would do exactly that: its sole purpose is to improve safety. At its heart is the recognition that it is vital to have a written record of the preliminary discussion in the way that my amendment provides, because it would act as a legal gateway to the assisted dying process and provide a permanent trail of evidence for a decision that is final and irreversible.

Maintaining a robust written record of the preliminary discussion, and ensuring it is completed and circulated promptly, is therefore a fundamental safeguard required to ensure the transparency, accountability and clinical safety of the assisted dying process. Without such a record, the preliminary discussion will always be regarded as having been conducted properly, making it impossible, in effect, to regulate the process. So it is not good enough for the noble and learned Lord to point to Clauses 7, 9, 10, and 11 as if to say, “What’s the problem?”, not least because Anna Dixon’s amendment in the other place—which explicitly required a doctor to

“record and document the discussion and the information provided”

and give a copy of the record directly to the patient—was not included in Kim Leadbeater’s new Clause 7 on recording.

The noble and learned Lord may rely on Clause 44 and say that the Secretary of State would have the power to require this. However, that would not put in the Bill that there should be a record of the preliminary discussion or set a minimum standard format or a required level of detail for its contents. The Secretary of State would have the power to require this, according to the Bill, but I draw noble Members’ attention to the Delegated Powers and Regulatory Reform Committee’s recommendation which signalled that this was inadequate. It recommended, instead, that the Bill should be amended to explicitly clarify

“what type of event or other information must be notified or the principles underlying notification”

in primary legislation. That is what this amendment seeks to do.

In closing, I simply highlight that my amendment and the others in this group seek to address what is already, sadly, a known problem in other jurisdictions, including Canada and Australia, resulting in disciplinary action and official findings of non-compliance. Let us learn from them and pay heed to the evidence given to the Bill Select Committee by Dr Michael Mulholland, honorary secretary of the Royal College of General Practitioners. He said:

“If you were having assisted dying conversations, you would want to make sure it was recorded at every point that people were thinking about this on the way through”.


Indeed. Why would you not? I hope the noble and learned Lord will accept my amendment. I beg to move.

[Baroness Hollins (CB)]

My Lords, I commend the important speech of the noble Lord, Lord Shinkwin. Decisions at the end of life are complex, and a single conversation simply is not enough to capture someone’s physical condition, mental state, and personal and family circumstances. Attempting to record such a complex conversation is quite a daunting prospect.

Requiring a preliminary step also adds an unnecessary layer of stress before a proper evaluation can even begin. Both Clauses 5 and 7 add more steps but not more safeguards. The key protections in this Bill—checking capacity, ensuring that decisions are genuinely voluntary and identifying any coercion—can and would be addressed within a multidisciplinary specialist assessment. As it stands, requiring a preliminary discussion and recording it adequately risks duplication while causing unnecessary delay, when time is of the essence. Instead, a specialist multidisciplinary panel would provide a full and balanced assessment from the outset, and of course it would be properly documented.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Hollins and Lord Shinkwin

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I will speak briefly to Amendment 405 because the Equality Act is relevant to it. It provides a legal duty to provide reasonable adjustments for disabled people, which is defined quite broadly and I think would include a person who was terminally ill. The amendment is currently worded that the doctor must

“take all reasonable steps to ensure that there is effective communication”.

Will the noble and learned Lord consider changing his drafting to say that the doctor must “ensure reasonable adjustments are provided to ensure effective communication”?

[Lord Shinkwin (Con)]

My Lords, I rise to speak on Amendment 405. It is a pleasure to follow the noble Baroness, Lady Hollins, and to echo some of the points she touched on. I clarify that of course the amendment is in the name of the noble and learned Lord, Lord Falconer of Thoroton. I do so because, as a disabled person who was on the National Disability Council in the late 1990s developing codes of practice and advising the then Government on the importance of language—a point that the noble Baroness has just mentioned—I fail to see how changing the Bill’s wording from

“must first ensure the provision of adjustments for language and literacy barriers”,

which was the language of the amendment adopted by the other place, to “take all reasonable steps” can do anything other than weaken this Bill.

The noble and learned Lord would have us believe that this is just a drafting change; indeed, he said in his opening remarks that it makes it “clearer”. I contend that this is no drafting change because, yes, it changes the sense of meaning. The amendment would take us backwards because it would fundamentally weaken one of the Bill’s safeguards, such as they are, which was inserted as a result of Jack Abbott’s Committee amendment in the other place, and which the Bill’s sponsor in the other place described as “very sensible”—she was happy to support it.

I have a few questions for the noble and learned Lord that I would be grateful if he could answer in his closing remarks. Is this Committee being asked to believe that today the Bill’s sponsor in the other place is happy for the noble and learned Lord, in effect, to overrule her? Can he confirm in his closing remarks that she and Mr Abbott have been consulted, or is it that, together, the noble and learned Lord and Ms Leadbeater have decided to water down one of the few safeguards in the Bill because, well, it is only the House of Lords so no one is going to notice? The whole point of the Bill is to make it as easy as possible for people to have assisted dying, so let us minimise the constraints.

I began my career at the Royal National Institute for Deaf People during the first Blair Government. It was an exciting time. To the credit of Tony Blair and the noble Lord, Lord Hutton, who was Health Secretary, digital hearing aids were introduced on the NHS. The RNID, when I worked there, was listened to, and it should be now. So could the noble and learned Lord explain why this amendment implicitly ignores the finding made this year by the RNID and SignHealth in their report that some patients did not understand their diagnosis or treatment?

As a disabled person, I thank our Labour colleagues most sincerely. I know that I owe a debt to the Labour Party’s long-standing and noble—in the true sense of the word—commitment to advancing disability rights. However, this amendment underlines an inescapable but painful truth. The Bill makes a mockery of that fine, noble and honourable tradition. It shreds a tradition that deserves to be preserved, not sacrificed in such a profoundly cynical and misleading way as to make out, as the amendment does, that this is somehow only a drafting change.

There is a reason why not one organisation of or for disabled people supports the Bill; they know that disabled people need the Bill like a hole in the head. I marvel that the noble and learned Lord does not seem to realise that the Bill is dangerous enough already without the removal of provisions that would at least acknowledge the obligation to first ensure that communication adjustments were made; for example, for people with learning disabilities or users of British Sign Language.

The last thing that we as a House should be doing is endorsing an attempt to make the Bill an even poorer piece of proposed legislation than it already is. Noble Lords could be forgiven for thinking that that was not possible, but, as the noble and learned Lord’s Amendment 405 clearly states, he is perfectly capable of making his poorly drafted Bill even worse.