Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I declare an interest, as past chair of the Equality and Human Rights Commission, which ended on 1 December last year. I say that because it is pertinent to the remarks I will make. I gave evidence to the Select Committee in the other place as long ago as 2024. While the Equality and Human Rights Commission took a neutral position on the principle of assisted dying, it found several flaws with this particular Bill.

After we started proceedings on the Bill on 22 January this year, I, with the support of 60 or so other Peers, wrote to the noble Baroness, Lady Merron, asking for a revised equality impact assessment, because the original one was by then so out of date and so much new information had come to light during our deliberations. The Bill itself had changed so enormously from when it was first tabled, so we thought it was important to get more up-to-date assessments of what the Government thought the impact of the Bill would be.

The noble Baroness, Lady Merron, very generously wrote back to me very quickly on 29 January. She recognised that these were important considerations but declined a revised impact assessment. However, she promised that, once the Bill became an Act, the Government would review all the impacts of the Bill. In other words, we were being asked to legislate blind—to move amendments without knowledge of what the impacts might be. That is an essential requirement of an Act of Parliament or primary legislation. We were asked to legislate blind. While I understood the Government’s position and their neutrality, that has been the effect of where we have been. It may be one of the reasons we have had so many amendments that some noble Lords find time-wasting.

I want to turn to one important thing in my final observation. I will not speak for long, but I want to impress upon the House the responsibility that we have when the state is asked to sanction—indeed, assist in—the taking of life rather than saving it. This is particularly so when so many other jurisdictions appear today to have stretched the ethics of where that balance should lie. That may not have been where they started out, but that is where they find themselves decades later. I believe that it is right that we in the UK, with our particular constitutional arrangements, take care and apply the due diligence that careful scrutiny seeks.

If we have people who find that the level of their suffering is so intolerable, I completely accept that perhaps we should think of a way of death for those people. I say that only to re-emphasise what the noble Baroness, Lady Campbell, said what seems an aeon ago but was only a few hours earlier: autonomy without protection is not freedom; it is a risk. I will go further: it is a risk that we as legislators should not in good conscience allow to pass to be exploited by the unscrupulous. I believe we have discharged our duties, but that is not to say that this should be the final word on this most difficult and contested ethical issue. I hope that the proposers will take note of the good faith that we have all employed and try better next time, as I believe they may well be entitled to.

[Baroness Jay of Paddington (Lab)]

My Lords, like the noble Baroness, Lady Hayman, I was a Member of the House when we looked at the original Bill introduced by the late Lord Joffe in 2004. I have also been Leader of this House and, over the decades, I have never experienced quite the extraordinary exploitation of the procedures—one could almost say the sometimes rather relaxed procedures—of this House as on this Bill. Today, for example, I thought we were perhaps going to start again dealing with the House of Lords Act 1999. I have been through all the convolutions of Brexit, but never—I repeat “never” and, indeed, “exploitation”—have I seen the relaxed procedures of this House so negatively exploited. That is something we need to return to, and I echo the concluding remarks of the noble Lord, Lord Cashman.

I have a very big concern about the content and quality of some of the topics of the hundreds of amendments we have seen. It is about the way in which, as many noble Lords have referred to today, they have ignored the concerns of the people for whom the Bill is directed: terminally ill adults. My noble friend Lady Berger asked for examples of the way in which our lack of compassion had been demonstrated. In the interests of time, I will not go into any in particular, but I refer her to the 27 February discussion in Committee, when we spoke for some hours about the composition and the structures of the commission assessing people’s ability to take assisted dying. There was enormous emphasis on the activities of the commissioners and their convenience, et cetera, but scant regard was paid to the concerns of those people for whom this service was being offered: those who might be frail, bed-bound or concerned about their personal and emotional situation. We dealt almost exclusively with bureaucracy and administration. That, frankly, has been the tone of so much of the debate.

I am aware of the Chief Whip sitting there with his stopwatch, but I want to refer briefly to the other major and concerning omission from our discussions, which is the lack of any sort of detailed discussion about the international evidence and experience of assisted dying. I remind the House that more than 30 jurisdictions in the world have now satisfactorily introduced ways to give their citizens the choice of an assisted death. These places include our close neighbours in western Europe, major Commonwealth countries and American states, as well as the capital city of Washington and the District of Columbia. Some of those jurisdictions have voted very recently to establish new systems. In the western state of Oregon—which the Select Committee on which the noble Baroness, Lady Hayman, and I sat some years ago visited to establish the realities of the situation—assisted dying has been in place for nearly 30 years. I have no doubt that there have been some difficulties and some mistakes as these different places have developed their own plans—there always are when major changes in social policy are introduced on anything—but no assisted dying laws have been repealed. None of them has been challenged at that level. There has been no collapse in palliative care. Indeed, with proper choice at the end of life, palliative care has often been improved. That is certainly the case in the state of Oregon. To disregard or distort international experience, as the debates in this House have done recently, or to suggest that only the Westminster Parliament can produce a legally proper system is, in my view, a dangerous form of arrogance.

In conclusion, this is the fourth assisted dying Bill that I have taken part in and there have always been profound differences of principle, but in none of the others was there the atmosphere of unpleasant tension and antagonism at a personal level that has characterised recent sessions. Indeed, 10 years ago, when my noble and learned friend Lord Falconer introduced his similar Bill, the Times reported our proceedings extolling the serious, calm authority of the debate and congratulating the House of Lords on its deliberations as a demonstration of Parliament at its best.

I very much regret that we have today to take note that the current proceedings have greatly damaged the reputation of the House. I can only hope, like other noble Lords, that when a future assisted dying Bill returns—and it most certainly will—the issue of choice for the terminal ill will be both constitutionally and compassionately considered by this unelected second Chamber.

[Lord Wolfson of Tredegar (Con)]

My Lords, this has, I can say without qualification, proven to be one of the most contentious Bills that has come before your Lordships’ House in this Session and perhaps, indeed, in any Session. One of the reasons why it has been so contentious is that it is so important. No one can deny that the Bill, if passed, would result in a profound change in the relationship between the individual and the state. It is therefore, obviously, a very important Bill.

The fact that it is such an important Bill has meant that noble Lords across the House, whether for or against the principle of assisted dying, have taken the scrutiny of the Bill very seriously, as they rightly should. I suggest that there is both a general and a specific reason for that. The general reason is obvious— it is part of our unique constitutional role to scrutinise legislation in detail. That is why we are here. It is why our procedures are both substantively and essentially different from those of the House of Commons; I will not get into whether they are better or worse, but they are certainly different. The specific reason is that many MPs voted for the Bill not only in the knowledge but also on the express basis that it would be properly scrutinised here. Indeed, it was noted by several noble Lords at Second Reading, including in my own speech, that some Members of the House of Commons voted in favour of the legislation because they supported the underlying principle of the Bill trusting that this House would undertake the heavy task of detailed scrutiny in due course.

Detailed scrutiny is separate from the question of the principle underlying the Bill. You can be for or against the principle of assisted dying and you can be for or against the Bill, but they are not the same thing. I know that there are some noble Lords who are and will always be against assisted dying on principle. Some of them have made that clear in their speeches. They would therefore be against any legislation that legalised assisted dying. But there will be others, and perhaps many, who are not against the principle of the Bill but are none the less anxious to ensure that we pass a Bill that is safe, contains proper protections and, importantly, is workable in practice.

Whether one is for or against this Bill, it is regrettable that your Lordships’ House has not been able to reach a conclusion on it one way or the other. I feel uncomfortable that the Bill has run into the sand rather than being either sent back to the House of Commons in an amended form or voted down. I would have preferred either of those options to where we have ended up, where the Bill will simply be lost when the Session ends.

The primary reason for the large number of amendments, many will say, is the large number of questions that the Bill, as drafted, left open. Many amendments raised complex issues, as those of us who have been at all the Committee days will know. It is understandable that there was a large number of amendments; some were designed to effect change and some were probing amendments designed to introduce greater clarity. However, regardless of how many amendments there have been, whether or not to legalise assisted dying is clearly a question that the public would like Parliament to answer.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Stevens of Birmingham (CB)]

On the thrust of the argument, I agree with the noble Lord, Lord Moylan, that approaching this probabilistically, rather than with a single number, clearly makes sense. It is wonderful to hear the impact that these new immunotherapies have had in his own personal case as well as for oesophageal cancer.

Just for the record, I want to associate myself with the comments of the noble Baroness, Lady Royall, because the evidence is pretty clear that there is not an association between positive thinking and cancer survival. There may be a link with quality of life, but frankly, it is perfectly normal, having had a cancer diagnosis, for people to feel depressed or anxious.

The only reason for raising this very briefly at this point is that we need to be very sensitive. When somebody’s cancer progresses and ultimately kills them, we should not be leaving the impression that we think that is because they lacked the positive attitude that would in some way have enabled them to survive. I know that is not what the noble Lord was suggesting, but just for the record, I think that the noble Baroness, Lady Royall, was right to draw that to our attention, and we should be clear about that.

[Baroness Jay of Paddington (Lab)]

To add to what the noble Lord, Lord Stevens, said, I very much dislike the death notices, for example, which refer to people having put up a great fight or having failed to deal with the battle, or whatever expression is used, which suggests precisely what the noble Lord said—that they have somehow failed in a mortal combat.

[Lord Young of Norwood Green (Lab)]

My Lords, I only want to challenge the point that was made that the Bill suggests that six months is inevitable. It does not do that at all. In fact, all Clause 7 says is that if you go to the doctor, there will be a record of a preliminary discussion. It does not say anything else. Clause 8 refers to the initial request for assistance and first declaration. Where does the idea come from that the Bill somehow inevitably leads to a six-month progression? There is no such thing in it, other than the fact that the doctor is required by law to produce a written record of the preliminary discussion. In that preliminary discussion, he or she could raise a whole range of things, as we have heard from noble Baroness, Lady Cass, and a number of others.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I added my name in support of the amendment from the noble Lord, Lord Evans of Rainow, for in-person assessment by the assisting doctor—the first assessment and the second. As has been said, how on earth can any doctor judge the mind—the physical and mental condition—of the person whom he or she may be ticking off to death without being in the room with them, particularly as this doctor may never have treated them in person?

I know that since Covid there has been an increase in remote consultations, but it is still the case that the average number of in-person consultations that a patient has with a doctor is three a year. In the case of consultation for assisted suicide, that such an appointment with the doctor is in person matters, as other noble Lords have said. We have heard a reference to telemedicine from the noble Lord, Lord Blencathra, but let us look at exactly what the British Columbia study reported of telemedicine: it limits the ability to observe non-verbal cues, subtle signs of distress and general context, and it fails to provide the emotional support, human contact and rapport essential to the therapeutic relationship between both parties in what is a shared decision. The study goes on to say that it provides limited evidence on long-term outcomes, especially with regard to hard data on assessment quality or adverse consequences. It goes on to say that ticking boxes rather than doing an in-person examination risks further streamlining to avoid an impact on scarce medical resources.

We know, for instance, from the Liverpool care pathway figures released in 2012 under the Freedom of Information Act, that two-thirds of the trusts had received incentive payments for meeting targets for using the pathway, amounting to around £12 million—that was in 2012. Telemedicine is also inappropriate for some patients: people with learning difficulties, autism, poor communication or verbal skills or mental health illness.

I conclude by asking whether the noble and learned Lord, the promoter of the Bill, disagrees with Professor Mumtaz Patel, President of the Royal College of Physicians, that face to face assessment really matters? She says:

“Face-to-face assessment is really important and then the wider decision-making has to be done as a team, through shared decision-making and with somebody who knows the patient well. It goes back to the continuity”.


Does the noble and learned Lord acknowledge the evidence of the “off camera” abuse example from the US state of Michigan? The noble Baroness, Lady Coffey, mentioned the difficulty of detecting abuse online at the very outset of the debate. In Michigan, a prosecutor noticed a domestic abuse victim being coerced off camera during a Zoom hearing. I hope the noble and learned Lord can reply to some of those points.

[Baroness Jay of Paddington (Lab)]

My Lords, I wonder whether the House will listen to the point made by the noble Baroness, Lady Gerada, which is that she is probably the only person in the House—and certainly the only person who has spoken this morning—who has had practical experience of assessing people. She spoke very well about the issues which have been raised this morning in relation to the Covid epidemic, saying that, “There was not a clinical or ethical necessity to see people face to face to make proper judgments”. I really want the House to accept that someone with that practical experience should be listened to.

I will make one other short point, which is that I am again surprised, frankly, by the number of people who have spoken this morning who, without, as it were, even mentioning the question of the circumstances of those who are terminally ill and are asking for assistance, talk so much about administrative procedures, the way in which a network might be formed, or the way in which technology could be used. Frankly, I would like to hear a little more from everybody who contributes about the circumstances and problems of those who are actually seeking assisted dying and who may well be those who, frankly, for one reason or another—because they are physically in a way that they cannot do it, or they are perhaps geographically remote or have other circumstances which prevent them being able to access a face-to-face agreement or a face-to-face assessment—none the less very much want an assisted death for their terminal illness. Their concerns should be the ones we primarily consider.

[Baroness Smith of Newnham (LD)]

My Lords, the noble Baroness, Lady Jay, just asked us to consider the circumstances of those who are seeking an assisted death, but I would like to give a salutary lesson—I am sorry to disagree with the noble Baroness, Lady Gerada.

My father was taken ill during the Covid pandemic. He did not have a smartphone and was not able to have an in-person consultation. He had jaundice. The message he came away with from speaking to a doctor on the telephone—the doctor had never met him—was, “It’s pancreatic cancer”. My father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he did not have pancreatic cancer.

That demonstrates one of the flaws of doing something remotely, which is: what are the messages? The doctors are not getting the cues and the patient is not necessarily hearing what the doctor is saying. I am sure that the doctor did not say, “Mr Smith, you have pancreatic cancer”—clearly, they could not have said that—but that was the message that my father heard. I therefore very strongly support the amendments in the name of the noble Lord, Lord Evans of Rainow, and two of the amendments from the noble Lord, Lord Blencathra.

However, I want to express one serious reservation about Amendment 406A from the noble Lord, Lord Blencathra. If the discussion has to be taken by video conference, it might not be appropriate to say that in every circumstance the only person who should be on that call is the patient. We all know that, when you go to the doctors, even if you are there in person, you have capacity, you are a rational person and you do not have any cognitive difficulties, you do not hear everything. Sometimes, if it is a difficult diagnosis, you do not take everything on board. For some people who are told that they have a terminal diagnosis and understand that that is the case—unlike in the false case of my late father, who did not have a terminal condition at that stage—we know what their settled will is. There are several people in your Lordships’ House who have what their settled will is very clearly on record, in the public domain. But there will be other people with whom the doctor has never spoken before, so they cannot know whether it is somebody’s settled will in a way that the legislation requires.

If, then, there has to be a video conversation, or indeed an in-person conversation, it might be appropriate for there to be an independent advocate or somebody else who would support that person and could say, “The doctor did not really say that, you know”. We need to think about real-life cases. Yes, we need to understand from the medical profession, and it needs to be from the perspective of somebody with a terminal diagnosis, but we also need to understand the reality for ordinary people who do not have the advantages of the internet or the accessibility that Members of your Lordships’ House have.

--- Later in debate ---

[Lord Pannick (CB)]

It is a great pleasure to follow the noble Baroness, Lady Campbell of Surbiton, and to say how pleased I am, as I am sure all noble Lords are, that she is very much still with us. I hope she will be for many years to come.

This is an important group because, as has been emphasised, scientific precision is of course not possible in this area. Nobody could say that a doctor can tell you that you will die within six months. But the Bill does not so provide. Its conditions require only that the doctor, and the panel in due course, are satisfied that

“the person has an inevitably progressive illness or disease which cannot be reversed by treatment, and … the person’s death in consequence … can reasonably be expected within six months”.

The term “reasonably be expected” recognises the absence of scientific certainty and absolute knowledge in this very difficult area.

The noble and learned Lord will give his view on this in due course, but why, in my view, is the Bill right to so provide? It is because—we are down to the fundamentals of this legislation—if I am told by my doctor that, sadly, I have an inevitable progressive illness or disease and my death can reasonably be expected within six months, I should have the choice of saying that I wish to end my life by taking advantage of the provisions of this Bill. Each of these amendments seeks fundamentally to undermine the core of the Bill and the philosophy that guides it. I entirely accept that its opponents disagree, but this is the core of the Bill and why it rightly so provides.

It is no answer to these provisions and this philosophy that, happily, having been given that prognosis, I may well, should I choose not to exercise the powers under this Bill, live for seven months, 12 months, two years or however long. It would be wonderful if my doctors were incorrect, but it is my choice, having been given that prognosis. That is what this Bill is about—we have taken days debating this—and it is right and proper that we ensure that that decision is made on a voluntary basis and that there is no coercion. But, once those conditions are satisfied, if I am told by my doctor that that is my prognosis, it should be my choice whether to use the provisions of this Bill.

[Baroness Jay of Paddington (Lab)]

My Lords, does the noble Lord agree with me that one of the international facts that supports entirely the position he is taking is that, in the now 33 jurisdictions where assisted dying is allowed, it is usually the case—I cite one or two—that, following that suggestion by a doctor, or prognosis or however you want to describe it, over a third of those who make the choice he has described then do not use the provision? There is no question that they want to die; they are simply using it almost as an insurance policy.

[Lord Pannick (CB)]

The noble Baroness makes an important point, because this Bill is concerned with providing choice. Of course there is no mandatory obligation, but, if you are given this information, you should have the right—it is your life—to decide whether you wish to take advantage of these provisions. In many cases, if it were me or my family, I would argue strongly that there are other options and other things should be done. But it is a choice, and people should have that choice. That is the philosophy and what has guided so many jurisdictions around the world. Many noble Lords do not agree with that, which is their right, but that is what this Bill is all about.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Deben (Con)]

It seems to me that this an opportunity for the noble and learned Lord to help the Committee and speed the Bill. Here are a whole series of amendments designed to deal with the genuine concerns of the experts who are going to have to actually carry this law into effect if we are to pass it. Some of us may have strong views about the principle, but we have a duty to do our best to make the Bill work.

One of the problems people have is that the noble and learned Lord has so far not been willing to tell the Committee that he will meet concerns by proposing amendments himself. In this particular group of amendments—which is why I tried to wait until the end of it, because it is not only on an individual amendment that I speak—there are a whole series of reflections of the concerns of those who will have to deal with the Bill when it is passed.

This is an occasion in which we can overcome a lot of the concerns—I might even say suspicions—that there is no intention of changing anything, and that it will just be pushed through, however long it takes, in order that there should not be a concern at the other end of the Corridor. I am sure that the noble and learned Lord does not really think that, but he needs to reassure the Committee. We will get much further, much faster if he can look at these amendments and say he is going to bring forward amendments that reflect the concerns here, which themselves reflect the concerns of the various medical bodies in particular, in order that the Bill will be a more effective Act.

If the noble and learned Lord does not do that, there is a very serious criticism of the Bill, that we are not reflecting in this House the concerns of those who, next to the people who make this choice, matter most: the people who have to implement it. All the medical bodies have reservations. Some few are opposed to it in principle. I am perhaps more interested in those who are not opposed to it in principle but who are concerned about it in practice. If we are not prepared to make the changes that make them happy—though perhaps “happy” is the wrong word—and able in good conscience to support the Bill and follow it through, then we will not have done our job as this reforming House. I say this because I have become rather weary with the fact that what appears to be true is that there are those for whom this is so important a doctrinal position that they are not prepared to consider that this particular formulation needs alteration.

Therefore, I ask the noble and learned Lord, when he comes to answer, to consider very seriously a willingness to say, “I will go through these amendments, talk to the people outside if necessary and bring forward the kinds of amendments that will meet the real concerns of those people upon whom I am going to depend for the efficacy of this legislation if it is passed”. If the noble and learned Lord is unable to do that, more and more of us will begin to wonder whether this is really a debate in which we are trying to improve the Bill and make it the best legislation possible, or merely one that will be prolonged for as long as possible in order to put through the exact same Bill to the House of Commons. Frankly, if it is that, all of us who have doubts about it should redouble our doubts. If it is not that, we have a duty to help the noble and learned Lord to get the best Bill possible. It is in his hands, and this may well be the moment for him to show his hand.

[Baroness Jay of Paddington (Lab)]

I wonder whether the noble Lord would accept the actual evidence of one member of the medical profession who gave evidence to the Select Committee. She reflected many of the concerns that people who support the Bill agree with. She said that, when the healthcare professions

“get it wrong … it is usually because we are being paternalistic”.

A great many of the amendments in this group are very well intentioned and meaning in their concern for patients, but we must allow for the fact that they rely on an assumption that the medical professions, in their doubts, may act paternalistically.

I have been married for a very long time to a doctor. He would certainly say that the practice of medicine has changed hugely in his lifetime, and that when he first qualified as a young doctor, the field was paternalistic. However, now there is a much greater assumption that the words, intentions and wishes of the patient should be the ones that carry force. That is obviously the philosophy behind so many of these amendments, which, in a sense, seek to reintroduce the paternalistic attitude of the medical profession. In contrast, those of us who support the Bill are much more concerned to support its underlying principle of the autonomy of the individual patient.

[Lord Deben (Con)]

I hope that it was an intervention, because, if so, I am able to comment on it. If we start talking about paternalism, we will go backwards in time. We are not really talking about that at all; we are talking about the legislation of this House and the House of Commons. We are talking about how we produce legislation that works. What worries me is that there are a lot of words being used, such as “paternalism”, “kindness” and others, that are making us less precise. Law has to be precise enough for it to be properly implemented.

Frankly, the intervention of the noble Baroness sums up something else. There is a paternalism among some in this Committee who feel that they are so right about the Bill and that they can therefore ignore the comments of people who are trying very hard to overcome their own prejudices—if that is the right word—to get the Bill right. I find it a bit discomfiting to be lectured to, from time to time, as if I should not be making any of these comments because I do not seem to understand the higher views that are being presented. After being a Member of Parliament for 40 years and knowing what goes on in families in terrible circumstances, all I am trying to do is protect people. That is my job; it has been my job all my life. In response to the noble Baroness shaking her head, I say: that is not paternalism; that is the role of leadership in any circumstances. It is what decent people do, and, above all, it is what kindness demands.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Lord Rook (Lab)]

With the greatest respect, that is not the conversation I am trying to have here. The conversation is about the necessity that someone who is going through the process has continuity of care and a relationship with that GP. We are suggesting that someone who is after a state-assisted end-of-life process should have the opportunity to see that GP on a number of occasions so that their judgment can be made in the context of continuity of care, not in one appointment.

To pick up the noble Lord’s questions, this amendment would not block access. It would not frustrate autonomy. It would simply ensure that assisted dying does not begin from nowhere. It grounds a grave decision in a minimal but essential relationship with the health service that is charged with safeguarding the person in question. Supporting autonomy requires a supportive context. It requires knowing whether a request reflects a settled conviction, a moment of despair, untreated depression or pressure that the patient feels unable to articulate. These things cannot be reliably assessed in isolation. Above all, care is relational. If Parliament is to contemplate legislation under which the state may participate in deliberately ending life, the very least we must insist on is that such decisions take place within the context of real and primary medical relationships, not on the periphery of the system.

This amendment would strengthen residency safeguards, improve the evidential foundation for clinicians, reduce the risk of doctor shopping and respect the seriousness of what the Bill proposes by rooting it in genuine and consistent care. I commend the amendment to the Committee.

[Baroness Jay of Paddington (Lab)]

Can I ask the noble Lord, having cited the doctor Michael Mulholland as a great authority in relation to his evidence to the Select Committee, whether he also accepts what Dr Mulholland said to the Select Committee? He said:

“As GPs, we are very used to providing holistic care and trying to understand where the patient is coming to us from in lots of situations”.

[Lord Rook (Lab)]

I absolutely agree with that. The reason why the doctor is able to do that is because he gives consistency and continuity of care. He does not see patients on one occasion on one big issue, but is able to travel with them in a longitudinal relationship, and that gives him the ability to make those decisions.

Terminally Ill Adults (End of Life) Bill

Baroness Jay of Paddington Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I declare that I was a vice-president of Hospiscare in Exeter. I am probably the only person in this Committee who has tried cases of capacity, again and again, both as a High Court judge and in the Court of Appeal. One case was so difficult that the Court of Appeal, where I was presiding, sat until 1 am. Noble Lords may not have thought that the Court of Appeal did that very often. It is important for your Lordships to realise that some cases that I tried were extremely easy to try—one in particular involved a Miss B, who was obviously competent—but other cases were extraordinarily difficult. One case—the one that we did until 1 am—concerned somebody with a needle phobia who was expected to need a caesarean, and she objected because she could not bear the idea of a needle. At one in the morning, we took the view that she did not have the mental capacity to decide on her caesarean. She was hugely relieved and had the operation without any trouble. But that was not a unique case—the time was, but not the problem.

[Baroness Jay of Paddington (Lab)]

My Lords, I of course enormously respect the experience of the noble and learned Baroness and her ability to make these judgments. I am sorry that she had to sit until 1 am. But does she feel that those decisions would have been more or less complex and difficult if she had been judging them on the basis of ability?

[Baroness Butler-Sloss (CB)]

I have not the remotest idea. It is such an important point that I would have to go away and reflect. I am not commenting on ability or capacity; the point I am making to the Committee is about the difficulty of this for a doctor, or several doctors—probably GPs. The Royal College of Psychiatrists, of which I am an honorary fellow, has said firmly that it wants nothing whatever to do with the panel or with this, so doctors who are not psychiatrists will decide, with other people, whether somebody has or does not have capacity. That is what is currently in the Bill.

I warn your Lordships that this can be difficult, particularly when it involves depression. I had a friend, a solicitor, who suffered from depression. She said that she used to fall into a black pit and try to crawl up the sides, which were slippery. It was clear to me that, when she was in that depression, she certainly did not have the ability to make serious decisions. So I warn your Lordships about the potential problems of assessing capacity.

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[Baroness Jay of Paddington (Lab)]

My Lords, I am grateful to my noble friend Lady Thornton for raising the question of other countries. Some of us here have sat on Select Committees on this subject over a large number of years; for example, I did so 20 years ago. I would not suggest that that evidence is necessarily completely relevant, but the fact is that we have taken evidence. We have not simply taken written evidence; we have been to countries where this has been in practice for many years. If, for example, noble Lords were to look at parts of the United States such as Oregon—one of the states that introduced assisted dying many years ago—they would see that the improvements in palliative care have been enormous and coincident with the application of assisted dying. It has never been the case, for those of us who support the Bill or support the general principle of assisted dying, that there is a choice between palliative care and assisted dying: both should be available.

[Baroness Scotland of Asthal (Lab)]

I never suggested that they should be alternatives. The truth is that palliative care is not available in all parts of our country, so this has to be a real choice. That is the only element I made.

Also, I hope that all of us would look at the evidence, from wherever it came. We know that we have to make evidence-based decisions, and the best evidence will help us to make the best decisions.