Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Friday 12th December 2025 Lords Chamber

[Baroness O'Loan (CB)]

I remind the noble Baroness that we are talking about people who are terminally ill, not the general population.

[Baroness Lawlor (Con)]

My Lords—

[Baroness Fox of Buckley (Non-Afl)]

I will just finish, because it relates to this. I appreciate that, once given a terminal diagnosis, that might be true, but not necessarily. That is the honest reality of the situation.

We have a moral dilemma here. GPs are being called on as though they are important to this Bill, but if they are just passing and you do not have continuity of care, they are actually being treated with contempt. On the other hand, in truth, the demand that you have to have continuity of care before you can ever be offered assisted dying seems unrealistic in today’s modern health service.

[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 30B, 220 and 265A in my name. They share the aim of other amendments in this group to ensure that the GP knows and has looked after the person who wants to end his or her life, but go beyond them in proposing the extent and length of the relationship needed and in requiring a letter from the GP to provide important additional safeguards. I will explain the amendments.

First, I propose that the patient be known personally to a doctor for two years through having been seen for at least six appointments. Secondly, I propose that the doctor submits a letter to the assessment panel on the patient’s physical and mental health during that period, and a prognosis. Thirdly, I stress that the doctor, as we see their involvement in this Bill, may be the patient’s GP, but that is not required; the doctor may be the first doctor, but, given Clause 11(8), this is unlikely, and it will probably not be the second doctor. The important point is that a medically qualified practitioner knows the patient over time and can write an assessment for them.

Why does this matter? Advocates of and those concerned about the current arrangements in the Bill want adequate safeguards. We all do. We want to protect the weak, the elderly and people with physical or mental health conditions from being influenced, pressured or coerced into wanting to end their own life. But if the request for assisted suicide can be accepted without a doctor who knows the patient personally over time, there will be no such safeguards. “Knows” does not mean a fleeting acquaintance but a professional knowledge of the patient built up over years. That is the aim of my amendments. By contrast—

[Lord Pannick (CB)]

What happens if my doctor retires and I therefore have not had a doctor who knows me for two years? Am I to be denied access to the provisions under this Bill?

[Baroness Lawlor (Con)]

I thank the noble Lord. I hope to come to deal with that question.

By contrast, all the Bill requires is the involvement of two doctors, neither of whom needs to be at the practice where the patient is registered or even has to have had prior knowledge of them before the process begins. Under the Bill as it stands, there is no connection between a doctor who knows the patient well and the process that leads to the assisted suicide. The other amendments in this group go some way to mitigating this, but it matters that there is a guaranteed role in the process for the doctor who may have known the patient.

The Bill recognises that the patient’s GP may not wish, as a matter of conscience, to be involved in the process, but that does not mean that they or another doctor who knows the patient should not submit a letter to the process of the assessment panel as one of a number of documents seen by the multidisciplinary panel, which would be part of the public record of the assisted suicide. It will be in a different format—neither a checklist nor compiled from the hasty notes that GPs are obliged to write that they squeeze in between their 10-minute appointments.

I turn to possible objections to these two-pronged amendments. First, the requirement that the same doctor has seen the patient six times over two years to allow adequate safeguards may be thought too much. Anything less would hardly amount to knowing the patient, the condition and their state of physical and mental health. It is feasible. Some evidence suggests that, on average, in 2018-19 patients had 3.3 face-to-face consultations per year with their GP, and 8.7 when every sort of consultation was taken into account. This data has not necessarily changed over the 20-year period of the study. Other data puts the face-to-face consultations lower, at 2.6, but these are averages. Very seriously ill people will have had far more consultations.

Moreover, only face-to-face consultations, when the patient is physically with the doctor, give a good idea of physical and mental conditions as they develop. If the Bill is so amended, in answer to some problems that have been raised, it might encourage more face-to-face GP consultations with seriously ill patients. If there is a seriously ill patient and the GP retires, they might like to leave a letter providing the evidence over the period they saw them before they retire. But there will always be objections—

[Lord Pannick (CB)]

The GP might have died 18 months ago; what happens then?

[Baroness Lawlor (Con)]

These things can happen, but we should have a process or an alternative mechanism. I am not going to deal with exceptional cases. My GP is still in situ, and I can see my GP when I want to; other practices could aim to do the same thing. We have very great demands on the practice in Cambridge, with many students registering.

[Baroness Wheatcroft (CB)]

Can the noble Baroness tell the Committee whether she actually listened to what the GP in our midst said about how practices work?

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, but I would like to press on. There are other GPs who want to see the same patients; they want to build up the patient relationship over time because they say it makes for better diagnosis, care and treatment for their patients. We should not put up with the worst-case scenarios simply because it does not happen or because we think a multi-doctor practice works well. It may work well in some cases, but there is no replacement for knowledge of a patient over time.

The letter gives the multidisciplinary panel an assessment of the patient’s illness and state of mind by someone who knows them. If anything raises suspicion that there has been pressure or that the patient is not in a state of mind to make the decision, the panel can investigate further. Moreover, unlike the other matters and activities in the process, the letter is not a matter of ticking boxes. The demand is for something that doctors are used to doing; to write a coherent letter about one of their patients is something that requires thought and careful concern for the individual case. It is standard practice in referring a patient to a consultant for specialist care where there are letters passed to and from. Doctors and consultants write letters.

If the Bill is to have real safeguards in the form of coherent and analytical evidence from a doctor who has known a patient over time, such amendments are needed. I ask the sponsor of the Bill to require it.

[Lord Deben (Con)]

My Lords, we are supposed to be making the Bill more practical; it does not make it more practical to ask for something that is manifestly impossible. I could not demand assisted dying, because I have not seen my registered practitioner in Suffolk for many years. I do not have a particular practitioner because that is not how the local system works. We are not in a sensible position if that is what we are going to ask for.

But the noble Lord, Lord Rook, has an important point that I do not want us to lose because of the suggestion that all people have the kind of National Health Service that we would all wish to be the case. We have to take his point rather differently. I was surprised that the noble Lord, Lord Winston, suggested that the proposition is that the general practitioner or the team—in normal circumstances it is the team—could in some way stop the application.

The point is—and I ask the Committee to think about this seriously—that if someone has a general practitioner, it is important that the GP and his or her team are informed of the request in case they are able to contribute to a sensible decision. The fact that this is assumed in the Bill, as was put forward by the noble Baroness, Lady Fox, does not prevent us insisting that they should at least have the opportunity. If we do that, we will be doing a very valuable thing.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

Yes, we should get the information from those responsible for the care of the individual in a health sense. However, I am not willing to commit myself to that in relation to the family. The person making the decision should think, “What should we do about the family?”—but what if the patient has not seen their family for a long time or are at odds with particular family members? I believe that it should be done very much on a case-by-case basis.

[Baroness Lawlor (Con)]

My Lords, the noble and learned Lord thought that it was ludicrous that a patient would see the same doctor. Is it ludicrous, in his view, that, on average, 3.5% of consultations between a patient and a doctor are face to face? Is it ludicrous that we should expect those consultations to be with the same doctor?

[Baroness in Waiting/Government Whip (Baroness Anderson of Stoke-on-Trent) (Lab)]

I am sure that my noble and learned friend will respond to that in the debate, but the noble Baroness has just intervened on an intervention. The Chief Whip made clear reference to that earlier.

--- Later in debate ---

I turn now to Amendments 30B, 265A and 443A, tabled by the noble Baroness, Lady Hollins. The effect of these amendments is to require a person seeking an assisted death to have a letter from a GP who has known them in a professional medical capacity for at least two years—

[Baroness Lawlor (Con)]

I beg the Minister’s pardon but she is referring to my Amendments 30B, 265A and 443A, not those of the noble Baroness, Lady Hollins.

[Baroness Merron (Lab)]

I am most apologetic and grateful for the clarification. I hope that the noble Baroness, Lady Hollins, will forgive me, too.

I will continue. The GP must also have seen them at least six times in face-to-face appointments during those two years. Noble Lords may wish to note that these amendments introduce requirements that may result in people seeking GP appointments that are not clinically necessary. This may have an impact on wider access to GP services. Noble Lords may also wish to note that, even if a person has seen their GP the required number of times over the two-year period, their GP could still refuse to provide the explanatory letter, as they are not under any duty to participate in the provision of assistance, as per Clause 31. This would result in the person being unable to access an assisted death.

Lastly, Amendment 220, tabled by the noble Baroness, Lady Foster, seeks to add an additional step in the assisted dying process. It would not be a compulsory step; therefore, it would not have a major impact or be unworkable. However, this amendment has not had technical drafting support from officials and, although the issues raised are rightly a matter for noble Lords to consider and decide, would likely require further consideration in order to be made fully workable, effective or enforceable.

[Baroness Lawlor (Con)]

If there are on average 3.5 consultations a year face to face, with calls and so on bringing it up to 8.7, it would not necessarily make for additional unnecessary appointments for a person with such a condition. That is my first clarification. My second is about a letter being required and the doctor concerned not wanting to assist in the process. The letter is not about the process. The letter would go into the person’s history over the two years they have been consulting the doctor. It has nothing to do with the process of seeking an assisted death.

[Baroness Merron (Lab)]

Acknowledging that the amendments that I was referring to were tabled by the noble Baroness, Lady Lawlor, I have nothing to add to the points that I have already made, other than to say that the noble Baroness used the word “average” and therefore there is a question about workability. Therefore, our interpretations on the noble Baroness’s second point do differ.

Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I apologise for interrupting at this stage. This has been a very good debate, and it might be helpful if I indicate what my position in relation to this is. The thinking behind 18 is that that is the age at which you can make your own decisions about medical care. If you are suffering from a terminal illness, you can decide at 18 whether you want to withdraw treatment, for example, or what the treatment should be.

In answer to the noble Baroness, Lady Berridge, we were aware of the different views about when your brain and maturity develop, and what the noble Baroness, Lady Cass, said is absolutely correct—she read Sarah-Jayne Blakemore’s view—in that these age cut-offs that the law imposes generally are not based upon a close study of neurology; they are the law’s attempt to reflect maturity. I am indeed very aware of the fact that if you are 18, you may be more emotionally impulsive and more easily influenced than somebody of 25, 24 or 23. Equally, anybody who has had contact with people who are young and terminally ill will have found that some 18 year-olds are incredibly thoughtful and mature and some are not, for obvious reasons.

I am very influenced by the fact that I have been listening to people expressing real concern about this issue in this House. I still think 18 is probably the right age, but I am very influenced by what the noble Baronesses, Lady Finlay and Lady Cass, have said: that maybe the answer is some assurance that there is a more intense assessment for people aged between 18 and 25. The Bill says that you can have an assisted death only if you have

“a clear, settled and informed wish to end”

your life, and it is being done voluntarily. How can we be sure about those aged between 18 and 25? Two doctors and a panel have to make the decision, but some additional thing might be required.

We are slightly going around in circles again and repeating ourselves, so I suggest that I talk in particular to the noble Baronesses, Lady Cass and Lady Finlay, and that we come back on Report and see whether we need a more thorough assessment for people aged between 18 and 25—although I am not saying I am going to change the age of 18. That is broadly my position.

[Baroness Lawlor (Con)]

My Lords, I thank the noble and learned Lord for his intervention, for which I am very grateful. I point out first that I think that many noble Lords feel there is a very great difference between a decision to refuse treatment or withdraw treatment, which may or may not end one’s life, and to ask for something which will definitely end one’s life. That point is brought up by supporters of the Bill.

I will speak to my Amendment 5 and to the related Amendments 250, 258, 305 and 338.

[Baroness Butler-Sloss (CB)]

I wonder whether the noble Baroness might think it wise for us all to find out, after the discussions with the noble Baronesses, Lady Cass and Lady Finlay, what the noble and learned Lord, Lord Falconer, is proposing to do before we discuss this any further.

[Baroness Lawlor (Con)]

I thank the noble and learned Baroness, but I have a few points to add to the discussion.

[Noble Lords]

Oh!

[Baroness Lawlor (Con)]

I hope that noble Lords will show the customary courtesy, particularly with regard to views to which they have objections.

[Baroness Watkins of Tavistock (CB)]

Would the noble Baroness consider joining the meeting with the noble and learned Lord, Lord Falconer, to talk about her additional points? I think the majority of the Committee is keen to move on so that we can facilitate further groups.

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, and I certainly will consider it, but I think it is important that we have a discussion about what I regard as a compromise Motion, which may be useful in the discussions noble Lords have with the sponsor or those who wish to proceed in that way.

[Lord Carlile of Berriew (CB)]

Would the noble Baroness, for whom I have a great deal of respect, consider whether she is really adding anything at all to the debate by continuing? We can read her amendments; we know the difference between 18, 21 and 25. I and the noble and learned Lord, with whom I do not disagree on the fundamental principle behind the Bill, are both of the view that we should have proper discussion on it and get through Committee in the way that is expected of us as the House of Lords, so when the noble and learned Lord intervenes and says he is willing to hold meaningful discussions, we should do that and move on to the next business.

[Baroness Lawlor (Con)]

I thank the noble Lord, Lord Carlile, for his intervention. I recall one of my first horrific experiences in your Lordships’ Chamber when I sat on those Benches. We were speaking about a Bill to which the noble Lord was opposed, and he asked the Front Bench to say I was out of order in speaking because I had gone out to get a glass of water, even though I had sat through not only that debate but all the previous debates. That hardened me to those sort of objections to free speech in your Lordships’ Chamber, and I was very disappointed in that debate and others to have noble Lords from the other side shouting at me, “Shame! Shame!” if I mentioned a view with which they disagreed. So I will persist with addressing my compromise Motion amendment, and I hope I will be brief, but if noble Lords continue to interrupt me, that will make it more difficult.

We have heard—I will not repeat the arguments—that 18 is too young given what we know about neurological science. I have one piece of evidence to add for the whole House, not for the private discussions which might take place. As I understand the rules, this is a Committee of the whole House. So we have heard about that, and I will return to that with one additional piece of information. We have heard also that the law recognises the special vulnerability of young people until the legal age of majority and how it supports different routes.

I go back to something the noble Lord, Lord Moore, said. He referred to how difficult it was for younger people, and even those who may not have given a great deal of thought to the subject, to address dying. I would add to that: to understand what it is to choose to die. For most, the thought of death is distant, and the way society has been conditioned to see death in rather euphemistic terms, in the very language we use, reinforces that remoteness. In the multigenerational families of the past, where the members shared a house, visited frequently, supported one another in all the challenges they met every day in life, death, with its traditional rituals—the funeral and the period of mourning—were ever-present in the lives of children as they grew up. I remember, as a very young child, seeing a mother who had died in childbirth—

[Baroness Blackstone (Lab)]

I apologise for interrupting the noble Baroness, but I think the Committee has really made it clear—

--- Later in debate ---

[Baroness Lawlor (Con)]

I thank the noble Baroness, Lady Blackstone, for that intervention, and I am going to my point. I think it is important to the whole argument to recall the various arguments; I am not repeating them, although I did make some of the same points or similar ones, and I have cut those.

We have heard also, in the context of the Bill, rare and sad cases of young adults diagnosed with terminal illness. But I do not think we should underestimate the decision, which is one of the suggestions, to end one’s own life as opposed to withdrawing treatment, given the very variable assessments we get. The science is very difficult. Consultants will tell you that they get different slides back from the lab, depending on how the various scientists and pharmacological people look at the evidence. It is difficult to know how long people will live.

Moreover, as we have heard today, if the Bill becomes law, it is probable that its provisions will gradually become looser in practice. The idea of killing yourself and having help to kill yourself will become normalised. Under these circumstances—alas, they are not those of a dystopian fantasy but are most likely in future if the Bill, in its present guise, has its way—the common depressions and anxieties of late adolescence, which often translate to thoughts of suicide, will be encouraged.

I speak here as someone who has taught 18 to 21 year-olds in university. People who have suffered terrible emotional stresses with which they cannot cope have been referred to me, for me to teach them history. Their tutors have mentioned privately that they want to commit suicide, saying, “They have already tried, but they want to continue doing their course on whatever. Will you take them on?” It may be objected that, since 18 is the legal age of majority, whatever choices are being opened up for older adults must stretch down to a person’s 18th birthday.

I will add just one thing on research in neurosciences. We have spoken a lot about neuroscientists’ view of emotional maturity, but—

[Baroness Morgan of Huyton (Lab)]

I am sorry to interrupt the noble Baroness, but she said that she would be coming forward with a compromise. I am not really clear on what that is, because it seems that this is still the same evidence as before.

[Baroness Lawlor (Con)]

I thank the noble Baroness for her intervention.

[Lord Moylan (Con)]

My Lords, I have not spoken in Committee at all so far. I briefly say to those who are objecting—and who take the view that the intervention of the noble and learned Lord, Lord Falconer, should bring the debate to an end—that the debate we are having is about 18, 21 or 25 year-olds. The noble and learned Lord has not said that he is willing to compromise on any of those; as I understand it, he wishes to persist with the age of 18, although he is willing to look at additional safeguards. It does not seem to me, therefore, that his offer of discussions—welcome though it no doubt is—addresses the core question in the debate. So I do not see why the debate should be brought to an end simply by his intervention.

--- Later in debate ---

[Baroness Lawlor (Con)]

My Lords, up to the age of 25, people often struggle to grasp that death is irreversible. They understand in notional terms the point that death ends a person’s life on earth, but they do not really grasp the sense—both those who accept and those who deny the afterlife know this—that life as we know it ends.

Somebody who has not been mentioned is Professor Leah Somerville, a Harvard academic who specialises in psychology and is the director of the Affective Neuroscience and Development Lab. An article on her research says:

“Adolescents do about as well as adults on cognition tests, for instance. But if they’re feeling strong emotions, those scores can plummet. The problem seems to be that teenagers have not yet developed a strong brain system that keeps emotions under control”.


I have suggested the age of 21, not 25, as the lower limit. I regard this as a compromise, and I proposed it at the outset. As I say, the medical evidence points to 25; I am happy to support that.

In conclusion, opponents might say that the seven-year gap between the age at which a person is thought to be an adult for legal purposes and the age at which they become eligible for assisted suicide is simply too long, but no young person should be presented with the option of taking their own life—certainly not those who have been diagnosed as having a terminal illness. They are not physically, psychologically or emotionally developed to the maturity needed to make a judgment devoid of emotion. Although my moderate amendment places the age of eligibility at 21—I stress that it is a compromise—I would be prepared to support other noble Lords on the age of 25.

[Lord Harper (Con)]

My Lords, I want briefly to respond to a point made earlier in the debate by the noble Lord, Lord Winston, whose medical expertise I respect greatly. He quoted a comment from Sarah-Jayne Blakemore, which has not been said already in this debate, and talked about the context in which decisions are made. In a paper, she said:

“Adolescence is characterized by making risky decisions … This suggests that decision-making in adolescence may be particularly modulated by emotion and social factors, for example, when adolescents are with peers or in other affective (‘hot’) contexts”.


That tells me—it is relevant to an earlier discussion—that it is not just the age of the person that is relevant, which is why Amendment 4 from the noble Baroness, Lady Berger, is very helpful. It is about context in decision-making.

I listened carefully to what the noble and learned Lord, Lord Falconer, said about the thought process that he was going to undertake, having listened carefully to some experts. Like him, I am torn on the age issue. The amendment from the noble Baroness, Lady Berger, is very helpful in setting out some of the issues, but I was also struck by what the noble Baroness, Lady Fox, said, so I am slightly torn on whether age is the right way of doing it. I do not know whether it is an assessment.

My final point is that I was struck by what the noble Baroness, Lady Berridge, said—

--- Later in debate ---

[Lord Ashcombe (Con)]

My Lords, I wish to express my particular concern regarding Amendment 416. The question I must put to the noble and learned Lord is, why should an independent doctor tasked with providing a second opinion not have access to the notes of the first? Is the intention to prevent any influence on the second medical professional, even when the first has identified grounds for dissatisfaction and declined to proceed with the possibility of assisted death?

We have already engaged in lengthy debates on the crucial matters of decision-making capacity and the risks of coercion. What if the first independent doctor had uncovered evidence of precisely such concerns? This situation inevitably calls to mind the troubling prospect that a patient, or indeed another party exerting influence upon that patient, might seek out a doctor willing to endorse the view of the co-ordinating physician. Surely the medical notes generated throughout the process are of fundamental importance to all involved in the medical profession, and it cannot be right that they should be withheld from any participant in the decision-making claim. I therefore earnestly ask the noble and learned Lord to give me his thoughts on this, as I do not really consider this to be a straight drafting issue.

[Baroness Lawlor (Con)]

My Lords, I would like to refer to Amendment 6 from the noble and learned Lord the sponsor of the Bill, because I have concerns with it. In inserting the words

“has a preliminary discussion with a registered medical practitioner”,

Amendment 6, which is described as a drafting change, adds to the uncertainty about what discussion takes place with the patient and when. It is a dangerous uncertainty as, if the Bill was so amended, it would be left open for one or more such discussions to take place before the person is 18, so long as the discussion that is required as a preliminary discussion takes place after the person has reached 18.

In particular, the amendment would do nothing to restrict the scope of Clause 5(3), which permits a medical practitioner to engage in preliminary discussion about assisted dying with a patient who raises the subject. Since there is nothing to tie the discussion referred to as “a preliminary discussion” to be inserted in Clause 1 with “a preliminary discussion” in Clause 5(3), the amendment will not stop these discussions taking place with under-18s.

Grammatically, a “such and such” refers to any “such and such”, and the word “preliminary” does not imply a restriction on number; there could be one or 100 preliminary discussions. Although Clause 5(3) does not oblige the registered medical practitioner to discuss assisted dying under the Bill’s provisions with any patient who raises it, Clause 5(6) obliges the practitioner concerned to direct the patient to

“where they can … have the preliminary discussion”—

and that is the preliminary discussion. Therefore, even as amended, the Bill requires that any patient, whatever their age, who raises the possibility of assisted dying under the Bill is enabled to have a discussion about it. It cannot be objected that in Clause 5(6), the reference is to “the”, not “a”, preliminary discussion, since here “the” refers back to the preliminary discussion in Clause 5(3) to Clause 5(5), where the phrase used is “a preliminary discussion” or “such a preliminary discussion”—that is to say, any preliminary discussion of the matter.

These points may seem technical and pernickety, but consider how the Bill, even as amended, might lead a young person to end their life prematurely without proper adult consideration of the matter. Take a 16 or 17-year old who is suffering from a disease that makes their life expectancy uncertain, or who has been warned that they might die rapidly or deteriorate and die at any time. We may all try to imagine, but we can hardly know how such a young person might feel: isolated, lonely, afraid, and perhaps hypersensitive to remarks or innuendo, real or imagined, or indeed to some of what we have heard today about social media and pressures from peer groups in the Netherlands. They might share not only the worries about the illness, but the normal doubts of people of that age that even those in the best health who are depressed and unsure of themselves have. How easy for the unfortunate young person to say, “I wish I were dead”.

Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I support the amendments in this group. I am a research director at Politeia, a think tank that has commissioned a great deal of work from lawyers and academics, including on this subject, but I speak in my own capacity as a historian. I associate myself with the remarks of the noble Lord, Lord Griffiths of Burry Port, and the right reverend Prelate, who reminded us that we are part of a whole society and not just one person against another.

I support these amendments because they aim to tighten this Private Member’s Bill and prevent it being unsafe by prohibiting inducement to assisted suicide by those who, for whatever reason—we have heard about the reasons—seek to induce, encourage, advise or influence another to take his or her own life. My Amendment 57A would prohibit someone from planting the idea in the person’s head and getting them to consider suicide as an acceptable or even necessary course of action, so inducing them to choose an assisted suicide, which he or she might not otherwise have considered as an option. Given that the planting of such an idea could be done in a number of ways, directly or indirectly, under the Bill as it stands, and given the gravity and irrevocability of the decision to end your own life, the safeguard is needed.

Let me illustrate this with a possible conversation between someone suffering from cancer, whose diagnosis indicates that he or she has no more than six months to live and is in a state of shock and misery and depressed at the idea that nothing can be done, and a relative, friend or person such as a doctor, social carer, social services provider or someone else in a professional position. The person talks about the diagnosis and their feelings to the other party, who might reply: “Have you considered an assisted death?”, “I know someone who didn’t want to go through with the whole thing until the bitter end, and the doctor was very supportive” or “Others find it very helpful to plan an assisted death; it’s straightforward and can all be prepared for. The family can be with you at the time and you just doze off”. None of these possibilities is ruled out by the Bill as it stands—

[Lord Pannick (CB)]

What is the difference between that conversation and the conversation that happens every day, in tragic personal circumstances, where the relative or friend says to the dying person, “Have you considered giving up your chemotherapy”?

[Baroness Lawlor (Con)]

I thank the noble Lord for the intervention but, if he will permit me, I would like to finish. We can imagine many different sorts of conversation. If noble Lords would like to hear more examples, I am sure they will ask for them.

None of these possibilities is ruled out by the Bill as it stands. They would not be considered an instance of coercion or pressure. Nor will it be possible when this Bill becomes law to investigate with due legal process whether someone has been instrumental in inducing a person to assisted suicide, provided they are covered by the terms of the Bill. Clause 34 outlaws dishonesty, coercion and pressure, and Clause 35 the destruction of documentation or the falsification of what purports to be a declaration, but the Bill does not address other means of inducing someone to opt for assisted dying. Under Clause 32, criminal liability for providing assistance will be removed from the Suicide Act 1961; as will civil liability under Clause 33, which stipulates that

“providing assistance to a person to end their own life in accordance with this Act”

or assisting a person to end their life while performing a function under the Act does not of itself give rise to any civil liability.

Moreover, the Coroners and Justice Act 2009—the duty to investigate certain deaths—will be amended so that the reference to unnatural deaths does not include a death caused by the self-administration by the deceased of an approved substance within the meaning of this Bill. Similar changes will be made in respect of arrangements for medical certificates under the new regulations and for Schedule 1 on suspension of investigations. These changes mean that there will be no effective way of investigating improper behaviour after an assisted death has taken place. The Bill already, in effect, recognises this problem by making absence of coercion and pressure a condition for eligibility for someone to be given assistance to die under its provisions. It opens the possibility to object to an assisted suicide going forward on the grounds that the person about to die has been coerced or pressured.

Furthermore, Clause 10(2) gives the first doctor—the co-ordinating doctor—the duty of ascertaining that the person concerned has not been coerced or pressured. We have heard from the noble Baroness, Lady Finlay, and others who have great professional experience in looking after people with terminal and other grave illnesses how difficult it is to establish coercion. It is often very difficult to establish coercion. It is true that the Bill wants to establish coercion—or so it alleges—but, as has been argued, the grounds are too narrowly defined.

A person in a poor mental state, because of their terminal diagnosis, is especially likely to be open to suggestions from other people, especially figures of authority such as their doctor, or their own family, whom they want to believe are thinking only of them. If we want to be sure that the decision to have assistance to die is genuinely their own, it is not enough just to rule out coercion or pressure. We need also to outlaw subtler, more insidious, but no less effective forms of persuasion. There is a danger that, if the Bill includes, as it does now, just a prohibition on coercion and pressure, the inference will be drawn that any form of encouragement or inducement, so long as it is not coercion or pressure, is allowed. Surely that is not what the proponents of the Bill would want.

The noble and learned Lord the sponsor and his co-sponsor are putting forward the Bill under the banner of giving dying people more choice over what happens to them, and providing greater freedom. Surely, in pure consistency with this underlying purpose, they must be intent on ensuring that the irrevocable choice a person makes to undergo assisted suicide is genuinely that person’s free choice, and therefore must support the amendment I am proposing, and indeed the amendments that others are proposing.

I hope that we can go even further. If my amendment is adopted, a further provision could be added to Clause 10(2), making it the duty of the co-ordinating doctor to ascertain not just that there was not coercion or pressure but that the idea of assisted suicide was not suggested to the person by another party.

[Baroness Grey-Thompson (CB)]

My Lords, I have three amendments in this group—Amendments 52, 58 and 181—which seek to explore coercion and ensure that people are free from undue influence, including social, economic and care-related pressures—not only active coercion, which is very difficult to prove. These amendments also seek to understand the reasons why someone would choose to end their life, so that we can look at how we might improve further NHS services or use that in important debates on reforming the welfare system.

It was raised on the first day in Committee that definition is important, and I believe that much further work needs to be done on the definition of “pressure” and how it becomes a strict liability. However, we find that it is very hard to gather data. We have been told that there is no evidence of coercion in other countries, but Ellen Wiebe et al, in a paper on the reasons why people request assisted dying, highlighted some of these very important issues.

In 2018, Dr Wiebe’s team looked at 250 deaths in Canada and noted that data was collected differently across different jurisdictions. Of the 250 deaths, six charts had no reasons; 56 gave one reason; some of the charts gave three or four reasons, but only two reasons were coded. This does not show the whole picture of why people are choosing to end their life on top of having a terminal condition. Looking to other jurisdictions, in Belgium, legal requirements were more frequently not met in unreported cases of assisted dying than in reported cases, and we still do not really know how it is practised. In Oregon, the data and the records are destroyed a year after someone has died.

Admitting coercion is highly unlikely to occur, so that is why we need a robust process of identifying it so that it can be acted upon. I look forward to debates in other groups on the role of the coroner in this. It is hard to find studies on coercion—I spent a lot of time trying—but it is possible to find a huge number of individual cases. In Canada, Lisa Feldstein was with a patient when the patient was pushed towards assisted dying. The person who suggested it did not realise that Ms Feldstein was a lawyer. Heather Hancock, a woman with cerebral palsy, was told by medical professionals while she was in hospital that she was not living but merely existing. I wonder how that made her feel.

Again in Canada, slideshows of MAID have been shown to healthy patients, which would make you think as your condition deteriorates that you do not have any other options apart from ending your life. In Australia, in November this year, three people were arrested after a man was found dead with euthanasia drugs in his system, and the police believed he was part of a suicide encouragement ring. Ruth Posner ended her life abroad with her husband; a friend spoke publicly about Ruth’s emotionally controlling husband and did not believe it was a free choice. But the difficulty is that, once you are dead, it is really hard to prove. As the noble Baroness, Lady Berridge, raised, the Bill does not take into account the impact of social media.

In New Zealand, doctors are told to do their best to detect how pressure may be placed on a patient, but this is completely unclear as to their duties and does not stand as a safeguard. This is listed in the review of the End of Life Choice Act 2019 in the report published on 19 June this year. In Washington state, physicians are rarely there when lethal drugs are ingested, which makes it nearly impossible to ensure that the patient’s decision is free from last-minute coercion, impairment or doubt. In Holland, it was found that GPs in an interview study felt pressured by emotional blackmail, family influence, time constraints or systematic pressures when processing assisted dying requests. As mentioned before, real-world data from Oregon shows that the top reported reasons for assisted death are loss of autonomy, loss of enjoyable activities, loss of dignity and being a perceived burden—not uncontrolled pain, which is missing from the Bill.

At the Select Committee evidence sessions, the honourable Stephen Kinnock, the Minister for Care, was asked about protecting vulnerable people, but the panel has no power to ensure that unmet needs are supported, such as increased care hours, adaptive technology and palliative input. We should ensure that the law does not default to death as a substitute for deficient services, which is an ethical red line repeatedly emphasised by disability advocates and UN experts reviewing permissive regimes. Best practice guidance from jurisdictions with assisted dying frameworks highlights the importance of exploring whether enhanced external support might address these factors, and it should be the case that the approval process checks them.

What is presented as a voluntary choice may in fact be a choice made under hidden pressure. The Australian Care Alliance research shows that the training for voluntariness and assessing absence of coercion was a two minute and 10 second video, with slides that take approximately two minutes and 50 seconds to read. Qualitative reporting in Canada shows disabled applicants citing inadequate housing or lack of care rather than unmanageable pain.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I will come to that in a moment, because I have to get through the amendments—we have to make progress a bit. However, I completely understand the question.

Amendment 50 is from the noble Lord, Lord Evans. He basically said that when anybody tries to behave badly, trying to coerce or pressure somebody into making the decision to have an assisted death, that should be sufficient to bar it for ever, even if it had no impact whatever in relation to it. I see the force of that; I think it would be a wrong amendment, for the following reasons. Somebody—a doctor—might go over the line, but it is absolutely clear that the person definitely wants an assisted death. I do not think they should be barred from doing that because they are concerned about what might happen to the doctor or to the person they love if it is absolutely clear that they have not been coerced or pressured into it.

On Amendment 52 from the noble Baroness, Lady Grey-Thompson, she is saying that somebody should not be subject to or at risk of coercive control. Everybody agrees that the person who is adopting the assisted death should not be subject to coercive control. If they are at risk, I would expect the two doctors and the panel to investigate that fully and, if they are not satisfied that the person is reaching a decision of their own, plainly an assisted death cannot go ahead. But I think we are all on the same page in that the risk has to be properly investigated and a conclusion reached.

Amendment 57A in the name of the noble Baroness, Lady Lawlor, says you should not be allowed to have an assisted death if someone has been

“prompted to consider ending their own life”—

presumably in the context of assisted death—by any professional person. Clause 5 leaves it to the judgment of the doctor as to whether they raise the question with the patient. If they raise it, they have to raise it under Clause 5 in the context of the treatment available to the patient and all other options available, including palliative care. I do not think that if a doctor, or indeed any other professional person, makes a judgment that it would be sensible to raise it, that should thereby debar the person from having an assisted death. The noble Baroness wants to intervene. By all means let us prolong the debate if it is a new point.

[Baroness Lawlor (Con)]

It is about the level of authority which the professional person, who is in a way a public servant, and the trust which one endows in one’s GP or family doctor. As we have heard today from other people who are medically qualified, that has great weight with the patient—I speak as someone who comes from a medical family. They constantly agonise about their prescriptions for patients and their emotional condition, and all that. But if one raises assisted dying with somebody who is terminally ill, the professional—the doctor, say—is planting the idea.

Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[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.

[Baroness Lawlor (Con)]

My Lords, I support the amendment in the name of the noble Baroness, Lady Finlay, to substitute “ability” for “capacity” in Clause 1(1)(a). As Clause 3 explains—we have already spoken about this at length—capacity is to be understood as defined in the Mental Capacity Act 2005. But, in my view, capacity so defined is the wrong measure to use to discern whether someone is in a position to make a proper judgment about ending their own life.

The Mental Capacity Act sets a very low threshold for having mental capacity. The Act requires—it could hardly do otherwise—that the person concerned must be able to understand the information relevant to a decision, but it dictates that this requirement should be understood in the laxest way, because Section 3(2) states:

“A person is not to be regarded as unable to understand the information relevant to a decision if he is able to understand an explanation of it given to him in a way that is appropriate to his circumstances (using simple language, visual aids or any other means)”.


We have heard from the noble Baroness, Lady Finlay, about the problems of information, facts, evidence and understanding that she has encountered in her very distinguished specialism. In effect, then, someone who can grasp only a diluted, simplified version of the information needed for a decision is still thought to have capacity to take it.

In Section 3(3) the Act adds that, although the person concerned may be able to retain the information, as per Section 3(1)(b):

“The fact that a person is able to retain the information relevant to a decision for a short period only does not prevent him from being regarded as able to make the decision”.


The Act therefore allows that someone who cannot retain information in the normal sense of the word “retain”, which means that something is kept, in this case in the memory, none the less has capacity.

Although the Act makes the threshold for mental capacity as low as it can, arguably that is good for the purpose of the Act, because very strong reasons are required before we take an individual’s power of agency over important decisions about the conduct of their life, which is the result of declaring that they lack capacity. If there are any grounds, however slight, we should accept that they have capacity.

But, in the case of the Bill, this position is reversed. We are dealing here with a decision that, in its gravity and irrevocable nature, is completely unlike most—or all—of those important decisions that the Mental Capacity Act was designed to regulate. Where the decision is to end one’s own life, what matters above all is that the agent is able to understand its meaning and consequences. It is not enough in this case that the information relevant to the decision is grasped in a simplified or pre-conceptual form, as the Mental Capacity Act definition would allow, nor that the information is retained only for a moment, then to be forgotten, as again is allowed by the Mental Capacity Act definition. The threshold for being allowed to take the decision must be much higher. Even though making it higher would take away the power of agency from more people than a lower threshold would, it is wholly justified when, as here, it concerns a decision that, if made, will entirely and irrevocably remove an individual’s power of agency.

I agree that “ability” lacks the precise legal definition— I am very grateful to the noble and learned Baroness, who was very candid about what that could mean—that “capacity” has. It is better to have an imprecise phrasing that points in the right direction than one that points the wrong way. Moreover, the phrasing of the amended clause indicates how we should understand ability. It is an ability to make the brave and difficult decision to end one’s own life. Clearly, an ability commensurate with the gravity of that difficult and brave decision is an appropriate way. I support the aim, and, indeed, the wording, of the noble Baroness’s amendment, because of the gravity of the decision that is being taken.

--- Later in debate ---

[Lord Sandhurst (Con)]

I wanted to make it plain because some people listening to the noble and learned Lord might have thought I had not said that.

[Baroness Lawlor (Con)]

Before the noble and learned Lord finishes, can he clarify for the Committee that a person who can grasp only a diluted amount of information, or who cannot retain the information in any real sense that would be intelligible to us, can be deemed to have capacity for the purposes of the Mental Capacity Act, but for this Bill, which is designed to give people agency and allow an individual as much choice as possible to choose treatment or have agency over medical and palliative care decisions and so on, an entirely different threshold should, quite rightly, be expected for such a serious measure as this?

[Lord Falconer of Thoroton (Lab)]

I respect the noble Baroness for repeating her speech. Section 3 of the Mental Capacity Act says that if a person is unable to

“understand the information relevant to the decision … to retain that information … to use or weigh that information ... or … to communicate his decision”,

then they do not have capacity. I am content that that should be the approach under the Bill.

Complications from Abortions (Annual Report) Bill [HL]

Baroness Lawlor Excerpts

Committee stage
Friday 6th June 2025 Lords Chamber

[Baroness Freeman of Steventon (CB)]

My Lords, as part of my work in Cambridge, which is in my register of interests, I was involved, and still am, in the making of decision aids to help NHS patients make decisions about their healthcare treatments. Part of my work was to find the evidence about the risks and benefits of different treatment options, so I am very familiar with the lack of data in many respects on the efficacy and, in more cases, side-effects of different treatment options.

I would absolutely stand by any Bill that aimed to improve the data for individuals to make decisions, but I do not see why abortion is being singled out in this way in this particular Bill. I am bearing in mind the Chief Whip’s notes, and although I could speak for some time on the lack of data for side-effects in many treatments I will give just two examples. I was involved in the decision aid for osteoarthritis in hips. Hip replacements are an example where, again, we have large numbers of treatments being done outside of NHS clinics. We are really lacking in long-term follow-up, particularly asking patients about the really important patient-reported outcome measures—the things that are important to them. Cataracts are another example. It is one of our biggest and most numerous operations, and more than half of them are done outside of NHS clinics. Again, you would think that actually asking how many people would say afterwards that their vision has improved would be a very basic thing, but we are lacking that data.

I would absolutely love to have more data on side-effects and the efficacies of these things, including side-effects that are not expected and not on the official list to be collected. I did a decision aid on gall bladder surgery. Diarrhoea is a very common outcome of this surgery—in more than 10% of cases—and yet it is not often recorded. Sexual dysfunction is a side-effect of many treatments, but it is not something that patients want to bring up. These are all really important.

There are so many issues about data, but if you look at the data on abortion statistics and complications, you find that the 2023 report is very good. It highlights the numbers that patients would need to make decisions. The rates are not changing every year. We do not update our decision aids every year. The data remains stable, unless there is a very dramatic change in clinical practice.

I would absolutely support the better collection of data, and I am hoping there are opportunities to do that in the future. But on this particular occasion, I very much support the noble Baroness, Lady Thornton.

[Baroness Lawlor (Con)]

My Lords, I do not support the noble Baroness’s opposition to Clause 1 standing part of the Bill. My noble friend Lord Moylan has mentioned the 2023 analysis by the Office for Health Improvement and Disparities. It based its evidence solely on NHS England statistics: the database of admissions, A&E attendance and outpatient appointments. Using this data, different outcomes were recorded. It used only the data contained in records for patient admissions and for abortion-related complications as the primary or secondary diagnosis, not those for incomplete abortions that did not have a further complication. We see, therefore, that the complication rate varies depending on the evidence that is before the statistician.

For these reasons, there is little disagreement among the groups concerned that we all, whether parliamentary or non-parliamentary, want good data collection. Some of us are more concerned with data collection on one kind of procedure, and others with another, but, now that we are updating and digitising the NHS system, this seems an opportunity to improve data right around the system. But this should not be excluded, and I do not think that noble Lords should suggest an exception. It is an exceptional thing to require accurate data where possible and where it can be obtained, so that we can use the digitisation of the system to encourage the best statistics.

My noble friend referred to some of the changes that we have seen. The position has changed since the statistics were last checked for compliance with the code of practice for statistics in 2012, with the increase of medically induced abortions from 48% to 85%. In England and Wales, 75% of abortions were completed at home. As a result, complications may not be recorded on the HSA4 forms that are the basis for the present statistics under the abortion notification service. With women administering medication at home, if there is a complication, they may go to their GP surgery, dial 111 or go to A&E. The fact that these episodes are complications will not necessarily be recorded on the HSA4 forms that are used to compile the reports we have. But it has been used, which is why I find this a statistically interesting debate, by the 2023 analysis, which I mentioned on opening, and it can be used.

For these reasons, I welcome that the statistics regulator is going to check on the compliance and that the Department of Health and Social Care has agreed to this—I applaud that. The timing is quite important. As the NHS system is digitised, it can prepare things so that the records can be read digitally, accurately and cheaply, with the data on complications from abortions entered into the system. I suggest that, as my noble friend Lord Moylan proposed, the compliance check should be instituted in advance of digitisation so that the statistics authority can then report on—and, as a result, the Department of Health can be made aware of—where and what digitisation is needed, so that the records can be used in digital form cheaply and with the transparency that we need for statistics. This will save money on any further necessary updates later.

I do not take the point that some noble Lords have made about confidentiality. Confidentiality is extremely important—I agree with all confidentiality requirements; it is vital if one is to have trust in one’s health service and provider—but these things are done by codes. As far as I know—I ask the Minister to correct me if I am wrong—every operation has codes. People are not named, but there are codes for referring to whatever procedures take place. This is very useful for digitisation.