Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

In conclusion, let us never forget that it is not just our reputation to perform our duty to scrutinise that hangs in the balance. As a result of our consideration of the Bill, the lives of people far more vulnerable than many of us will ever be hang in the balance too. Those who have no voice are depending on us, however loud the siren voices to rush our scrutiny, to subvert the transparency of the House—where, as my noble friend Lord Harper reminded us, every word spoken is on the public record—and to do grubby deals through some shady, so-called shadow usual channels process. We must not fail them. I trust that the noble and learned Lord realises that how he responds to this and other amendments will show whether he appreciates that our reputation depends on our not failing them.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, all these amendments address motivation, one of the areas that the noble and learned Lord, Lord Falconer, identified as a key area in his email sent to some noble Lords on Wednesday. This therefore feels an appropriate moment to make some short observations on general matters arising from that email. My amendments focus on risks to people with learning disabilities and autism, and there is also an amendment to exclude hospices that provide palliative care, which is, I believe, true assisted dying.

As I understand it, the email’s proposal has two parts: first, that we move away from this House’s established line-by-line scrutiny and condense 74 groups into 13 areas; and, secondly, that any concessions will be limited to those areas. My question is straightforward and has been asked in various ways by my noble friends Lord Harper, Lord Deben and Lord Blencathra. When will we see the detail? What amendments will the noble and learned Lord make to address each of the areas of concern he has identified as key in the Bill? What are the terms of the noble and learned Lord’s proposals to address the concerns raised by the Delegated Powers and Constitution Committees?

We are told that amendments will be brought forward on Report to address a limited number of these concerns: advertising, independent advocates and some regulation-making powers, but we have not been told which ones. There are now 42 such powers and a further seven Henry VIII powers, but no detail has been provided. Commitments to respond to these reports were made months ago. We need to know.

The email identifies only three further changes: on the position of those aged 18 to 25, those deprived of their liberty through the Court of Protection, and the role of multidisciplinary teams. These are important but they do not go very far. Nor is there any reference to excluding hospices, as suggested in the email from the noble and learned Baroness, Lady Butler-Sloss. Finally, there is no mention at all of the serious concerns raised by five major royal colleges. They were flagged as long ago as May.

To conclude, we need answers long before Report so that all Members of this House can properly consider what is proposed.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank the noble Baroness, Lady Monckton of Dallington Forest, for that excellently clear way of expressing some of the discomfort and what we would like to see. I would be much happier and feel that I did not have to speak too much if I was getting reassurance and seeing on paper what exactly will address our concerns. At the moment, we are not getting that. We wish the noble Lord, Lord Shinkwin, were here. The fact that he is not is a real shame for the quality of this debate.

Inside and outside this House, I know plenty of people who support assisted dying and this Bill, inasmuch as they know the broad sense of what it is about. I try to avoid living in echo chambers. Whenever we discuss why they support the Bill, and potentially have a bit of an argument, they invariably say, in a very humane and compassionate way, that they think it will help people who are suffering, and that anyone who says they are suffering should have access to assisted dying. It is assumed, therefore, that the motivation of illness-induced suffering is at the heart of the Bill. That is what most people think. It has come up a lot in this Chamber but, ironically, suffering is not mentioned in the Bill, and neither is there any reference to motivations in the way that one would imagine. That bothers me, because the Bill checks on capacity, prognosis and residence, but it does not enforce a check on motivation. It seems to me that we should ask somebody who says that they want assisted dying, “Why?” It is a crucial absence in the Bill, and I hope that the noble and learned Lord, Lord Falconer, might rectify that or explain exactly why the Bill does not think that doctors should ask, “Why do you want assisted dying?” I think it would throw up a whole range of red flags in relation to coercion.

I have added my name to two amendments in this group, Amendment 30 in the name of the noble Baroness, Lady Foster, so ably moved by the noble Lord, Lord Weir of Ballyholme, and Amendment 56 in the name of the noble Baroness, Lady Coffey. To save time,I will concentrate on Amendment 30, which seeks to ensure that those who seek assisted dying are not substantially motivated by a number of factors. I will focus on two of those—not wanting to be a burden on others or public services, and not being motivated by mental disorder, including depression.

This week was the 29th anniversary of the death of my father, John Fox. He was only 66. He was diagnosed with cancer and given three months to live, although he actually made it for four and a half months. When he was told, the whole family was devastated, as anyone would be. The one thing that really shocked me to the core, and stays with me, was that when I had that initial, very emotional father to eldest daughter conversation, my father kept apologising. Believe me, that was not usual. In our relationship, he did not say, “Sorry, Claire” lots of times. He was so distraught. He was convinced that he would be a burden on us, and that his daughters and my mother, in looking after him, would all have to miss work and all the rest of it. He kept saying, “I’m really, really sorry”. He was worried about how we would cope. He did not want to distress others—a point that the noble Baroness, Lady Lawlor, was making on her amendment to this amendment.

I also noticed that he kept saying sorry to the nurses and the doctors. To everybody, he kept saying, “I’m really sorry for taking up your time. I’m really sorry that you’re having to give me so much attention”. There were stories in the media at the time about bed blocking. He was a vociferous reader of newspapers, and I was hiding the newspapers because I thought he would say sorry even more, convinced that he was taking up NHS resources. It took some time and determination for the family to reassure him, but I kept thinking afterwards how sad it would have been if he had been on his own or in a care home or whatever. To be honest, if a GP had suggested that assisted death was a medical option, in today’s circumstances, I think my father would have said yes—not because he wanted it but because he felt he was a burden on the family. It would not be the GP’s fault, as it is an internal feeling of being a burden. That is not the same as choice.

I was struck by a letter from Lord Sumption in the Times that is worth reflecting on. He says:

“The current bill contains a number of provisions designed to ensure that patients are not ‘pressured by any other person’ into taking their own lives”—

that was in relation to something else. He continues:

“The real problem, however, is not the pressure applied by ‘other persons’. It is assumptions which many old and ill people spontaneously make about the attitudes of the society around them. They are afraid of being an emotional or financial burden”.

That is very important.

By the way, I had better say that, in the four and a half months following his diagnosis that my father lived, we had some of the most meaningful time of our lives with him. It was through a veil of tears, but there was love, joy and reconciliation, there were conversations that would never have otherwise happened, and so on and so forth. It was a time that was important to him and to us as a family in a way that I cannot really describe.

Another motivation that I feel strongly we need to explore is on the part of those with a mental disorder. As many noble Lords have noted, a number of mental health conditions have suicidality as a feature. Again, I am sorry to do the personal stuff, but the first time I encountered that was as a young mental health community worker. I met a young man who was bipolar. I and others—psychiatric medics and social workers—worked hard not just to prevent his suicide but, using all our skills in pharmacological and psychological interventions, to alleviate the terrible “black dog” of depression and the horror of the obsessive suicide ideation that that young man had. I have to ask, then, whether the Bill would allow such a suicidal person’s depression-induced desire for death, and whether all those who had worked with him would suddenly be expected not just to welcome it if this young man made the choice of an assisted suicide but to say, “Oh, look, a perfect exemplar of autonomy and choice”.

I was therefore a little taken aback that the noble and learned Lord, in his summation of the last group on eligibility, said in relation to those with a mental disorder that it is their choice, and that if they want it and they have capacity then that is all right. I point out that, for anyone who wants to commit suicide, it is their choice and they want it, but some of us spend a lot of time asking them please not to do it, not saying, “Yippee!” I cannot think that, in that situation, if that young man had said, “I’ve got a terrible story. I’ve got a terminal illness in addition to my bipolar depression, and I want your support and help in assisted dying”, I would say that it is all perfectly fine and he should get on with it, and be delighted for him being able to show that he is a free, autonomous individual. I would say, “Please don’t”. The four and a half months that we had with my father was the kind of quality time that I would want to ensure that young man had, every day of his life, even if he was terminally ill and dying. I would want to make sure that he was not depressed or suicidal during the time he lived.

Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, I rise very briefly to support my noble friend Lady Berridge’s Amendment 30A on EHCPs, and I declare my interest as founder of a special educational needs college. All our students have EHCPs, and all of them, in their various ways, are vulnerable. What I have learned in the years that I have been campaigning for people with learning disabilities is that they are always at the bottom of the heap when it comes to making legislation. I can only think that, once again, in drafting this Bill, this cohort has been forgotten. People with an EHCP should not be included in the Bill.

[Baroness Stroud (Con)]

My Lords, I support Amendments 22, 308 and 347, tabled by the noble Baroness, Lady Grey-Thompson. Amendment 22 rightly seeks to exclude serving prisoners and those detained by a hospital order from accessing assisted dying under the Bill. As we have heard, the Bill speaks the language of choice, autonomy and settled intention, yet this group are, in effect, the group least likely to have choice, autonomy and settled intention. Nevertheless, these are men and women living in overcrowded, often violent environments, cut off from family contact and support networks, access to services and meaningful work—those things that provide a context for someone’s life. Many are traumatised, mentally ill or struggling with addiction.

Prisoners, as we know, are an exceptionally vulnerable population. In a report published in July this year, the Prison Advice and Care Trust—PACT—warned of the mounting mental health crisis in prisons, where mental ill health is the norm and not the exception. It goes on to note that rates of self-harm in prisons have more than trebled in the last decade, from nearly 26,000 in 2014 to just over 79,000 in 2024, and reflects that recent data shows that, among prisoners, 56% of men and 74% of women report having mental health problems. In the year to June 2025, government statistics show that there were 86 self-inflicted deaths per 1,000 prisoners.

Behind these statistics lies a culture that breeds hopelessness. It is into this context that we are proposing to make serving prisoners eligible for an assisted death. I am deeply concerned that, terminal illness aside, if you design a scheme in which a person’s own sense of despair may well be a key trigger, and there is no requirement for asking someone what their motivation is for engaging in this act, those who feel most hopeless will be the most susceptible. By any objective measure, prisoners are perhaps among the most hopeless within our society.

I note that in response to a question during the Select Committee evidence sessions, the Minister of State for Courts and Legal Services, Sarah Sackman KC, MP, commented that, as we have already heard, this is a policy choice on which “the Government is neutral”. But she went on to say that much will depend on its interaction

“with the wider prison regime and some of the challenges that lie therein”,

and that there would be a need to ensure that the Bill operates in a way that

“does not lead to abuse or is not misused”.

I would like to learn from the noble and learned Lord, Lord Falconer, precisely how he intends to ensure that this is not misused within the prison system.

I wonder whether the Minister and indeed the noble and learned Lord have considered the 2021 Hospice UK report Dying Behind Bars. The authors note that

“up to 90% of older incarcerated people have at least one moderate or severe health condition, with over half having three or more”.

I have great sympathy for the comments made by the noble Baroness, Lady Fox; clearly, the state has already taken from these individuals their liberty as a punishment to protect the public. The state is of course also responsible for the delivery of healthcare within prisons. In such an imbalanced power dynamic where the state has such overwhelming power, the shift this legislation represents as drafted, whereby the state may say to a prisoner who otherwise meets the eligibility criteria, “We will help you die”, is a profound challenge. I am concerned that if we fail to exclude prisoners from the remit of the Bill, we risk undermining the comprehensive suicide prevention programmes operating in our prisons.

Providing access to assisted dying in prison sends a chilling message that where the state has failed to provide adequate care, resources or meaningful autonomy, its final offer is death, which is why I support this amendment. I am conscious of time, though, so will speak only briefly in support of Amendments 308 and 347 in the name of the noble Baroness, Lady Grey-Thompson.

Noble Lords will perhaps be aware that I ran community projects for homeless people for the better part of two decades. I will not repeat what others have said, but the complexity of the lives of people who are homeless cannot be overstated, and I am deeply concerned that the Bill fails to account for their specific needs and risk factors. People experiencing homelessness already face significant obstacles to accessing the healthcare they need. The NICE guidelines for integrated health and social care for people experiencing homelessness note:

“Barriers to access and engagement with preventive, primary care and social care services can mean that problems remain untreated until they become very severe and complex”.


It seems entirely reasonable to reflect the complexity of the lives of people experiencing homelessness, as the amendments in the name of the noble Baroness aim to do.

I accept that the legislation is based upon the premise of autonomy, but autonomy is not absolute, and we do not live as isolated individuals. It is reasonable and appropriate to ensure that this legislation is as safe as possible, with vulnerable populations in mind. To that end, I also strongly support Amendments 308 and 347.

Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, the Mental Capacity Act 2005 assumes capacity until proved otherwise. However, many people with learning disabilities have neither the ability nor the capacity to make life-changing or even death-making decisions. Under the Bill, because they are chronologically adults, they are not permitted to have anybody with them when the subject of assisted suicide is raised. This is something I will be discussing later in Committee.

[Baroness Hollins (CB)]

My Lords, I am glad to be able to follow the noble Baroness, Lady Monckton. I declare my interests as a past president of the Royal College of Psychiatrists, and I have a parliamentary scholar, a psychiatry trainee who is appointed by the Royal College of Psychiatrists to work one day a week with me. I was a member of the post-legislative scrutiny committee on the Mental Capacity Act. I also founded and chair a visual literacy charity called Books Beyond Words, which is relevant in a way.

I was listening to the noble Baroness, Lady Lawlor, speak about communication. It reminded me that 18% of the adult population in this country are functionally illiterate. This is really important when we think about making decisions of such importance. I have an amendment later proposing a different framework for assessing capacity, and I will obviously talk about that then, but I want to reflect on how the charity Beyond Words creates really difficult stories in pictures, without any words, to try to help people who struggle with words to understand and make decisions about such things as the care and the treatment that they might require. We currently have about 80 stories, all about the whole story that people can discuss with their peers, their healthcare professionals and their families, to help them to understand an issue, so that they will not be left out but will truly understand. It is very easy to think that somebody understands when you have explained something in words, in simple words, and that the person is compliant with it, but when you explain in pictures and enable the person to say what they have read in their own words, then you get an idea of whether they have understood.

I have been trying to think about how I would be able to create a story in pictures to explain this Bill. It would be several stories. It would take an awfully long time and an awful lot of work to be able to do it. I just wanted to respond to what the noble Baroness, Lady Lawlor, said; I thought it was very important.

Artificial Intelligence: Safeguarding

Baroness Monckton of Dallington Forest Excerpts

Tuesday 4th November 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend describes a disturbing situation. The independent regulator, Ofcom, has made it quite clear that if an AI service searches the live internet and returns results, it will be regulated under the Online Safety Act as a search service. Ofcom can take robust enforcement action, including issuing fines of up to £18 million or 10% of qualifying worldwide revenue, whichever is higher.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, I declare my interest as chair of Team Domenica. The people who most need safeguarding from these AI chatbots are those with learning disabilities. In Brighton and Hove, we work closely with the police, who train our candidates how to be safe online. Will the Minister consider special training for police and social workers to protect this highly vulnerable and suggestible cohort?

[Baroness Merron (Lab)]

I understand the need for training, as the noble Baroness rightly outlines, but I would emphasise that AI chatbots are in scope of the Act, as I mentioned just now to my noble friend. What matters is the fact that they actually search the live internet. The point the noble Baroness raises is very important, and it is also about literacy in terms of using the internet, equipping individuals to try to stay safe, and safeguarding those who are more vulnerable, as she describes; training is certainly part of that.

Learning Disabilities Nursing

Baroness Monckton of Dallington Forest Excerpts

Tuesday 17th June 2025 Lords Chamber

Asked by

[Baroness Monckton of Dallington Forest]

To ask His Majesty’s Government what steps they are taking to develop and maintain the specialist branch of learning disabilities nursing.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we recognise the vital role that learning disability nurses play in supporting those with learning disabilities, and we are committed to developing that workforce. We continue to work with partners to attract people into the profession through various routes, including apprenticeships, and provide a non-repayable grant and additional learning disability nursing payment. Later this year we will publish a refreshed workforce plan to ensure that the NHS has the right people with the right skills in the right places.

[Baroness Monckton of Dallington Forest (Con)]

I thank the Minister. The Darzi report highlighted that people with learning disabilities have greater health inequalities than the general population and are four times more likely to die from treatable causes. The Mencap campaign Nurses Not Hearses confirmed that services where there are learning disability nurses have fewer such deaths. However, this nursing workforce has reduced by 42%, universities are closing their courses—there is not one left in the south-east—and the profession is at risk of extinction. Will the Minister commit to ensuring that learning disability nursing is embedded in upcoming policies, including the 10-year plan?

[Baroness Merron (Lab)]

I pay tribute to the noble Baroness for her work as a campaigner in this area, particularly through Team Domenica. I know that through my office she will be meeting the Minister for Care next month to discuss all these important issues. It certainly is the case, and is totally unacceptable, that people with a learning disability die earlier on average than the general population. In England alone, we are talking about 1.5 million people with a learning disability, and they have significant health inequalities. Learning disability nursing is one of the four specialist fields of nursing, and those areas will be attended to in the forthcoming workforce plan. That will tie in with the 10-year plan, which is the first plan that will be published and noble Lords will not have to wait too long for it. The commitment to improving care for those with learning disabilities, and, if I might say so, with autism, is absolutely going to be in there; the noble Baroness will recall the discussions that we had, for example, on the Mental Health Act. I hope that this will show the way in which we are going, but I certainly agree with her about how much more there is to do.

Autism and Learning Disabilities: Hospital Detention

Baroness Monckton of Dallington Forest Excerpts

Tuesday 11th March 2025 Lords Chamber

[Baroness Merron (Lab)]

Yes, because we are, as my noble friend knows, updating an Act that is over 40 years old, to keep pace with demands and changes, and to meet our expectations of providing care through a compassionate and appropriate service. There were particular circumstances in this case, which I do not seek to excuse, but it is not appropriate for me to go into them. It is important to look at specific cases.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, there are over 2,000 people with autism and learning disabilities locked up in these facilities at huge cost. Putting them into the community does not necessarily work because the infrastructure is not there. Will the Minister commit to funding the necessary care and housing for this cohort?

[Baroness Merron (Lab)]

The noble Baroness is quite right to raise the fact that at the end of January 2025 there were some 2,065 people with a learning disability, autism, or both, in mental health in-patient settings. The population I referred to is not a static one; there are new admissions every month. We know, for example, that in January 2024, some 10,000 discharges to the community had been undertaken since 2015. So it is not necessarily the same group of people. She will know that funding decisions are made at the appropriate point. Again, this is a matter of great importance to the Mental Health Bill, and we will continue to take that through the House to get it into the best place possible.

Care Homes: Safety Ratings

Baroness Monckton of Dallington Forest Excerpts

Wednesday 5th February 2025 Lords Chamber

[Baroness Merron (Lab)]

I assure my noble friend that the department has discussions with the CQC at fortnightly meetings. Those discussions are about performance, including clearing the backlog of registration of new providers, and this will continue in order to make the necessary improvements that my noble friend seeks.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, does the Minister agree that a lot of the problems in care homes would be alleviated if becoming a carer in a care home required certified training, supervision and a defined career path, rather than it being a job of last resort for itinerant job seekers, as it seems to be in many homes at the moment?

[Baroness Merron (Lab)]

I certainly agree with the noble Baroness that the workforce is absolutely crucial, and I very much value the contribution that is made by those who work in care homes. Perhaps it would be helpful to say that, just last month, we announced that the care workforce pathway, a new national career structure for adult social care, will be expanding to support opportunities for career progression and development. This is the direction of travel that we want to take.

Young Disabled People: Social Care Services

Baroness Monckton of Dallington Forest Excerpts

Tuesday 28th January 2025 Lords Chamber

Asked by

[Baroness Monckton of Dallington Forest]

To ask His Majesty’s Government what plans they have to address demand for support from young, disabled people and their families, particularly in relation to provision of social care services, as they transition to adulthood.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, the Government recognise the difficulties that young disabled people and their families can face when they transition into adult social care. This has been a neglected area, which is why the Department of Health and Social Care is now working across government to identify opportunities to better support young people and their families at this crucial stage in their lives. My ministerial colleague, the Minister for Care, Stephen Kinnock, has recently met his counterpart at the Department for Education to discuss how the two departments can make progress on this issue.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, for many people with learning disabilities, transition into adulthood is purely chronological. Their needs and care requirements remain exactly the same. Parents have described this transition into post-18 services as like jumping off a cliff.

I was approached by the parents of Cameron, a young man with severe learning disabilities. Melanie, his mother, was a nurse for 30 years, and his father, David, was a Royal Marine commando who fought in three wars. Their professional life serving the community and their country has not prepared them for the battle they are facing with Somerset Council to get the right accommodation for their son. Melanie told me that the day he turned 18, all support fell away. Will the Minister accept that these are the same people, with the same condition and the same continuing needs, and that, as part of adult social care reform, there needs to be a separate category for people with learning disabilities, who are so neglected? In this spirit, would His Majesty’s Government consider a Minister for learning disabilities?

[Baroness Merron (Lab)]

I understand and am sympathetic to the points that the noble Baroness makes about Cameron and his family. I listened very closely to the concerns that she raised. As I mentioned in my Answer, we are very aware and absolutely accept that the services are not in the places they need to be. That is why I made the commitment to work closely with the relevant department.

Looking to the future, as recently as November we published what I regard as a very ambitious and wide-ranging whole-system plan, called Keeping Children Safe, Helping Families Thrive. It seeks to break the cycle of crisis intervention and to rebalance the system back towards earlier help for families, which I hope would have been helpful in the situation the noble Baroness describes. All local authorities, including Somerset, have to set out the support available for those with special educational needs and disabilities as they move into adulthood.