Terminally Ill Adults (End of Life) Bill

Baroness Nicholson of Winterbourne Excerpts

Friday 20th March 2026 Lords Chamber

[Baroness Berridge (Con)]

My Lords, Amendment 174 is in my name, and I am grateful to the noble and learned Lord for the meeting on this issue. This amendment states:

“Any interpreter provided under subsection (4) must be aged 18 … or over”.


It is a probing amendment.

If you put two lawyers in a room and give them wording from the NHS guidance saying that it is “inappropriate” to use children, you would have a fascinating discussion about discretionary versus mandatory, and that is the point behind this amendment. It might be that a different age, say 16, is appropriate, but since meeting with the noble and learned Lord, I have looked at certain guidance from particular NHS hospital trusts. Leicestershire Partnership NHS Trust states that you “must not” use children. The Milton Keynes University Hospital trust says that children “should not” be used as interpreters. So we have overall NHS guidance using the word “inappropriate”, which seems to imply discretion, but then we have certain hospitals—I obviously have not checked them all—using mandatory language. It is important that we consider whether, in this scenario, there should be any discretion to use children, whether they are under 18 or, as I say, under 16.

The TIA process should be mandatory, because it is a substantial process. This is the communication of a profound state of affairs. It includes numerous complicated stages, from a preliminary discussion to different co-ordinating doctors. It involves a Mental Capacity Act assessment and could involve the discussion of quite sensitive information about the administration of lethal substances and their potential complications. It is a serious and, as we have said, irrevocable decision.

My submission to the Minister is that it should not be an option that interpreting lies in the hands of a child, but that we should provide for qualified, skilled adults to be present and to provide that service, so that any relative, including children, can sit, support and have their own potential needs met. Is the noble and learned Lord satisfied that this should be a service provided by the National Register of Public Service Interpreters?

This is not a small problem. The census in 2021 shows that around 7.1% of people in the UK speak English as a second language and around 5% do not speak English well at all. The NHS website states that there are 1 million people who do not speak English well at all, who will need assistance with communication. If we do not provide this within the Bill, it might be that relatives, particularly children, are used in situations where the interpretation services are underfunded in that area—it is local commissioning that provides interpretation services.

I acknowledge that noble Lords may want the lower limit of 16, which some hospitals use, but I find it interesting to note that the limit may in the past have been too low. The former Member of the other place, Sajid Javid, talked about this. He said of his mum:

“I used to go to the doctor’s surgery with her—not because I was ill, but because I had to interpret for her. I was six or seven and an interpreter”.


I believe we should make sure that children in our jurisdiction are not placed in that situation.

From the evidence that was given to the Commons Public Bill Committee by Dr Jamilla Hussain, who is a palliative care specialist, we know that this issue disproportionately affects ethnic-minority communities, though not solely, of course. There are numerous reports of poor communication and interpretation that lead to adverse health effects and life-threatening illnesses being more prevalent in those communities. It would be the safest way possible if we put something mandatory into the Bill that does not allow for the possibility of situations where a young person feels they cannot say something, having been alongside their parent or guardian for many years. Putting something mandatory can actually protect those young people.

In relation to other clauses in the Bill, we have spoken about the profound effect on young people’s brains and development—I believe this is relevant and not repetition—of traumatic events such as the death of a close family member. That casts a new light on the possible neurological impact that interpretation by a child for a relative seeking assisted dying could have; it could give rise to further health conditions as they develop. Reports state that, if a child’s hypothalamic-pituitary-adrenal axis is faced with traumatic stress—in this instance the loss of the primary carer—it can lead to long-term functional and structural changes in key areas of the brain’s development. This can contribute to various psychopathologies, obviously including PTSD. Putting something mandatory into the Bill, so that children cannot be placed in this situation, is important to make it clear for all NHS hospitals which may have to deliver this.

It goes to a conceptual point, raised when I met the noble and learned Lord, about autonomy and choice. There are circumstances in which we limit autonomy and choice, particularly with children; we say that it is better for us all, as the legislature, to have taken a decision to protect those children. It should be mandatory that those under the age of 16 in this context are not taking part in the process of interpretation. It may be that, as we discuss this, there are situations and circumstances, such as terminal illness and advice about treatment, where it should be mandated that children are not involved as interpreters.

[Baroness Nicholson of Winterbourne (Con)]

My Lords, I will speak in support of my own Amendment 171, where I am suggesting that there is an adjustment to insert “hearing or visual impairments”. I declare an interest on both. First, I am a vice-president of Mary Hare School for deaf children, which is one of the world’s most wonderful schools for deaf children, not just in the United Kingdom but internationally; I have been a vice-president for a very long time, as were my parents before me. I do not speak on its behalf. Secondly, my other interest is that I recall my darling mother, who was completely deaf, completely blind and 100% paralysed for 13 months before she died, because of an unfortunate slip-up in an operation. It was, I am afraid, just one of those things. I therefore understand the needs of looking after someone who is 100% disabled, fully blind and fully deaf.

--- Later in debate ---

[Baroness Nicholson of Winterbourne (Con)]

My Lords, I follow the noble Baroness, Lady O’Loan, with reference to our shared amendment, Amendment 174A. I apologise for not raising this in my previous discourse, but the differences are so acute that I just did not feel it right to share them in the same comment, and I believe the Companion allows me to speak twice in Committee.

I declare an interest in this amendment’s matters as I have worked with enclosed communities for most of my life. My most recent responsibilities have been with the AMAR International Charitable Foundation, which I founded about 35 years ago. We have worked consistently with the enforced enclosed community of the Marsh Arabs and the enclosed communities of the Yazidis—the genocide victims—and others, covering different parts of the globe. I work particularly closely with the Church of Jesus Christ of Latter-day Saints—the Mormons, as they were known—and with other enclosed communities.

My concern today is for Muslim women. We have two minority faiths in the United Kingdom where women are deemed to be secondary to men. As the noble and learned Lord will realise, I know very well that women are actually superior to men, not inferior. I am not quite sure whether I will cause a dispute between the right reverend Prelates the Bishop of Newcastle and the Bishop of Southwark on this, but either way I welcome and endorse what they said about minority faith communities in the United Kingdom.

I am speaking particularly strongly about Sunni women who do not speak English. I am sorry to say that, because we in the United Kingdom have made so little effort to help these women become numerate and literate in the language of this country, there are at least a quarter of a million of them—there may be more. Those women, some of the men in their family and even those running the religious side of their lives may believe that verse 74 of the Holy Koran—which places women subservient to men in all cases and puts them at risk of physical violence if they disobey—is the law here. They do not speak English and they do not know our law. Many of them are functionally illiterate and non-numeric in the language of the countries from which they came. In some of those countries, in particular Afghanistan, women do not legally exist at all. The World Health Organization tells me that Afghanistan is the only nation in the world of which this has ever been known.

If a woman comes here from a country such as that—a unique country, in that women do not exist—they will not understand that they are actually a full person here, that they have rights and that they are on the same level as everyone else. It does not matter whether they have money or who they are; if they are a citizen of the United Kingdom, a visitor or even an illegal immigrant, they still have that right as a woman and a citizen.

My colleague on the Cross Benches referred to children in this context. The United Nations Convention on the Rights of the Child was drafted here in this Chamber by our former Member Baroness Faithfull, who was a great lady. The convention, on which I have worked all my life, is very clear about the rights of children, but these rights will not exist in the minds of these women because they do not know about it. That is our fault and our failing as a nation. We have made no effort: we have not helped them learn English, to get out, or to understand their rights here. This is coming not just from Afghanistan but from Sistan and Baluchestan, where it is believed that a woman must drape herself completely. That is not in the Holy Koran at all; there is nothing like that in the Koran.

I hope that all Members of your Lordships’ House have read the Koran. It is an interesting, rich and full document—I have read it a number of times, and it is important that we understand it. It does not say what some of its practitioners claim or offer.

I also suggest clearly that UK law predominates. These women and the men who work with them—who are their families, maybe even groomers—believe that they are doing the right thing. The new law in Iraq, a country I know intimately, declares that girls of nine may be married to men of any age. A huge number of boat people come from Iraq. It is well organised by northern Iraqis in Iraqi Kurdistan who have a wonderful business going, bringing illegal immigrants by boats across the channel to Britain. If you come from Iraq, you come with that thinking and that background. Unless you are taught British law, you will not have any understanding of what you are.

This abuts on our discussion if you are nearly dying—or possibly you are not, but your family wants to get rid of you. It is worth remembering that 11% of all deaths, which is the highest number, are those who have Alzheimer’s or similar diseases. Someone could say: “Mum’s a bit of a burden; granny’s even worse. Aunt can go as well. What about cousin? What about my sister? I don’t actually like her. They will do as they are told”. This will, in a true sense, crucify them. As my noble colleague just said, certainly in Islam, suicide is outside, so they will be declaring themselves to be outside their own faith. Do we expect them to understand enough to do that? I do not think so.

My suggestion to the noble and learned Lord, Lord Falconer, is that perhaps he would grant me a meeting. Since this is not a government Bill, I have taken this round the various religious centres for Islam in London. Nobody has consulted them, and they really like to be consulted because suicide is against Islam. The question they ask me is, “Why haven’t the Government been to see us about this?” I put this forward.

[Lord in Waiting/Government Whip (Lord Leong) (Lab)]

May I ask the noble Baroness to speak to the amendment?

[Baroness Nicholson of Winterbourne (Con)]

This Private Member’s Bill has not been discussed with the mosques in London, nor anywhere else. My suggestions are that we have a meeting, that I bring suitable people with me and that we start to open this up. It is against the faith to commit suicide, so this is very important.

[Lord Falconer of Thoroton (Lab)]

Of course I agree to a meeting and the noble Baroness should bring anybody she thinks appropriate to it.

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[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank everybody who spoke in the debate. I am very conscious that I stand between noble Lords and their lunch, so I will try to sum up quickly. I agree with the noble and learned Lord that we are all trying to ensure the same thing. I am disappointed by his response pointing to his amendments around the right to an independent advocate, because that is only one small part. My Amendment 167 was really about seeking assistance in the preliminary conversation. The reason for that is understanding that, as my noble friend Lord Shinkwin so eloquently said, it is about thinking about the process from the perspective of the person with the communication issues.

Any of us might find ourselves at any moment in our life, through illness, accident or frailty, in this position. Turning the tables and thinking about how we would feel going through this process and the preliminary conversations is really important.

I want to just quickly give examples of why words really matter and why it is not just about independent advocates. We have the next group after lunch on that. In Scotland we had the “right to speak” legislation that went through after the campaigning of Gordon Aikman, and the Scottish Government put in the right for people to access communication aids and support. The problem in practice is that many people have been able to access aids but not the support; that was the essence of my probing.

The noble Baroness, Lady Hollins, mentioned training. Yes, people are trained to support, and independent advocates might be in that camp, but it tends to be very basic. If you consult the Royal College of Speech and Language Therapists, it is extremely concerned about the number of professional people available to support this group of people. Clarity is vital all the way through the process.

I am conscious as time goes on that I cannot mention everybody. The point is that language being either mediated by someone else, culturally shaped or indirect can cause an issue at any point in the process, and therefore we must have support for people with severe communication issues and other issues. I pay tribute to my noble friend Lady Nicholson. We must surely do all we can to ensure that the decision of a person to end their own life is truly that of the individual and not simply a miscommunication.

[Baroness Nicholson of Winterbourne (Con)]

I add my thanks to the noble and learned Lord, Lord Falconer, for his comments. I look forward immensely to the meeting with him. I also point out that his colleague on the Front Bench stood up and said something about me and, of course, I could not hear it. Hearing is a very difficult thing to ignore. I sincerely hope that the amendments will cover that.

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to withdraw my amendment.