Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Friday 6th February 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I believe that there may be some people who wish to speak before I come to my final remarks. I certainly want to hear from the Front Benches and the sponsor of the Bill. I will therefore withhold any remarks at the moment.

[Baroness O’Loan (CB)]

My Lords, I have added my name to Amendments 102 and 106 in this group. Clause 2 is of the utmost importance because the definition of “terminal illness” underpins everything in the Bill. Without a terminal illness, the Bill does not apply and there is no ability to seek assistance in suicide, so the definition is enormously important. Clarity is absolutely necessary and would be enhanced if a list of terminal illnesses were required to be published before the clause on the voluntary assisted dying commissioner could come into effect, as Amendments 85, 894 and 896 would require. Some conditions need to be excluded, such as being elderly, as in Amendment 99. Amendment 102 seeks to ensure that dementia is recognised as a disability and not in itself a terminal illness.

Amendment 105 would exclude anyone with a congenital, genetic or lifelong condition, for which treatments are improving rapidly. Life expectancy has increased dramatically in conditions such as cystic fibrosis, COPD, Parkinson’s and Duchenne muscular dystrophy. Pathfinders Neuromuscular Alliance says:

“Many individuals with progressive conditions, such as muscular dystrophy, live far beyond their initial life expectancy due to advances in medical care. Misjudgments in prognoses could lead to premature decisions, effectively ending lives that might have been enriched by appropriate care and support”.


This Bill does not provide protection for those with such conditions, who may be coerced into seeking an assisted death.

Amendment 106, in the name of the noble Lord, Lord Hunt, and the noble Baroness, Lady Grey-Thompson, to which I have added my name, would prevent assisted dying being offered where medical negligence, malpractice or omission has occurred and given rise to disability, impairment or a terminal condition until all investigations, compensation claims et cetera have been concluded. In many cases involving medical negligence, a failure to diagnose a condition which may have been treatable when the patient first presented is finally diagnosed as a cancer at stage 4 and has metastasised. This may happen, for example, when a young woman, sometimes even a child, has cancer of the cervix or uterus: some doctors do not think they could have such a problem, because they are too young. This will be profoundly difficult for the patients and their families, and it is vital that they do not lose benefits or part of the compensation they might have received by dying of assisted suicide, rather than a death which would have been recorded as having been caused by medical negligence. Those resources may be vital for a single parent with a young family. Does the noble and learned Lord accept the need for these amendments, or what is his alternative suggestion?

There are conditions which can be stabilised or controlled for years, and which, if not stabilised or controlled, may cause a doctor to predict death. Noble Lords have articulated the concerns that exist about the inadequacy and danger of this primary definition. Illnesses that can be stabilised, halted or effectively managed by treatment must be excluded, ensuring that only genuinely terminal illnesses are included in the definition.

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[Lord Falconer of Thoroton (Lab)]

Of course it is a difficult decision, but that is the decision the person has to be clear, firm and settled about. I do not see parity between the decision the individual has to make and making sure there are appropriately qualified people ensuring that the person has the disease. They seem to be two important but different requirements.

The next group of amendments, primarily advanced by the noble Lord, Lord Frost, is on the question of whether suffering should be an element in the eligibility—that terminal illness itself is not sufficient. We have had this debate a number of times, particularly at Second Reading, on some the circumstances where a terminal illness should be excluded. For all the reasons I have given in the past, I am not in favour of suffering being the requirement. What suffering is will vary from person to person. In some cases, it will be the indignity. In some cases, it will be the appalling thought of the change in relationship with those they love. For others, it will be the pain they are going through. It is not, in my respectful view, an appropriate or easily applied condition. So, for all the reasons I have given on a number of occasions before, I am against putting in the question of suffering.

The next group of amendments is that advanced this morning by the noble Baroness, Lady O’Loan. They say that if you are the victim of medical negligence, you should not be entitled to an assisted death. If, for example, your doctor failed to diagnose your condition early enough for you to get treatment and, as a result, you are likely to die earlier, even though you have the condition—for example, prostate cancer—is the position that, because of the negligence of your doctor, you are truly to be denied the right to an assisted death? Unfortunately, I cannot see the logic of that.

[Baroness O’Loan (CB)]

With respect, I did not say that you should be denied an assisted death. I said that assisted death should not be available until all compensation matters and so on have been sorted out.

[Lord Falconer of Thoroton (Lab)]

I think that I have dealt with that point. I have dealt with “inevitably progressive”; I will now deal with the list of illnesses mentioned by the noble Lord, Lord Moylan. Again, I do not think that that is either practical or sensible. The state would have to identify all illnesses in a list; it might miss some, and new illnesses come. Surely it is much better that one has a definition of what the policy aim is, which is to cover

“an inevitably progressive illness or disease which cannot be reversed by treatment”.

I will indicate by an example why the noble Lord, Lord Moylan, is wrong. If you think about HIV/AIDS, how many people would have died without this option—if it had been made available—before the state would have been willing to recognise that it was a fatal condition? It would seem jolly unfair to people that you have to wait for the state to make that decision. The noble Lord, Lord Moylan, also asked for a—

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[Lord Falconer of Thoroton (Lab)]

I apologise unreservedly for saying that the noble Lord, Lord Shinkwin, suffers from a condition. I completely accept the way in which he put it. I also sympathise with him and accept that he suffers from prejudice on a regular basis in relation to it. That is obviously a fate that he has suffered and I have sympathy for him in that respect. On the question of filibuster, my issue with the way in which noble Lords have been dealing with this is that we are now on the ninth day of Committee and we have got to Clause 2. My experience of this House is that it is able to focus on the things that—

[Baroness O'Loan (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Let me finish. We focus on the things that matter and we should not have taken nine days to get to Clause 2.

[Baroness O'Loan (CB)]

The noble and learned Lord keeps saying that we have only got to Clause 1 or Clause 2, but the reality is that over these nine days we have discussed multiple clauses of and schedules to the Bill. It is misleading to suggest that we have only done Clause 1 and a bit of Clause 2.

[Lord Falconer of Thoroton (Lab)]

If that is the position, let us agree a process by which, having covered so many topics already, we can speed our process so that perhaps we can get through Committee in the next day or two.

[Baroness O'Loan (CB)]

The House has its procedures and generally stays by them. There is nothing going on during this Bill which is filibustering. It is analysis of the defects and the flaws in this dangerous Bill.

[Baroness Finlay of Llandaff (CB)]

My Lords, after a very long and extensive debate, I thank all noble Lords who have contributed, particularly those who contributed with their own personal stories and descriptions of the way those experiences have affected people. However, I remind the Committee that we are legislating for the whole country, not for individual stories, and must look at eligibility carefully.

Frankly, the response from the noble and learned Lord is deeply disappointing. These amendments were tabled to make the boundaries of this Bill safer and to avoid opening the door to the wide creep that could happen. In terms of the six-month prognosis, there is an extensive body of evidence that there is no clinical truth in a six-month prognosis. I am delighted to be sitting next to my noble friend Lord Carter of Haslemere, who illustrates that beautifully, as does the noble Baroness, Lady Campbell of Surbiton, who was deemed to be terminally ill many decades ago.

I will try briefly to summarise. Frailty is not included, apparently, but geriatricians will say that frailty has a six-month prognosis, as does cancer. I would not want frailty included and am glad that it has been ruled out. However, people who are frail will also get other conditions. This group of amendments hit to the very issue of informed choice and patients making those choices. As was said, knowledge is power. The information that people need is that their diagnosis is accurate. They need information about the prognosis. It is very disappointing that the wealth of research evidence—systematic reviews, observation studies and so on—has shown that at six months the margin of error is huge.

My noble friend Lady Freeman is absolutely right regarding the way of communicating risk. You can say to people, “In 100 patients, so many are likely to be alive at six months”. The follow-up question that you will always get is, “Yes, but which group am I in?” That is the unknown. Their family will then push further—though not always—to know which group they are in. It is important in communicating information that we are honest and do not pretend that there is some clinical truth around “six months”. There is also, sadly, bias in the minds of doctors. I was concerned to hear from the Minister, if I heard it right, that a different six-month test would be applied by two different doctors—the co-ordinating doctor and the independent doctor—but I will go back to Hansard to look at that. The noble Lord, Lord Wolfson of Tredegar, pointed out the legal uncertainty around “reasonably be expected”. I caution that we should not ignore that.

It is disappointing that there is still a view that, somehow, six months is absolute, ignoring that there are patients who are expected to die not only in six months but possibly much sooner but who remain alive many years later. This is not about five months or seven months. This is about years—five years, 10 years, 15 years. I will not go into individual cases now, but I have a catalogue of them. The six months is not predictable. The attempt in these amendments was to make sure that the patient has better information on which to make probably the most difficult decision that they will ever make and the most irreversible—to end their life.

We have been trying to look at the problems in and improve the Bill. Rejection of all these amendments out of hand, without any invitation to look again at the wording or try to tighten it, is disappointing. With that, I beg leave to withdraw the amendment at this stage.

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[Baroness Hollins (CB)]

My Lords, I added my name to Amendment 87, which details the exclusion of those with diagnosed eating disorders from accessing assisted dying, because I consider this a tricky area deserving of very careful debate. There are serious and specific risks that the Bill poses to people with anorexia nervosa and other eating disorders—conditions with the highest mortality rate of any psychiatric illness, but which are not terminal illnesses. They are complex fluctuating disorders, characterised by impaired insight and a distorted relationship with food, weight and how people view themselves.

Written and oral briefings that we have received make it clear that this is not just a theoretical concern. The Complex Life and Death Decisions group briefing on eating disorders documented how, in jurisdictions with assisted dying laws, eating disorders have been redefined as terminal once patients stop eating and drinking. This is despite the availability of effective evidence-based treatments and well-documented cases of recovery, even after decades of illness. A systematic review published last year in Frontiers in Psychiatry identified at least 60 individuals with eating disorders who died by assisted death in Oregon, Colorado and California—jurisdictions where, as in this Bill, assisted dying is restricted to terminal conditions. A third of those who died were in their teens or 20s, and all were women.

Cases such as this demonstrate the danger of conflating treatment refusal with terminal illness, and of mistaking the voice of a life-threatening psychiatric disorder for a wish to die. Starvation affects the brain in profound ways, including causing rigidity of thinking and allowing the illness itself to dominate choices. This can happen even to the point where perceived thinness is valued over life.

Yet people with anorexia can appear highly articulate and lucid, which can mask these deeper impairments and make capacity assessments unreliable. Many are judged to have capacity in other areas of life even while their decision-making around food, weight and choosing self-preservation is seriously distorted by the disorder. Someone may seem capable of making an end-of-life decision while simultaneously lacking capacity for the very decisions that would keep them alive. We need to acknowledge this complexity and proceed with the utmost care, recognising that these individuals are among those most at risk under the Bill.

Those who refuse to eat or drink because of mental illness must also be excluded from the Bill’s scope so that we can properly safeguard them and ensure that they receive the treatment and support that they need to recover. Amendment 87A would offer a valuable clarification, ensuring that this would apply regardless of whether the refusal of food or drink is voluntary or arises from a mental disorder. This would prevent any ambiguity that could otherwise allow conditions such as catatonia or other serious mental illnesses to be misclassified as terminal under the Bill. It would provide further safeguards for people with mental disorders.

There are mental-health conditions where life-threatening physical complications can occur without the restriction of food and drink. Amendments 90, 92 and 103 also cover this key area and would ensure that assisted dying is limited to people who are genuinely terminally ill due to disease progression and not because they choose to refuse care, food, fluids or treatment. A person cannot be considered terminally ill if their life-threatening condition arises from the secondary effects of mental illness.

[Baroness O’Loan (CB)]

My Lords, the issues raised in this group are extensive and a matter for great concern. Refusing food and hydration is a sure way to die, as, in many cases, is refusing treatment such as dialysis and insulin. Refusing food or treatment is a choice that a patient is entitled to make, if they have the capacity to make such a decision. However, that cannot translate into an obligation on the state to help the person to kill themselves. That was recognised, as the noble and learned Lord, Lord Falconer, said, by the Bill’s sponsor in the other place, hence the wording of Clause 2(2). However, the noble and learned Lord’s Amendment 87 would remove the safeguard offered by Clause 2(2), as it would prevent the Bill applying only where the person has a mental disorder and the act of refusing food or hydration causes them to have an illness or disease.

Many states start by offering assistance to die in very limited circumstances, but, only a short time afterwards, the grounds for the state helping people to kill themselves expand—in some cases, almost inconceivably. Do you have no wheelchair? We will help you die. Do you have no home? We will help you die. Are you suffering from PTSD after military service? We will help you die. In many jurisdictions, anorexia, which is a treatable illness, is accepted as justification for assisted suicide and so on. All the examples that I have just given—no wheelchair, no home and suffering PTSD—were grounds for assisted dying in Canada recently.

There are many suggestions for how to address the terrible vacuum through which all sorts of conditions that are not terminal could, as a consequence of refusing food, treatment or hydration, become terminal. I put my name to one such amendment, Amendment 101, in the name of the noble Baroness, Lady Parminter, and all the amendments in this group, other than Amendment 87, seek to address the issue. However, it is clear that the list of conditions and situations currently provided in Clause 2 as exceptions to the definition of terminal illness is not adequate. The noble and learned Lord, Lord Falconer, has even removed from the Bill the more general safeguard inserted by the MP for Batley and Spen. The noble and learned Lord will have to move far beyond his Amendments 87 and 87A if he is to satisfy the Committee that the definition of the situations that do not qualify as terminal illness is in any way satisfactory.

The prevalence of eating disorders goes way beyond what one might perhaps reasonably expect. NHS statistics for 2023 tell us that the prevalence of any eating disorder in the age group of 11 to 16 year-olds was 2.6%, but that in the case of girls it was 4.3%, compared with only 1% in the case of boys. If we move to the group of 17 to 19 year-olds, the figure is 12.5% in the whole group but, among girls, the number suffering from an eating disorder rises to 20.8%, compared with 5.1% among boys. Those are NHS figures. A review of current literature up to 2022 investigating suicide in eating disorders found that the prevalence of suicidal ideation was 51% and the prevalence of suicide attempts was 22%. I am very grateful to the young intern doing a PhD who provided me with these figures from the NHS. They demonstrate the magnitude of the problem of eating disorders today and, even more terribly, the 51% prevalence of suicidal ideation. Half of all people suffering from anorexia or other eating disorders will contemplate suicide, and more than one in five of those suffering from an eating disorder will attempt to take their own lives, although the disorder that they suffer from can be treated if they get proper treatment.

The Bill effectively creates a class of people—particularly disabled people, diabetics, those on dialysis, and others who need continuous life-sustaining treatment—who can at will cause themselves to have a terminal illness as defined by the Bill. Experts and the courts have agreed that refusing such treatment and creating a terminal illness out of a desire to die does not vitiate capacity. Can the noble and learned Lord, Lord Falconer, explain how creating a class of disabled people for whom voluntary suicide is legal and state-supported is consistent with the UK’s obligations under Articles 2 and 14 of the European convention?

[Baroness Finlay of Llandaff (CB)]

My Lords, I have in this group an amendment that was recommended by the Complex Life and Death Decisions group at King’s and which builds on the clause that was proposed in the other place by the MP for Bradford West and accepted, currently Clause 2(2). It seems that Amendment 87 before us would knock that out, but it has an amendment to it that has been clearly explained by the noble Baroness, Lady Keeley.

This seems to be the start of an improvement that is very necessary, but it does not do everything. There is a concern that those with other types of eating disorder can be missed out or slip through the net, particularly those with bulimia and those who go on completely bizarre diets and end up with severe malnutritional states. I have known two examples directly: one person believed that he could live only on cottage cheese, and another was eating kilogrammes of parsnips every day in the belief that that would cure her disease, and ended up with quite severe metabolic disturbances.

The problem with the amendments so far is that they fail to exclude the voluntary stopping of eating and drinking that is designed deliberately to make you terminally ill. I mention, if I may, the problem of T1DE—that is, a type I diabetic with an eating disorder. Lesley and Neal lost their young daughter Megan at Dignitas, after years of inadequate treatment. I have permission to quote them. They said:

“Following inadequate and inappropriate in-patient and community treatment for T1DE, our daughter chose to take her own life after asking for a Dignitas referral from her care team. She clearly would have taken up the assisted dying option if available to her, however, just before she committed suicide she said ‘I don’t really want to die, I just can’t do this any more’”.


That illustrates the real difficulty for young people with disorders that are on the boundary here. I hope that we can build on these amendments on Report to make sure that they really are watertight.

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[Baroness Gerada (CB)]

My Lords, I am completely in favour of Amendment 87. I have permission to use the name of my patient, Melanie Spooner, who died from anorexia nervosa—she died from taking her own life. The end point of anorexia nervosa is often that the patient wants to die. As such, it is a terrible mental illness, and I think that not conflating and excluding this group is absolutely the right way forward.

One other issue has been bothering me ever since I have been coming to these Fridays: it is the conflation of the words assisted suicide with assisted death. For a decade now, I have been looking after those bereaved following the death by suicide of their loved ones, and I have about 100 people whom I care for. Suicide is often a violent act; it is often an act done alone and it is often done to punish people—I am terribly sorry if anyone here knows people who have killed themselves. It is a very prolonged bereavement, and a very complicated grief that affects up to 60 to 70 people in its wake.

Assisted death, as we have heard from the group that came from Australia, can sometimes be filled with hope and sometimes with joy, with family around for those last moments. It affects both groups: those whom I look after, who have been bereaved following suicide, and the relatives of those who have taken voluntary assisted death. It is such a small thing, but it really grates, and it is one of the most inappropriate and irresponsible ways of conflating the language.

[Baroness O'Loan (CB)]

Before the noble Baroness sits down, can I ask her whether she is aware that recent research has shown that 42% of people think that assisted death is actually the provision of palliative care, and that it is actually quite important to distinguish between the two?

[Baroness Gerada (CB)]

I was not aware of that research. The evidence shows, and we heard it from the Australian group, that where voluntary assisted death is in place, the provision of palliative care is improved. In Australia, a great deal more resource was put in to providing palliative care. My point, however, is: please can we no longer conflate the language of assisted suicide with that of voluntary assisted death.

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[Lord Falconer of Thoroton (Lab)]

It may assist in the light of that exchange if I indicate what my position is. We had a debate some weeks ago about the question of people who had had their liberty deprived within the preceding 12 months. That would obviously include those who were still the subject of a DoL order or a DoL application, and the noble Baroness’s amendment refers to a number of other categories as well, which are similar and which I think would be included. I indicated explicitly in the debate that I think it would be appropriate for me to bring forward explicit extra protections in relation to those people, and in particular, those extra protections might include a specific compulsory further psychiatric examination for that purpose. I have been in discussions with various people in the House in relation to that, and I am seeking advice from officials and others so that I will be able to bring forward proposals on Report. I hope that very much helps my noble friend Lady Berger.

[Baroness O’Loan (CB)]

My Lords, as a consequence of our earlier debates, as the noble Lord, Lord Markham, said, we know that in the context of applications for assisted suicide, the Mental Capacity Act, which is to be used for determining capacity, would permit an unwise decision—we have all agreed on that—even if driven by depression, loneliness or despair. We know that it would treat brief retention of information as sufficient even when the Bill requires a clear, informed and settled wish, and even though we know that, in cases of dementia, 76% of patients who refused life-saving treatment while delirious have no memory whatsoever of having done so 24 hours to 72 hours later.

Another study found that more than 60% of patients who voiced a wish to die during a bad day had no recollection of it when mood or cognition improved. People who cannot retain or consider information on their choice the day after making it will not be able to avail themselves of the cooling-off period, which is for contemplation about what is proposed. They will be in a very dangerous position, especially if their particular condition leaves them suggestible to options offered to them by those who care for them professionally, in whom they will probably place great trust.

The Mental Capacity Act also imposes a duty to support decision-making, which in this context risks becoming a duty to facilitate a decision to die. The Mental Capacity Act says that capacity expressly includes making an unwise decision, even if it would be irreversible and total self-harm. Alex Ruck Keene said in giving evidence that “if you simply read across the Mental Capacity Act, there is a duty on all the people carrying out the assessments to seek to support the person to have capacity to end their own life.”

We also know that it will rely on time-specific capacity, despite the Bill requiring consistency across all these stages, from one, two, seven, eight and so on. The reality is that the only one that requires an interaction between the doctor and the patient is the first one. The rest of them are exercises that may not involve any consultation with the patient who is making the application, let alone a face-to-face engagement. The Bill purports to introduce a statutory framework for determining capacity, but it does not do so in reality because the MCA is designed to test when a person cannot make a decision, not whether someone is capable of doing so. I hope that the noble and learned Lord, Lord Falconer, will accept the intent of these clear and effective—

[Lord Falconer of Thoroton (Lab)]

The noble Baroness suggested that the only interaction will be with the first doctor. She will be aware that Clause 12 requires both doctors to examine and have discussions with the patient and she will also be aware that, under normal, though not all, circumstances, the panel must speak to the patient—unless there is an exceptional reason why they should not.

[Baroness O'Loan (CB)]

Those are both qualified as exceptions. I will carry on.

[Lord Falconer of Thoroton (Lab)]

It is exactly the same for the co-ordinating doctor and the independent doctor. I am not clear what distinction the noble Baroness is making between the two. Perhaps she can explain to the Committee.

[Baroness O'Loan (CB)]

I will revert to the Bill and come back to the noble and learned Lord in due course. If I am wrong, I apologise.

The noble and learned Lord has committed, in your Lordship’s House, to build special protection for those currently or recently subject to a deprivation of liberty order, as raised by the noble Lord, Lord Markham, but the detail has not emerged. What will the specific protections be? Will there be an outright ban for those, for example, under DOLs or in prison? In Committee on 16 December, the noble and learned Lord said that, where somebody has made an application that a person’s liberty be taken away because they are seriously mentally ill or lack capacity, or a person has actually been deprived of their liberty, special provision should be made. I know the noble and learned Lord has said he will make provision, but time is passing and we still have no indication what that provision must be.

Previously, on behalf of the Government, the Minister noted that denying those under DOLs access to assisted dying might later be interpreted by a court as a breach of ECHR obligations. I would like to ask the Minister what the Government’s view is as to the minimum protection that must be offered to those deprived of liberty and susceptible to suicidal ideation if the Bill is to be compliant with the Government’s obligations under the Human Rights Act and the ECHR.

The presumption of capacity in the Bill may result in the acceptance of unwise decisions by those who will have forgotten about them the very next day. We know that clinicians and practitioners want clarity and certainty; they do not want to be left repeatedly in situations in which they must exercise their discretion. All the professional bodies have told us that. The risk of litigation, or intervention by a regulator or the police, would inevitably exercise the minds of those who act professionally. Without clear rules, the system cannot work; things will fall apart.

The Bill provides for a period of reflection once a decision is made to allow someone carefully to consider the choice involved, weighing all the information again and thinking over this life or death choice. The noble and learned Lord and the Chief Medical Officer have claimed that the MCA requires a higher threshold for life and death decisions. Legal experts, including Alex Ruck Keene KC, confirm that the Act contains no such stipulation; it does not provide a higher threshold.

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[Lord Deben (Con)]

I have some sympathy with the noble Baroness. She is very fortunate with the care home her husband is in, as is he. For many years, I represented the constituency that had perhaps the largest number of care homes in the country. Suffolk Coastal is an elegant area, and with towns such as Southwold, Aldeburgh and Felixstowe, it is a natural place for them. I would, of course, visit them on a regular basis, as indeed did my wife.

I have to say to the noble Baroness that the difference between the best and the worst is very considerable indeed. In grave humour, if I displeased my children, they would mention the worst one as the one where I might be placed. I put it like that because they recognised it, too: the very considerable difference. The reason why I think the amendment from the noble Lord, Lord Blencathra, so important is precisely because it does not exclude people. It says that the conditions of care homes are such that it is important to protect people rather differently, because of our experience. Some of the care homes in my former constituency are absolutely wonderful, with really good care by really good clinicians. However, I cannot say that that is universal, so I think we should have some protection—and this seems to me to be very sensible and it does not exclude anybody.

The noble Baroness suggested that this would exclude people, but this is a proposal that would protect those who are less happily off than the noble Baroness and her husband. It is very generous of her to share her current concerns: mine are not as current, but they are very much wider and from a much longer period. I looked again at the devastating effect of Covid, which came after my membership of the House of Commons, because of connections that one had—and that has made me even stronger in my belief that we should be especially concerned for those in care homes, not because of the best or even the average, but because there are many where people would otherwise be vulnerable.

[Baroness O'Loan (CB)]

My Lords, I will speak to Amendment 112 in the name of the noble Baroness, Lady Eaton, who cannot be with us today. I have put my name to this amendment, and Amendment 111.

Although this is a small group, it addresses a very important matter. I endorse what the noble Lord, Lord Deben, said. I extend my sympathy to the noble Baroness, Lady Hayter, because I know what it is like to have someone in a care home. In my case it was someone who had dementia for years and was in a very deteriorating situation. It is profoundly difficult. However, there are huge variations in the standards in these homes. Because of that, this is trying to introduce an additional safeguard for the situation where all is not as well as it might be.

For example, in the care homes during Covid, people were put under DNRs as a matter of process by the care homes. It should not have happened, but it did happen. That was the result. If you are in a care home and fall down the stairs, you may have a broken hip and all sorts of consequential problems. Ambulances, certainly in the part of the country where my mother was, do not attend care homes for at least four hours. They are not priorities. So there are difficulties with care homes.

Importantly, it is about care homes and nursing homes. The residents of care homes and nursing homes often have very few visitors. Some of them have family who come to them, but many of them do not. Another experience I have had is that they latch on to you and want you to visit them, too, because they are lonely. They have little or no contact outside the home and can become very isolated and alone, although they are living in a community within the care home in which they must live. The British Geriatrics Society gave evidence to the Select Committee emphasising that robust specialist assessment is essential where decisions carry finality—and there is no more final decision than this.

Amendment 111 would therefore require a heightened evidential standard, demonstrable through a specialist clinical assessment, for residents of registered care or nursing homes. One in three people with dementia in the UK is never diagnosed. Alzheimer’s Research UK told us that the dementia diagnosis rate in England was 66.3% in December 2025. Dementia incidence is over 20% higher among Black adults compared with the UK average.

The noble and learned Lord, Lord Falconer, has agreed that it is necessary to make provision for those who have been made subject to a DoL. He said last week that he was preparing the amendments, for those who are between 18 and 25 and those subject to DoLs, and that he is considering what additional assessment could apply. We have talked about that a little. Age UK confirms that 70% of care and nursing home residents suffer from cognitive impairment. They have a heightened risk of delirium and confusion arising from infection, dehydration and medication effects. Compassion in Care, based on more than 1,000 calls from care workers and family members, found that the predominant concern raised by both groups was the issue of capacity, with 97% of helpline callers raising the issue of fluctuating cognitive capacity of care home residents.

The issue of UTIs was raised in 97% of calls. The issue of lack of fluids was raised in 89% of calls. Lack of fluids is a very common problem, because people with cognitive impairment or a form of dementia may not receive sufficient hydration. When a drink is provided, they may forget it. My mother used to welcome the drink and get all excited that a cup of tea had been delivered to her, then just ignore it. She would not drink it unless we coaxed her repeatedly to do so. That is not an uncommon experience. Also, the elderly are very susceptible to UTIs, which require antibiotic treatment. Very often, the UTI is recognised first by the visitor, not by the care home staff, because the visitor can see the level of confusion which is consuming the person who is in distress.

A significant proportion of people who are living with dementia or cognitive impairments are not diagnosed until the later stages of the disease. Standard mental capacity assessments conducted by non-clinical professionals often fail to take these factors into account when seeking to establish capacity. The high proportion of undiagnosed dementia among care home residents presents a margin of error that, I would respectfully suggest to your Lordships, no legislature can reasonably and responsibly ignore.

To address the problems identified, Amendment 111 would require a higher evidential standard. Amendment 112 would provide for residents of registered care and nursing homes. The explanatory statement states:

“This amendment provides that, for residents of registered care or nursing homes, capacity may only be established following (1) a specialist clinical assessment ruling out reversible causes of fluctuating or impaired capacity, and (2) a capacity determination conducted by a consultant psychiatrist with relevant expertise. It further clarifies that an MCA assessment alone is insufficient given the heightened medical and institutional vulnerability to unstable capacity in care home settings”.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Whitaker (Lab)]

My Lords, that provision is in the Bill, if the noble Baroness would just look. I am afraid that I cannot put my finger on the actual clause, but the assessing doctor is required to provide interpreters where necessary.

[Baroness O’Loan (CB)]

My Lords, I have added my name to Amendment 65 in this group, but will first respond briefly to what the noble Baroness, Lady Gerada, said about remote consultations. This is the core of what we are discussing today. It is not just the doctor who needs to be able to see and understand. The patient needs to be able to see, understand and interact with the doctor.

During Covid, my brother tried for six months to see his doctor. There were regular telephone calls. On each occasion, he was told that his symptoms were resulting from cardiac problems and other problems that he had had, and that all he needed to do was take painkillers. When he finally presented to A&E six months later, he had stage 4 lung cancer and bone cancer. Remote consultations do not always protect. Because this is a matter of life and death, because this is a situation in which someone is seeking death, we need to be very sure of what we are doing.

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[Lord Falconer of Thoroton (Lab)]

I would not look a gift horse in the mouth if I were the noble Lord. First, I do not regard accepting amendments in Committee of the House of Lords as indicating that a Bill is fundamentally flawed; I regard it as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for this to happen through the Parliament Act. I want this House to do the job that it is supposed to do, which is do scrutiny and then send it back to the Commons.

In the debate on 8 January 2026, I gave in detail the reasons why I thought we were not going about it properly, and I thought that the House agreed with me when it said that we needed to move quicker. The problem is not that everybody does not have good ideas; the problem is that it is taking not just far too long but disproportionately long. My experience of the Lords is that we can do this, and we can do it much quicker than we are doing it and there still be quality. That was the point I made on 8 January and that I understood the House to have accepted.

[Baroness O'Loan (CB)]

My Lords, if I remember it correctly, the Motion that the noble and learned Lord put before the House on 8 January was a Motion that more time was required, not that the House needed to race through the Bill and proceed more quickly. The Motion did not say that we needed to move more quickly; it said that we needed more time. That is what the House agreed to.

[Lord Falconer of Thoroton (Lab)]

The Motion said that more time should be given so that we could complete the stages of the Bill so that it would have sufficient time to get back to the Commons. I was particularly impressed during that debate by what my friend, the noble and learned Baroness, Lady Butler-Sloss, said—that we have to “get through” this. We are not getting through it.

[Baroness O'Loan (CB)]

My Lords, the noble and learned Lord has made the point that I was making. We were saying—we agreed and did not vote against him—that more time was required. But the discussion earlier this morning was about the fact that the House must not rush this, because that we are talking about life and death, and in particular the life and death of very vulnerable and marginalised people who are living in poverty and all those things. These things require the kind of consideration which has occurred this morning, as reflected in the noble and learned Lord’s response.

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[Baroness Coffey (Con)]

My Lords, I am conscious that I might be accused of preferring quill and pen than the latest technology in Amendment 66. In recognising how artificial intelligence is emerging, I thought I would put down a blunt amendment to allow us at least to have a debate. Inevitably, in a variety of legal and health situations, we will start to see artificial intelligence being used routinely. There was a recent legal ruling in which it turns out a judge had completely relied on AI and gave a completely inaccurate ruling based on it. This is not simply about what would be considered by medical practitioners.

I worry about judgment. We have already heard, reasonably, that trying to predict when somebody will pass away due to a terminal illness involves a bit of science but is largely an art. Perhaps I am being ungenerous in that regard. Certainly, in the DWP, we moved accelerated access to benefits from a six-month consideration to 12 months simply because, routinely, the NHS does not require its practitioners to assess six months; it is much more accurate at assessing 12 months. It is interesting that this Bill is focused on six months when, routinely, the NHS does not use that period. However, I am diverting slightly from the point of artificial intelligence.

I was somewhat interested in the previous debate, because there seemed to be a majority—I will not say a consensus—who felt that face to face was an important part of this happening in practice. But there are still a significant number of people who seem happy that we use a variety of technology for some of the interactions.

Forgive me for fast forwarding, but I see this whole issue becoming pretty routine. What I want to avoid is outsourcing. It strikes me how much people rely on Wikipedia and think that they are actually dealing with the Encyclopaedia Britannica, even though a lot of what is on Wikipedia is a complete load of garbage. What is even more worrying is that many of the AI mechanisms use sources such as Wikipedia, or simply put two and two together and come up with 22. I saw this, not that long ago, when I was trying to find something from when I had been on the Treasury Committee and interrogated the FCA about something. The first thing that came out of ChatGPT was that, somehow, I had become a non-executive director of the FCA—if only. That certainly was not the case. I am concerned that an overreliance on AI might start to happen in this regard.

I want to avoid a world of chatbots that removes the human element. That is why I keep coming back to the themes of face to face, being in this country and this having a personal element. I am conscious that the NHS and other practitioners, including legal practitioners, will continue to evolve—I am not stuck in some dinosaur age—but I feel that the issues that those of us concerned about the Bill have will continue. We completely understand why people might want to do this, but we want to make sure that the safeguards, particularly around coercion, are as safe as possible. That is why I have raised for debate the consideration of whether, as a matter of principle, artificial intelligence should not be used in the deployment of the future Act.

As I said, there may be evolution in medicine; we see that that is already happening. I do not know to what extent the Government have confidence in the use of AI in the diagnosis of lifespans. A new evolution in government is that AI is now starting to handle consultations. That might get tested in court at some point, to see whether it is a meaningful way to handle consultations—it is certainly a cost-efficient way to do so. My point is that, according to the Wednesbury rule, there is supposed to be proper consultation, not just a tick-box exercise.

I will not dwell on this, but I would be very interested to hear, from not only the sponsor but the Government, their consideration of artificial intelligence in relation to the practicality and operability of the Bill if it were to become law. I beg to move.

[Baroness O’Loan (CB)]

My Lords, I have put my name to Amendment 66, in the name of the noble Baroness, Lady Coffey. At present, the Bill makes no allowance for any restriction on the possibility of the use of non-human assessment and automated administration devices during the application and decision-making process for assisted death. Obviously, AI will be used for recording meetings and stuff like that—I am not a quill and paper person to that extent—but AI has already been proposed for use in killing patients in the Netherlands, where doctors are unwilling to participate.

The Data (Use and Access) Act 2025 established a new regulatory architecture for automated decision-making and data interoperability in the NHS. It provides that meaningful human involvement is maintained for significant decisions—decisions which may affect legal status, rights or health outcomes. Of course, assisted death would come within that definition.

That reflects the purpose of the NHS. We have talked about its constitution. I looked at the constitution and the guidance. It says that the purpose of the NHS is

“to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives”.

I know that the noble and learned Lord, Lord Falconer, is going to put down an amendment suggesting that the constitution and guidance will have to be amended, but the current situation is that that is the purpose of the NHS. The assisted suicide of patients is certainly not provided for in the NHS, nor should AI be used in the crucial assessment and decision-making process for assisted dying, given the extreme difficulties in identifying coercion and assessing nuanced capacity, and the irreversible nature of death. What plans does the noble and learned Lord have to address these issues?

In the Commons, amendments were passed allowing the Secretary of State to regulate devices for self-administration. The amendment was not put to a vote; in fact, only seven votes were permitted by the Speaker on the more than 80 non-Leadbeater amendments. The Commons have accepted that devices will be used for self-administration. Of course, the assisted suicide Bill requires self-administration. Nothing in the Bill prohibits a device that uses AI to verify identity or capacity at the final moment. If a machine makes the final go/no-go decision based on an eye blink or a voice command, have we not outsourced the most lethal decision-making in a person’s life to technology? I have to ask: is this safe?

Public education campaigns on assisted suicide are explicitly allowed for in Clause 43. The Government have said that there will be an initial education campaign to ensure that health and social care staff are aware of the changes, and that there would likely be a need to provide information to a much wider pool of people, including all professionals who are providing or have recently provided health or social care to the person, as well as family members, friends, unpaid carers, other support organisations and charities. That controls only government activity. The other observation I would make is that I presume the public education campaign will inform families that they have no role in a person’s decision to choose assisted death, and that the first they may know of an assisted death is when they receive the phone call telling them that the person is dead. It is profoundly important that people know this.

There is nothing to prevent an AI chatbot or search algorithm helpfully informing a patient about assisted dying services and prioritising assisted dying over palliative care search results. By legalising this service, the Bill will feed the training data that makes these AIs suggest death as a solution. I would ask the noble and learned Lord, Lord Falconer, how he intends to police that situation.

There is also a risk of algorithmic bias. If prognostic AI is trained on biased datasets—we know the unreliability of the prognosis of life expectancy—it could disproportionately label certain demographics as terminal, subtly influencing the care options, including assisted dying, presented to them. The National Commission into the Regulation of AI in Healthcare established by the MHRA in 2025 is currently reviewing these risks to ensure that patient safety is at the heart of regulatory innovation. I ask the Minister: will that work cover assisted dying?

The AI Security Institute’s Frontier AI Trends Report in December 2025 highlights that:

“The persuasiveness of Al models is increasing with scale”,


and:

“Targeted post-training can increase persuasive capabilities further”.


In a healthcare context, this raises the risk of automated coercion, where the person interacting with a chatbot or an AI voice agent might be subtly persuaded towards certain end-of-life choices. The AISI has said that safeguards will not prevent all AI misuse. We have to remember that there will be financial incentives to provide assisted suicide; after all, the CEO of Marie Stopes received between £490,000 and £499,000 in 2024. There is big money, even though this will be charitable or NHS work. Clause 5 allows doctors to direct the person to where they can obtain information and have the preliminary discussion. That sort of information could be an AI or a chatbot at the present time.

Dr Sarah Hughes, giving evidence to the Lords Select Committee, said there was a real risk of “online coercion”. With newly developed AI functions and chatbots, we already know there are cases all around the world of individuals being coerced into all sorts of different behaviours, practices and decision-making. There is also an issue of misinformation around diagnosis and prognosis. Hannah van Kolfschooten questioned who has ultimate responsibility if the technology fails. She said:

“In traditional euthanasia settings, a doctor is accountable, but in AI-driven scenarios, accountability could become ambiguous, potentially resting between manufacturers, healthcare providers, and even the patient”.


AIs also have a record of encouraging suicide. We know that, and we have seen terrible cases among young people; they have no regard for human life.

Evidence shows that doctors suspect only 5% of elder abuse cases. Detecting subtle coercion requires, as was said in the previous group, professional judgment to interpret things such as non-verbal cues, body language and discomfort. AI systems are ill-equipped to handle these nuanced, non-quantifiable elements. It is imperative for trust in the system that the individual circumstances of each request for assisted death are recorded and are available for interrogation, or even potentially a criminal investigation, by the panel or another regulatory authority. The only insight as to what happened in the consulting room will come from these records. The patient will be dead. The current provision in the Bill does not provide any protection against the use of AI, which has algorithmic bias, to protect an individual in these circumstances. Can the noble and learned Lord, Lord Falconer, explain how he proposes to deal with these concerns?

[Lord Carlile of Berriew (CB)]

My Lords, I will add only a very short sentence to my noble friend’s excellent speech, and it is what AI says about AI. It says: “AI is technically capable of providing advice or information relating to suicide, but it is critically dangerous to rely on it for this purpose”. Enough said.

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[Baroness Finlay of Llandaff (CB)]

I am most grateful to the noble Lord, Lord Hendy, with whom I have had conversations going back to last September. I have looked after many patients dying of mesothelioma, and it seemed to be a loophole if the chain of causation was not completely intact.

We had advice in several calls from extremely wise sources—I will not list them all—and I learned a great deal about the legal side and the Fatal Accidents Act. I have some questions for the noble and learned Lord, whom I met with yesterday. He assured me that he would be bringing forward amendments, but unfortunately, I did not see them at the time; it was only much later that they appeared in my inbox. I have not been able to go through them in detail to examine the precise wording.

The concern is that unless this is watertight, these companies will wriggle out of any type of compensation. Therefore, what is the position of coronial oversight in these cases, where perhaps even the diagnosis might be questioned by a company, and it could be difficult for a family to provide the evidence it might be demanding? One does not know. Also, what is the position regarding the life insurance policy of the individual when they have an industrial disease and there is a chain of causation? They might be eligible, one hopes, for compensation. That needs to be followed through. However, somebody could claim that in some way, the chain of causation had been broken.

[Baroness O'Loan (CB)]

My Lords, I express my appreciation to the noble Lords, Lord Hendy and Lord Harper, for bringing these matters to our attention. I had prepared a speech describing the awful situation of mesothelioma, et cetera. I will not talk about that but will just say a couple of other things.

This has clearly identified a huge gap in provision in this legislation: a Bill is being passed that may have consequences it does not provide for in any way. I am thinking in particular of the Fatal Accidents Act: people are dying of these industrial diseases, including military victims. I had no idea that military victims would lose compensation in that situation. I am very grateful to them for identifying such a significant gap. This is very important for members of the Armed Forces, because many of them suffer from mental illnesses as a consequence of their service, in addition to any other condition from which they may suffer. That always makes life harder for them in trying to negotiate their way through and make decisions of such a profound kind. The noble Baroness, Lady Finlay, mentioned the problem with insurance policies and suicides. Most insurance companies will pay out after a suicide, provided that the minimum time has elapsed since taking out the policy. If someone has an assisted suicide, we do not quite know how that will affect their insurance policy; but it now appears that if the underlying cause of death—the terminal illness which led to the granting of assisted suicide—is something such as cancer, that may send the insurer straight back to find out what underlying habits were disclosed, such as the person being a smoker. It all becomes enormously complicated for the person suffering from a terminal illness who is trying to decide whether to seek an assisted death. There is no provision in this legislation for consequences for their families in situations such as this.

[Baroness Grey-Thompson (CB)]

My Lords, this is a really interesting group of amendments, and it has probably raised more questions for me than it has answered. When we talk about injury, I immediately think about people who have had a spinal cord injury and who have become a quadriplegic or a paraplegic.

By the very nature of my former career, I know a lot of wheelchair users who have been through various compensation cases. Luckily, these days the survival rate for someone with paraplegia or tetraplegia is very high. We also have to take that into account. I had not thought before about the impact on anyone who has been in the military. I know quite a few people who are injured through the military. Generally, the public are very supportive of the military and what they have gone through, and we would not want any unintended consequences for them.

When I was looking at conditions such as asbestosis, and others that have been debated on this group, it became very clear that in many cases these conditions present quite late and treatment is then very difficult, and many patients die before the compensation claim has gone through. We have talked before about coercion, and I know that Ms Leadbeater has said in various debates and comments that she is concerned about people being coerced not to end their life.

This is a situation where I could see this happening. If you go online and google asbestosis compensation or spinal cord injury compensation, a plethora of websites come up straightaway with calculators, so that you can have an indication of how much you could possibly gain. I had a look; it goes from a couple of thousand pounds for a back injury—which obviously would not account for this—up to £493,000 for someone with quadriplegia. The figures given as a range for asbestosis were £50,000 to £1 million. That is a life-changing amount of money for many families in this country, and it will colour the decisions they make.

It is slightly strange, because we talk about someone being a burden, but people will make a different decision because they are thinking of their children and grandchildren and protecting them for the rest of their lives. So a lot of clarity is needed to make sure that coercion does not go either way. I would be very interested in understanding what the noble and learned Lord intends to do to offer greater clarification for this group of amendments.

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[Lord Falconer of Thoroton (Lab)]

The reason, from discussing and thinking about this issue, is that the Government see the most convenient way of doing it is to have a review that can make sure every single aspect is covered. That is the argument for the review.

[Baroness O’Loan (CB)]

It seems from what the noble and learned Lord just said that the Government have been discussing this issue. If they have, is it his intention to ensure that, in providing such information as the Government provide under the terms of the Bill, they warn people that if they opt for assisted suicide in certain circumstances, it is possible that they will lose compensation to which they would otherwise be entitled and that this is a matter on which advice needs to be sought? Are the Government aware of any other situations in which this may happen to people who may opt for assisted suicide?

[Lord Falconer of Thoroton (Lab)]

I am afraid that I am not the Government. On the issue of risk, my proposal—although I recognise that some people want to go further—sets out a sensible course to reach the aim that everyone wants to reach, which is that the problem does not arise. One will have to look at the extent to which one has to warn against that problem when one sees where the review goes, because the question of what warnings have to be given will have to be addressed only at the point when the review has already reported and any action has been taken on it.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I will speak to Amendment 38 in my name. I have put my name to five other amendments in this group, all of which seek to ensure clarity on what in the Bill involves identifying vulnerability and providing protection for those who may be subject to coercion or who may be unaware of their rights.

I support Amendment 27 from the noble Baroness, Lady Finlay. The importance of this derives from the current structure of the Bill and the massive deficiency in the Bill’s provisions. As the DPRRC said, the Bill does not say how assisted death services are to be provided. This is a huge black hole in the middle of the Bill. It does not tell us where, when, by whom and how services are to be delivered, and is indicative of how unfit the Bill is.

As the noble Baroness, Lady Finlay, said, Clause 41 confers significant Henry VIII powers on the Secretary of State, requiring him to make provision to secure arrangements. Clause 42 permits Welsh Ministers to make provision, but there is no provision in the Bill that came from the Commons. The noble and learned Lord, Lord Falconer, has not introduced any amendments to address this lacuna. Does the noble and learned Lord intend to do so?

Those who were meant to deliver this service have not been consulted. As the BMA said,

“our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways – it is not something that a doctor can just add to their usual role”.

In 2024, 45% of BMA members said that they were not prepared to actively participate in the process, while 19% were undecided. Where does the patient get neutral, unbiased information? Dr Mulholland, from the Royal College of General Practitioners, said:

“The shape of the service is not set out in the Bill … GPs need to have a space where they can step away from it: that is the key point that we want to get across. For those who want to take part, it may be that they decide to do it, but it would have to sit outside the core general medical services that we provide at the moment”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 277.]


Chris Whitty said in oral evidence that Parliament should resolve this. How does the noble and learned Lord, Lord Falconer, intend to resolve it?

As a consequence, a person, particularly one who—for a variety of possible reasons—has no family or friends who can support them, when advised by a doctor that voluntary assisted death could be provided to them because of their condition, is intensely vulnerable. This could happen even when they have made no request for such provision. It may come as a significant shock to them, on top of their existing vulnerability as a consequence of the diagnosis and prognosis that they have received. In such a situation, the patient—isolated, vulnerable and accustomed to believing that a doctor will always seek to help their recovery and do no harm, and possibly even thinking that assisted death means palliative care rather than death—will need some independent person to talk to, if only to try to ensure that they understand what they are committing to. As far as I can see, there is no such provision in the Bill.

The Bill does not even say that the person who makes the request to die, provided for in Clause 1, line 13, must be the person referred to in Clause 1. Relatives, friends, a professional adviser or indeed anyone else could initiate the process. Hence I have put my name to Amendment 31, which would add the words “their own” to the phrase “on request”. Further, since the Bill does not exclude Sections 9 and 11 of the Mental Capacity Act, someone with a lasting power of attorney under that Act could request assistance on behalf of the individual concerned. Once that request is made, the provisions follow. Amendment 68A, in the name of the noble Baroness, Lady Coffey, is vital, because it ensures that someone with an LPA cannot assist the process. Does the noble and learned Lord, Lord Falconer, accept that this is a very real gap that this amendment must fill? If he does not accept the amendment, can he tell the Committee how he intends to ensure a person’s voluntary wish to end their life in these circumstances?

Amendment 38 in my name excludes from eligibility those with serious mental health conditions. It concerns whether they wish to die as a symptom of a specific illness and applies to those with conditions

“known to cause episodic or chronic suicidal ideation, including but not limited to bipolar disorder, borderline personality disorder, major depressive disorder, or schizoaffective disorder”.

It seeks to distinguish between those who might seek an assisted death as an autonomous choice and those who are seeking suicide because of a serious history of mental health or disorder. Some mental health conditions have suicidality as a feature of the disorder. These people are, by very definition, at high risk of suicidality and self-harm. The intention of the Bill should not be to view these people as the same as those who have made a voluntary choice to end their own lives. Serious mental health conditions impair decision-making and affect a person’s ability to make the irreversible decision to die. The amendment is limited and mental health issues such as depression or anxiety would not be within its scope. Dr Annabel Price noted that around 20% of terminally ill patients have diagnostic depression and that

“around 10% will have a wish to hasten death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 270.]

This is strongly linked to feeling suicidal. Professor Owen gave evidence that even sub-clinical mood problems or anxiety can affect judgment.

As the Royal College of Psychiatrists said in evidence, as the voice of psychiatry and an organisation that has campaigned for decades to prevent people dying by suicide, it is important that we directly acknowledge that the passing of this legislation would result in amendments to the Suicide Act. What then would this mean for suicide prevention efforts among the terminally ill population in England and Wales? A duty of care is imposed on clinicians to protect the safety and well-being of their patients, including those who are at risk of self-harm or suicide by the Mental Health Act, the Mental Capacity Act and the Human Rights Act.

In 2011, the commission of the noble and learned Lord, Lord Falconer, resolved that doctors must be satisfied that there is no treatable mental condition contributing to the suicidal wish. Is the noble and learned Lord now satisfied that these serious mental conditions are irrelevant to doctor and panel approval? I hope he will indicate that he will accept this amendment, but, if not, what amendments could he offer to establish protections for these individuals?

I also support the noble Baroness, Lady Finlay, on Amendment 28, which seeks to ensure that fast-track benefits are made to those who qualify, so that they do not end their lives for financial reasons. In so many cases, the availability of financial support that may be critical is not known about. When my brother died of cancer a couple of years ago, we had no knowledge that such support should have been made available to him. There are many others in similar circumstances who may opt for assisted death because their situation cannot be improved as it could be if the financial help that should be made available were to be made available.

I also support Amendment 39, which deals with the situation in which a person in care may be suffering from undiagnosed dementia and all that goes with that. It is important that there is a dementia assessment in the three months preceding an application for assisted death, given the Government’s figures on undiagnosed dementia, which range from 29% to 71% of cases in primary care. Many of us, sadly, have seen people we know and love in care homes, and our experience has told us that they are suffering from undiagnosed dementia. It can take time for a diagnosis to be reached, especially where an individual with dementia still understands the questions they may be asked and how to answer them, although they cannot remember whether they had a visitor to that day and do not even understand why they have to see a doctor.

People can be very convincing, even when suffering from fairly advanced dementia. A visiting doctor, one of two independent doctors, will not necessarily identify undiagnosed dementia in a single visit. Amendment 39, which would require a specific clinical assessment for dementia in care homes, is a very necessary safeguard. The question for the noble and learned Lord, Lord Falconer, must be: would it be satisfactory for a patient with undiagnosed dementia, deemed compliant by an overworked care home staff member, to be signed off by a doctor who has met them once—always remembering that the second doctor does not have to meet them at all?

Amendment 68 makes a categorical statement that nobody can take a decision on behalf of anyone else. Such clarity is very necessary, as I am sure the noble and learned Lord, Lord Falconer, will accept. If he does not accept this amendment, can he provide details of any amendments that he will table to ensure that nobody, other than as provided for in the Bill, can take a decision that someone else should be helped to die?

[Baroness Berger (Lab)]

My Lords, I will speak to Amendment 31 in the name of my noble friend Lady Ritchie. It would clarify that the request for assistance to end one’s life must come from the terminally ill person, leaving no room for doubt over whether someone else is able to make the request for them. This may seem like a statement of the obvious, given that eligibility under the Bill depends on both a clear, settled and informed wish to die and an absence of coercion. But there are situations where it is possible to imagine the request being initiated by another person who claims to be speaking on the ill person’s behalf, and an assessing doctor being persuaded to go along with it.

The Bill contains a number of provisions that are designed to allow another person a substantive role in the process, from the independent advocate who helps a terminally ill person to engage with their options, to the proxy who can sign a first or second declaration on their behalf. It is not difficult to envision such a person taking it on themselves to tell a doctor that the ill person is interested in having a preliminary discussion under Clause 5, or being the one to make an appointment that they explicitly say is for the purposes of a first declaration under Clause 8. Neither scenario is explicitly ruled out by the Bill. Of course, there are no limits specified to the role of independent advocates in particular. This is just one example of the many things that are not in the Bill and are left to be decided through regulations later on. We might even imagine a partner, relative or friend purporting to speak on behalf of an ill person telling the doctor that he or she is shy, exhausted or overwhelmed, when in reality they are acting in their own interests.

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[Lord Falconer of Thoroton (Lab)]

I am grateful to all noble Lords who have contributed to this important debate. I will deal first with what the noble Lord, Lord Deben, said. Of course I have to listen and make changes; I am not Stonewall Jackson—a tactical genius who died at 39. I am a man trying to do his best aged 74, so I am in a completely different situation. However, the noble Lord makes an important point. I have to convince the House that I am listening and, if sensible proposals are put, I must deal with them. I believe that has been my attitude throughout.

I cite by way of example the very sensible proposals made in relation to involving the multidisciplinary team looking after somebody and incorporating that into the Bill. I am working to try to achieve that. Proposals were made that people between 18 and 25 might be especially vulnerable and need extra protection; I have sought to develop proposals on that. Another example is where somebody has made an application that a person’s liberty be taken away because they are seriously mentally ill or lack capacity, or a person has actually been deprived of their liberty. Again, special provision should perhaps be made for them. I mention these points only to indicate that, far from being Stonewall Jackson, I am the House of Lords trying to do its best to make sure that we improve the workability of the Bill.

In that spirit, I turn to these amendments. My noble friend Lady Merron has gone through the technical problems with Amendment 27. For example, it refers to somebody being referred to an independent voluntary assisted dying service, which might or might not be sensible. I suspect that the later proposals from the noble Lord, Lord Birt, might relate to that. The noble Baroness, Lady Finlay, was making the wider point, which she expressed very clearly, that you should not be making a decision about whether you want an assisted death until you have been fully informed about all the consequences and the processes. She referred to a number of issues, including diagnosis, prognosis and the effect of an assisted death in terms of the substance.

In my respectful submission, the Bill reflects exactly the points that she is making, namely that there needs to be proper information made available to the patient by statute. I draw noble Lords’ attention to Clause 5(5), on the preliminary discussion that has to be recorded. It says:

“If a registered medical practitioner conducts such a preliminary discussion with a person, the practitioner must explain to and discuss with that person—(a) the person’s diagnosis and prognosis; (b) any treatment available and the likely effect of it; (c) all appropriate palliative, hospice or other care, including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.


All of that has to be available at the preliminary discussion.

Then, noble Lords will remember that there are two doctors who have to look at it: the co-ordinating doctor and then the independent doctor. Both doctors must, pursuant to Clause 12(2)(c) of the Bill,

“explain to and discuss with the person being assessed—(i) the person’s diagnosis and prognosis; (ii) any treatment available and the likely effect of it; (iii) any available palliative, hospice or other care, including symptom management and psychological support; (iv) the nature of the substance that is to be provided to assist the person to end their own life (including how it will bring about death and how it will be administered)”.

The panel has to be satisfied that all these processes have been gone through. I completely agree with the underlying proposition of Amendment 27, which is that a person should be fully informed—though it is Amendment 42 that puts it in those terms. However, I believe that the Bill has both made provision for that and has the means of enforcing it through the panel.

[Baroness O'Loan (CB)]

I am grateful to the noble and learned Lord for giving way. Could he clarify what is meant by Clause 12(2)(c)(iii) when it refers to

“any available palliative, hospice or other care”?

We know that palliative and hospice care is available if you can travel to it or if you live in a particular area, but it is not available in a very significant number of areas. So what is meant by “available” in that context?

[Lord Falconer of Thoroton (Lab)]

“Available” in that context obviously means available in a practical sense for that particular patient. If you live in the western part of England and there is palliative care of a particular sort available in a place you cannot access, that would not be “available”.

My noble friend Lady Merron indicated what the effect of Amendment 28 is, which was again proposed by the noble Baroness, Lady Finlay. The effect is that there are two additional requirements before you are eligible for an assisted death: first, that you are eligible for certain specific benefits available at end of life; and, secondly, that there has been a home visit by a GP to consider it.

Neither of those is appropriate for eligibility requirements for an assisted death. As my noble friend Lady Merron said, you might well not be eligible for particular benefits because, for example, they are means tested and you are above the means. It would be wholly wrong for that to prevent you getting an assisted death if you are otherwise entitled to it. Again, I do not think that the purpose of the noble Baroness, Lady Finlay, advancing that provision was to say, “You’ve got to satisfy these specific requirements”, with all the problems my noble friend Lady Merron indicated.

What I think she was getting at is that you have to be sure that financial circumstance—being short of money—is not a relevant reason for an assisted death. I put forward the Bill on the basis that choice is the key thing. Your financial position might be an element in what makes you reach a decision. From the way that the safeguards are put in the Bill, they are trying to ensure it is your decision, freely made.

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The question of motivation matters if the Bill really is, as its proponents say, about dealing only with those people with a prognosis of six months, but even that is very uncertain. There are many cases of people living much longer than a six-month prognosis. If this really is about people with a terminal illness, what is wrong? What is the objection to asking people why they wish for an assisted death? If it is because they are afraid of pain, they do not think that they can get assistance, or that those things could not be dealt with, we should surely have in place arrangements that allow for people to have those conversations. At the moment, none of that is in the Bill. The motivations might not be simply about autonomy but about constraint. Not everyone has the privileges that many Members of your Lordships’ House have in being able to say that any choice they might make is unconstrained. We need to legislate for those people for whom many choices are profoundly constrained.

[Baroness O’Loan (CB)]

My Lords, it is a privilege to follow the noble Baronesses, Lady Grey-Thompson and Lady Campbell, who articulated for us the suddenness with which those with a disability can move into the category of those for whom death is imminent. It can happen very suddenly, without warning. Their contributions were enormously important to us as we contemplate this.

There is in the Bill nothing that, at present, would make doctors determine that they are able to identify real coercive threats, particularly where the ill person is being subjected to pressure that may be concealed on all occasions where medical and social care staff are available, but the person is afraid to speak because of those pressures. Making a person feel like a burden is abusive, but it is very hard to detect. There is no provision requiring doctors to inquire about those internal pressures. We have heard a lot about them: feeling a burden, financial pressure and lack of adequate NHS resources. Those are pressures that can lead to an inability to conceive of solutions that may exist or to access them. If the Bill is to provide for them, it must state what motivations are acceptable for the state to help someone to end their own life.

I wish to echo the words of the noble Baroness, Lady Smith, because I asked the noble and learned Lord, Lord Falconer, what was meant by saying that a doctor must discuss with someone seeking assisted death the availability of palliative care. I understood him to say that if it is not available, it cannot be discussed and it is not a matter. But why? Why does somebody in that situation, for whom palliative care would provide an answer, not have access to palliative care simply because of where they are? I have to ask the Committee whether it is happy, or even content, that that is a standard which we should accept.

In debating his own Bill on this topic in 2014 and looking at the issue of burden, the noble and learned Lord, Lord Falconer, said that he opposed someone choosing assisted death for feeling like a burden. I therefore ask him today: does he oppose making explicit what he has agreed is implicit in this type of Bill? If not, will he accept these amendments?

[Baroness Cass (CB)]

My Lords, I agree with everyone who has said that we must ask the question: what is the motivation for that individual? I submit that, unless a doctor can ask that question, they are not able to discharge their duties in two ways. First, they cannot assess the capacity of the individual to make that decision unless they hear the decision articulated in the individual’s own words. Secondly, if the doctor is going to offer them all the options that may help to address their fears or the issues, they cannot do that unless they know what the motivation is.

In this House and in broader society, there will be a spectrum of what anyone feels is acceptable in an assisted death. For some people, there is the absolute clarity that an assisted death is never acceptable under any circumstances. For those of us who feel that an assisted death is acceptable, we will have different cut-offs: for some it will be because they do not want their children to be financially disadvantaged by their illness; for others it will be that intolerable suffering is the only acceptable rationale.

I would guess that, across most of society, the main line that they have been given for this is that it should be related to suffering. On that spectrum—we could all line ourselves up along it—is there any practical way of determining where that cut-off should be? If we go back to the long discussions we had about coercion on the first day in Committee, it became clear, as it has during the course of this debate, that it is impossible to determine coercion driven internally—namely, the feeling of being a burden—from coercion driven externally in subtle or less subtle ways. It is very hard to determine that if you live with the family and know them well, let alone if you have one or two contacts.

It is easier to make an objective assessment of whether what the patient describes to you as their personal distress makes sense in the context of the illness that they are discussing. That may be being incontinent, losing independence or unmanageable pain. If we are asking the doctors involved in this to assess for coercion, we are giving them an impossible task. If we are asking them to determine whether the person has a source of distress that will only get better and cannot get worse because of the terminal illness, that is a much more tangible form of assessment. Therefore, I suggest that that suffering related to the illness itself, however the sufferer describes it, is the only way to distinguish objectively those who are being coerced from those who have an internally driven reason for seeking an assisted death.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I would like to comment on this group in response to what the noble and learned Lord, Lord Falconer, has just said.

In its recent briefing for Peers, the Royal College of Psychiatrists gave its view:

“Assessors should be required to take all practicable steps to work with professionals involved in a person’s health and social care, and to talk to a relative, carer or nominated friend, including by accessing medical notes from both primary and secondary care”.


It expressed concern that

“a consideration of suicide protection duties are being bypassed by the Bill in its current form”

due to unmet need not being formally assessed. A previous DoLS is relevant to consideration of current capacity to decide to end one’s life. What would be the mechanism for reliably ensuring information that there has been a DoLS before it gets to the assessors and the panel?

Having mentioned the Royal College of Psychiatrists, I would like to make a short statement. The college has asked me to respond to the allegations about its leadership made by the noble Baroness, Lady Murphy, on 14 November, our first day in Committee. The president of the college, Dr Lade Smith, wrote to the noble Baroness asking her to withdraw her allegations, as they are inaccurate. But although the noble Baroness was present in the Chamber the following week, no clarification was provided. As a past president myself, I beg leave to set the record straight.

The college’s recommendations on the Bill are, in fact, based on 18 months’ consideration by a cross-college working group involving membership surveys, debate with members on proposals before other jurisdictions, and discussions with colleagues in other jurisdictions where assisted dying is practised. The president is clear that Dr Annabel Price, the appointed college lead for the Bill, has accurately represented its views when giving formal evidence to both Houses. With the Bill before the Lords, the Royal College of Psychiatrists is focusing on how to make it safer for people with mental health needs and learning disability needs, and better aligned with the responsibilities of psychiatrists. I feel that, in the light of the discussion on DoLS, this is an appropriate statement to make.

[Baroness O’Loan (CB)]

My Lords, I have put my name to Amendment 16. I also support Amendments 16A, 114 and 114A because the very general definition in Clause 1 of a terminally ill adult who has the capacity to take their own life does not contain any consideration of those who have been deprived of their liberty under Section 4 of the Mental Capacity Act. It is an unfortunate reality that many of those detained in hospitals or care homes are detained because they lack the capacity to make a decision about their own care or treatment. As the noble Baroness, Lady Finlay, said, in such circumstances it is surely axiomatic that there should be careful consideration of cases involving individuals subject to a DoLS.

As the noble and learned Lord, Lord Falconer, said, even assessing the capacity of someone with dementia or another neurological condition, for example, can be profoundly difficult. This is not just because of the frequent fluctuation of both capacity and the extent to which any identified capacity enables the making of a particular decision; a medical practitioner or social worker who meets a person for the first time may be misled as to the capacity they actually have. As the Royal College of Psychiatrists noted in its written evidence,

“an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding”

than in other assessments of capacity.

In the 1997 case of Re MB, the noble and learned Baroness, Lady Butler-Sloss, said:

“The graver the consequences of the decision, the commensurately greater the level of competence required to take the decision”.


Capacity assessment is not a precise science. The unique context of this Bill makes taking a cautious approach appropriate. It is common sense that there is a likely correlation between incapacity in one area, so extreme that the state must deprive the person of their liberty, and incapacity to decide whether to end one’s own life. People whose incapacity for basic decisions is so severe that they are deprived of their liberty are the most vulnerable members of society.

I want to give your Lordships a brief example. I was aware of a woman in her late 80s who had been assessed and was subject to a DoLS. She objected to it and appealed against it. Intellectually, she was enormously able, possessed of considerable social skills despite her dementia. She was able to persuade those dealing with her appeal that she had capacity despite the very real concerns of her family, who knew the extent of her incapacity. The DoLS was lifted and she went back to her own home. Shortly afterwards, she was found playing golf in the road in her pyjamas at two o’clock in the morning. She was going to the supermarket at 4 am. She was leaving the door unlocked all night for her husband and cooking his dinner every night; he had died some 20 years previously.

That lady was my mother. She certainly would not have understood a suggestion that she should opt for an assisted death. The DoLS was subsequently reinstated. This is not an unusual situation. If the noble and learned Lord, Lord Falconer, rejects these amendments, how does he consider that such vulnerable individuals can be protected from making this final decision, although they may not understand exactly what they are doing?

[Baroness Royall of Blaisdon (Lab)]

My Lords, forgive me. What the noble Baroness is saying is extremely interesting, but the noble and learned Lord, Lord Falconer, has already said that he will seek a meeting with the noble Baroness, Lady Finlay, and all other noble Lords who are interested in this. He is not rejecting the amendments; he is willing to enter into a discussion.

[Baroness O’Loan (CB)]

I thank the noble Baroness for that helpful intervention, but we do not know what the outcome of that meeting will be. I think I have the right to make my remarks.

[Baroness Berridge (Con)]

My Lords, I will speak to the amendments in this group. I did not table one in my name about a group of people who are also subject to deprivation of liberty safeguards. I am pleased to hear the noble and learned Lord repeat his offer of a meeting, which was made last Friday. I was disappointed not to receive an invitation to a group meeting to discuss the various groups of vulnerable people who may need additional conditions. Had there been such a meeting, I would not be taking up time today or on the later group, where I had offered to withdraw amendments had a meeting taken place.

There is another group of people under deprivation of liberty safeguards who are not under the Mental Capacity Act. These are young people who are under the High Court jurisdiction of deprivation of liberty safeguards—called High Court DoLS. I thank the President of the Family Division for ensuring that there is research available on this group and the Children’s Commissioner, who has visited very many of them. Those young people are so troubled that their liberty needs to be restricted, but they cannot currently be detained under Section 25 of the Children Act in a secure children’s home. That was for a variety of reasons. One was that we ran out of places, but another was that some of them were in such a situation that they could not even bear a communal secure environment like that.

I did not table an amendment also because under the Children’s Wellbeing and Schools Bill these young people will possibly be brought under the statutory jurisdiction of the Children Act, though it would not be all of them. There were 1,280 applications made last year, and around 90% of them were granted, so this is not, as was originally envisaged, a handful of young people. Are any of those young people also ill? Are noble Lords content that at 18 years and one day old they should have assisted suicide raised with them? Are they also happy that if a child has been under mental health treatment but is also physically ill, at 18 years and one day they come under the jurisdiction of this Bill? The same applies to those detained in a young offender institution. Sadly, due to the Private Member’s Bill process, I do not believe that there has been any consultation, a White Paper or pre-legislative scrutiny to flush out the details and data that we need to properly legislate.

I am grateful to the Children’s Commissioner for attending the Select Committee, but I was surprised that the Public Bill Committee in the House of Commons did not hear from her.

In addition to the issue of those who are 18 years old and one day, some of whom are still under the jurisdiction of the Children’s Commissioner until they are 25 and under the jurisdiction of the local authority, it is not wrong to say that there will be enormous societal change that affects children. I would be grateful to know, whether now or in the meeting that the noble and learned Lord has promised, whether he is aware of this group of children and what meetings he has had to establish how many would be affected at 18 years old, how many are in this group and how they can be protected by additional conditions and safeguards.

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[Baroness O'Loan (CB)]

My Lords, I tabled Amendment 20 and I have put my name to Amendment 220, in the name of the noble Baroness, Lady Foster, who is not able to be here today. I am sympathetic to Amendments 21 and 29 and to the process devised by the noble Baroness, Lady Lawlor, in her Amendments 30B, 265A and 443A.

A huge range of clauses—Clauses 7, 8, 10, 12, 15, 19, 20, 23, 24, 28, 29 and 30—refer to the applicant’s GP practice and the importance of keeping a GP informed. Clause 12(2)(f) includes a provision for the assessing doctor to recommend that the applicant informs their GP practice. These amendments also refer to the very relevant information that may be available from those who are close to the person seeking assisted death.

There is an assumption that the GP knows the patient and that the patient has an ongoing supportive relationship with the UK GP practice. Notwithstanding what the noble Baroness, Lady Gerada, has just said, that is no longer the case for many people. Many patients now see different clinicians on each visit. Locum and temporary staffing arrangements reduce the possibility of a GP being familiar with the patient’s condition or with the context in which they live. Home visits have almost disappeared. People in need of care often have to go to A&E, since doctors no longer visit as they once did. A major theme in UK and international data on GPs is declining continuity of care, particularly where people live in poverty or deprived areas. The Government’s equality impact assessment notes that such people experience “poorer quality healthcare”. They

“have a higher patient to GP ratio … have worse continuity of care”

and

“are more likely to struggle with navigating the healthcare system”.

Amendment 20 in my name would provide that it is not enough to be registered with the GP, but that there must be an established relationship between the GP and the patient. The GP must be able to certify that they have good knowledge of their personal circumstances, having seen the patient at least four times in the year and made at least one home visit in the last 12 months. As I said, the reality today is that many sick and elderly people do not have the relationship they might like with their GP; it is a thing of the past. Moreover, when a person moves into a residential or nursing home, they are often required to change to the GP who attends that facility and who may only have seen them on a few occasions, if at all. A GP who does not know a patient may not have the ability to make the necessary assessment.

The Select Committee heard evidence highlighting the very real inherent difficulties in detecting coercion, pressure and complex capacity issues. Making someone feel that they are a burden does not normally happen by direct coercion but is more likely to occur over a period of time. The National Care Forum stated:

“Our members are concerned that some of the people they support may sadly already see themselves as a burden. This can be financial, or just because they are now reliant on those who once relied on them. The concern is that this makes them vulnerable to deciding for this reason alone, or as a result of exploitation”.


Dr Annabel Price of the Royal College of Psychiatrists said in her evidence that coercion

“is everybody’s business. It is an area that is difficult to rule out confidently”.

It needs to be thought about throughout the process, not just at the scrutiny at the end of the panel. Professor Patel, president of the Royal College of Physicians, said in his evidence:

“Involvement of family within decision-making is important … I feel that the complex decision-making is hard. It has to be shared”.


Amendment 220 would provide a mechanism to allow GPs to consult with those who have a close interest in the applicant’s welfare when there are concerns about safeguarding capacity and undue influence. Such concerns, regrettably, often arise. Family members and close contacts may possess information which could be vital for a robust assessment and which is otherwise unavailable to the assessing medical practitioner.

Professor Katherine Sleeman said that

“complex capacity assessments do conventionally require triangulation, with input and information from the family”.

This amendment would allow access to professional records, including police and local authority records. Medical practitioners may be unaware, for example, of existing domestic abuse situations which have been reported to the police but have not made their way back to the doctor, where you have got a patient or an elderly person.

It should never be the case that the first time that somebody finds out that a family member has been granted a request for assisted dying is when they are asked to go to the mortuary to view the body. Anybody with any experience of the situation in which a person dies by suicide will know the terrible shock and trauma which ensue for surviving family and members. The reality is that, by extending the concept of autonomy to this extent, there can be a terrible impact on the ability to function of those who love the person who has died. Autonomy in this context can cause serious medical problems for those who are left behind. Autonomy, to the extent provided for in the Bill, does not ensure sufficient protection for a vulnerable—

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness accept—because she has been quoting some of the evidence given to the Select Committee of which I was a member—that the committee was not able to hear either from people who were dying or indeed from the families who had been through what she is talking about? That was absent; we lost that. On the particular point she raises about the first time a family may know about it, might she also reflect that the evidence was that most families try to discourage somebody from taking their own life rather than the other way round?

[Baroness O’Loan (CB)]

My Lords, I thank the noble Baroness for her intervention. It is of course the case that the Select Committee was very truncated in its ability to hear evidence. That was a decision of the House and, although we would have preferred to hear evidence from others, it was not possible.

[Lord Markham (Con)]

I just say, if I may, as a member of the Select Committee, that it was decision by the Select Committee not to hear from terminally ill people. It was not to do with the time available; it was to do with the majority of the committee being opposed to hearing from terminally ill people.

[Baroness O’Loan (CB)]

I cannot comment on the deliberations of the committee. I think there are others here who possibly can.

[Baroness Berger (Lab)]

My Lords, for the record, I inform the Committee that there was only one vote taken in the Select Committee. The vote was on whether the committee should receive written evidence; that vote was taken and the committee did not receive written evidence, which is a great shame because we would have heard from so many groups that people are raising in their contributions today. So, for the record, there was only one vote taken. There were many witnesses whom people on all sides wished to hear from. There was a deep regret that we were truncated and had only those three weeks to have those 13 panel sessions. If we had had more time, we would have been able to hear from many other groups. Again, for the record, only one vote was taken, which was not to take written evidence.

[Baroness O’Loan (CB)]

I thank the noble Baroness for her intervention, which is very helpful. All I was trying to say is that we are aware of many situations in which people are subject to coercion and where there are financial and other interests that cause people to be subject to pressure or to think that perhaps they are a burden. The autonomy which currently exists in the Bill in terms of decision-making, where there is no provision for access to police and medical records, does not ensure sufficient protection for a vulnerable individual who is making an application for assisted death. That is why these amendments are important, so that the GP who is faced with dealing with the situation and all those involved can have access to other documents.

[Baroness Butler-Sloss (CB)]

My Lords, I am currently a patient, in a very minor way, at an excellent medical practice where the nurses know me well. There are five GPs; I have met two of them briefly, but they do not really know me. I have huge sympathy with these amendments, but I think this is unrealistic. Over the years that I have been at this excellent practice, I have never got to know a GP, certainly to an extent of more than twice. Since there are five, and I am extremely well looked after, I do not see any problem with it. However, the idea that you should know your GP, or rather that your GP should know you—I just do not think that happens across the country. Going by what the noble Baroness, Lady Gerada, said, that is the reality.

[Baroness O’Loan (CB)]

My Lords, could the noble and learned Baroness possibly accept that there are situations in which patients either cannot get access to GPs or, when they do get access to GPs, have GPs with huge patient loads, which means that they cannot see the patients? While she may be in the privileged position of having five GPs, many doctors’ practices do not have that number, and people quite simply do not get access to the doctor. I am not fabricating anything as I say this, and I ask her to reflect on the fact that it is established in the Government’s equality impact assessment that there are problems with access.

[Baroness Butler-Sloss (CB)]

Yes, I entirely agree. That is the basis of what I am saying. I think it would be admirable if anyone who was seeking assisted dying in fact had the opportunity to be known by the local GP. All I am saying is that, yes, I am lucky, but I do not actually know my GPs. Of course, I accept what the noble Baroness, Lady O’Loan, says: there are many people who never meet their GPs and never have access. That is why it seems to me that what is required cannot be achieved. That is all I am saying.

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[Lord Winston (Lab)]

My Lords, the noble Baroness, Lady O’Loan, in fact destroys her own argument, because access to GPs, unfortunately, is still a major problem. In that respect, I greatly congratulate the noble Baroness, Lady Gerada, who gave a fantastic maiden speech yesterday explaining the role of the GP and the ideal situation. The fact is, in this Chamber, there will be a number of people who, quite rightly, absolutely deplore or disagree with assisted dying, as they have every right to do.

It is also true that, in my practice many years ago, I saw patients who had requested termination of pregnancy—certainly, in more than one case. However, there is one particular patient who I remember very clearly. Several years after the Abortion Act had been agreed to and had started, I saw a patient who came into the hospital having been refused referral by a GP because he disapproved, as he was entitled to do, of abortion. She did not get a further referral. She went to an illegal practitioner in the East End of London and ended up with infection of the uterus and was in bed for several weeks with septicaemia. She did not die, but her laparotomy required her uterus, tubes and most of her pelvis to be removed. That is the risk. It is always going to be the case that individual GPs have the absolute right to decide how they might handle a particular difficult ethical issue. Of course, the problem here is that these vary from patient to patient; we have to understand that, and simply relying on the GP in this way seems to me to be deeply flawed.

[Baroness O’Loan (CB)]

My Lords, it is very regrettable that the noble Lord had a patient in an abortion situation. We are not, in this group, discussing the doctor’s wishes or otherwise and his views about abortion. I ask the Minister, because I can hear mutterings here, what provision says that you cannot intervene in a debate where you have not been present, perhaps, at the very first moment of the debate? What is the section in the Companion that provides for that?

[Baroness Fox of Buckley (Non-Afl)]

My Lords, returning to the amendments that we are discussing, I want to commend the sponsors of the Bill in the sense that, when I read the Bill, multiples clauses referred to the applicant’s GP. There is an assumption, however, of an ongoing relationship with that GP. If there is not, we can come back to that. I had assumed that there is an ongoing relationship. The noble Lord, Lord Rook, has raised some of the real challenges to why that might not be realistic.

The problem is that, if there is no assumption of an ongoing relationship but simply a visit to a GP, it seems to me completely meaningless. You go in for a 10-minute meeting with a GP, which is transient and patchy at best, as they are unlikely to be able to make any clinical assessment of great merit. The noble and learned Baroness, Lady Butler-Sloss, referred to the real-life situation of not seeing a GP but how pleasant it was.

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However, to be even-handed, I have a degree of sympathy with the noble Baroness, Lady O’Loan, who spoke very well to her Amendment 20, but when I read the amendment I thought, “Who on earth is ever going to have access to this?” Home visits are mentioned in a number of amendments. Who has ever had a home visit recently? These are a thing of the past. I know that we are all getting on, but honestly. I am confused, because I want the Bill to embody a sense of the GP being important, but that requires continuity of care.

[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—

--- Later in debate ---

An impending trial, whether one is bailed or remanded, or the sense of hopelessness a prison sentence can induce are particularly confounding factors when a person receives a diagnosis of terminal illness, in terms of what steps they wish to take. We cannot ignore the extent to which these factors will profoundly compromise their applications for assisted suicide, so barring them from the provisions of this Bill would be compassionate to both them and the alleged or proven victims of their crimes.

[Baroness O'Loan (CB)]

My Lords, I have put my name to Amendments 22 and 24 in the name of the noble Baroness, Lady Grey-Thompson, and support the other amendments in this group, which relate to the fact that prisoners, people detained under a hospital order, homeless people and those who are pregnant require special care because of their situations.

Suicidal ideation and depression as a result of incarceration, with limited ability to access outside resources due to imprisonment, are very common among prisoners. One study found that 61% of elderly male prisoners had a mental disorder. Primary care mental health services are still being developed in prisons to provide for conditions such as depression, anxiety, post-traumatic stress disorder and learning disabilities. That vulnerability, combined with a terminal illness and probable lack of access to good palliative care, means that their welfare is a special responsibility of the state. Special arrangements must be made to ensure that they do not feel they have no option other than to opt for assisted death.

Suicidal ideation is also very common among the homeless. The noble Lord, Lord Bird, recently spoke eloquently in your Lordships’ House about the problem of poverty, which so often results in homelessness and the hopelessness which accompanies poverty. Solutions to things such as poverty and homelessness should not involve offering people assisted death rather than a home, possibly in sheltered accommodation, in which they may be able to flourish.

The noble Baroness, Lady Grey-Thompson, spoke eloquently about pregnancy. I want to add just a couple of things. Pregnancy is not an illness, but pregnant women are at a higher risk of mental illness. The Maternal Mental Health Alliance reported that at least one in five women develops a mental illness during pregnancy or within the first years after having a baby and that maternal death due to mental health problems is increasing and suicide remains the leading cause of death in the first year after birth.

[Baroness Berger (Lab)]

I declare an interest as chair of the Maternal Mental Health Alliance. The figures have been updated; currently, one in four women experiences a mental health condition in the perinatal period, either during pregnancy or in the two years after birth.

[Baroness O'Loan (CB)]

I thank the noble Baroness for her intervention. I also want to raise the risk of domestic abuse, which is much higher during pregnancy. The Maternal Mental Health Alliance says that up to 30% of domestic abuse cases begin during pregnancy.

Ending someone’s life with lethal drugs while they are pregnant raises additional layers of moral, legal and medical concern—for example, consent, the viability of the baby, conflicts of interest, et cetera. Pregnancy causes drugs to be processed differently. The rate of absorption is affected by physiological changes. That could mean a slower or more prolonged death from the approved substances for both mother and child. Women are particularly vulnerable, and the safeguards just do not seem to be in the Bill at present.

The amendments from the noble Baroness, Lady Berridge, in this group relate also to those up to the age of 25 who have an EHCP, which may be provided to vulnerable children, including those with special educational needs and mental health concerns.

Finally, the noble Baroness, Lady Hollins, has told us that young people with complex needs may be at a higher risk of internalising negative societal values about their disabilities. The National Down Syndrome Policy Group states that people with learning disabilities can be highly suggestible and prone to acquiescence bias, agreeing with authority figures to please them.

There may also be diagnostic overshadowing, the risk that a young person’s desire to die might be as a consequence. In this context, a young person with an EHCP, for example, might request assisted dying not because their condition is intolerable but because the social care and support legally promised to them has failed to materialise, making their daily life situation unbearable. That could be misinterpreted by clinicians as a rational choice due to their disability. It is therefore the case that special provisions, such as those identified in these amendments, are necessary to ensure proper support, and that the various vulnerable groups of people do not feel that they have no choice.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I want to speak specifically to Amendment 22, about why prisoners should not be eligible for assisted dying. The amendments from the noble Lord, Lord Farmer, are also pertinent here.

The right reverend Prelate the Bishop of Gloucester raised the real and specific safeguard issues from the lack of medical records of prisoners, and I am sure we will hear more about the problems of medical care for prisoners. The terrible terminal diagnosis that one might get as a prisoner would be particularly frightening, I would think, because of the lack of medical care.

That is actually not my concern. Regardless of where one stands on assisted dying in general, I really hope that, when it comes to this Bill, noble Lords will consider the very particular circumstances of those incarcerated by the state. I hope the sponsors of the Bill will still be open to excluding prisoners and keeping them out of the Bill, on the basis, if nothing else, of their lack of autonomy.

I have to confess that I was rather taken aback when I heard Minister Stephen Kinnock in the other place state that excluding prisoners from this Bill would lead to a difference in treatment between prisoners and non-prisoners, an inequality, citing Article 8, private life, and Article 14, discrimination, of the ECHR. He noted that differential treatment would require objective and reasonable justification. It seems a bit shocking to me to have to explain this to a Minister, but my objective and reasonable justification is that, if you are in prison, you do not have the same rights as if you are not in prison. I did not make that up—although I know the Sentencing Bill has gone a bit liberal.

Actually, I think that, you know, you are deprived of your liberty. Many of the arguments made by the advocates of the Bill about autonomy and giving people choice towards the end of life, in particular circumstances —which I completely understand, philosophically and politically—are entirely appropriate for free people. But when you are not free and do not have autonomy, it brings with it a whole new range of ethical dilemmas.

The purpose of prison is, as I have said, to suspend certain rights from people to protect the public, to ensure deterrence and to uphold a sense of justice in society—I could go on. When the state has deprived an individual of so much autonomy, for all the criminal justice reasons we know, offering the option of an assisted death does not increase their autonomy in a meaningful way. It is saying, “Oh, well, we’re giving them choice”—but their real choice would be being able to leave. In other words, we have limited their choices.

Why does this matter? It is because, when the state decides to deprive somebody of their liberty, it is a very serious decision. For me, it is the worst possible punishment you could give: you are limited in being free, which I obviously consider to be very important. Prisoners, inevitably, are depressed: and often they are vulnerable in the first place. That is why they are prone to suicidal ideation.

Those of us who have had the privilege of doing some work with prisoners will know that we spend a lot of time tackling self-harm, with people hating themselves and the circumstances they are in. We do a lot of work on that. I and many others have worked on IPP prisoners, who are, ridiculously unfairly, still in prison indefinitely based on an abolished sentence, often for minor breaches of the law in the past. It is always shocking when you hear of another IPP prisoner who has taken their life. It is particularly horrible, as many noble Lords here have articulated far better than I can, because it is almost like it is on the state’s conscience. That is the reason why coroners make such a fuss about it. Those prisoners should not be there; they are in prison because the state made a mistake with the sentencing regime that it will not resolve and then they take their life. The state is somehow implicated in those suicides and we make a particular point of that.

Those of us who have worked in prisons will also know that suicide prevention is something we take very seriously. It does not matter how heinous the prisoner’s crime is. They could be a child abuser, a rapist or a murderer, but, if there is even a hint that they might commit suicide, there is suicide watch. We do all sorts of suicide prevention. The reason is that, as a humane society, we do not think that people should be allowed to take their own life, if at all possible. We have suicide watch in prison because the state has somebody incarcerated. Therefore, as a humane society, you take seriously not letting them kill themselves: otherwise, you could just say, “Carry on boys, it doesn’t matter”. We do not do that because we think that we have to protect those prisoners in the state’s care.

Right, I will finish. Letting prisoners have access to and be eligible for assisted death would be very close to reckless state abandonment of those prisoners to something very deeply dark. Philosophically, if a penal sentence in Britain ends up with the state effectively putting a prisoner to death via lethal drugs—I do not want to go on, but that is what would have to happen: they would be locked up in a prison, in the state’s care, the state would then make them eligible to ask for assisted dying, with limited autonomy, and would then hand them lethal drugs—that is far too like capital punishment, which I have long opposed and do not approve of. Therefore, even if you do not agree with me on the rest of the Bill being a completely difficult challenge to humanity, which I think it is, I none the less suggest that, if we pass it, we should absolutely exempt prisoners from it.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Shinkwin (Con)]

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

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

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

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

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

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

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

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

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

[Baroness O’Loan (CB)]

My Lords, could the noble and learned Lord, Lord Falconer, clarify for me the impact of Amendment 290 and whether it deals with matters of coercive control and economic abuse effectively for the purposes of the legislation? I ask this because Amendment 290 would remove

“including coercive control and financial abuse”

from the Bill. The same principle applies to Amendment 366, while Amendment 931 would remove the requirement for members of a panel to receive training on coercive control and financial abuse.

Even taking into account the Domestic Abuse Act, which I will come back to in a moment, there is a difference between coercion and pressure and coercive control and abuse. It is for that reason that I support the comments previously made about, for example, Kim Leadbeater in the Commons being pleased to support mandated training on domestic abuse, including coercive control and financial abuse, and the Health Minister in the Commons Committee noting that the amendment would require training regulations to include

“mandatory training relating to domestic abuse, including coercive control and financial abuse”,—[Official Report, Commons, 18/3/25; col. 1212.]

which clearly would ramp up the requirement.

However, the definition of domestic abuse in Section 1 of the Domestic Abuse Act 2021 refers to behaviour in the context of personal relationships—persons who are connected—and there is a list of the persons who are connected. Section 1(4) of the Act does not cover those who are not personally connected but who may be capable of having enormous influence upon people on behalf of those who are. I think, for example, of financial advisers, lawyers and even doctors, people like that, who may be able to put pressure on people, and we have seen situations in which such pressure has been brought to bear. Does the noble and learned Lord consider that the situations in which pressure may be brought to bear by someone not personally connected should be otherwise provided for?

This group also contains amendments to Clauses 10 and 13, the provisions in relation to the situation in which a doctor is unable or unwilling to act as the independent doctor. There are provisions in Amendments 332, 418 and 419 for a further referral if a doctor is unable or unwilling to continue. His reasons for unwillingness could include ethical concerns or suspicions of undue influence on the patient. Despite the fact that there is a provision that he can seek specialist advice on this issue, there may be a situation in which the doctor will simply withdraw from the process. The single additional referral was approved in the other place to protect the patient, but these amendments would enable doctor shopping to occur. We will come back to that in group 44. Moreover, if a doctor withdraws from completing the process because of suspicions of possible or undue influence, the reason must surely be recorded.

Amendment 405 would remove from the Bill the requirement to have regard to “language and literacy barriers”, replacing it with the new more general requirement to

“take all reasonable steps to ensure … effective communication”.

The noble Baroness, Lady Hollins, explained during the previous debate the extent to which people with a disability have complex needs, which must be satisfied to enable understanding. The inclusion of “all reasonable steps” et cetera introduces a far less specific test, and consideration must be given to setting standards for the level of communication which is required. I have to ask the noble and learned Lord: does this amendment inadvertently disadvantage those with specific learning difficulties and similar vulnerable groups?

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The reason it is covered already is that the Bill says that the training must cover domestic abuse. Domestic abuse is defined by reference to the Domestic Abuse Act 2021. Domestic abuse in the 2021 Act includes coercion, control and economic abuse. That is how there is a mandatory requirement in the Bill for all those things to be covered.

[Baroness O’Loan (CB)]

The definition of economic abuse in the Domestic Abuse Act is limited to actions that will prevent the person getting money or being able to spend money, if I remember correctly. There could well be financial abuse, depriving a person of very large sums of money, while they are still able to get money and spend money, so I think it needs further thought.

[Lord Falconer of Thoroton (Lab)]

I will certainly give it thought, but my reading of the definition of domestic abuse in the Domestic Abuse Act 2021 is that it is an effective means of covering the sort of economic abuse habitually seen between domestic partners. I think that covers it but, because of my respect for the noble Baroness, I will certainly look at whether it needs to be expanded. What the noble Baroness is referring to is a problem in the definition of domestic abuse generally in relation to economic abuse, which I do not think is there and was certainly not the intention of the 2021 Act.

I turn to the other issues. First, on “other than illness”, this is about when one or other of the two doctors withdraws from the process without giving a reason—simply withdrawing from the process. I completely understand what the noble Baroness, Lady Fox, is saying, which is that if someone is withdrawing because they think the person is being pressured, that must be recorded somewhere and any other doctors must be able to see it. What we are dealing with here is not that situation. We are simply dealing with a doctor who withdraws and gives no reason. Should the patient have to establish that there is a good reason for the withdrawal, or is it enough that the doctor has withdrawn and is no longer willing to participate? All the amendment does is to say, “If you can’t or won’t go on, you can get another doctor”, which is not a change in sense but makes clear what those provisions are. When I say “those provisions”, I am referring to those that allow for a replacement doctor when one of the other doctors—the originally appointed one—cannot go on.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Deben (Con)]

My Lords, I am not a lawyer, and it is dangerous to follow the noble Lord, Lord Pannick, but I think on this occasion he is mistaken. The fact that this kind of protection is not there until this Bill does not actually mean anything—perhaps it should have been there in any case—but, if we are going to have this protection, it needs to be proper protection.

I say to those who, at least today, live a privileged life that they ought to remember that there are many people in this country who, for the first time, are within touching distance of large sums of money, because the housing situation means that there are many old people who have houses of a value that those families have never seen ever before—grandma’s £200,000. I say to the noble Lord, Lord Pannick, that, as somebody who was a Member of Parliament for 40 years and works now in a community, that this is a very real fact, and we just have to accept that some people in this House are a long way away from those people. I was brought up in a slum parish by a clergyman. I have spent my life trying to deal with the very people we are talking about. I think these amendments are crucially important, because we are talking about circumstances which we are about to change deeply.

The fact is that the Bill itself changes the way in which we think about old age and infirmity. I desperately want people to know that they are always valuable and always got something to give, even at the end of life. This Bill removes that. If we are going to have it— I hope we will not, but if we are going to—we must make sure that people are protected not just from coercion but from encouragement, which I am afraid is sometimes driven by a sort of misunderstanding of what we can give. I can see people who will say, “You know that your grandson is in some real difficulty. You have a last opportunity to do something worthwhile. If you die now, your house will save his marriage, will save his firm and will look after his future”. That is what will happen. We, who are in happier circumstances, should just remember that we have a deep responsibility for those people.

[Baroness O’Loan (CB)]

My Lords, these amendments seek to prevent and/or identify coercive behaviours and pressure which may fall short of coercion, and situations in which vulnerable people may be encouraged to make what is actually an involuntary decision to end their own life that they would not otherwise have made. There is no definition of coercion or pressure in the Bill, although new offences are created by Clause 34. That is unfortunate.

Arrangements made did not enable the taking of evidence from those with disabilities until the recent Select Committee on the Bill. Liz Carr said in evidence to that committee:

“The absence of our … involvement has led to disability rights organisations making a formal complaint to the UN Convention on the Rights of Persons with Disabilities”.


That is very serious. We know that 40% of those who die by assisted dying in Canada have lived with disabilities.

--- Later in debate ---

[Lord Goddard of Stockport (LD)]

I moved from my position at the front, because there was a presumption that I was the Front-Bench spokesman trying to force something. I apologise; I was not. This House has a free vote, and nobody is whipped. I happened to be sitting on the Front Bench, and I have moved back; I understand the alarm I may have caused by standing up then, but I was not trying to derail the debate. I was just trying to be helpful, because lots of people have spoken, and I respect every single person who is doing so in the House—for and against. Within my own party we have the same difficulties.

It is about evidence. I want to help the House today, on the specific premise of coercion. Sir Max Hill, the former Director of Public Prosecution, said that

“throughout the time that I served as DPP … we did not have the coercion offences created by the Bill, which I suggest would be a significant advance, and nor did we have a legal system in which the investigation was taking place before the death. … The major advantage of the Bill, if I can put it that way, is that … scrutiny will be before death”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 86.]

That comes to one of the points the noble Baroness, Lady Grey-Thompson, made—that when you are dead, it is too late to find out what has gone on.

In the other place, mandatory specific training on domestic violence, including coercive control and financial abuse, was introduced into the Bill and agreed through an amendment tabled by Jess Asato MP. Participating doctors and members of the multidisciplinary panel will have to undergo specific training in this area, as well as in assessing mental capacity. I believe there are now safeguards in the Bill—I think that was what the noble Lord, Lord Pannick, was alluding to.

It seems to me that we in the House think this is the first time this has ever happened, but the fact is that 300 million people across five continents have some form of assisted dying legislation. Not one of those countries has ever repealed it. It is right that we make it the safest and the best, and that the amendments be debated at length.

Noble Lords should forgive the cynicism of those who support the Bill—one Member said last week, causing some humour in the House, that they were sorry they came second to another Member in getting amendments down. This is not a competition; this is about getting the Bill right and fit for purpose.

I find it quite amusing when I see the noble Lords, Lord Pannick and Lord Carlile— it is worth the admission fee just to see the interaction. The points from the noble Lord, Lord Carlile, were right about trying to come to a conclusion and move forward. It is right that everybody speak, but that we speak to the amendments and try to get to a conclusion.

The noble Lord, Lord Dodds, is right: we should give it time. But we do not have time. We have four Fridays and no more. The Government have said they are not going to give way. If we do not finish the debate on these amendments, which are increasing every day—I believe we are up to 1,500 now—the Bill falls. Somebody—not me but someone else—might say, “Well, it is somebody’s objective that we run out of time; then we can stand here wringing our hands and say that we were just trying to make it the best Bill we could but we ran out of time and are very sorry”. That is not acceptable. Our role here is to ensure that legislation goes back to the other place, fit for purpose and the best we can make it. Somehow, we have to distil these amendments into something understandable.

[Baroness O’Loan (CB)]

I do not want to interrupt the noble Lord for very long. I just wanted to ask him this: is he aware that this House has the right to reject this Bill should it choose to do so? It is a Private Member’s Bill, and there are no conventions that apply in that situation. It is important that the House fulfils its scrutiny role. Another Bill could be brought forward that might be very different, but this is the Bill we are asked to debate, and we will debate it as best we can to improve it as best we can.

[Lord Goddard of Stockport (LD)]

And if we run out of time at the end of that, the Bill falls. Someone will say, “it is not our fault”, but it is our fault.

--- Later in debate ---

[Baroness O’Loan (CB)]

I have a very quick question. I cannot find in the Bill the powers that would allow the doctors to carry out the investigation to which the noble and learned Lord has repeatedly referred. If people do not co-operate, that is it.

[Lord Falconer of Thoroton (Lab)]

With the greatest respect, the noble Baroness has missed the point. If, for example, a person says to the doctor, “I’m not telling you things”, the doctor can never be satisfied. That is the protection.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I declare my registered interest as a trustee of St John & St Elizabeth Hospital in London.

The first clause sets the tone for the rest of the Bill. It has so many deficiencies and such inherent danger that it has rendered necessary the tabling of so many amendments. Multiple amendments were, of course, tabled in Committee in the other place, but they were not permitted to be debated or voted on. Our duty is therefore to scrutinise the Bill, not to meet arbitrary timetables and a limited number of Committee days. We have to do it properly, because on this work that we do rest questions of life and death.

Clause 1 deals with the “who”; who can decide to end their life with medical support or to be assisted to end their own life when they cannot do it themselves. The definition of “who” is simple and sparse. It demands only that someone has capacity, has reached the age of 18, is ordinarily resident here and is registered with a GP. Clause 1 also deals with what is required—the process for determining. It requires that any decision made by a person who fits the definition in Clause 1 is made by someone with

“a clear, settled and informed wish to end their own life, and … has made the decision … voluntarily”,

and who is not the product of coercion or pressure. We will come to that, but it is not enough.

The decision to end one’s own life is the most profound decision that one can make. One might argue that some decisions are not as immediately serious. If, in a fit of despair or loss of hope, I decide to refuse treatment, I might still change my mind. Similarly, if I stop eating, I may choose to reverse that decision. If I decide to end my life, there is no coming back and no reconsideration, and that is why it is such an important matter.

I think the noble Lord, Lord Pannick, referred to advanced directives in these provisions, by which people can declare their future care, but the decision to refuse treatment and go for a natural death is not a proactive decision to end life. There is no precedent for the Mental Capacity Act being used for a decision to end life.

[Baroness Murphy (CB)]

I would like to briefly intervene, because every day of the week there are hundreds of decisions made in the NHS and independent care about life and death. I will give a very brief example. My brother has had renal failure for 40 years. He has been brilliantly looked after by Guy’s Hospital, and, after the failure of the last transplant, he has been on dialysis for the last five years. It has become more and more wearing and disabling for him, and he has decided that, by Christmas, he would like to make the final decision, with the help and the support that he is getting from the Guy’s team, to end his life.

He is supported in that by his wife, brother, sister and children. We have supported him to make his own decision. It is a life and death decision that he will be supported through. That is the way it happens, day in, day out, in the health service. It is a nonsense to say that life and death decisions are not made. Furthermore, what test will they use? They will use the Mental Capacity Act.

[Baroness O'Loan (CB)]

My Lords, the noble Baroness has told us a very sad story about her brother, but it really is not on the issue that I am speaking of today. It is, of course, the case that decisions about life and death are made. What I am saying is that, in this case, the decision is to ask the state to enable the person to administer that, and for the state to bring all the forces and resources available to do it. That is what we are debating today: does the Bill provide a situation in which “capacity” is the correct term to use in this clause?

I support Amendment 2. The use of the word “capacity” is undoubtedly provided for in the Mental Capacity Act. This Bill says that

“references to a person having capacity are to be read in accordance with the Mental Capacity Act”,

which is very helpful. The Mental Capacity Act was not passed to deal with the decision to end one’s own life, but rather it was formulated with the basic assumption that a person has capacity. In November 2021, the Supreme Court said in A Local Authority v JB:

“‘A person must be assumed to have capacity unless it is established that he lacks capacity’”.


It continued:

“This principle requires all dealings with persons who have an impairment of, or a disturbance in the functioning of, the mind or brain to be based on the premise that every individual is competent until the contrary is proved. … Competence is decision-specific so that capacity is judged in relation to the particular decision, transaction or activity involved. P may be capable of making some decisions, but not others”.


Therefore, there are circumstances in which capacity cannot be assumed and a person may not be capable of understanding, to the necessary extent, the information that should underpin any decision-making, or of analysing the consequences of that information or of making a decision in their own best interests. When these conditions are not fulfilled, the Mental Capacity Act requires, in particular circumstances, that a decision be made by a third party, but always in the best interests of the person. As the Royal College of Psychiatrists told us in evidence,

“an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding”

than assessing capacity for treatment decisions.

We have received very helpful evidence from Professor Gareth Owen, Professor Alex Ruck Keene, and Professor Katherine Sleeman of the Complex Life and Death Decisions group at King’s College London. They have stated quite clearly that

“the MCA 2005 was not designed to be a universal framework for determining capacity.  It is primarily a workaround for the inability of a person to give consent to actions required to secure their health and social care needs. In the MCA 2005, the principles applying to and the test for capacity apply in a context where a decision can be taken on a ‘best interests’ basis for the person if they lack capacity”.

In the context of the Terminally Ill Adults (End of Life) Bill, they state that,

“no such best interests decision could ever be made”.

Capacity is not a constant state. It may fluctuate depending on a variety of circumstances, including some illnesses, disabilities and the side-effects of medication. A person can have capacity in relation to one decision and not another. A person may have capacity at one time, but not another. It is an enormously complex issue. When the decision in question is the decision to end one’s own life, capacity to make that decision requires very significant analysis in each case at the time in question.

That is the reason why “capacity” is not an adequate word to deal with the situation in which a person is coming to make a clear, settled, and informed decision. “Capacity” cannot be the test. “Ability” is a wider test, and there will be opportunity for the Committee to consider what that might look like as we go through future groups.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this issue was well discussed in the Select Committee, and I want to refer to Professor Sir Chris Whitty, who I think knows a little bit about this. I want also to respond to and endorse the words of the noble Baroness, Lady O’Loan, because she talked about concentrating on the interests of the person concerned. They were not exactly her words, but she was saying how important that was. We are talking here about someone who is dying. They are in the last months of their lives and, under the Bill, they must have capacity throughout the stage for which this legislation will provide. In other words, at each stage, they must have capacity. Professor Sir Chris Whitty, who knows a lot about this, spoke on it—it is on page 153 of the committee’s report, if anyone would like to look. He said:

“There is plenty of evidence, and it goes with common sense, that, when people use an existing system that they have used for many years, that they are used to and that has been tested in the courts, they are far more likely to be able to follow a reproducible and sensible pattern of making decisions than if they are faced with a completely new approach which they have not used previously and in which there may well be legal ambiguities the courts have not yet adjudicated on”.


If we want this Bill to work, as I assume the House of Commons did when it sent it to us, and as I think a majority of this House does, we must give to doctors and everyone else a form of words that they already understand, they can use and, above all, what is in the best interests of the patient in front of them.

--- Later in debate ---

[Baroness Andrews (Lab)]

My Lords, at the heart of this debate is the question of safety. It is very impressive to hear all the experience around the House and I know that people shared my experience when we took the Mental Capacity Act through the House in 2005. That Act had been years in the making. It had most profound and serious consideration in this House and, most unusually, it then had post-legislative scrutiny, where we went into every aspect of the Act. The noble Baroness, Lady Browning, is quite right; there were many concerns raised about the practice and the absence of proper training, but no one, to my knowledge, challenged the definition of “mental capacity”, recognising the huge complexity of the term, the different circumstances in which it is implemented and people’s responses to it.

The noble Lord, Lord Pannick, said that we have a framework. Safety, I think, relies on and is expressed in the 20 years of practice in the way the Mental Capacity Act has been implemented and has benefitted so many. The assumption that there is mental capacity was in itself a huge and very important statement of a positive right in the law. The Bill before us is another statement of a positive right in the law, where there has not been one, and where so many people are desperate for us to find a route through this urgently.

We have the experience of that Act, the experience and expertise that this House put into reviewing that Act and confirming it with the recommended improvements, and the way the Act is understood—as my noble friend has said, not least by Chris Whitty—as well as its unknown interpretations. We have just heard about the complexity of defining “ability”. We already know of the huge, unframed and unknown complexity of creating another concept in law in the context of a Bill which, itself, has to be so carefully understood, implemented and communicated. We have to stick to what we know, even though it is still a work in progress, because it can still be improved. I hope it will be improved, in the course of this Bill. But it will be immensely dangerous, unless I hear a completely conclusive explanation as to why “ability” is better, if we were to depart from “capacity”.

[Baroness O'Loan (CB)]

My Lords, under the Mental Capacity Act, the decision is not made by one individual; the Mental Capacity Act provides for decision-making, which includes the experiences of families et cetera. It is a profound process. This is not a profound process; it provides for a doctor to make a decision about whether a person has capacity and a second doctor to sign it off. It is not the same thing at all.

I attended a meeting, as did the noble and learned Lord, Lord Falconer, during which a doctor told a story about a patient who had signed up for assisted suicide. When the time came, he took a sip of the medicine and said, “I’m not drinking this”—upon which his family told him, “You decided you would die this day; you must do it”. He would not drink it. It took him seven days to die.

[Baroness Andrews (Lab)]

The noble Baroness is quite right, and it is a very important part of mental capacity decisions that the families are involved, supportive and completely understand the implications of what it means to have either incomplete capacity or capacity that varies from time to time. There is no reason— I will leave my noble and learned friend Lord Falconer to answer this point—why this should not be a better Bill, and maybe it can be better if we address these particular questions.

--- Later in debate ---

[Lord Kennedy of Southwark (Lab Co-op)]

I thank the noble Lord for that point. As I said at the start, the Government remain neutral and will not be providing government time for this Bill. Obviously, we will look at things when we get to the end of our four days in Committee. I will then work with the usual channels to see what other time can be made available from non-government time, but we will have to see whether we will move on over the next few days.

[Baroness O’Loan (CB)]

I say to the Minister that we are talking about four days. The general public know that a sitting Friday lasts from 10 am to 3 pm. People have made arrangements accordingly, and there are reasons of faith and things such as that which require that we respect that ending at 3 pm. On a normal day, the House would sit for up to 10 or 12 hours, so four days is just not enough.

Telemedical Abortions

Baroness O'Loan Excerpts

Wednesday 12th November 2025 Lords Chamber

Asked by

[Baroness O'Loan]

To ask His Majesty’s Government what assessment they have made of recent proposals to extend access to telemedical abortions, and how they will ensure women’s safety and informed consent in the absence of in-person medical consultation.

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

Before I respond, I join the Lord Speaker—I am sure on behalf of the whole House—in extending our condolences sincerely to the late noble Baroness’s friends, family and loved ones. We will miss her greatly.

The Government have no plans to extend access to telemedical abortions. As with other matters of conscience, abortion is an issue on which the Government take a neutral stance. It is for Parliament to decide. The safety of women accessing abortion services is of paramount importance. All providers are required to have effective arrangements in place to ensure women’s safety and to obtain informed consent.

[Baroness O'Loan (CB)]

My Lords, before I ask my supplementary, I pay tribute to the noble Baroness, Lady Newlove, who was so brave and effective in all she did in this House and in her work for victims after the murder of her beloved husband, Garry. Helen had such compassion and courage, and she really was such a lovely person that she will be sorely missed, not only by her family, to whom I am sure we all send great sympathy, but by so many of us in this House and in the world beyond. We were indeed blessed by her presence among us.

I thank the Minister for her reply. It is not possible on the telephone to ensure a woman’s privacy, to ensure that she is not being coerced, or to verify that the woman seeking the medication is actually the person who will take it, particularly in cases involving domestic abuse, child abuse and trafficking. Government stats show that, since 2020, 54,000 people have been admitted to hospital in England for complications from abortion pills. Last year alone, some 12,000—over 6% of women taking such medication—required hospital treatment. To safeguard women and girls, will the Minister take action to restore the requirement for face-to-face consultations? Will she also assure the House that there will be no extension of the time limits for access to medical abortions?

[Baroness Merron (Lab)]

My Lords, the evidence base for telemedical abortion is sound. It has been thoroughly evaluated and it is recommended as safe by the World Health Organization, the Royal College of Obstetricians and Gynaecologists, and NICE’s evidence-based guidelines. There are no plans to do what the noble Baroness has requested, and I have to say that I do not recognise the statistics she raised, although I would be interested to hear more about them. But I assure your Lordships’ House that telemedical abortion is and must be carried out in line with clinical guidelines published by the royal college.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness O'Loan (CB)]

I thank the noble and learned Lord for yielding. I simply wanted to say that a number of Members of the other place have said that the Bill did not receive proper scrutiny in the other place. They have also said that they expected that it would receive scrutiny in this place because that is what we do. That is profoundly important, and I do not think that what the noble and learned Lord just said is actually correct. I would also say that there were a number of amendments tabled and a number of MPs who wanted to speak who were not permitted to do so. That is reflective of the fact that the Bill did not receive proper scrutiny in the other place.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness for her intervention. I have laid before the House the facts. I recognise that some Members of Parliament say that the Bill was not given proper scrutiny. I wonder if those were Members of Parliament who did not agree with the conclusion—I do not know. I have laid before your Lordships the time that was spent and the fact that it got more scrutiny than government Bills.

The essence of this Bill is that those who are terminally ill—and that means that they have a diagnosis that they will die within the next six months—should have the option, subject to safeguards, to be assisted to take their own life. One of the features of this debate was the personal experience that so many people have had of how, had that option been available, it would have ended terrible suffering. That suffering is not often about the pain but about the lack of dignity and the profound desire to keep control, because that is what people want.

I believe, from my own experience and from talking to so many people, that having that option is important. The points that have been made against it, which I have listened to incredibly carefully, are, in essence, not that people should not have that choice but that it brings dangers with it. The dangers are, first, that people will be overpersuaded and, secondly, that it will affect society in other ways.

On the idea that people will be overpersuaded, the Bill provides for the following: first, a conversation with the doctor in which all the options, including the palliative care options, are laid out; secondly, that a doctor decides that it is a free choice; thirdly, that a second doctor decides that it is a free choice; and, fourthly, that a panel, consisting of a senior judge or a King’s Counsel, a psychiatrist and a social worker, concludes that the person is not being coerced, that they are capable of making the decision and that it is their free choice. As it happens, that is probably the most safeguarded procedure in the whole of our healthcare system. It is certainly the most safeguarded process when compared with terminal illness Acts in other countries in the world.

I profoundly believe that people should have this choice—a profound belief that is based not on either my spirituality or my lack of spirituality, but on looking at the evidence from other countries that this will not lead to people being overpersuaded. I have in mind those countries that already have a terminal illness Act. The one that has been in force for longest is the one in Oregon, but there are many other states in the United States of America that have terminal illness Acts that have been in force for 20 years and more. They do not have those safeguards. They do have annual reports and record-keeping of the highest sort about assisted death. They show no evidence of the coercion that some noble Lords referred to in this debate.

I would have expected that, if there were real evidence of that, somebody in the course of the debate would have referred to a case from one of those countries where there is a terminal illness Act showing that there was coercion. There was none. I am convinced, first, that the Bill has had proper scrutiny in the other place and, secondly, that there is no real danger in relation to coercion. Thirdly, I completely accept the point made by noble Lords who said in this debate that they wanted more palliative care—I want more palliative care, and we should do everything we can to promote it. However, as so many people said, it is not either/or—it is both.

Some 75% of people in Victoria, Australia, who have had an assisted death came from palliative care, and 92% in Oregon came from palliative care. The Select Committee in the Commons to which I referred, which reported in 2024, said that palliative care in many jurisdictions went up in terms of its resources. In answer to the question that was raised about what the effect will be on palliative care: on the basis of other jurisdictions, it will get better. In fact, the debate here has provoked the Government to spend more money on palliative care.

Many noble Lords have talked about language. I take no point about language. I simply say this. For over 10 years of having been engaged in this debate, I have found that, for people who are terminally ill and want an assisted death, nothing upsets them more than saying that that is suicide. They hate that because of the impact it has on those they leave behind. What they feel is that they are dying anyway, and what they want is some degree of control over when and how it will happen.

I turn briefly to what happens next. I very much welcome my noble friend Lady Berger’s Motion to set up a Select Committee that can hear evidence. I very much welcome that it is time-limited, because, as my noble friend and I indicated in the letter we sent to every Peer, it allows for the Bill to go through all its phases after 7 November. I will therefore support my noble friend’s Motion to set up a Select Committee.

We have a job of work to do. I agree with everybody that, plainly, this House must give the Bill a Second Reading. We must listen to the evidence that my noble friend Lady Berger’s Select Committee will supply, and then we must do what we do so well, which is scrutinise and amend the Bill as necessary, and then send it back to the other place for a decision.

I have heard some noble Lords say, “Oh well, we can say no to this Bill”. Ultimately, on an issue such as this in our system, somebody has to decide. It is not the electorate because it is never in anybody’s manifesto, with the exception of the Greens. Therefore, Parliament has to decide. Ultimately, in our system, that means it will have to be those who are elected—not those who are unelected—who make that decision.

I end by expressing my profound gratitude to the House for the attention and quality of the debate it gave to the Bill. I commend this Bill to the House.

Health and Care Bill

Baroness O'Loan Excerpts

Lords Hansard - Part 2 & Report stage
Wednesday 16th March 2022 Lords Chamber

[Baroness Brown of Cambridge (CB)]

My Lords, at this very late hour, I just rise to say that I hope your Lordships will not confuse individual anecdotes, however moving, with the very extensive scientific evidence base quoted by the noble Baronesses, Lady Sugg and Lady Watkins.

[Baroness O’Loan (CB)]

My Lords, what is proposed in this amendment is a fundamental change in the law. What we must look at is, I think, fundamentally for each woman, what actually happens in each situation, and what care is provided for the woman in that situation.

I believe that the Government were right to say that this provision would come to an end and that it is not necessarily safe. There are major uncertainties for many women when they conceive. They do not always know when their last period was, as noble Lords have said. But it is not just that. They do not always know the nature of their own medical health and the consequences of taking the telemedical abortion pills.

In that period after 2020 alone, 10,000 women needed hospital treatment for the complications arising from telemedical abortions. It is not an anecdote but a scientific fact that losing a baby, whether by miscarriage or by abortion, is a very bloody and, on occasion, very painful business, which gives rise to all sorts of problems and complications.