Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

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.

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[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.

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[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.

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[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.

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[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.

Medical Abortion Pills

Baroness O'Loan Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

As I am sure noble Lords will acknowledge, this is a very sensitive area. Initially, it was meant to be a temporary-only service. If we do decide to respect its temporariness, an extension will probably be made to ensure that the clinics and other medical services have time to adapt before returning to the position before the pandemic.

[Baroness O'Loan (CB)]

My Lords, is the Minister aware of a recent study, based on FOI requests to NHS trusts, which revealed that in 2020 more than 10,000 women who took at least one abortion pill at home, provided by the NHS, needed hospital treatment for side-effects? That is equivalent to more than one in 17 women, or 20 women a day, needing hospital treatment. Does the Minister agree that such reports indicate a serious and disturbing lack of understanding by its advocates of the dangers of the telemedical abortion policy?

[Lord Kamall (Con)]

I am grateful to the noble Baroness for giving the other side of the debate; it shows what a difficult subject this is. Sometimes people dig up the wider debate, but I think we have to be very careful and focus on the issue. This was a service offered to women, and the initial consultation was in person, but we made temporary provision, rightly, during the pandemic to ensure that women were treated with dignity, while appreciating that it had to be done at distance. We have looked at whether this should continue to be temporary or become permanent, and we are still weighing up this difficult decision. I think the debate today shows that there are a number of views, and it is not as simple as either side proposes.

Health and Care Bill

Baroness O'Loan Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness O’Loan (CB)]

My Lords, I congratulate the noble Lord, Lord Stevens of Birmingham, on his excellent maiden speech. I think, too, that this is an appropriate time to pay tribute to those staff in hospitals, care homes and the community who have laboured so hard over the past two years. However, routine medical care did not happen. Elective surgeries were cancelled and treatment for the most serious conditions and illnesses was limited or not delivered, and now we have a major problem. The problem is actually worse in Northern Ireland, where people routinely wait five years for necessary treatment. Across the UK, the frustration of doctors and other medical practitioners at their inability to provide essential services because of staff shortages—resulting in part from the Covid emergency, but not just from Covid—is well-known.

I first served in 1996 on one of those health boards to which the noble Baroness, Lady Murphy, referred. Then people remained in hospital because they could not be discharged to their own homes with proper care packages or to residential and nursing accommodation. Some 25 years later, it is still a problem. For 25 years the issue has been discussed, papers written, committees formed, strategies devised—and the problem has got much worse.

The compulsory immediate Covid vaccination of staff, low levels of salary for the intense and difficult work of caring for those with reduced mobility, dementia and serious ill health, and a lack of support have resulted in a further loss of staff from the care sector. Care of this kind is inevitably resource-intensive. It is not just mechanistic; it requires a compassion and humanity that very often simply make it possible for people to settle in places where they would rather not be but must be. Will the Government ensure that there is a change of philosophy that will result in a greater respect for and appreciation of those who care in such circumstances, consistent with our proudly-proclaimed Great British values?

The repeal of Section 75 of the Health and Social Care Act 2012 is welcome. The new processes, which are still being developed, must enable proper procurement and remove unnecessary bureaucracy but ensure that contracts are awarded with proper scrutiny and that there is consideration of the impact of individual contract awards on the provision of services generally. Can the Government give an assurance that accountability and transparency really will result from the passing of this Bill?

There is also a need to ensure that the creeping privatisation of the NHS will not result in increased costs, reduced equality of access to services, and longer waiting lists. The public sector NHS trusts and NHS foundation trusts must be the default provider of NHS services.

The potential conflicts of interest for those such as employees of private healthcare providers as members of ICBs has been referred to repeatedly. They will be responsible for the commissioning of NHS services. I can see the benefit of private sector experience, but government must ensure proper accountability and there must be a mechanism for regulating and identifying conflicts of interest when they emerge.

Finally, the proposed level of delegation of power to the Secretary of State over operational clinical matters is quite simply unacceptable.

Medicines and Medical Devices Bill

Baroness O'Loan Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness O’Loan (CB) [V]]

My Lords, I would like to thank the noble Baroness, Lady Cumberlege, for her excellent work on the report that she has presented to the House. I would like to support her recommendations, and most particularly her recommendation for a patient safety commissioner.

This is an important Bill, and there is an opportunity presented by it to improve the regulation of human organ harvesting across the world. Organ transplantation is one field of medicine that offers great hope to the recipient. Organs are taken from deceased donors in particular circumstances and for years living donations have been possible. A person can donate a kidney, part of a liver and so on, and live perfectly well afterwards. I have seen it. It can make the difference between life and death. It is a rapidly growing field of medicine in which demand exceeds supply.

Here in the UK, we have stringent regulation of the process of organ donation to ensure that those who donate are protected and that donation is only allowed from those who are fit and are willing to donate without any payment but to help someone else. That is how it should be and at its best this is a wonderful development. Similarly, organ transplantation after death can, in the right circumstances, bring untold blessing to those who receive an organ.

However, the very fact that demand for organs for transplant exceeds supply means that there is a market in organ harvesting, both from the living and the dead. For decades, people have been forced through poverty to sell their own organs. This is unethical and wrong. There should be no support for such practices, and we must ensure control over any contribution made by British companies that enable such activity.

We know, too, that there is transplant tourism, where people travel to countries where they may be able to get a transplant, in some cases with few questions asked about where the organ donated to be transplanted came from. We know, too, that organs can be shipped and transplanted into recipients across the world without proper procedures. There continues to be a major problem in the lack of global control over organ harvesting. There has been a reference to the work of the China Tribunal and to reports of a state-run programme of forced organ harvesting in China, the organised butchery of living people to sell body parts, which the China Tribunal compared to the

“worst atrocities committed in conflicts of the 20th century.”

We know that Uighurs, Falun Gong practitioners and others are being killed and subjected to forced organ harvesting.

When an organ is taken, whether from a living or a dead body, it needs to be preserved and transported to its destination. Just as we now require that imported products, whether they be clothes or anything else, should be manufactured in ethical conditions, we need to ask ourselves whether British manufacturers are selling to China the devices, medicines and technology which will enable China to sell organs which have been harvested from people in China’s detention camps or otherwise wrongly obtained. There could be many spin-offs from such activity, including the use of such organs—that can be imported here without any evidence of consent or traceability—for medical research, a market in immunosuppressant drugs for the recipient, and a market in harvested organs which might even be imported and used here in the absence of full regulation.

China is not self-sufficient; it is highly reliant on the West for the equipment and medicines which it needs to help its organ transplant and harvesting industry. The extent of British engagement is not immediately accessible in the context of the Chinese organ transplantation process. The report The Economics of Organ Harvesting in China indicates that there are British companies with interests in this area—in research and in producing and selling organ-preservation solutions to China.

It is right to support and develop ethical, regulated organ transplantation. It is profoundly important that this Bill provides for proper regulation. We can provide regulation to prevent companies being empowered and enriched by the mass crimes that may be facilitated elsewhere. This will show the People’s Republic of China and the Chinese Communist Party that the balance between human rights and commerce will change.

We need to think very carefully about how this Bill will proceed, so that it does that which it seeks to do and protects the health and safety of those who may be forced organ donors.

Abortion

Baroness O'Loan Excerpts

Wednesday 6th June 2018 Lords Chamber

[Lord O'Shaughnessy]

It has been the position of successive Governments that abortion policy and law is a devolved matter for Northern Ireland, to be decided by elected politicians in Northern Ireland on behalf of the people of Northern Ireland. That is our position: they should be the group that makes the decision.

[Baroness O'Loan (CB)]

Can the Minister confirm, given the decision by a majority of the democratically elected Northern Ireland Assembly made in February 2016—an Assembly elected by the men and women of Northern Ireland—that it does not wish to change abortion law, and given that it has been recognised since the Government of John Major that Westminster would not impose abortion on Northern Ireland, that if the Government move to decriminalise abortion in England and Wales or to direct rule in Northern Ireland, they will not impose any change in abortion law on the people of Northern Ireland, particularly at this most difficult and sensitive time?

[Lord O'Shaughnessy]

Our intention—that of the Government and the Northern Ireland Office—is to restore a power-sharing agreement and arrangement in Northern Ireland so that it will be up to the people of Northern Ireland and their elected officials to decide on abortion policy.

Abortion (Disability Equality) Bill [HL]

Baroness O'Loan Excerpts

Report stage (Hansard): House of Lords
Friday 24th February 2017 Lords Chamber

[Lord Mackay of Clashfern (Con)]

My Lords, I am, of course, not a doctor, although I have the great honour of being an honorary fellow of the royal college of which the noble Lord, Lord Winston, is such a distinguished member. I well remember the situation which produced the result that the noble Lord has spoken of—that of amendments on abortion being made to our very interesting, important and ground-breaking Bill on IVF and related matters. I was clear, as were the Government, that the approach to the main part of that Bill depended on one’s conscience, so there was a free vote in both Houses of Parliament. There was always the possibility that the result of a vote in this House would be different from one in the House of Commons. That was a very serious thought in relation to a Bill of such ground-breaking importance, and the introduction of amendments on abortion in the Commons rather increased that difficulty.

However, I am glad to say that in the end we got what I think is regarded in the general scientific areas of the world concerned with these matters as a very good Bill. It allowed research which is not allowed in quite a number of other parts of the world. I know that the noble Lord, Lord Alton, has a different view from mine, but that was an important aspect of the Bill which depended very much on people’s consciences.

So far, I have understood this Bill to deal with the principle of equality as defined in our legislation in relation to disability. I understand that the Bill is based on the proposition that abortion would be in breach of the principle of not regarding disability as a ground for discrimination. It is as simple as that. The idea that this amendment would destroy the Bill and bring back back-street abortions and so on strikes me as rather excessive. It is an amendment to the existing Bill; it does not seek to abolish the Abortion Act. It simply suggests—with a good deal of merit, as I think my noble friend Lord Shinkwin has said—that the principle of not discriminating against disability should apply to this provision.

This amendment, produced by the noble Lord, Lord Winston, suggests that something else might be done. It proceeds on the basis that the nature of the condition is such,

“that the fetus will die at, during, or shortly after delivery due to serious fetal anomaly”.

That is not quite the same as what is in the Abortion Act. If that were the formulation of the clause, it might well avoid the idea that this provision of the Abortion Act is a breach of the rule against discrimination on the ground of disability. This is a different point and I can see the force of it as a different matter entirely from the provision in relation to this matter which is currently in the Abortion Act.

[Baroness O'Loan (CB)]

My Lords, I pay tribute to the noble Lord, Lord Shinkwin, for bringing the Bill before your Lordships’ House. It is very important that we come back to what the Bill deals with and possibly leave behind some of what I might regard as the slightly unwarranted assertions that we are in danger of reintroducing back-street abortions wholesale as a consequence of this Bill. What it actually does is give us the opportunity to remove the right to abort after 24 weeks an unborn baby which has a disability unless there is a risk of serious permanent damage to the mother or her life is at risk. I say with the greatest respect that it is, therefore, perhaps a rather more modest proposal than was described by the noble Lords, Lord Winston and Lord Lester.

Amendment 1 deals with the situation in which the foetus will die at or shortly after delivery due to serious foetal abnormality. I absolutely oppose this amendment. The noble Lord, Lord Alton, has very competently articulated some of the problems with the amendment, and I am not going to rehearse all the arguments against it. I will simply tell another little story. I have a friend: her name is Tracy Harkin. Tom and Tracy have a little daughter. When Kathleen Rose was born in November 2006, she had trisomy 13, which is one of the conditions that is generally regarded as what is loosely described as a fatal foetal abnormality. Kathleen Rose is now 10 years old. I want to quote her parents: “She has a beautiful, distinct personality. She is known for her mischievous laughter and her enormous hugs. Last year, she was the angel in the school nativity play, and to all of us, of course, she was the star of the show”.

I have another concern. The amendment in the name of the noble Lord, Lord Winston, would extend the provisions of this Bill to Northern Ireland. As noble Lords will know, Northern Ireland is currently in the midst of a very fraught election campaign. I know that in Northern Ireland the tabling of Amendment 1 and Amendment 8 has caused considerable anger and concern. Both justice and health are devolved to Northern Ireland. Therefore, the law on abortion in Northern Ireland—undoubtedly a sensitive and very controversial topic—should be dealt with only by the people of Northern Ireland through their constitutional processes. And my goodness, the right to do business in Northern Ireland through constitutional process has been very hard won. The Abortion Act does not extend to Northern Ireland. That is a position which, despite consideration, has not changed since 1967. It is therefore entirely inappropriate for this House to be considering introducing a change to an Act that does not apply in Northern Ireland and making that change apply in Northern Ireland.

As noble Lords may be aware, only last February, the Northern Ireland Assembly considered the question of whether abortion should be legal in Northern Ireland on the grounds of what is described as “fatal foetal abnormality”—a term which even the noble Lord, Lord Winston, explained to us lacks clarity. For a disability to be fatal, when does it have to be fatal—within hours, days, weeks, months or years? What of Kathleen Rose, heading for her 11th birthday? After a lengthy debate, the Assembly decisively rejected this move by 59 votes to 40. Following last May’s election, an MLA brought forward a Private Member’s Bill to allow for abortion on these grounds. The Northern Ireland Assembly had plenty of time to consider this Bill—in the nine months since the last election, the Assembly passed one Bill: the Finance Act. However, the Private Member’s Bill was not dealt with and it fell. The Northern Ireland Assembly is the place where this issue should be developed and debated, as it affects the people of Northern Ireland.

I know that some noble Lords do not accept the law on abortion in Northern Ireland, but when Parliament accepted the principle of devolution, we accepted that devolved parliaments have a right to make decisions about their own law, whether we like them or not. Reversing that principle and bringing the powers back to Westminster would be a major constitutional change, which Parliament would have to consider very seriously in the light of all the implications of such an action. It is fundamentally wrong for this House to seek to make a decision in this area and we should not, therefore, support these amendments.

Equally importantly, the sensitivities which surround this amendment are greatly compounded by the fact that they are proposed within five days of the elections in the Northern Ireland Assembly. Those elections are unlikely to result in a devolved Assembly because the two parties having the greatest number of seats currently have indicated that they will not go into government together unless significant preconditions are met. In those circumstances we are moving rapidly towards direct rule, with all the political sensitivities attaching thereto, including the threat to our fragile peace process. Only yesterday there was an attempt to murder a police officer. A bomb was placed under his car; that bomb exploded and in all probability it would have killed him. These are fragile days in Northern Ireland and noble colleagues who are supportive of this Bill are understandably there today and unable to address your Lordships’ House.

Whatever happens, there will eventually be a devolved Assembly which has a mandate to uphold or change Northern Ireland abortion law, and that is where this debate should take place. I hope, therefore, that other noble Lords will join me in rejecting Amendment 1 because of the effect of it on the Bill of the noble Lord, Lord Shinkwin, and in rejecting Amendment 8 because it is repugnant.

[Lord Brown of Eaton-under-Heywood (CB)]

My Lords, my position on the Bill is rather less in favour of the noble Lord, Lord Winston, than it is against the Bill as a whole. I come to the Bill with no pretence to any medical expertise or direct experience in this field but, alas, as an arid lawyer. As such, I seek to stand aside from the huge emotional weight which always attaches to debates on abortion and on disability—as here, where both those emotive topics come together, there is much to be disregarded.

The Bill is concerned with cases where there is a substantial risk, recognised by two doctors, of a child being born with a serious handicap. As the noble Lord, Lord Shinkwin, for whom I have the most profound regard, recognised at Second Reading, at column 2546 of Hansard, if that risk comes to light within the first 24 weeks it is highly likely that, if the mother so wishes, she may be aborted under Section 1(1)(a) of the Act. However, if it is discovered later, the question arises—and this is the crunch question—should the mother be compelled to carry that child to birth or should she be allowed a later abortion?

According to the statistics given at Second Reading by the noble Baroness, Lady Chisholm, at column 2560 of Hansard, in 2015 there were some 230 abortions carried out under the Section 1(1)(d) provision after the 24-week initial period. That squares with the figure given by the noble Baroness, Lady Hayter, of some 200 to 300 women.

The noble Lord, Lord Alton, for whom I have the greatest respect, as I have for all who have taken part on both sides of this debate, referred at Second Reading—as he has again today—to terminations on grounds of “rectifiable disabilities”, and mentioned cleft palate and hare-lip, and in Committee he added club foot. I find it difficult to suppose there have been Section 1(1)(d) cases after 24 weeks on those grounds, and that two registered medical practitioners have certified in the terms of that provision. If they have, that seems to be a matter for the proper policing of this legislation. It is not the altar on which should be sacrificed the interests of those 200 or 300 women a year whom this Bill is otherwise condemning to be required to bear that child, whatever feelings they may develop, and however justifiable that it is a disability which only came to light after 24 weeks. For my part, I would not wish that they be so condemned.