Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Blake of Leeds (Lab)]

I just reinforce to the noble Lord that it would be completely wrong to pre-empt the decisions of Parliament—I am sure he is fully aware of that. I just want to give reassurance that, across all these issues, evidence would be considered in the usual way in considering the substances to be used should the Bill pass. I think I have been exceptionally clear on this, and we need to move forward.

Given the size of the group, I reaffirm that it would be impossible to address each amendment specifically, but the broad thematic workability concern is that the use of unclear and ambiguous language could result in unworkable duties and increased risk of legal challenge.

I turn to amendments tabled in relation to the regulation of approved substances and clinical trials. Many of these amendments are policy choices and are therefore a matter for the sponsor and for Parliament. However, noble Lords may wish to note that many of these amendments also introduce new concepts that would require significant work to ensure the policy intent is clearly understood and that they are coherent for the rest of the Bill. I draw noble Lords’ attention to a number of amendments where the Government have major workability concerns.

Amendments 701 and 713, tabled by the noble Baronesses, Lady Grey-Thompson and Lady Hollins, relate to clinical trials for approved substances. First, these amendments could delay implementation of the Bill until a clinical trial or evidence-gathering study is completed, which could make implementation within the four-year timeframe difficult. Noble Lords may wish to be aware that these amendments could create workability concerns relating to the ethical and regulatory challenges for clinical trial processes for approved substances.

[Baroness O’Loan (CB)]

Does the Minister think it is ethical and right to administer drugs that have not been cleared through a normal process and to expedite their use? Surely we have to wait until the drugs have been properly tested.

[Baroness Blake of Leeds (Lab)]

I do not think it would be appropriate to comment on that level of detail at this point.

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[Baroness Blake of Leeds (Lab)]

Apologies; I thank the noble Baroness for her clarification on that point. I was mid-sentence, so forgive me if I repeat myself. Limiting the number of manufacturers based on prior prescriptions is operationally impractical and could risk supply shortages.

I turn to Amendment 713A from the noble Baroness, Lady Hollins. This amendment appears to seek to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power.

[Baroness O’Loan (CB)]

I just want to ask the Minister about her response to the noble Baroness, Lady Lawlor. She was, I think, saying to the Committee that limiting the places at which you can get the lethal drugs that will be required for death would inhibit the process. I say to her that there are situations in which the supply of medication is limited in exactly that way. Some years ago, I had toxoplasmosis, and the only place the drug could be administered then was Scotland. So it is possible; such systems exist now. I do not quite understand why drugs to treat toxoplasmosis have to be controlled, but the suggestion is that drugs that will kill people do not.

[Baroness Blake of Leeds (Lab)]

I would be happy to write to the noble Baronesses with clarification on that point; I thank them for their interventions.

As I was saying, Amendment 713A appears to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power under Clause 27 to specify the list of approved substances. This could lead to operational uncertainty. Although the amendment could be delivered, establishing a dedicated regulatory pathway would likely require adjustments to the MHRA’s remit and internal processes.

I turn finally to Amendments 887A and 888A from the noble Lord, Lord Empey, which would amend Clause 57 by removing the reference to Northern Ireland. This would mean that regulations made under Clause 37 would not extend to or apply in Northern Ireland. As medicines regulations are UK-wide, should this amendment be accepted, it might create legislative divergence across the UK. This does not mean that assisted dying would be legalised in Northern Ireland.

As noble Lords will be aware, many of these amendments have not had technical drafting support from officials. If your Lordships support these amendments, the Government will need to revisit the drafting of amendments and the Bill as a whole to ensure that they are workable and coherent, both internally and with the wider statute book.

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[Baroness Hayman (CB)]

My Lords, I have found some of this discussion quite difficult to compute with my own very limited—non-doctor—experience of end-of-life care and relatives who have been dying. The noble Baroness, Lady Lawlor, spoke as if there was a very binary division between assisted dying care and palliative care. Yet the cases that I have been involved with and seen very closely have been of people very definitely frail and at the end of their lives, and where the range of options they wanted to talk about were not simply pain relief. This whole time, no one has mentioned the right of people to exercise autonomy, to stop eating and starve themselves to death. Does the doctor not consider what happens in those circumstances and talk about options then? There is the option, of course, to turn off life support. There is the option—which my mother chose—to refuse any blood transfusions. Doctors talked her through how that would reduce her life expectancy.

[Baroness O’Loan (CB)]

My Lords, I will speak to Amendments 150, 156, 166 and 205, to which I have put my name, and in support of other amendments in the group.

As drafted, the Bill would permit a discussion about assisted dying with the patient before any requirement to discuss expert palliative care. The noble Baroness, Lady Blackstone, said that it would be irresponsible not to allow this. In Australia and New Zealand, doctors are not permitted to initiate such discussions.

As drafted—

[Baroness Blackstone (Lab)]

Doctors in Australia are now allowed to do so. The law has been changed there.

[Baroness O’Loan (CB)]

I accept the noble Baroness’s intervention, but they certainly thought it was a bad idea, and there is further discussion in South Australia about the issue.

If I may go on: as drafted, the Bill will permit discussion about assisted dying before discussion about palliative care. It would come as something of a shock—

[Lord Falconer of Thoroton (Lab)]

I think the position was that there was an Act in Victoria, Australia. After the five-year review of the operation of the Act, the Government recommended that the prohibition on raising it be removed as it was found to be impeding access and undermining patient-centred care. The Royal Australian College of GPs welcomed the recommendation as a sensible step and the law was changed.

[Baroness O’Loan (CB)]

I accept that, no problem.

It would come as a shock if a doctor came to one’s bedside and said, “In these circumstances, you may wish to consider an assisted death”. Experience would tell us that a patient might not hear much more of any discussions about treatment and palliative care, given the shock and their already vulnerable state.

Can the Minister explain why the Bill is drafted as it is in this context, permitting a discussion about assisted dying without requiring a previous discussion about palliative care? Can the noble and learned Lord, Lord Falconer, assure your Lordships that there will be a genuine choice?

[Lord Falconer of Thoroton (Lab)]

The noble Baroness will know that Clause 5 specifically says that if a registered medical practitioner raises the question of assisted death, he

“must explain to and discuss with that person … all appropriate palliative, hospice or other care”

that is available. It says:

“Accordingly, such a preliminary discussion may not be conducted in isolation”


of, among other things, palliative care. I am not sure of the basis on which the noble Baroness is saying that that should come before rather than at the same time.

[Baroness O’Loan (CB)]

I am saying that it should come before, because Clause 5, as drafted and as the noble and learned Lord read it out to the Committee, says it is to be part of a discussion about assisted death. I suggest to the Committee that if a doctor mentions assisted death, that will focus one’s mind in a way that may cause distress, shock and all sorts of things.

There is another problem: the issue of the doctor raising the issue despite the fact that the patient has given no indication that he wants to talk about it. The Bill is said to be a matter of autonomy, but it cannot be denied that there is an unequal relationship between the patient and the doctor. Doctors are perceived as knowing and acting in the interests of the patient. Under the constitution of the National Health Service, it is provided:

“It is there 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”.


Even where a patient may have autonomy, were a doctor to initiate a discussion about assisted dying, he or she would fundamentally undermine patient autonomy. Offering assisted suicide is not the same as offering palliative care, cancer treatment or any other care. These are all directed to the treatment of a living person. Assisted suicide is about killing the person.

When doctors raise assisted suicide or assisted dying, patients may interpret this as an implicit recommendation or, indeed, a judgment about the value of their life, not a neutral option. That undermines agency. A choice influenced by authority, fear or deference is not a free choice. There is a huge risk of a doctor exercising undue influence and exposing patients to pressure at the most vulnerable point in their lives. I heard the noble and learned Lord, Lord Falconer, acknowledge that doctors hold exceptional authority over patients. He should reflect on that.

The solution to these problems, as in Amendments 150, 151 and 154, is to amend Clause 5 to provide that there would be no discussion with the patient until the patient says that they want the discussion. Amendment 156 would delete Clause 5(2) and is consistent with the other amendments. Amendments 159 and 160 would clarify the meaning of the Bill to state specifically what is to be discussed: the death of the person sitting or lying in a bed before the doctor, not any other matter. All these amendments would bring clarity and additional protection.

Amendments 157 and 164 would protect the patient even further by providing that, where a person has told their GP they do not want a discussion about assisted dying, this should be recorded in their notes. That should provide an audit trail of the wish of the patient. This must then be complied with by any registered medical practitioner.

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[Baroness Berridge (Con)]

Am I right in understanding that the noble Baroness’s amendments are designed to achieve a situation where someone experiences and receives the best palliative care before the discussion takes place? Otherwise, as the most reverend Primate the Archbishop of Canterbury has said, any choice that you exercise could be illusory, unless you are in that situation.

[Baroness O’Loan (CB)]

I thank the noble Baroness for her helpful intervention.

There is a further problem. As drafted, there is nothing to prevent any other health professional—a nurse, health visitor or physio—raising assisted dying with a patient. Sometimes, patients form stronger relationships with these people than with doctors because they see more of them. It is essential, therefore, that there is no possibility of a warm-up conversation being initiated by a professional to ease the ground for the doctor when he wants to make his approach. It may be said that this would not happen, but we have seen ample evidence of situations in which cost savings to be secured by freeing up beds and ending treatment are regarded as justification for assisted death. We have, of course, seen situations in which a person who has suffered an amputation or has a terminal cancer seeks a wheelchair and is told the waiting list is two years, but that assisted dying can be provided tomorrow. Any situation in which assisted dying is discussed for the first time must be strictly patient initiated, tightly confined and take place through a clearly defined process.

Amendment 205, to which I put my name, as well as Amendments 207 and 207A and other amendments in the group, would prevent any discussion about assisted suicide with a person who has a learning difficulty or autism without a family member, guardian or independent person present. The effect of this would be to do what all professionals and caring organisations do when dealing with or engaging with people with such disabilities. I also support Amendments 317, 346, 457 and 512 in this group, which seek to protect those who experience feelings of suicidal ideation, which may be transient.

What about the doctors? The MDU, which represents over 200,000 healthcare professionals, is deeply concerned about the proposals in the Bill. The MDU points out that the position whereby doctors are not required to raise this but are still permitted to do so is the worst of both worlds for doctors because they would be liable to complaints in either situation. If the doctor does not raise it, a complaint can be made against them for not having done so; if they do raise it, a complaint can be made against them. As the MDU points out:

“Such proceedings can take a vast toll on doctors. The time taken; the emotional toll; the procedural concerns. This cannot be overstated”.


This is one of the many unintended consequences emanating from this clause as drafted. The clause requires substantial amendment to make it safe.

There seems to me to be a whole range of circumstances that you would want a doctor to be able to talk to the patient about. It is not simply, “We can offer you a way”, and they only talk to you and say, “This is the palliative care available, and only if you have heard that, seen it and chosen from it can we then talk to you about something different, which is assisting your death”. It seems to me—

[Lord Moore of Etchingham (Non-Afl)]

As I understand it, the noble Baroness is talking about various possible options. Would she think it a good idea if the doctor were free to advise the patient to stop eating?

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Only the massive advocacy of a powerful network of noble Lords and noble friends managed to save my noble friend’s life. However, the Bill would allow very similar situations: options constrained by NHS failure, government decisions not to fund treatment or just logistics. Any doctor could raise the option, explain that nothing else can be done and ask immediately whether they want to sign the declaration for the first assessment, or arrange for someone else to. They would put them on the conveyor belt to the second assessment seven days later, which would be followed immediately by the panel, with the reflection period reduced to 48 hours. That is a timeline of just nine days to save your loved one, who has been told that there is no other option.

[Baroness O'Loan (CB)]

My Lords, I would like to clarify something that the noble and learned Lord, Lord Falconer, said in response to my statement that assisted dying was not something that doctors could suggest in Australia. The website of the Department of Health, Victoria, states:

“It is against the law for a medical or other health practitioner to suggest voluntary assisted dying as an end of life option to one of their patients. A medical practitioner cannot talk about voluntary assisted dying unless a person asks them about it first”.


If I can take noble Lords to New Zealand—

[Lord Falconer of Thoroton (Lab)]

Before the noble Baroness references New Zealand, I was saying that that was the position. There was then a five-year review in Victoria and the law was changed.

[Baroness O'Loan (CB)]

It has not changed on the Government’s contemporaneous website. If I go to New Zealand, it says that the doctor cannot advise or discuss assisted dying with you unless you ask for it first. Those are both government websites today. I accept that there may be changes due and that they may come, but they are not there, as far as I can see.

[Baroness Hollins (CB)]

My Lords, when a doctor, the very person entrusted to preserve life and relieve suffering, raises the possibility of assisted dying, it is no longer a neutral act. For some people, particularly those who are depressed, isolated or overwhelmed, the mere introduction of the possibility of an assisted death risks planting the idea that this course is rational or even expected. In an inherently unequal doctor-patient relationship, suggestion is easily perceived as a recommendation.

There is no requirement for an independent advocate—somebody to sit beside the patient and help them process and grasp what is being said. We are leaving some of the most consequential conversations a person can ever have to take place in isolation, within an asymmetrical, authoritarian relationship. There is no requirement for the discussion to take place with someone with specialist expertise. A “registered medical practitioner” could be a locum doctor who the patient has never met before, a foundation-year doctor in their early years of practice, or someone with no training in palliative care or experience of autism or learning disabilities, and yet they are the people who may introduce a conversation that could seriously alter the trajectory of a life.

No clinician should be allowed to initiate such a conversation; it should arise only if a patient independently raises it themselves, and even then the doctor’s role should be limited to acknowledging the request and directing the patient to an independent body while remaining firmly focused on diagnosis, treatment and the provision of appropriate and timely palliative care, as needed. Assisted dying must not be presented as an equivalent option alongside treatment, support and comfort. To do so risks the medical service being seen as one that no longer values preserving and improving life but rather one that enables the end of life.

The Royal College of GPs has stated that the role of a GP should be limited to signposting patients to a designated specialist service if, and only if, the patient raises the subject. This week, the Royal College of Psychiatrists wrote to me expressing its continuing concern. Its view is that

“all applicants should receive a holistic, multidisciplinary assessment at the preliminary discussion stage, including for mental health needs”;

in other words, something much more like the multidisciplinary panel proposed by my noble friend Lady Finlay in the previous group. I therefore suggest that Clause 5, and, in consequence, Clause 6, should not stand part of the Bill.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, Amendments 430 and 434 in my name go to the practice in operation. I will introduce them by making this point. I was one of the seven people fortunate enough to be identified in the Observer a couple of weeks ago as having tabled a lot of amendments. Contrary to what the Observer—and the quite numerous hostile messages I have received by letter or email—suggested, these amendments, together with all the others I have tabled, except for two relating to the victims of industrial disease, were put forward by the Law Society of England and Wales and by the CLADD group at King’s College London. The latter, for those who were not here the other week, is a group of a distinguished psychiatrist, psychologist, social scientist and lawyer with a particular interest in this and related issues. They and the Law Society are neutral on the principle of the Bill but want to see a safe and effective Bill. Amendments 430 and 434, together with others I have tabled, are aimed at that.

Amendment 430, some will be pleased to see—others will not—is for a streamlined, non-panel basis. It would insert a new clause saying:

“This section applies where the Commissioner receives … a first declaration … a report about the first assessment … which contains a statement indicating that the coordinating professional is satisfied as to all of the matters … a report about the second assessment of the person which contains a statement indicating that the independent professional is satisfied as to all of the matters … The Commissioner must, as soon as reasonably practicable, consider the person’s eligibility to be provided with assistance”.


He or she may then

“consider the person’s eligibility personally … refer the person’s case to a person qualified to sit on the Assisted Dying Review Panel”,

or

“refer the person’s case to a multidisciplinary panel”.

In practice, this means that it would be a modified procedure where there is agreement between the co-ordinating and independent professionals. The commissioner could then consider the application alone or refer it to the panel, so it would not necessarily have to go to the panel. A full panel would be mandated only if the independent professional is not in agreement with the co-ordinating professional that the criteria are met, or if it becomes clear during the modified procedure that further evidence is needed.

Some of those who are not in favour of the Bill may be concerned that this amendment could potentially weaken the process. I remind the Committee that Dame Caroline Swift, latterly a High Court judge but formerly lead counsel in the Shipman Inquiry, has said she is afraid that safeguards on assisted dying are likely to be eroded. We have to be very careful, because Dame Caroline Swift was right at the sharp end of looking at this. That is important, as she has seen what happens with a rogue doctor. She said:

“Those safeguards may seem adequate now but they are likely to be eroded over time. As Leading Counsel to the Shipman Inquiry, I saw how this had happened with the safeguards for the issuing of cremation certificates … Over the years, the second doctor’s role became diluted, they were seldom independent of the first, rarely examined the body and the signing of the second form became little more than a ‘tick box exercise’”.


My Amendment 430 might later be at risk of leading to dilution, but I hope it is an indication that there might—in clear cases, where everyone is agreed early on—be a way of moving it on swiftly, to the advantage of someone who is really anxious to go down this course and has capacity and all the other requirements. I hope that will be seen as a positive move and not a wrecker’s move. I am surprised that no one has come to me since this was tabled and said, “That’s a good idea; we’ll stick it in the Bill”.

Amendment 434 would amend Clause 16 and is simply intended to make it clear beyond doubt that referral to the panel is mandatory wherever the independent professional is not satisfied that all the requirements are met. The Law Society believes, and I agree, that as it stands it is not necessarily mandatory, and it should be. So, I ask rhetorically, why not? Are these not both jolly good amendments?

[Baroness O'Loan (CB)]

I will speak to Amendment 146, tabled in my name and the name of the noble Baroness, Lady Eaton, but before I do so, in the interests of brevity, I say that I support all that has been said in the context of the appointment of the commissioner. This cannot be a personal prime ministerial appointment; it cannot be a matter of patronage. The role must be insulated from day-to-day politics, especially given the risk of damage to trust in nurses, doctors, the judiciary and in this new process by which the state enables the taking of life. I agree, too, with the amendments which seek to introduce some process to the actual appointment of the commissioner, and I agree with the amendments in relation to conflicts of interest and registers of interests.

Through Amendment 132, the noble Baroness, Lady Cass, seeks to establish conclusively that the commissioner’s principal functions are monitoring and reporting on the assisted dying process. Her Amendment 122 would introduce a new role, that of director, who will put the assisted dying regime into action, selecting and overseeing panels, receiving applications, and deciding on appeals and the other duties in Clause 44. Both the British Association of Social Workers and the Law Society gave evidence that an independent regulator for VAD was essential. In Amendment 128, the noble Baroness, Lady Foster, who is not able to be with us today, identifies necessary duties which would provide additional safeguards, ensuring compliance, identifying risk and identifying the circumstances in which things may go wrong with possible tragic consequences.

I want to speak to Amendment 146—the noble Baroness, Lady Eaton, is unable to be with us today—which is about the very specific risk to people in care and nursing homes, the majority of whom are vulnerable for one reason or another. The situation of care homes is a matter which the noble Baroness and I have raised repeatedly during the course of the Bill. This amendment develops an obligation which would be imposed by the noble Baroness’s Amendment 128, requiring identification and mitigation of risk. It imposes a duty on the commissioner to monitor and identify emerging risk in the operation of assisted dying in registered care or nursing homes, and to take reasonable and proportionate steps to prevent or mitigate that risk. Where such risk appears systemic, the commissioner must notify the Secretary of State for Health and Social Care, so that appropriate remedial action can be taken.

The issues of vulnerability and capacity, the risk of coercion and the risk of abuse are all particularly relevant to care and nursing homes. Can the noble and learned Lord, Lord Falconer, assure the Committee that these matters really have been properly considered and provided for? I have some difficulty, because the scope of the issue is massive. In 2023, the year for which there are the latest official figures, nearly 400,000 people lived in some 15,000 care and nursing homes in England and Wales. Some 85.7% of the total number of beds in care homes were occupied at the time of the survey. Some 70% of all care home residents have dementia or severe memory problems. The average period of residence in a care home is about two and a half years, and most of them die in the homes. Those figures will have increased in the three years since they became available. Some 120,000 people a year over 75 are diagnosed with cancer. There will therefore be a significant number, possibly the largest cohort in England and Wales, with a terminal illness—however you define it—who will have a prognosis of six months or less to live, and who live in our care homes. On the basis of these figures, it is possible to extrapolate that tens of thousands of people living in care homes will be eligible for assisted dying.

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[Lord Falconer of Thoroton (Lab)]

Would the noble Lord mind if I did not, as I think what one has to do is focus on this particular Bill?

[Baroness O'Loan (CB)]

It is all very well talking about access to judicial review when things go wrong, but the reality for the ordinary man in the street is that judicial review is largely out of the realm of possibility: it just costs too much. Therefore, we need to make sure that things are so laid down in the Bill that there do not have to be multiple requests for judicial review. For that reason, I ask the noble and learned Lord to consider this further.

[Lord Falconer of Thoroton (Lab)]

I could not agree more with the noble Baroness, Lady O’Loan. That is why, in addressing these issues, we have been very specific about what the voluntary assisted dying commissioner can do in both Clause 4 and the schedule. What is more, that is why we have such a limited panel that can be made for the voluntary assisted dying commissioner. It has to work, and that is why it has been drafted in this way. The noble Baroness is absolutely right that judicial review is an expensive process, and it provides a guardrail, but ultimately there must be sufficient detail in the Bill to give the public confidence that the system will work. That is why we have, for example, restricted it to a Supreme Court judge, a Court of Appeal judge or a High Court judge. We are absolutely on the same page on that.

I turn to the noble Lord, Lord Sandhurst. My understanding of his Amendment 430—although I may not be correct—is that, where the two doctors agree, the assisted dying commissioner, if he or she agrees, can then short-circuit the need to go to the panel. That is my understanding of the amendment, which is interesting. However, my anxiety is that we would then, in every single case, almost, be getting rid of the panel. The position would be that you only ever get to the panel if both doctors have agreed. The sponsors presented the Bill to this House on the basis that, in every case, the safeguard is—to shorten it—two doctors and a panel. So I respect the thinking, because it is trying to streamline the process, but I do not think that it is appropriate, and it would undermine the safeguards.

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[Lord Falconer of Thoroton (Lab)]

I will certainly reflect on that, and may I express my gratitude to the noble Baroness, Lady Berridge, for facilitating the meeting with Professor Ruck Keene? It was incredibly helpful, and I genuinely appreciate it. Yes, I will reflect on what the noble Baroness said. I suspect there will be a similar answer to the one I gave to the noble Baroness, Lady O’Loan: we have to be as specific as we possibly can in the Bill, because judicial review is difficult for normal people, particularly in those circumstances. That is why, whether it is a court system or any other system, we must try to make this as clear as possible in the Bill.

Amendment 146, in the name of the noble Baroness, Lady O’Loan, says that the assisted dying commissioner should be able to investigate patterns. In particular, she cites what may happen in relation to care homes. I agree that the assisted dying commissioner should have that ability. He does have that ability under Clause 49(1)(a), (b) and (c); so, for example, if he is concerned about a pattern developing in care homes, he already has the power to monitor that.

The noble Lord, Lord Morrow, asked whether there should be a further Equality Act assessment. I dealt with that last time and said I had looked carefully at what the former commissioner had said and I did not think that a further impact assessment was appropriate, because, if you constantly make particular points that are covered in general, you are never going to get to an end of it. I do not think that the points the commissioner raised were ones that had not already been considered in the impact assessment.

[Baroness O’Loan (CB)]

I accept that there is a general power in Clause 49 to look at what is happening in relation to the regime, but I say again that there is an issue raised by Amendment 146 which definitely requires further consideration. I ask the noble and learned Lord to reflect again not just on the monitoring of delivery of the service, but on the arrangements for the delivery of the assisted dying process in care homes, where people are vulnerable, isolated and largely unsupported in many cases. There is a very serious problem, given the remarks of Age UK, care homes, et cetera.

[Lord Falconer of Thoroton (Lab)]

I will certainly reflect on it, but the issue of somebody who is isolated and alone in a care home is why there are five steps before you get to assisted dying, and the question is whether the sequence of doctor number 1, doctor number 2, doctor number 1 again, the panel, doctor number 1 again is a sufficient safeguard. My own view is that it is a sufficient safeguard and it is particularly focused on protecting the vulnerable.

[Baroness O’Loan (CB)]

My Lords, may I just—

[Lord Falconer of Thoroton (Lab)]

I should get on. I apologise, but the noble Baroness has had a very fair crack at that particular whip.

I come to the question of the noble Baroness, Lady Maclean, which is: should there be a register of the interests of the assisted dying commissioner? I understand what motivates that. I do not think that that is necessary because, as my noble friend Lady Levitt said, that is something that would be dealt with by the normal process governing conflicts of interest. There would not necessarily be a record of it, but it would be something that would have to be disclosed before a decision was made.

The noble Baroness, Lady Grey-Thompson, raised various issues in relation to the appointments process, but I hope that I have dealt with them by referring to the process that would apply. I think I have dealt with all the other points, including the point from the noble Earl, Lord Howe, about Amendment 913A.

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[Baroness Berridge (Con)]

For the accuracy of the record, I am grateful that my noble friend referred to a story that I presented to him at lunchtime because it was relevant to Suffolk. Marie Curie’s overnight nursing service—the part of the service that offers palliative care in Ipswich and Suffolk—will end after the NHS withdrew funding. The service supported 470 patients and delivered 15,385 hours of vital care in the last financial year. It relates to my noble friend’s particular area of the country. I know I was not here at the start of the group but, for the accuracy of the record, I have intervened.

[Baroness O'Loan (CB)]

My Lords, I thank the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, for these amendments. There is a very serious issue here, evidenced by the nature of the conversation we are having, because it is a conversation about realities. The noble Lord, Lord Empey, said that it was time we started using the language that described exactly what we are doing. I think that is what we are doing now. We are talking about how this is going to be paid for and who should pay for it. How should it be managed?

We have seen the Canadian experience. The noble Baroness, Lady Grey-Thompson, spoke about wheelchair access. In Canada, it is regularly reported that people who cannot get wheelchairs are offered assisted dying instead. I grant you that that would not necessarily apply in this particular Bill, but you can see how, with mission creep and with changes, this could happen. We could end up in a situation in which we are making the kind of decisions that the noble Lord just referred to in this matter.

I must declare that I have an interest, because I am a trustee of a hospice—an unpaid trustee, I would add, and it is not in my register of interests for that reason, but it is relevant to this debate.

The noble Baroness, Lady Finlay, defined the variety of costs attached to the proposals quite clearly. I have to ask, following the noble Lord, Lord Deben, if the estimate of £2,000 is in any way realistic for providing a service which requires for each individual the cost of clinicians, the commissioner, panels, admin staff, communications, monitoring and audit, et cetera. That is to say nothing of maybe a national help service, independent advocates and all sorts of other things. We know that to die at Dignitas and places like that costs an average of £10,000, not £2,000. I would like the noble and learned Lord to ask the Minister if we can have a proper assessment of what is currently planned might cost and where it is to come from.

I have another question for the noble and learned Lord, because it is not the Government who pay; it is us. It is taxpayers who pay. If the noble and learned Lord, Lord Falconer, rejects these proposals or something which approximates to taking the cost away from the National Health Service—as the noble Lord, Lord Deben, says, it is in such a parlous state that palliative care services are being extinguished or diminished very significantly—does he think that the public and the voters will think well of a Government who fund suicide while not funding hospices properly? Does he think it will enhance trust and confidence in the Government?

[Baroness Levitt (Lab)]

My Lords, I will speak only to the amendments about which the Government have significant operational workability concerns. Before I do so, I want to say a few words on the general points about funding raised by a number of noble Lords, including the noble Lord, Lord Harper, the noble Baronesses, Lady Fox and Lady Grey Thompson, and others.

I make it absolutely clear that I entirely understand the point that the noble Lord, Lord Deben, is making and why it might seem as though the choice is being restricted if you do not actually know the amounts involved, but I reiterate that it is for Parliament to decide whether this service should be provided and, if so, whether it should be publicly funded. If that decision is made, the Government will fund it. I am not evading the issue when I say that I simply cannot explain how that will be done, because that would be to put that ahead of Parliament’s own decision. We cannot possibly start, for example, putting aside a war chest for something that Parliament may decide that it does not want. As far as priorities are concerned, as I say, it is not a matter of evasion; it is a matter of principle.

It is also not right to assume that funding this, if that is the will of Parliament, will involve taking money away from other parts of the health service. That is not what the Government are saying; we are simply saying that the funding will be made available if that is what Parliament wants. My noble friend Lady Merron, the Health Minister, has written twice on this subject, and those letters are available in the Library for anybody who is interested. As for palliative care, there is an absolute commitment by the Government to increase funding for palliative care and make sure that palliative care is offered properly, irrespective of what happens in relation to this.

As for the noble Lord, Lord Deben, of course I am not upset by what he says about the impact assessment—as if I would ever be upset by anything that he says—but we are doing what is usual, which is to deliver the impact assessment at the outset and, as with other Bills, a further updated impact assessment will be provided following Royal Assent, if we get to that stage. There is a logic to this, because there are so many different elements to what has been debated in Committee that to provide a costing for each and every one would probably keep us here for as long as we are here debating all these amendments anyway. It simply cannot be done. It is not practical. I am not upset, but I am simply saying that we cannot do it and we will not do it until Royal Assent.

Turning to the amendments in the name of the noble Lord, Lord Moylan, these are collectively intended, as we have heard, to prevent the establishment and running of this service being publicly funded. Your Lordships may wish to note that, if passed, these amendments would create an internal inconsistency with Clause 41(5), which requires that the provision of voluntary assisted dying services must be provided free of charge.

Amendments 835 and 868, in the name of the noble Baroness, Lady Fraser, propose a delivery model whereby the Secretary of State must make regulations for the assisted dying service, which would be delivered only by private providers. The key workability risk here is that the new clause created by Amendment 835 would duplicate Clause 41, but with additional constraints, and that would create legal uncertainty, when the Act is looked at in the round, about the limits on the Government’s powers when commissioning a service. The Committee may also wish to note that this amendment may have implications for the devolution settlement, as Wales and the Welsh NHS trusts are implicitly included, which potentially constrains the powers for Wales in Clause 42.

--- Later in debate ---

Finally, I turn to the change of the relationship between the doctor and the patient. If you go to other countries where this has been introduced, far from it leading to a change in the relationship, it has very often promoted a better relationship between a doctor and an individual patient because of the options available.

[Baroness O'Loan (CB)]

I am concerned about the figure of £37 million being articulated as the absolute cost of this service. I find it somewhat difficult to believe that it could be the cost. If we have regard to the costs of similar public organisations that are already set up, the running costs alone run into millions. We are going to be talking about a national service for England and Wales that, presumably, will be provided in the patient’s location—the death will take place not where we want it but where they want it—and therefore there will be a lot of costs. I firmly believe that they have not been costed into the figures that the noble and learned Lord and the Minister have given us.

When I go shopping, I see whether I can afford what I want to buy. Yet we, as a Parliament, are being asked to decide whether we want to do this. One of the things that we should responsibly take into account is cost, otherwise we would not have had an impact assessment. We are being asked to consider it on the basis that it will cost £37 million and that that is peanuts—well, I wish I had £37 million pounds put into palliative care now. This is not an accurate figure.

This is the only point that I want to make. Can the noble and learned Lord put his hand on his heart and say to me that he really believes that this is what the service will cost, given the number of people who may avail of it and the number of safeguards that need to be introduced into the Bill because of its very significant flaws?

[Lord Falconer of Thoroton (Lab)]

First, I am grateful to the noble Baroness, Lady O’Loan, for her speech, rather than a question clarifying something. Secondly, as I have said, the figure of £37 million has been provided in the impact assessment for the 10th year. I note the points that the noble Baroness has made. Maybe the right course for her is to send a detailed letter raising the questions with the Department of Health and Social Care and the Ministry of Justice, because it is their assessment—and I do not dissent from it.

Crime and Policing Bill

Baroness O'Loan Excerpts

Committee stage
Tuesday 20th January 2026 Lords Chamber

Moved by

[Baroness O'Loan]

422: After Clause 151, insert the following new Clause—
“Police disciplinary proceedings: use of force(1) Schedule 2 of the The Police (Conduct) Regulations 2020 (S.I. 2020/4) (standards of professional behaviour) is amended as follows.(2) In the heading “Use of Force”, at end insert—“Where a police officer uses force on the basis of an honestly held but mistaken belief, they can rely on that belief as justification for the use of force only if the mistake was an objectively reasonable one to have made.”.”Member's explanatory statement
This amendment seeks to (1) codify the decision in W(80) UKSC 24, that in police disciplinary proceedings involving use of force, an officer may rely on a mistaken belief only if that belief was both honestly held and objectively reasonable, and (2) and enable parliamentary consideration of the appropriate test in this context.

[Baroness O'Loan (CB)]

My Lords, Amendment 422 relates to the test used to determine whether an officer acted in breach of discipline when he or she used force in self-defence. We come late to this, but it is a very important issue. Currently, the test used in police disciplinary law is the civil law test. Under the current law, an officer must hold an honest belief that they or others are in immediate danger, must use only proportionate and necessary force, and, critically, where their belief is mistaken, their mistake must have been an objectively reasonable one.

The amendment is necessary because, following the police accountability rapid review report, published in October 2025, a recommendation was made to change the legal test to the criminal test. This would allow officers to rely on an honestly held but mistaken belief, even if it was unreasonable. The Government have said they will implement this change through a statutory instrument without public consultation. At this stage, I thank Justince and Inquest for their research on this matter.

The criminal law test, which the Government propose, would allow officers to rely on a mistaken belief, even if it was unreasonable, so long as it was honestly held. I fully understand that officers are under great pressure when faced with possible or actual violence. Split-second decisions must be made on the ground in the immediate context. That is why it is critical that officers are properly trained and managed. However, it is not a good reason to move from the civil to the criminal law test.

This determination arose from a criminal law test where the Supreme Court made a decision in the W80 case, where an officer shot a man. When misconduct proceedings were brought, he claimed he had done so in self-defence. The IOPC recommended to the MPS that the officer should face misconduct proceedings, the MPS declined to initiate those proceedings, and the IOPC wrote to the MPS directing disciplinary proceedings. That decision was challenged by judicial review. The Divisional Court allowed the appellant’s claim. The IOPC appealed to the Court of Appeal, and the appeal was allowed. On further appeal to the Supreme Court, the decision of the Court of Appeal was upheld. In dismissing the appeal, the Supreme Court judges commented:

“This is an area of the law of vital importance to the public and to the police. It is essential that the public and the police should be informed in straightforward terms of the law which applies. We hope that it will now be possible to recast legislation and guidance so as to achieve this result”.


This amendment is not about criminal law, and it is not about whether an officer should be prosecuted for the use of force. It seeks only to provide the clarity that the Supreme Court advocated.

The criminal law test is simply not appropriate for disciplinary proceedings. Applying it would undermine public confidence in the police disciplinary process, weaken accountability and make meaningful scrutiny of police use of force far more difficult. The Home Office’s statutory guidance makes it clear that the disciplinary framework is intended to encourage a culture of learning and development for individuals in the organisation. This focus on learning and development is part of what makes disciplinary procedures distinct from criminal procedures. Misconduct processes are an important and excellent opportunity for forces to identify mistakes, learn from them and prevent recurrence.

The Supreme Court in W80 made clear that the criminal law test conflicts with the fundamental principle of the disciplinary process, which is

“to contribute to learning and development for the individual officer concerned or for the organisation as to the reasonableness of mistakes”.

If the objective reasonableness of an officer’s mistaken belief is no longer relevant, unreasonable beliefs, however dangerous and widespread, may never be identified. Allowing unreasonable but honestly held beliefs to serve as a defence would strip away the incentive to examine, understand and remedy the factors that led officers to hold those beliefs in the first place. For public safety it is essential that unreasonable mistakes and the conditions that enabled them are identified and addressed.

Moreover, the introduction of the criminal law test would risk allowing honestly held beliefs based on prejudice or stereotyping, however unreasonable, to provide a defence following police use of force. Police use of force is continually increasing, with over 812,000 recorded uses in 2024-25, an increase of 9% on the previous year. Police complaints about use of force rarely lead to investigation by the IOPC, because most complaints are referred back to the officer’s force for investigation. Fewer still result in disciplinary proceedings, and hence the opportunity to identify training or management deficiencies to enable institutional learning and improvement is not there.

--- Later in debate ---

The noble Baroness, Lady O’Loan, raised the case of W80. I reserve my position on the point that the noble Baroness made about the standards for when you decide to make a prosecution. As the Minister will know, these are very complex legal issues. I am not qualified to talk about that, and certainly not in the space of hearing the noble Baroness’s comments; I am not here to say that she is wrong. But W80—

[Baroness O’Loan (CB)]

I did not talk about criminal prosecutions at all.

[Lord Hogan-Howe (CB)]

I did not say that the noble Baroness did. My point is that after a public inquiry, where it was found that W80 had lawfully killed Jermaine Baker in 2015, and a series of further hearings that led eventually to the Supreme Court, W80 appeared before a gross misconduct hearing by an independent body—nothing to do with the police; it was ordered by the IOPC—and was found to have no case to answer. It was not found that there was an arguable case, or that there was mitigation. There was no case to answer, 10 years later. It had been through the Court of Appeal and the Supreme Court, and nobody had noticed that there was no case to answer.

One of the central problems in these cases is that they are rare. Every time an officer waits years to be cleared, there is an outcry asking why they were charged in the first place or why it took so long to resolve. Every Government affected by this has said, “We will review it, and improve”. In fact, the noble Lord, Lord Jackson, has just mentioned the latest example of that.

My broad point is that all the reviews in the world have produced absolutely nothing. Nothing has changed. I have given two examples but there are many more, where people have been waiting 10 years for something to be shown to be not a criminal offence. I am afraid that the reviews have not produced anything, which has led to me tabling this amendment.

The officers are under a triple jeopardy. First, the IOPC considers whether there is a criminal offence or an offence of misconduct. That can take around 18 months. If there is a claim of a criminal offence, that is considered by the CPS, which probably takes another year. In the event that there is a criminal charge, the officer will go to court. During this period, the inquest into the person’s death will have been suspended. If there has been no charge, the inquest, usually with a jury, will be resumed. Those juries can find, and have found, that there was an unlawful killing, which then must be reconsidered by the CPS, usually leading to a criminal charge to go through a criminal court and then back through the IOPC. It has been hard to establish the facts, but by my calculation there have been around five officers charged with murder following cases over the last 20 years, each leading to a finding of not guilty at a Crown Court. The people who seem to be able to appreciate this issue, and deal with it with some wisdom, are called jurors.

My amendment is designed to give some comfort to firearms officers that their case will have to reach a higher bar before a prosecution can be started. It is modelled, as the noble Lord, Lord Carter, has mentioned—he is the one who pointed this out to me—on the householder defence to murder that already exists in criminal law. If a householder is attacked in their home and, in the process of defending themselves, kills the intruder, there is a higher legal threshold to pass before a prosecution for murder can follow. All I am asking is for the same to apply to a firearms officer.

I have talked to the Attorney-General about this. He reminded me that lawyers generally have concerns about this because it creates a unique group, a group of people who are treated differently by the criminal law, but I have two points in response to that general principle. First, householders are already a unique group. The criminal law has decided that they are a unique group and that is okay, but that it would not be all right for police firearms officers, who—I argue—are also a unique group. Why can we not add one more group? This was decided by Parliament on the advice of lawyers. What is different about this group? More importantly, for the reasons that I have given, they are a unique group. They the only people in society who use a firearm to prevent a crime, save a life or make an arrest. We say that no one can carry a firearm for that purpose, even if they are a legal firearm owner.

--- Later in debate ---

[Baroness Levitt (Lab)]

My Lords, as we have heard during this short but important debate, these amendments all relate to the same matter of principle—namely, the legal standard by which an authorised firearms officer should be judged on the thankfully rare occasions when they discharge a firearm.

The Government pay tribute to our armed officers. Theirs is a difficult, dangerous and stressful job. They do it to keep us all safe, and we have a great deal for which to thank them. Of course we recognise that they often find themselves in exceptionally difficult circumstances, having to make life and death decisions in an instant. That said, there is the matter of public confidence in the police. I do not think that any of your Lordships would disagree that confidence in the police is of equal importance. I would not be doing justice to this debate if I did not recognise and mark the fact that some of our citizens feel great anxiety about the accountability of firearms officers. In the past, when there have been high-profile fatal shootings by the police, this anxiety has boiled over into anger and social unrest.

The Government’s job is to balance these factors. We must ensure that the law offers protection to our brave police officers while at the same time providing reassurance to our fellow citizens that, if officers do fire their weapons, their conduct will be rigorously scrutinised. It is only right that the public should have confidence that any officer whose actions fall below the high standards we rightly expect will be held to account in the public interest.

Our conclusion is that we should not create a two-tier justice system where police officers who kill or injure in the course of their duties are judged by a more lenient standard than applies to the rest of the population. Our reason is this: we are confident that the criminal law which covers self-defence, defence of others and the use of force in the prevention of crime already provides sufficient protection for police officers. Because of the lateness of the hour, I am not going to go through the details of this, which I had intended to do, but will move straight to the amendments.

Amendment 423, in the name of the noble Lord, Lord Carter of Haslemere, would change the law so that an authorised firearms officer who acts with disproportionate—in other words, unreasonable—force would still be guilty of an offence, but it would be manslaughter, not murder.

I want to say a few words about what the law says about how a jury must consider whether the amount of force used by the officer was reasonable, sometimes described as proportionate. While this is an objective test, if the jury is told that what the officer did in the heat of the moment, when fine judgments are difficult, was no more than they genuinely believed was necessary, even if they were mistaken in that belief, that would be strong evidence that what they did was reasonable. If the jury also considers that the officer may have done no more than was reasonable in the light of what they believed to be happening, they are not guilty of anything. In other words, the law provides a full defence.

It is unclear whether Amendment 423 is intended to replace this full defence with a partial one, or whether, as I think is the case, it is intended to work alongside it in some way. If the noble Lord’s intention is to create a partial defence, then what he is saying is that officers who use unreasonable or excessive force should be held to a different standard from the rest of the population. We cannot accept this because the Government believe that to do so would fundamentally damage confidence in the police and in the justice system.

I turn to Amendment 423A in the name of the noble Lord, Lord Hogan-Howe, which seeks to amend Section 76 of the Criminal Justice and Immigration Act 2008. As your Lordships have heard, Section 76 deals with householder cases. The noble Lord’s amendment seeks to make authorised firearms officers subject to the same standard as the householder confronted by an intruder. The amendment attempts to raise the threshold for when force becomes unreasonable from disproportionate to grossly disproportionate for firearms officers. In effect, this means that firearms officers could rely on the defences of self-defence, preventing crime or making a lawful arrest if they used force that was disproportionate in the circumstances, provided it was not grossly disproportionate.

For the reasons I have already given, the Government are of the strong belief that it would be wrong in principle to authorise the police to use excessive force and that this would be extremely damaging to public confidence. In any event, we do not think there is a proper comparison to be made between householders facing an unexpected intruder and trained firearms officers. The threshold was raised in householder cases to recognise the exceptional nature of being unexpectedly confronted by an intruder in one’s home. The unique stress and shock of a home invasion justifies greater legal protection, allowing a higher level of force than in other self-defence contexts. The same logic does not apply to firearms officers, who are trained and equipped to use lethal force and are deployed only in the most high-risk situations. They are subject to strict command, control and training protocols to ensure that lethal force is used only when necessary and in accordance with the current legal framework.

I turn finally to Amendment 422, in the name of the noble Baroness, Lady O’Loan. As the noble Baroness has explained during the debate, her amendment deals not with criminal trials but with police conduct hearings. The previous Home Secretary commissioned Timothy Godwin and Sir Adrian Fulford to carry out an independent police accountability rapid review because it was recognised that there was ongoing complexity and confusion, and that there were concerns that this was having an impact on recruitment and retention of these essential and much valued officers. Sir Adrian and Mr Godwin examined the matter thoroughly and heard evidence from a wide range of stakeholders. Their conclusions and recommendations, published in October 2025, were clear that the Government should change the legal test for use of force in police misconduct cases from the civil to the criminal law test.

The reviewers found that police officers need confidence and greater consistency in the disciplinary system and that this would improve fairness and public confidence. The Government have taken on board that recommendation and we are in the process of making the necessary changes to The Police (Conduct) Regulations 2020. Our intention is that these changes will come into force in the spring. We accept that the amendment is well intended, but I hope that the noble Baroness will understand why the Government cannot support it and, for the reasons I have given, I invite her to withdraw her amendment.

[Baroness O'Loan (CB)]

My Lords, I thank the Minister and everyone who has spoken. There is a major issue of public trust in policing which has yet to be fully explored, but for the moment I beg leave to withdraw the amendment.

Amendment 422 withdrawn.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I have put my name to a number of the 79 amendments in this group. As the noble Lord, Lord Carlile, said, there was initially provision for judicial management of these cases, given the magnitude of the risk. The assisted dying panel was substituted as a consequence of the difficulties that were identified.

So, what is unsatisfactory about the assisted dying panel process, and why is change necessary? Despite the remarks of the noble Lord, Lord Pannick, the Bill does not provide for family knowledge or involvement as a right. Surely, we do not want our people to end up in the position of the woman who heard of her mother’s death in Switzerland when she was told the ashes were in the post to her. We do not want families to discover after the event that their child, whom they are trying to support after a diagnosis of a terminal illness, having reached the grand old age of 18, has opted for physician-assisted death, leaving them no chance to intervene.

Inevitably, there will be major difficulties in providing professionals to act as panel members. We know that the lowest level of assisted dying deaths is in Oregon, where it is nearly 1%, but in Canada and the Netherlands it is nearly 6%. If only 1% of deaths here were assisted deaths, it would be 6,000 deaths a year. This is the figure referred to by Sir Nicholas Mostyn when addressing the Commons Public Bill Committee.

There are only 29,500 social workers in England and Wales, according to the impact assessment. There are quite simply not enough of them to care for and protect children and vulnerable adults now, so what element of the crucial and challenging work of child and vulnerable adult protection would be sacrificed to support the existence of assisted death panels? This is a very real question. The Royal College of Psychiatrists has said consistently that it cannot support the Bill, and there is a major shortage of registered psychiatrists.

As the noble Lord, Lord Pannick—and, indeed, the noble Lord, Lord Carlile—said, the Bill requires that the legal member of the panel holds high judicial office, is a KC, etcetera. But there are currently only 107 High Court judges, 20 Family Division judges and 41 designated judges, and our KCs tend to be fairly well occupied. Nearly 104,000 children were trapped in the family court backlog during 2023. The average time for dealing with cases involving children—very important cases—is 43 weeks, and there are currently thousands of couples and nearly 20,000 children waiting for hearings. Given the delays, and despite the intervention of the noble and learned Baroness, Lady Butler-Sloss, I do not believe that family court judges would be available to act as legal members—yet the decisions by the panel required by the Bill must be subject to time pressure, because there is the requirement of death within six months. Even if we allowed only three hours a case, at the lowest figure of 6,000, we would need 54,000 hours of members’ professional time. If the figure was 5%, it would rise to 270,000 hours.

How is this to be funded? How are these professionals to be trained, supervised and managed? What will be the cost of the panel members and the administration of the panels? The impact assessment provides no answers to these questions. Where is the money coming from? It is not coming from savings in care, because most palliative care is actually provided by donations from the public; only 30% is funded by the state. Therefore, the system now in the Bill is simply unsafe. It provides virtually no protection for the weak and vulnerable; it is not workable.

The very extensive amendments tabled by the noble Lord, Lord Carlile, and others are complex. Like the noble Baroness, Lady Hollins, I welcome the introduction of the changes in the terminology of, for example, a terminal illness and lethal drugs. However, the Bill’s current panel provision would be replaced by this new system. Judges would be able—and would be most likely, I think—to appoint a medical adviser in each case, as provided for in proposed new subsection (5) of Amendment 426. That would provide additional assurance.

Amendment 116, tabled by the noble Lord, Lord Carlile, sets out an excellent framework for judicial decision-making. It includes the consideration of six complex reports, including submissions by the applicant; evidence about diagnosis and prognosis of the illness; evidence of a specialist medical practitioner’s assessment of a mental condition; evidence about living conditions; evidence about the availability of suitable housing, effective palliative care and social care; evidence of a specialist palliative care practitioner; and evidence of people who are familiar with the applicant’s character and personality. This is the kind of evidence that would enable proper consideration to be given to this momentous decision to apply to end one’s own life with the assistance of the state—a state that has previously devoted all its resources to protecting and saving life.

If such proper evidence is to be considered in each case in which an assisted death is sought, there would be a requirement for some further 30,000 reports from specialists of various kinds as well as social work reports on a person’s living conditions. Without this type of evidence, there could be no assurance that an applicant actually satisfies every requirement of the Bill, that there has been no coercion or undue influence, or that the person has simply lost all hope of anyone helping them live out their life in peace and with dignity. There is also a major shortage of specialists in virtually every area of NHS work. Although the system proposed in the amendments in this group does not immediately provide a definite route for family and friends who fear coercion and so on, that would be required.

If there were 6,000 applications for assisted death a year, and if a judge had to gather and consider all the evidence and reach a conclusion, it would probably take him or her at least four hours—about 24,000 hours of judicial time would be required. Family courts have frequently been described as complex, inefficient and difficult to navigate for families without legal support. The PAC heard concerns that court staff, legal advisors, and Cafcass staff are

“poorly resourced or trained to support domestic abuse victims, and that their needs are not being met by the family justice process”.

Moreover, if those courts cannot identify and provide for abuse arising in the current context of current cases, how will they identify abuse in cases where a person seeking an assisted death has been subject to coercion or abuse? Yet failure to do so may well result in the state dispensing death to someone who is not making an independent and informed decision.

There is also a problem about the cost of lawyers. The current fees for the family court range from £579 to £200 per solicitor per hour. Noble Lords can calculate what this would cost a family seeking to be represented in the court. The assumption must be that this will not be publicly funded. The PAC recently published a report about access to legal aid. It states that about 24% of the population, often those most in need of legal assistance—disabled people or those living in poverty—are excluded from the remote access now provided by digital means.

These matters should have been considered in a public consultation, but there was none. There should have been an assessment of risk and cost, but there was none. If judges are to make these decisions, we need more judges. It is not enough to say that judges will deliver if we tell them to. The reality, as we know from examining and observing the operation of the courts, is that cases are delayed. There are 80,000 cases alone waiting in the criminal justice system for trial. Rape cases are being listed for hearing in 2029. How are we to care for rape victims and other litigants when we are also providing this extra urgent need to make determined applications for assisted death? I therefore ask the Minister: how do the Government propose to resource even the panels’ work. Is the intention to designate other judges who sit largely in the Crown Court? A person making an application will have six months to live, so this is going to be urgent in any situation.

The amendments tabled by the noble Lord, Lord Carlile, are necessary and would provide far greater protection. However, if the original proposal, which gave very little protection and was secret, could not be delivered, it is difficult to envisage how judicial capacity could be found to deliver the service in a timely manner. An impact assessment is urgently needed before your Lordships can rationally make a decision on these cases.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

I will take the advice of the noble and learned Baroness, Lady Butler-Sloss, and now get rid of what I was going to say, because the noble Lord, Lord Markham, has said most of it. I now have only three points to add, so I thank the noble Lord for that.

First, the big discussion is on whether it should be a court or panel. The reasons for the panel have been put, so I do not need to repeat that. The only thing I would say is that when this was discussed in the Commons, it was not about the capacity of the courts that made them make the change to a panel but about the advice they got that this would be a much better, holistic and patient-focused way of doing it. In fact, making sure that that bit was added was very much welcomed by the British Association of Social Workers and the Association of Palliative Care Social Workers.

Secondly, the mention just now of legal aid says it all. Surely, we do not want this to be an adversarial process. It should not be argued in front of a court that way. I want to be very brief, because I am taking the advice of the noble and learned Baroness to be very brief, but we want this to be a conscientious decision and not one that is adversarial, which is why I think the panel would be so much better.

Lastly, this is not a life-or-death issue, because these people are dying. We are discussing only when they die, not whether. That is different from deciding that a baby will die who was not going to die anyway, or even someone in a permanent vegetative state. That is why I really do not agree that it is right to use the word “suicide”, rather than “assisted dying”. People are dying, and this is the issue of when they die and not whether.

[Baroness O'Loan (CB)]

Is the noble Baroness aware that we are discussing the possibility of having either a panel or a court process? The research and reports show that families and individuals have great difficulty negotiating the Family Division of the High Court and the family-designated judges processes. Legal aid may well be necessary to assist in some of these matters.

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[Lord Falconer of Thoroton (Lab)]

I take that to be a yes. The position the noble Lord is proposing is that the judge hears the evidence of the doctors on issues, for example, of coercion, capacity and firm and settled view, and then makes the decision. The comparison we have is between what is in the Bill—two doctors each forming a view on the terminal illness decision and the issues of capacity and whether the person has reached a voluntary decision as to whether to have an assisted death, and the panel either endorsing it by giving the certificate or rejecting it—and, as the noble Lord is suggesting, letting the court in effect decide the whole thing. I reject that view because I am absolutely satisfied, although I accept that this issue requires a lot of work and thinking about, that you are much better off having a multidisciplinary approach to somebody making an assisted death decision. It is much better to let the social worker, the psychiatrist, the doctor and the legally qualified person look at the situation and then decide whether somebody should make that decision on assisted death.

The evidence given in Committee—

[Baroness O'Loan (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

May just continue? I will come back to the noble Baroness in a moment. This is very important—it is the critical bit of the whole thing.

There was a lot of evidence given to the Commons Committee in which this very issue was discussed. Sarah Cox, an expert, gave evidence. She said:

“The other thing that concerns me is that we are putting all these assessments on the shoulders of two doctors individually, followed up by a High Court judge. In any other clinical practice, when we are making very serious decisions, we know that shared decisions are much better quality, much more robust and much safer. In clinical practice, we make all these decisions in multi-professional teams. I would never make these decisions independently of my team, because the perspective they bring can help me to understand things that I am not seeing”.”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 28/1/25; col. 74.]


Judges are marvellous, but a number of pairs of eyes in relation to this is better.

A huge number of questions were asked as to why the sponsor in the Commons and I—

[Baroness O'Loan (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

Will the noble Baroness let me finish? I am sorry but I am not going to take interventions at this stage. I will come to the noble Baroness in a moment, but I think I should make this argument in full.

The argument is that we made the decision to change from the judge, which I initially favoured, because of pressure and advice from the Ministry of Justice. That is not right. The change was made because the evidence was very clear, and I accepted that people are better off and it is safer if one does it with a multidisciplinary panel.

What are the reasons the noble Lord, Lord Carlile, has advanced for saying that we should have a court-based, not a panel-based process? First, he says that the court has experience of making analogous decisions. The type of decision he is referring to is the one the noble and learned Baroness, Lady Butler-Sloss, referred to: the Bland case, and whether people in a permanent vegetative state should have their life support turned off. That would be of assistance, but what we are proposing in the Bill is a panel, supervised by a commissioner, devoted completely to the question of whether assisted deaths should be permitted. Yes, we would get the benefit at the very outset of the analogous decisions the court has made, but here we would have a panel devoted only to that issue, and which is bound to become more experienced in it than the courts, which are rightly dealing with a whole range of things.

Secondly, it is said that the courts would give a reasoned judgment. As was pointed out in the debate, there is a requirement in paragraph 9 of Schedule 2 to the Bill that the panels give reasons in writing, and that will give rise to a body of decisions being made.

Thirdly, it is said that the court is a court of record. Yes, it is a court of record, but the key thing is, who is best at making the decision? Is it better to have just a judge, or an experienced legal member, a psychiatrist and a social worker? I do not think in all honesty that the fact it is a court of record will make any difference to that.

Fourthly, it is said that you can appeal to the Court of Appeal. We are talking here about people who want an assisted death. We want a safe process; we do not want an overengineered process. In my respectful view, the idea that you have to go into a system that carries with it appeals puts too much of a burden on the people.

Fifthly, it is said that the judges have a special respect in our system, a point made by the noble and right reverend Lord, Lord Harries. The key thing is not whether the judges have respect but whether our system of assisted dying will carry respect. This is a better way of making the judgment; that is why I support it.

A final point made by the noble Lord, Lord Pannick, who raised it and said it was the answer—it may have to do with the fact that it is a court of record—was that the courts have discovery powers et cetera. Yes, they do, but if the panel feels that there are areas that it is not getting to the bottom of, then of course it will not be satisfied and cannot give the certificate. For all those reasons, the panel is better than the courts. That is why the decision was made.

I will now answer the question from the noble Baroness, Lady O’Loan; I apologise for not answering it before.

[Baroness O'Loan (CB)]

I thank the noble and learned Lord. The question I wanted to ask him was connected to him telling us about panels and judges. As I understand it, the three members in the legislation he has presented to the House have expertise in their own area of competence. Does he accept that the benefit of the system devised by the noble Lord, Lord Carlile, is to bring many more disciplines—medical disciplines in particular—into the agenda? In particular, the judge would have the right to sit with the doctor, and there would be a psychiatrist’s report on the capacity et cetera of the individual, so the psychiatric issues would be taken care of. The amendment from the noble Lord, Lord Carlile, proposes something wider than that which the panel could provide.

[Lord Falconer of Thoroton (Lab)]

I do not accept that. The position is in relation to the panel. If it wants a report from a doctor, it can get it. I understand the noble Lord, Lord Carlile, to be saying that the court can ask for all these things—which of course it can—and if it thinks they are appropriate, it will do so. I assume it will not ask for them when it does not think they are necessary to the resolution of the issues. The panel can do the same and, if it does not get them, just like the court, it will have to say no.

--- Later in debate ---

[Baroness Cass (CB)]

My Lords, I will be brief, because many of the points have been made, but I would really like to make two points. My first point follows the comments of the noble Baroness, Lady Smith, about—I hesitate to use this term—“levelling up”. We know that there is a spectrum of provision available, not just in palliative care but in all the other aspects of care that a dying patient needs, as referred to in Amendment 221 in the name of the noble Baroness, Lady Hollins. I would love there to be the kind of wraparound care within the community that my noble friend Lady Gerada described, but for some patients that is not the case. So, specifying those components that should be available and making them available should be the basic right of every dying patient, particularly one who is carrying as onerous a decision as seeking an assisted death.

But I think the second, and equally important, point about this is front-loading the multidisciplinary assessment, and, ideally, having it clearly written down and held by the patient, which empowers the patient to hold that information and take it with them. Therefore, it facilitates the co-ordinating doctor, the independent doctor and the panel or judiciary process to have available that information from the team who know the patient best, so that they are not having to delay the process by scurrying around in hospital notes or seeking additional information late on in the process, when the patient will inevitably have made a decision, potentially with their family, and a delay due to missing information would be unbearable. So, front-loading is absolutely key to streamlining this process throughout.

[Baroness O'Loan (CB)]

My Lords, I have put my name to nine amendments in this group and I declare my interest as an unpaid trustee of a hospital which has a hospice attached to it.

We are very fortunate in your Lordships’ House to have among us distinguished doctors who have spoken with great experience and understanding of the need for access to expert palliative care when a person faces death from terminal illness. For many people, particularly those in care homes, such palliative care is simply not available. I think of my own mother, who died just three years ago and was in a care home, and for whom such care was provided either by the GP or by paramedics who came and administered morphine—that was not expert palliative care. Many people, if this Bill is passed, will be in exactly the same position as my mother, unless there is change to the current systems. Expert palliative care, as has been said, is unavailable in many parts of the country, and so it is not enough to know that expert palliative care could be available, it must be available. That is the most significant thing.

Police, Prison and Probation Officers

Baroness O'Loan Excerpts

Tuesday 13th May 2025 Lords Chamber

[Lord Timpson (Lab)]

I am pleased to know that we have a race action plan that we are working with police constables; it is really important that we recruit fantastic people and make sure that we represent the communities we serve.

[Baroness O'Loan (CB)]

My Lords, in answer to the noble Lord, Lord Rogan, the Minister said that there was an extra £1 billion coming into policing this year. However, not one penny of that £1 billion will go to Northern Ireland because policing is a devolved matter. Given that the Northern Ireland policing budget is significantly eroded by paying out for dealing with legacy in Northern Ireland, when will the Government create ring-fenced funding to deal with the situation in Northern Ireland, which will then allow Northern Ireland’s police to serve the community in the way in which they wish—properly staffed and properly resourced?

[Lord Timpson (Lab)]

I will pass that question on to the Northern Ireland Secretary responsible for legacy issues and write to the noble Baroness.

“Hillsborough Law”

Baroness O'Loan Excerpts

Tuesday 22nd April 2025 Lords Chamber

[Lord Ponsonby of Shulbrede (Lab)]

The Government have said that they want to introduce a duty of candour, with criminal consequences for those who do not live up to that standard. But it is part of a greater whole, which is the reason why the legislation has not come forward as we would have liked and why we are undertaking further talks with the parties I have mentioned.

[Baroness O’Loan (CB)]

My Lords, is the Minister aware that, in 2021, following a very lengthy process, which was exacerbated by prevarication, obfuscation and failure to deliver materials to the panel, the Daniel Morgan Independent Panel, which I chaired, recommended the creation of a statutory duty of candour, to be owed by all law-enforcement agencies to those that they serve, subject only to the protection of national security and relevant data protection legislation? The response of His Majesty’s Government, in June 2023, was that the Home Office was reviewing this recommendation and working with HMICFRS on the introduction of a statutory duty of candour. Will the Minister please tell your Lordships’ House the current position of the Government?

[Lord Ponsonby of Shulbrede (Lab)]

Yes, the Government are very clear: we remain fully committed to bringing legislation forward at pace, which will include a legal duty of candour for public servants and criminal sanctions for those who refuse to comply with that duty of candour.