Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

The guidance that was given changed in the light of the Montgomery case. I envisage that the GMC guidance would be of some significance and would change from time to time as people’s concepts change.

On the question from the noble Baroness, Lady Berridge, it is Clause 32 and it is about criminal liability.

[Baroness O’Loan (CB)]

I want to be really clear about this, because it is so fundamental and so important. The noble and learned Lord just described Clause 12(2)(c). Sub-paragraphs (i) to (iii) are not relevant to this discussion, but sub-paragraph (iv) and paragraph (d) are. They require three pieces of information in order to enable an informed wish:

“the nature of the substance … how it will bring about death and how it will be administered”,

and the person’s

“wishes in the event of complications”.

It does not require communication of what the complications might be. I simply ask him: why will he not put in the Bill a requirement to explain the complications?

[Lord Falconer of Thoroton (Lab)]

My answer to that—because the answer I gave in my long and tedious speech was obviously inadequate—was that to be properly informed, you would have to say what the effect of the drugs and what the complications would be. That comes from the word “informed”. If there could be any doubt about that, the fact that you have to discuss how, physiologically, it brings about the death and you need to discuss what happens in relation to the complications puts that beyond doubt.

I will just go back to the question from the noble Baroness, Lady Berridge. It is Clause 33, not Clause 32, which is the civil liability for providing assistance. That provides that if it is done in accordance with the Act then there is no civil liability, but it needs to be done in accordance with the Act, which means it has to be the informed wish.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

If the person said, “I will take more poison”, then the person can do that. It is perfectly permissible.

[Baroness O'Loan (CB)]

Can I ask a question before the noble Lord sits down—eventually? There is a clause—I apologise, but I cannot remember which one it is—that says that if the patient cannot administer, push or whatever the substance, then the doctor can assist. If the patient comes around and is fitting, and has said that they want to die, is the doctor supposed to put their thumb on the switch or whatever it is and push it to make them take it themselves? It seems so uncertain what the obligation of the doctor is. For the people watching outside, this must be horrific. We are thinking about people coming round—we know there is a significant risk of them coming around—and we are not telling doctors in the Bill what they are required to do.

[Lord Falconer of Thoroton (Lab)]

Again, I do not think it needs to be on the face of the Bill, because the Bill is clear about the rights of the doctor in relation to that.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

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

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

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

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

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


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

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

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

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

[Baroness O'Loan (CB)]

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

“any available palliative, hospice or other care”?

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

[Lord Falconer of Thoroton (Lab)]

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

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

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

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

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Committee stage
Friday 9th January 2026 Lords Chamber

[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.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Thursday 8th January 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

My Lords, I think we have exhausted the debate. There is widespread support for this Motion, and for that I am incredibly grateful. Can I say just one thing? What this Motion, if passed, means is that the House is saying loudly, clearly and, I hope, unanimously that our job is to get to the end of the process of scrutinising the Bill.

I shall answer just two or three particular points that have been made. What is at the heart of it is the questions raised by the noble Lord, Lord Stevens, and the noble and learned Lord, Lord Garnier. What will we do and how long will it take? I agree with the answer given by the noble Lord, Lord Pannick. We need to craft informally a process that ensures that we get to the end of the process.

The Leader of the House was kind enough to say that, if this Motion were to pass, the usual channels would, in effect, convene a meeting and we would then seek a way forward. I have to say I am incredibly attracted to the things that the noble Lord, Lord Carlile, has said: not his opposition to the Bill, I hasten to add, but to the proposition that there are—and this number may be wrong—about 10 crucial issues in relation to this Bill. Let us immediately try to identify what those 10 or so issues are and then reach a process by which we go through them. To the credit of the noble Lord, Lord Carlile, that has been his position all along. He very helpfully led us to an identification of those 10 issues and we tried to do a grouping that reflected that, but it did not command support. I think we should look at that again.

It is so important for the House to come to the right conclusion. If we pass this Motion now, we will send a signal that our job is to craft a structure that means that we can get through the Bill.

[Baroness O'Loan (CB)]

I have listened to all that the noble and learned Lord said and I agree with the various statements which have been made about the duty to scrutinise, but I have also listened to those who have said that he has not responded to any of the amendments, apart from that on age. The issues are identified. Can he tell the House how he will respond in a positive manner, as Members on the Front Bench normally do when we are discussing Bills?

[Lord Falconer of Thoroton (Lab)]

My Lords, that is a perfectly fair question. I have quite scrupulously, as we have gone through the amendments in Committee, indicated which I accept or in principle accept; for example, in relation to 18 to 25 year-olds. Subsequent to that, we have had meetings, and I have gone through in some detail how we should deal with that, and we have reached agreement at those meetings in principle as to what to do. I am very grateful to see that the noble Baroness, Lady Finlay of Llandaff, is nodding in relation to that.

In addition, for example, I have indicated that I am in favour in principle of some special protection for those who have suffered from a deprivation of liberty. I have also indicated—and I do this just by way of example—that in relation to multidisciplinary teams looking after people who are grievously ill or terminally ill, we should think of some way of incorporating their role into the Bill. It is obvious that I am not doing it enough, but I feel I have responded in some detail in relation to individual points. I have also indicated where I do not accept amendments. However, I am listening, and I need to improve in relation to that, because many people are saying that I am not responding adequately; but that will need to be part of the process that we adopt.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

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

[Baroness O’Loan (CB)]

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

[Lord Falconer of Thoroton (Lab)]

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

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

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Lord Falconer of Thoroton

Committee stage
Friday 21st November 2025 Lords Chamber

[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

Debate between Baroness O'Loan and Lord Falconer of Thoroton

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.