Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Baroness Berger

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness O'Loan (CB)]

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

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

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

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

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

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

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

[Baroness Berger (Lab)]

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

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

Terminally Ill Adults (End of Life) Bill

Debate between Baroness O'Loan and Baroness Berger

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness O’Loan (CB)]

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

[Baroness Berger (Lab)]

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

[Baroness O’Loan (CB)]

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

--- Later in debate ---

[Baroness O'Loan (CB)]

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

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

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

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

[Baroness Berger (Lab)]

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

[Baroness O'Loan (CB)]

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

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

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

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

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