Terminally Ill Adults (End of Life) Bill

Baroness Royall of Blaisdon Excerpts

Friday 20th March 2026 Lords Chamber

[Baroness Smith of Llanfaes (PC)]

My Lords, I shall speak to my Amendments 844, 903 and 905 in this group, but I first turn the Committee’s attention to the LCM debate, as the noble Baroness, Lady Coffey, just did, that took place in the Senedd on 24 February. At the beginning of the debate, Jeremy Miles, the Cabinet Secretary for Health and Social Care, set out to the Senedd:

“I … wish to be clear about what may happen if the Senedd were to withhold consent today. The sponsors of the Bill have confirmed that, in those circumstances, they would seek to remove clause 42 from the Bill. That would mean the law in England and Wales would change to permit assisted dying, but there would be no powers in the Bill for Welsh Ministers to implement assisted dying services in Wales or to oversee or regulate such services”.

That clarification is important for the Committee. Throughout the debate, many MSs stated dissatisfaction with how the Senedd was being treated. I apologise, but I will quote several MSs today because I think it is important that they are heard here. One said:

“We are being asked to vote in the dark”,


and another

“we’re … being asked to sign a blank cheque”.

Another said

“we are … legislating with a blindfold over our eyes … This is no way to treat a Parliament. This is no way to treat a nation”.

The Senedd was put in an impossible situation by this Parliament. A vote against this LCM would result in assisted dying services being available only privately, and a vote in favour at least retains some power for the Senedd to shape such services through the NHS in Wales. That was what the vote was about specifically. I thought this was concisely put—

[Baroness Royall of Blaisdon (Lab)]

The reason that the Senedd was voting in the dark was that this Bill had not reached its conclusion in the House of Lords. If it had done so, the Senedd would have been legislating in the daylight.

[Baroness Smith of Llanfaes (PC)]

I thank the noble Baroness for her intervention. However, that is not the case in terms of the practical reason why the Senedd Members raised those points; it is also in relation to the fact that they passed an amendment to this LCM, which I was lately going to touch on, which states that the Senedd “regrets” that this Parliament has not properly considered the

“constitutional implications of this Bill for Wales”.

It is important to note that, yes, they passed the LCM, but they amended it with a point about this Parliament not having done its duty and gone through the implications for Wales in detail. A lot of those in Wales who support the Bill just do not feel that they have had an opportunity to shape this Bill. I thank the noble Baroness for her intervention, and I hope that that clarifies my point a little further.

The point was concisely put by Adam Price during that debate:

“Supporters of assisted dying do not argue for access determined by wealth. Opponents do not argue for a system outside NHS governance in a matter as grave as this … No country’s Parliament should have to stand aside while another decides the terms on which its own citizens live and die”.


He went on to say that he sincerely hoped that the vote was the last time that the Senedd—and other devolved Parliaments—was put in that situation.

The Senedd passed the LCM with an amendment stating, as I just mentioned, that the Senedd:

“Regrets the lack of thorough consideration of the constitutional implications of this Bill for Wales during the legislative process”.


As I just said, the passing of that amendment also showcases that we have failed in our own duty here in relation to those implications.

Amendments 903 and 905 in my name aim to restore an amendment that was agreed in Committee in the other place. The amendment was later taken out on Report without resolving the purpose behind it having been put forward and agreed in Committee. Simply, my amendments would give the Senedd a vote on the final Bill passed here before regulations could be created by Welsh Ministers for the delivery of an assisted dying service in Wales. The reason for this amendment is simple: as I highlighted at Second Reading, although the criminal law is a reserved matter, the legality of assisted dying in this case, and the delivery of such a service, is a devolved matter. Not allowing the Senedd to have a vote nor the opportunity to fully scrutinise and amend this Bill infringes on devolution and disrespects the roles and duties of Members of the Senedd.

Health and social care makes up over half of all spending from the Welsh Government’s budget. Do noble Lords not agree that it is therefore essential that Members of the Senedd are able to scrutinise all health spending? Not allowing Members of the Senedd to shape this Bill limits their ability to do that. The Covid pandemic is the most recent prominent example of how Wales does things differently when it comes to health. This Parliament needs to wake up to this reality and let devolved Parliaments do their job. This matter is an anomaly from a devolution perspective. As in Scotland, this is a fully devolved area. The Scottish Parliament recently had the opportunity to debate and shape its own Bill that could be suitable for Scotland. If the Scottish Parliament has the right, why can this not be the case for Wales?

I turn to Amendment 844, which would create a new clause to address this exact issue. The amendment would deliver parity between Scotland and Wales on this matter by amending the Government of Wales Act to remove offences related to suicide from reserved matters. This would allow the Senedd, if it chose to do so, to introduce its own Bill on assisted dying. It would allow the Senedd’s health committee to take its own evidence, including from NHS Wales and the Welsh Government’s Health Secretary. Your Lordships will be aware of the list of witnesses who were called to recent Select Committees ahead of this Bill. The chief executive of NHS England was called to give evidence, but there were no representations from Wales. I respect the work that members on that committee carried out; however, would they agree that the Senedd should also be able to take evidence from within Wales and be able to make decisions on the establishment of a new service in Wales for the people of Wales, based on Wales-specific information? Amendment 844 would be the best course of action in order to recognise that this Bill has not been designed with Wales or for Wales and to align Wales with Scotland in making a decision on this matter.

I turn finally to the amendments in this group from the noble Baroness, Lady Coffey. In the hypothetical scenario that we passed her amendments alone, we would be leaving Wales in a grey area. Wales would be taken out of this Bill, but with no way for the Senedd to legislate on this matter. In this Committee, we must consider the full consequences and where those decisions will then lie. My Amendment 844 would avoid that scenario and ensure that the Senedd had a way of legislating on this matter if it chose to do so.

To conclude, and as I already highlighted at Second Reading, I support people’s right to choose how they die. However, in the case of services being made available in Wales, they must be shaped and designed by the people of Wales. That must be an ability for the Senedd and not for us here in Westminster.

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[Lord Deben (Con)]

What I am saying is very simple: the proposers of this Bill have not properly taken into account the particularities that the Welsh have put forward so nobly and well by the noble Baroness, Lady Smith. I never hear from the proposers of this Bill any comprehension or understanding that some other people might have contributions to make. That is why we have had no meaningful changes to this Bill. It is a Bill which is opposed either in principle or in practice by everybody who is supposed to carry it through, and it has now caused real trouble in Wales. I am merely asking the proposers of the Bill to give this House some belief that they really are listening and are not treating our conversations as nitpicking.

[Baroness Royall of Blaisdon (Lab)]

My Lords, I would like to point out that my noble and learned friend Lord Falconer has in fact tabled amendments and they have not yet been debated because we have not reached them in the Marshalled List. With regard to the very interesting and important discussion about Wales, many of the facts which were quite properly given by the noble Baroness, Lady Smith, are related to the devolution settlement itself. That is, quite frankly, a much wider issue than that which we are debating today.

[Lord Carlile of Berriew (CB)]

My Lords, as a former member of another place who represented 2,900 square miles of Wales, I have the feeling that we are getting into a horrible conceptual muddle in this debate. I feel the phrase “horses and carts” applies to several sentences around what is being debated here. I was one of the advocates of devolution when I was a Welsh Member of the other place and supported it very strongly when it came about, and I absolutely recognise the points that have been made so ably by the noble Baroness, Lady Smith. However, after hearing earlier parts of this debate, what I am hearing is that actually the money side of this is not the horse; it is part of the cart.

We have heard Ministers, including my noble kinswoman by the way, repeatedly saying in response to amendments in this debate that this House and this Parliament decide whether we pass this Bill. If the Bill is passed, the Government will have to provide the resources to enable it to work. I apprehend that, if this Bill is passed, if it is given enough time to reach the end of its parliamentary stages, which I think it should be allowed—though I do not support the Bill in principle, by the way—then the money would have to come from somewhere and the adjustment would be made to enable Wales to provide the services required.

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[Lord Deben (Con)]

We are not going to change the devolution settlement in this Bill—of course we are not. That is not the issue and that is not what is before us. Instead, this comes back to the Government. I entirely agree with the speech from the noble Lord, Lord Carlile, but we are supposed to rely on the Government saying that, after we pass this, they will deal with the money. That is the problem. I do not believe them. They have to tell us what the money will be and where it will come from. They have to tell the Welsh that the money going to Wales will be increased proportionately so that Wales can deal with it. Until they do that, we cannot make proper decisions. I totally agree otherwise with what the noble Lord, Lord Carlile, said.

[Baroness Royall of Blaisdon (Lab)]

My Lords—

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[Lord Moylan (Con)]

My Lords, I will speak to Amendments 175 and 384, in my name, and I am grateful to the noble Baroness, Lady Fox of Buckley, for her support.

These amendments concern prognosis. We have discussed prognosis briefly in previous debates, but I wanted to raise this in the context of my own experience of cancer and to bring some sort of mathematical thinking to bear on the question. In August 2023, I was diagnosed with stage 4 oesophageal cancer. It was a fatal diagnosis and I was told that I had 12 months to live—18 months, if the character of my tumour qualified for immunotherapy, which it did. I do not need to be congratulated on being particularly brave for sharing this story, since noble Lords will hear, if they stick around, that the story has a happy ending.

Within a week or so of that diagnosis, a friend of mine sent me an article which had been written in 1991 by Professor Stephen Jay Gould of Harvard University. Professor Gould was an evolutionary biologist, and he was quite well known because he wrote a number of popularising science books—the sort of thing that sixth-formers and undergraduates would have read widely. He was a well-known and liked figure. The article was about his story. In 1982, he had been diagnosed with abdominal mesothelioma, a fatal condition, and the hospital would not give him a prognosis. When he got back to Harvard, he went straight to the medical library, and he found on reviewing the literature that he had eight months to live.

After about 15 minutes of shock, he began to think about what that meant, and he realised that the prognosis was in fact, arithmetically speaking, a median. All that it actually meant was that half the people in his condition would be dead by eight months and the other half would live longer than eight months. In fact, this median told him nothing about himself; it was an abstraction. To understand his own prospects, he had to look at the underlying data. When he looked at it, he found that quite a lot of people lived quite a long time beyond eight months in his condition. He said that

“all evolutionary biologists know that variation itself … is the hard reality … Means and medians are the abstractions”.

He asked himself, “What do I have to do to be one of those people who live a long time?” Speaking to oncologists, he learned that the universal response from all of them was that the key to survival in cancer was a positive attitude. To quote again briefly from the article,

“those with positive attitudes, with a strong will and purpose for living, with commitment to struggle, and with an active response to aiding their own treatment and not just a passive acceptance of anything doctors say tend to live longer”.

That is how he approached it, and I think we can learn a few lessons from this. I would like to run through what I think they are.

[Baroness Royall of Blaisdon (Lab)]

My Lords, what the noble Lord says and the article that he cites are very interesting. I am jolly glad that, for some people who have positive attitudes, they live a long time with their cancer. I know from personal circumstances, as do many other people around this Chamber, that we have had loved ones who have had very positive attitudes towards their cancer and they have died.

[Lord Moylan (Con)]

My Lords, I am not saying—nor was anybody—that a positive attitude on its own is going to save somebody from cancer. Professor Gould also benefited from the fact that he had the best medical treatment, and he went on various experimental courses. That was not my point at all. But people with a positive attitude, as I quoted, tend to live longer. I think that is scientifically demonstrable. I am surprised at the noble Baroness’s intervention.

I think we can learn some lessons from this. First, prognoses are not generally individuated. They are medians drawn from large data sets based on clinical trials. As Professor Gould said, if you get a prognosis of six months, the average person will think that means that they are going to be dead in six months, which, from a scientific point of view, is precisely the wrong conclusion.

Secondly, even when a prognosis is not based on a median but is an attempt by a doctor to give an individual assessment, it is very likely to be wrong. There are well-established studies on this. I will cite just one, which is Orlovic et al in 2023. It shows that, beyond 14 days, a clinician’s prognosis is almost always wrong. It is extremely unreliable. Within that shorter period of a week or two, a doctor and indeed an experienced nurse can very often say, with great reliability, that somebody is not going to last very much longer. But beyond that, an individual prognosis is of very little value indeed.

I think we all accept that for anyone who gets a prognosis, there is a degree of unreliability about it. Nobody believes that a six-month prognosis means exactly six months, or that eight months means exactly eight months, but we have a tendency to think that it is because we do not have enough knowledge—that with a bit more science and research, we could refine that prognosis so that it was more accurate. But as Professor Gould pointed out, the prognosis is merely an abstraction arising from the variability in the data. It is not that we cannot make the prognosis more accurate; it is that—