Terminally Ill Adults (End of Life) Bill

Earl Howe Excerpts

Friday 21st November 2025 Lords Chamber

[Lord Mackinlay of Richborough (Con)]

My Lords, the debate on this matter this morning has been enlightening from all sides, with many with many distinctive speeches that will stay with me, including that of the noble Lord, Lord Griffiths, who brought a very personal account, though he is no longer in his place.

We are talking about concepts and words—whether it is encouragement, coercion or pressure. They are in a similar collective of words, and I worry that we are dancing with words a lot in this debate. The noble Lord, Lord Griffiths, brought the word “autonomy” to us this morning, which is very important. I know it has been described earlier in Committee and on the Floor here today. I would be significantly more encouraged and relieved if I could be absolutely sure that autonomy and freedom of action, freedom of movement, freedom of thought and of decision were clear, unambiguous and untainted. I cannot be assured by the Bill, as it stands, as it is weak on the coercion nature.

As I left the Chamber earlier—my wife had arrived— I thought back to the cases of Ruth Ellis and Derek Bentley, which were very significant as they stopped the death penalty in this country. It was a long time ago when the morality and thoughts of this country were in a very different place to today. One might talk about the deterrent effects of the death penalty—which is a whole different debate—but we were willing to put that aside because of the potential of getting things wrong, and we did not want miscarriages of justice. That was so powerful. However, here we are discussing this Bill with lots of suggestions on how we could strengthen the coercion measures and make sure that people are not being pushed towards an early death that they did not want. We are almost flippant about that because the unsaid words are, “They’re old and ill anyway, so they don’t really matter”.

In support of Amendment 58 in the name of the noble Baroness, Lady Grey-Thompson, my noble friend Lord Deben—with whom I do not always agree on everything—made a very powerful point. If you were to look at the bell curve of the wealth and status of us in this Committee, we are probably to the left of the public politically, but certainly to the right in terms of wealth and influence as a whole. There is a world of difference between how, if we were to face this, we would be treated—the voice we would have for ourselves and the way in which our families would know they have agency and power to speak—compared with others in society. It could be that the wealthy family would be in a different place, because they could afford the help at home and the support in a care home as necessary.

However, for those in the middle who perhaps have children who work away, which is increasingly likely in this country, the children are feeling guilty. There are lots of cases that have been talked about the real situation of how people feel. In cases of that type there may be no problem of wealth, but problems of support by children and others. The “I don’t want to be a burden” debate would be coming to the fore.

One of our Northern Ireland colleagues mentioned the issue of saying, “Do you know how much this costs the NHS?”. I will be exploring that in greater detail. I think Amendment 3 touched on having an independent person; I have laid amendments for another day examining whether the NHS should be part of this process at all.

I say to the noble Baroness, Lady Hayter, that I could be encouraged but I am not sure how we can overcome the facets and dimensions of autonomy and coercion, because people and families are complex. One’s situation in life is complex. Just as we were willing to change a major piece of criminal legislation on the back of two errors, we seem to be not so interested in looking after the vulnerable in this Bill. I wish I could advance an amendment that would satisfy me—a lot of these amendments would make me a little more satisfied—but, no matter what we do, I am tempted to follow the noble Lord, Lord Carlile, in saying that we need to look at this whole area of coercion and pressure all over again. It is absolutely apparent across this Committee that this is the sticking point for many of us, so please try to satisfy us.

[Earl Howe (Con)]

My Lords, in their various ways, the amendments in this group seek to protect those who are terminally ill from being coerced or pressured into a decision to seek an assisted death. One of the most worrying concerns that have been raised by opponents of this Bill is the risk of especially vulnerable people being encouraged or coerced into ending their own life. The noble Lord, Lord Dodds, was right about that. For that reason, I do not think the Committee should feel embarrassed about having spent the time on this debate that we have.

As has been pointed out, the Bill already seeks to cover the coercion issue in its existing drafting. However, given that it creates a totally new role for medical practitioners in a situation where a terminally ill person wishes to end their life, in my opinion noble Lords are surely right that a laser focus should be applied to delivering protections designed to prevent any such coercion or pressure.

As a number of speakers have pointed out, coercion can come from anywhere—family members, friends, neighbours, other trusted people in our lives or an institution—and it does not have to be overt. It can and often does take the subtlest of forms. The noble Baroness, Lady Finlay, and my noble friend Lord Deben vividly described situations of that nature. Of course, the vast majority of family and friends of someone suffering from a progressive terminal illness will act in good faith to support their loved one through what is in many if not most cases an incredibly difficult time. However, when framing legislation around a decision as momentous as whether to opt for an assisted death and, as the noble Lord, Lord Carlile, pointed out, human nature being what it is, it is doubly incumbent on us to look for ways of safeguarding those who might be most susceptible to external pressure.

Amendment 3 in the name of the noble Baroness, Lady Finlay of Llandaff, would state more clearly in the Bill that the decision to end one’s life must be made independently. I hope the noble and learned Lord, Lord Falconer, will look favourably on this amendment, as it seems to me in tune with the Bill’s aims and purpose.

The question, though, as posed by the noble Lord, Lord Pannick, is whether it is necessary. As far as I can see, in no part of the Bill is there any indication that where a person finds it difficult to make a decision about an assisted death, or where the possibility of an assisted death has not even entered their head, it would be appropriate for their thoughts to be influenced or guided by another individual. Indeed, the Bill contains specific prohibitions on advertisement and promotion, as well as the offences set out in Clause 34 in respect of inducing a person to seek an assisted death by dishonesty, coercion or pressure.