Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Harper (Con)]

I am going to limit my remarks to a couple of process points, which think are important. I have listened very carefully to those with considerable expertise on the clinical issues raised by these amendments, and I just want to cover these points.

The noble Baroness, Lady Parminter, has just made the point that this loophole has been well understood for some time and was not dealt with in the House of Commons, although it could have been. I gently say, because there is some frustration from the supporters of this Bill about the time taken to scrutinise it, in repeating what I have said before—it is part of the reason why noble Lords are having to table significant amendments and debate this Bill at length—that there are considerable gaps in the Bill that have been known for some time and have not previously been dealt with. The noble Baroness, Lady Parminter, was exactly right to point out that it is this House that will have delivered an amendment to make that considerable improvement, which has been argued for by a number of people for some time. We are doing good work here, whatever people may think of the principle of the Bill, in improving the drafting.

The noble and learned Lord, Lord Falconer, referred at the beginning to whether the Committee would accept this change to the Bill. I make a clear distinction here—and I am going to be very supportive of his position—between this debate and the earlier debate on what he described as drafting amendments. Many of us considered that they were not drafting amendments but quite significant changes, and we made it clear that, if he pressed them, we would oppose him. In this case, his Amendment 87, as amended by Amendment 87A, clearly resolves one issue in the Bill, and that is welcome. I would certainly have no objection if the noble and learned Lord pressed the amendment, and I hope the Committee would accept it, because there is general agreement that it would improve the Bill.

Finally, as has been said by the noble Baronesses, Lady Parminter and Lady Berger, the noble and learned Lord’s amendment fixes one problem. I am not at all an expert in this area, but I understand from those who are that it deals with the issue of anorexia but leaves other eating disorders such as bulimia unresolved, as the noble Baroness, Lady Berger, said. There are other amendments in this group that raise those issues.

I hope for two things. When the Minister responds, I hope that she can commit at a later stage to setting out that, in the view of the Government and the Department of Health, with regard to the span of eating disorders, the Bill will actually deal with them when we have made some more progress on it. That is a factual point, not an expression of a policy position. When the noble and learned Lord responds, as well as pressing Amendment 87 as amended by Amendment 87A, I hope that he can say something positive about what work he will conduct with the Department of Health on drafting some later amendments on Report to deal with the other eating disorders that have been explained, so that we can make sure that there are no loopholes covering any of these eating disorders. As we have heard, they affect a very significant number of people, particularly younger people, and particularly younger women. I want to make sure that we properly protect them as this Bill proceeds through your Lordships’ House.

[Lord Carlile of Berriew (CB)]

My Lords, I signed the noble and learned Lord’s amendment, and I thank him very much for introducing it. In my view, it is a very important amendment. Noble Lords who have seen a serious eating disorder at close quarters will know that it not only disturbs the person who suffers from that eating disorder, but dramatically affects everybody around them. It is all too easy to be fatalistic about it, not challenge it and try to make one’s way through it.

It is a condition that, in my view, produces three possible outcomes. One, in all too many cases, as we have heard, is suicide. For some, indeed in quite a number of cases, there is recovery. However, perhaps most people who suffer from anorexia, particularly at a young age, learn to live with it. It is that living with it that, in my view, is the most important reason for ensuring that it plays no part in the outcomes envisaged in this Bill. For everybody who suffers from an eating disorder—this perhaps particularly needs to be said to teenagers who suffer from eating disorders, whether boys or girls—the important thing is that there is hope of some kind of good recovery, even if it is just learning to live with it. Something that offers such hope should not, in my view, be part of anything remotely resembling this Bill.

[Lord Deben (Con)]

My Lords, I wanted to say, as I have several times pointed out, that one reason why this Bill has taken so long is that the proponents have not been willing to make some of the changes that many of us feel would be perfectly sensible. I therefore thank the noble and learned Lord for this amendment. I think he must also agree that the debate that has followed has brought to the surface a number of issues that need to be considered, and no doubt will be when we get to Report.

However, the reason I rise is just to say to him that I find it pretty unacceptable, when I have sat through almost every moment on this Bill and have learned so much from the discussions that have taken place, for him to suggest that somehow or other we ought to do it more quickly. The fact is that this is a very badly produced Bill. It is opposed by every single organisation representing the people who have to actually do it and by every single representative of disabled people. If this House is not here to go through the details that others have raised outside, I really do wonder what the House of Lords is supposed to be. The noble and learned Lord ought to give some of us credit for the fact that, whatever we think about the Bill, we want to make it as good as it can be. That means we have to discuss it properly.

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It is now nearly 4.50 pm. I will have to leave very shortly to catch my plane, because it is the only plane I can catch. Obviously, I want to stay to hear the Minister’s response to the observations I made and, indeed, to hear the contributions of any other noble Peers. I apologise to the Committee that I cannot do so. Again, it is inappropriate that so many of our colleagues have had to leave for similar reasons.

[Lord Carlile of Berriew (CB)]

My Lords, I will raise a practical problem, which I urge the noble and learned Lord to address, in connection with care homes and nursing homes. The problem has been drawn to my attention—and, I think, that of other noble Lords—by a letter received today from the charity Mission Care, which has 300 staff in and around London and looks after 230 residents, some of whom might wish to apply for assisted death. The point that Mission Care makes is that its staff, by reason of the fact that Mission Care is a committed Christian organisation, en bloc would not be willing to take part in assisted death under the Bill. The effect of that, says Mission Care, is that it would have to close, thereby depriving people of the quality care that they have in those institutions.

I know that the noble Lord, Lord Blencathra, has a visceral opposition to anything arising from the European Convention on Human Rights. However, I have known the noble Lord long enough, and have enough affection for him, to know that he is very practical and that if the European Convention on Human Rights will assist his argument, he will be very ready to adopt it—so I ask him to be patient with me. These amendments, particularly Amendments 110 and 112, which I support, would take the process out of nursing homes and residential homes and into the hands of outsiders.

It is not just a question of Mission Care. Among all the many residential and nursing homes up and down the country, there will be very large numbers of staff who would wish to take advantage of Clause 31(1), which says:

“No person is under any duty to participate in the provision of assistance in accordance with this Act”.


It is the opt-out, and a very important opt-out that I know the noble and learned Lord is committed to as part of his Bill.

If we find that, in nursing homes and residential homes around the country, a significant proportion of staff wish to take advantage of Clause 31(1)—or Section 31(1) if the Bill becomes an Act—it will cause real difficulties for residential and nursing homes. There will be division among their staff, and it may be that those divisions make it very difficult for them to play any part whatever in this scheme if it is made law. I invite the noble and learned Lord to consider this issue further to ensure that those staff are not put in a very difficult position in the exercise of their consciences.

[Baroness Watkins of Tavistock (CB)]

I want to draw attention to the fact that I raised this issue two days previously in Committee. It is essential that we retain staff, particularly nursing staff, who would object to anything to do with assisted dying. That can be achieved, as I said earlier, by enabling people, when they do their advance directives, to be very clear if they never want to have this discussed with them, which I think is completely fair. Nursing homes must also be able to be very clear that they want nothing to do with this in their marketing materials. That is a bit of a tough word, but I think it is real. We must respect the faith and choice of healthcare staff as well as patients or, in this case, residents and their relatives.

However, the vast majority of people who are in long-term care homes rather than nursing homes have cognitive disability, which means that they will not be eligible in this event. It is in the very high-tech nursing homes where people who have very complicated issues might want to choose assisted dying—it might be a 52 year-old with complex disease. I can see that noble Lords want me to hurry up, but I just want to be absolutely clear that we need to get this in context.

[Lord Carlile of Berriew (CB)]

I am grateful to my noble friend for that intervention. She has raised three points, and I want to answer all three quickly. On point one, I absolutely agree with her: we have to respect the views of staff, particularly views that are a combination of professional and philosophical principles. Taking this process out of the nursing home, in accordance with Amendments 110 and 112, does exactly that.

Secondly, advance directives are quite an esoteric issue. I echo what the noble Lord, Lord Deben, said, based on his experience as a Member of another place. There are a number of us here who used to go to nursing homes and residential homes at least twice a year, sometimes taking our children with us to add good cheer. We came out with very different impressions of those homes: the good, the indifferent and, in one or two cases, the really bad. We have to take that into account. In some of those homes, there is practically nobody with an advance directive. Advance directives on the whole are a middle-class thing. Probably most of us here have advance directives of some kind or another, which one has to pay one’s solicitor to produce; one has to pay a lot of money in London, happily rather less out in the provinces. Where there are advance directives, that is fine, but not everybody has them.

I have spoken to the third point, which related to the remarks of the noble Lord, Lord Deben. I repeat that I am making an extremely practical point that ought to be addressed. If this responsibility lies with nursing homes, then it will cause immense difficulty. Also, there is always the risk in the really bad residential and nursing homes that people will be subject to undue influence in the unusual atmospheres of such institutions.

[Baroness Finlay of Llandaff (CB)]

My Lords, I would like to provide some information to the Committee which I think supports these amendments quite well. Care England, which has 122 care providers, consulted its care providers some weeks ago. It found that:

“84% have not been consulted on the Bill or its implications. 24% said staffing would become very difficult due to conscientious objections, with a further 16% expressing similar concerns. Only 14% reported staff being willing to participate in the whole procedure … Only 13% said they could manage assisted dying in their Homes. Only 27% reported 24/7 access to specialist palliative care support on site”.


This demonstrates that the care home sector itself has been very worried about how it would cope with this. Sadly, it also demonstrates just why not having specialist palliative care in scope on this Bill has created quite so many problems.

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[Baroness Merron (Lab)]

It would not be possible in any case to stop it in that way, because it would not invalidate legislation. I am just drawing the Committee’s attention to the fact that it would require further work. As the noble Lord will know, if a court finds that primary legislation is incompatible, it may make a declaration of incompatibility. As I said, although it does not invalidate legislation, it is usual practice for the Government to consider and address these matters.

[Lord Carlile of Berriew (CB)]

I am afraid that the Minister is between a rock and a hard place here. If these amendments are not passed, she might find that the Government are in breach of Articles 9, 10 and 11. I would be grateful if she could consult her lawyers in relation to that matter.

[Baroness Merron (Lab)]

I will consult my lawyers with pleasure.

Lastly, all the amendments in this group address complex issues and, if they were passed, considerable further policy and drafting work would likely be required.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

My final point is another question to the noble and learned Lord, which I would be grateful to him for answering. I do not want to assume his answer, but I expect him to say that the criminal law is there to punish coercion. However, surely our job is to prevent coercion, not to put someone through the court system when coercion is suspected or spotted. Will the noble and learned Lord, either in the Bill or by answering today, explain how coercion will be prevented and how we can make sure that people do not, unwittingly or through force, choose to end their lives when it is not what they want?

[Lord Carlile of Berriew (CB)]

My Lords, I want to make two points about whether these consultations should be face to face. First, I remind the Committee of the General Medical Council’s remote consultation diagram, which is in the GMC guidance. It is not absolutist about whether doctors should see patients remotely or face to face, but it sets out guidance. It starts:

“Remote consultations may be appropriate when… The patient’s clinical need or treatment request is straightforward”.


We are not talking about straightforward clinical needs or treatment requests here. The other side of the diagram says:

“Face to face consultations may be preferrable when… The patient has complex clinical needs or is requesting higher risk treatments”.


As I have said previously, and it is historic, I was a lay member of the General Medical Council for 10 years and I was involved in helping to draft GMC guidance as well as dealing with conduct and health cases. It is unimaginable to me that the General Medical Council would create guidance in which it accepted the proposal that, save from the most exceptional circumstances based on the clearest evidence, such consultations should be done remotely.

Secondly, the medical profession is not the only group of people who have to give important advice to their patients, clients or customers. Like a few other Members of your Lordships’ House here, I have often had to give advice to people in critical situations when they faced spending possibly the rest of their lives in custody. I recall one case when, in the middle of a longish murder trial, the client asked to see me to ask a very simple question, “How do you think it’s going, sir?” The answer had to be robust and realistic, and it was very difficult. It changed the whole course of the case, which came to a quick end shortly afterwards. The result was a minor advantage to the client: he did not spend the rest of his life in prison, just a substantial proportion of it, but that was very important to him.

I would say to your Lordships that it is quite difficult to see a doctor these days, unless you go to a private doctor. Even if you have seen a doctor, it is quite difficult to see the same one twice. There are remote hearings in the legal profession in certain circumstances, but for the sort of important decisions that I have been describing, it is unthinkable—to us, the professional lawyers who do these cases—that such consultations should not be face to face. That is a qualitative analysis based on two examples, but I hope your Lordships found it convincing.

[Lord Sandhurst (Con)]

My Lords, I can be truly short here and it is further to a point made by the noble Baroness, Lady Grey-Thompson. Many of us are concerned about subtle pressure and coercion. It will not appear in all cases, but it will in some and these are legitimate concerns. If this is online, doctors are unlikely to know whether there is someone else present in the room or whether the door is open for someone to listen, nod and encourage the applicant—if I can call the person that—to make their request. If at least one of the panel is present in the room, they would be able to see and counter that. It is really important that there is at least one of those people, preferably the panel, in order to prevent that. That is an important safeguard and, if it is done online, such things could be missed. My recollection is that, in Canada, there have been instances where people, including coroners, have raised legitimate questions afterwards.

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[Baroness O’Loan (CB)]

My Lords, I have put my name to Amendment 66, in the name of the noble Baroness, Lady Coffey. At present, the Bill makes no allowance for any restriction on the possibility of the use of non-human assessment and automated administration devices during the application and decision-making process for assisted death. Obviously, AI will be used for recording meetings and stuff like that—I am not a quill and paper person to that extent—but AI has already been proposed for use in killing patients in the Netherlands, where doctors are unwilling to participate.

The Data (Use and Access) Act 2025 established a new regulatory architecture for automated decision-making and data interoperability in the NHS. It provides that meaningful human involvement is maintained for significant decisions—decisions which may affect legal status, rights or health outcomes. Of course, assisted death would come within that definition.

That reflects the purpose of the NHS. We have talked about its constitution. I looked at the constitution and the guidance. It says that the purpose of the NHS is

“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”.

I know that the noble and learned Lord, Lord Falconer, is going to put down an amendment suggesting that the constitution and guidance will have to be amended, but the current situation is that that is the purpose of the NHS. The assisted suicide of patients is certainly not provided for in the NHS, nor should AI be used in the crucial assessment and decision-making process for assisted dying, given the extreme difficulties in identifying coercion and assessing nuanced capacity, and the irreversible nature of death. What plans does the noble and learned Lord have to address these issues?

In the Commons, amendments were passed allowing the Secretary of State to regulate devices for self-administration. The amendment was not put to a vote; in fact, only seven votes were permitted by the Speaker on the more than 80 non-Leadbeater amendments. The Commons have accepted that devices will be used for self-administration. Of course, the assisted suicide Bill requires self-administration. Nothing in the Bill prohibits a device that uses AI to verify identity or capacity at the final moment. If a machine makes the final go/no-go decision based on an eye blink or a voice command, have we not outsourced the most lethal decision-making in a person’s life to technology? I have to ask: is this safe?

Public education campaigns on assisted suicide are explicitly allowed for in Clause 43. The Government have said that there will be an initial education campaign to ensure that health and social care staff are aware of the changes, and that there would likely be a need to provide information to a much wider pool of people, including all professionals who are providing or have recently provided health or social care to the person, as well as family members, friends, unpaid carers, other support organisations and charities. That controls only government activity. The other observation I would make is that I presume the public education campaign will inform families that they have no role in a person’s decision to choose assisted death, and that the first they may know of an assisted death is when they receive the phone call telling them that the person is dead. It is profoundly important that people know this.

There is nothing to prevent an AI chatbot or search algorithm helpfully informing a patient about assisted dying services and prioritising assisted dying over palliative care search results. By legalising this service, the Bill will feed the training data that makes these AIs suggest death as a solution. I would ask the noble and learned Lord, Lord Falconer, how he intends to police that situation.

There is also a risk of algorithmic bias. If prognostic AI is trained on biased datasets—we know the unreliability of the prognosis of life expectancy—it could disproportionately label certain demographics as terminal, subtly influencing the care options, including assisted dying, presented to them. The National Commission into the Regulation of AI in Healthcare established by the MHRA in 2025 is currently reviewing these risks to ensure that patient safety is at the heart of regulatory innovation. I ask the Minister: will that work cover assisted dying?

The AI Security Institute’s Frontier AI Trends Report in December 2025 highlights that:

“The persuasiveness of Al models is increasing with scale”,


and:

“Targeted post-training can increase persuasive capabilities further”.


In a healthcare context, this raises the risk of automated coercion, where the person interacting with a chatbot or an AI voice agent might be subtly persuaded towards certain end-of-life choices. The AISI has said that safeguards will not prevent all AI misuse. We have to remember that there will be financial incentives to provide assisted suicide; after all, the CEO of Marie Stopes received between £490,000 and £499,000 in 2024. There is big money, even though this will be charitable or NHS work. Clause 5 allows doctors to direct the person to where they can obtain information and have the preliminary discussion. That sort of information could be an AI or a chatbot at the present time.

Dr Sarah Hughes, giving evidence to the Lords Select Committee, said there was a real risk of “online coercion”. With newly developed AI functions and chatbots, we already know there are cases all around the world of individuals being coerced into all sorts of different behaviours, practices and decision-making. There is also an issue of misinformation around diagnosis and prognosis. Hannah van Kolfschooten questioned who has ultimate responsibility if the technology fails. She said:

“In traditional euthanasia settings, a doctor is accountable, but in AI-driven scenarios, accountability could become ambiguous, potentially resting between manufacturers, healthcare providers, and even the patient”.


AIs also have a record of encouraging suicide. We know that, and we have seen terrible cases among young people; they have no regard for human life.

Evidence shows that doctors suspect only 5% of elder abuse cases. Detecting subtle coercion requires, as was said in the previous group, professional judgment to interpret things such as non-verbal cues, body language and discomfort. AI systems are ill-equipped to handle these nuanced, non-quantifiable elements. It is imperative for trust in the system that the individual circumstances of each request for assisted death are recorded and are available for interrogation, or even potentially a criminal investigation, by the panel or another regulatory authority. The only insight as to what happened in the consulting room will come from these records. The patient will be dead. The current provision in the Bill does not provide any protection against the use of AI, which has algorithmic bias, to protect an individual in these circumstances. Can the noble and learned Lord, Lord Falconer, explain how he proposes to deal with these concerns?

[Lord Carlile of Berriew (CB)]

My Lords, I will add only a very short sentence to my noble friend’s excellent speech, and it is what AI says about AI. It says: “AI is technically capable of providing advice or information relating to suicide, but it is critically dangerous to rely on it for this purpose”. Enough said.

[The Lord Bishop of Hereford]

I thank the noble Baroness, Lady Coffey, for raising a very important issue in this amendment. However, I am concerned that, as it stands, as the noble Baroness said, this amendment is too blunt an instrument. It is important that we distinguish between AI tools and the more dangerous artificial general intelligence, or superintelligence. The use of AI in medical diagnostics in patient care is already commonplace. AI tools are currently used to read scans and X-rays and will frequently perform as well as, if not better than, clinicians. To exclude the use of AI altogether might deprive patients who are considering assisted dying of valuable diagnostic assistance and care at a very vulnerable time.

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[Lord Blencathra (Con)]

My Lords, I am very concerned by my noble friend Lord Harper’s amendment to extend the Bill’s definition of terminal illness to include simply the one word, “injuries”. I agree entirely with my noble friend Lord Sandhurst and with what the noble and learned Lord, Lord Falconer, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. I support entirely what the noble Lord, Lord Hendy, said on that, but I disagreed with his general thesis that the Bill should be extended to include all other injuries, because that could take us in a rather dangerous direction.

We all know that some injuries are awfully catastrophic, relentlessly painful and leave no prospect of meaningful recovery. For those individuals, the desire for control over the timing and manner of their death is understandable and deeply felt. If the law permits assisted death for terminal illness, it is in some ways emotionally coherent to ask why a grievous and irreversible injury that will inevitably lead to death should be treated differently. I think the amendment from my noble friend and the suggestion of the noble Lord, Lord Hendy, is born of a humane impulse: to extend compassion to a group whose suffering can be as severe as that of the terminally ill. However, compassion must be married to clarity and caution when Parliament contemplates measures that permit an irreversible outcome. Extending the definition to “injuries” raises serious legal, clinical and ethical problems. I will set out the principal flaws and risks that I see flowing from the proposed change.

First, the term “injury” is legally and clinically vague. What counts as an “injury”? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long-term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort the amendment’s proponents intend. Vagueness at this threshold invites inconsistent application and litigation.

Secondly, I suggest that the proposed threshold—that the injury be “reasonably expected to result in death”—is problematic. Prognosis after severe injury is often uncertain, as it is with terminal illnesses, and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside. Using “reasonably expected to result in death” without a clear evidential standard hands clinicians wide discretion and risks premature decisions made on the basis of an evolving clinical picture.

Thirdly, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contexts where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes. Allowing assisted death on the basis of an early prognosis risks decisions taken before full treatment options have been explored and before the patient has had the opportunity to adapt to new circumstances or to benefit from specialist rehabilitation.

I will not talk about civil law and compensation, because that has already been expertly covered by my noble friends and the noble Lord, Lord Hendy. My noble friend also mentioned the coronial and investigatory consequences which arise, so I will not elaborate on those.

There is a “slippery slope” argument here. Once “injuries” are included—just that one, simple word—pressure may grow to widen eligibility further to chronic disability, psychiatric consequences or non-combat trauma. Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed.

The clinical complexity of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require trauma surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The Bill’s processes must ensure that such expertise is mandatory before any irreversible step is taken, otherwise we risk decisions being made without the full range of clinical knowledge that these cases demand.

In conclusion, if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, higher evidential standards, mandatory specialist review, and explicit protections for families and compensation rights; only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect carefully on the human impulse behind this amendment and on the legal and clinical realities that make adding it to the Bill as currently drafted—with just one word, “injuries”, as my noble friend proposes—deeply problematic.

[Lord Carlile of Berriew (CB)]

My Lords, I return us to Amendment 829, to which I put my name and which was moved by the noble Lord, Lord Sandhurst. I added my name because I share experience with the noble Lords, Lord Hendy and Lord Sandhurst. We have all seen cases in which a potentially huge claim arises under the Fatal Accidents Act which will provide a family with a payment for their dependency on the deceased for many years to come, so these are very substantial claims.

Probably all three of us have done cases for both claimants and trade unions on the one side, and for insurance companies on the other. Insurance companies are very business-like and accurate, but they are not social services organisations. One question they ask their counsel—particularly their leading counsel, their KC—in such cases is, “Are we liable to pay? Is there a point we can make, saying that it does not arise because the death was caused by some other means?” There have been many cases in which novus actus interveniens, which the noble Lord, Lord Harper, referred to earlier, has been cited as a reason for not paying.

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[Lord Carlile of Berriew (CB)]

My Lords, I would never stand in the way of a colleague who has a trial. I hope it is an important trial that will improve general knowledge.

[Lord Wolfson of Tredegar (Con)]

My Lords, I am defending the interests of a Labour-supporting newspaper.

[Lord Carlile of Berriew (CB)]

Well, there we are: we know that the noble Lord adheres to the cab rank rule.

We have heard three very cogent speeches from the noble Lords, Lord Frost, Lord Carter and Lord Taylor, about the suffering point. If we look at the discussion we have had this afternoon, we now have a clear and stark difference between assisted suicide based on suffering and assisted suicide based on choice. I agree entirely with the noble Lords, Lord Frost and Lord Taylor: the public expect this Bill to be dealing with suffering. The public understand this Bill to be dealing with great suffering. They understand that the choice to have one’s life ended is based on great suffering, although it does not say so in the Bill. That must be clarified by the sponsor.

On the other side of the argument, we heard a very eloquent speech from my noble friend Lord Pannick, with whom I have a lot of sympathy. It is not generally known that, as he said, he has very personal experience of the issues arising from this Bill. However, the choice he is suggesting comes very close to being a choice for anyone who is seriously ill, not just someone who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. I fear that those of us who, like the noble and learned Lord the sponsor, are trying to reach the end of our process in the House of Lords on the basis that there will be a Bill, so it must be the best it can be, are not focusing on what choice really means.

We are talking about informed choice, accurate choice, if we can achieve it. I bear in mind very much what my noble friend Lady Finlay said. We are talking about a protective choice: the duty of the state to protect the citizen, even when they are making a choice. We do not, as citizens, have unlimited free choices in what we do; therefore, protection is important. It must be a morally sound choice, because that is part of our polity. We do things that are morally sound, and the Government protect us from those which may not be. It must be a choice founded on medical and scientific integrity: and there is the rub, going back to the points my noble friend Lady Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.

For those reasons, I support the amendments that are focused on choice. I will mention three other amendments that I also support. The first is Amendment 76, which is not in my name but in that of the noble and learned Lord, Lord Garnier, but he is not able to be here for the latter part of today’s proceedings and I agreed to mention it at his request.

Amendment 76 would do something very simple. In Clause 2(1)(b), it would add one word, “direct”, so that a person is terminally ill if, in the amended paragraph (b), their death as a direct

“consequence of that illness or disease can reasonably be expected within six months”.

It may not be the perfect word, but it is about facts and the consequences of those facts. I agree very strongly with the noble and learned Lord, Lord Garnier, that if there is to be a death of someone through the assistance of a third party, which is what the Bill is fundamentally about, then it cannot be just a consequence, or one of the many consequences, of the illness. It has to be the, or at least a, major consequence of the illness. That is the purpose of that amendment: there has to be a bond, as it were, between the illness or disease and the death which ensues.

The next amendment is Amendment 93. It suggests leaving out Clause 2(3) altogether as it lacks clarity as to when an assisted death would be permitted. The subsection says that

“treatment which only relieves the symptoms of an inevitably progressive illness or disease temporarily is not to be regarded as treatment which can reverse that illness”.

What if the relief that is provided for an inevitably progressive illness provides not only relief from the symptoms but extra time to the person who is suffering from the illness or disease? I argue that if it allows extra time, the individual concerned will be having a new experience: they will be seeing what can happen if their symptoms are relieved. They need to discuss with their medical advisers whether they can have that relief of their symptoms again and whether it will prolong their life if they do. The relief may cause a fundamental change of heart by the individual. Therefore, I do not believe that there should be any possibility of the six-month period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given so that the person concerned can have an informed choice.

The third amendment is Amendment 96, which suggests leaving out Clause 2(4), which says:

“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)”,


followed by an important further sentence that I will not read out because of time. This subsection fails to deal with the proportionality between the disease, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers. It is a complex little conundrum, but a very important one. I believe that proportionality needs to be clarified so that the Bill can be the best possible Bill we can have.

We have much still to learn about the issues that have been under discussion. I invite the noble and learned Lord, Lord Falconer, to consider these carefully and present some draft amendments to us before we meet again in a week’s time.

[Lord Blencathra (Con)]

My Lords, I seek a cast-iron assurance from the Government Whip that those of us whose speeches will be delayed till next Friday are recorded by the Government and will be allowed to speak. That is all I want to say at this stage. We want an assurance that we will be allowed to speak next Friday if we delay our speeches from today.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

I apologise for interrupting the Minister, who is being extremely helpful, but one point needs to be clarified as a result of what she just said. I understood the Government to say that, if an amendment is passed on Report, assistance will then be available of the same kind that was available to the sponsor, so that the amendment can become workable in the context of the Bill and other law by the time the Bill is passed. That was a very clear understanding given to me in various quarters. Are we hearing now that that facility will not be given if an amendment is passed on Report? If so, why?

[Baroness Merron (Lab)]

I am not sure that there is that difference, but I will review the Hansard of this debate and ensure that I come back to the noble Lord and place a copy of my response in the Library. I am not entirely clear about the point the noble Lord is making. I realise that that is disappointing for him.

[Lord Carlile of Berriew (CB)]

I will intervene only once more. It seems to be fundamentally necessary that, if an amendment is passed on Report that changes something put in the Bill by the sponsor, who has had the advantage of the consultation process we have discussed at length in these proceedings, the same attention should be given to it—and I am sure that is exactly what the noble and learned Lord expects. Otherwise, we run the risk of asking people like the noble and learned Baroness, Lady Butler-Sloss—if there is anyone like her—to move the goalposts, rather than do what she really does, which is be extremely nimble between the goalposts.

[Baroness Merron (Lab)]

I am grateful for the clarification on goalposts moving. What the noble Lord is saying is correct, and there is not going to be any change to what has been said previously. I hope that he and your Lordships’ House will forgive me if I have not put it as clearly as certainly the noble Lord would have liked. I will still make a review of the words and ensure that everything is clear. I hope that will be helpful.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, and I certainly will consider it, but I think it is important that we have a discussion about what I regard as a compromise Motion, which may be useful in the discussions noble Lords have with the sponsor or those who wish to proceed in that way.

[Lord Carlile of Berriew (CB)]

Would the noble Baroness, for whom I have a great deal of respect, consider whether she is really adding anything at all to the debate by continuing? We can read her amendments; we know the difference between 18, 21 and 25. I and the noble and learned Lord, with whom I do not disagree on the fundamental principle behind the Bill, are both of the view that we should have proper discussion on it and get through Committee in the way that is expected of us as the House of Lords, so when the noble and learned Lord intervenes and says he is willing to hold meaningful discussions, we should do that and move on to the next business.

--- Later in debate ---

The noble Baroness, Lady Coffey, commended a test of domicile. Domicile is one of the most complex legal concepts that we have. There is domicile of origin, domicile of choice and domicile of operation of the law. In my opinion it would be disastrous for us to incorporate such a concept into this legislation, not least because I can have domicile in this country simply because it was the domicile of my parents when I was born. I could have lived my entire life in the United States, France or wherever, but would be able to come back to this country to benefit as a health tourist and take advantage of this Bill if enacted. That is exactly what we all want to avoid. Domicile should be ruled out. I hope that the noble and learned Lord, when he responds, will confirm that.

[Lord Carlile of Berriew (CB)]

My Lords, I agree with my noble friend Lord Pannick. The concept of residence is clearly understood. I recommend to the noble Lord, Lord Moylan, that he might need a criminal lawyer just in case he was prosecuted for doing something wrong. I would be very happy to act for him, of course.

I recommend that all of us who are considering this matter should have a good look, as I have, at the National Health Service ordinary residence tool, which was revised in March this year. It gives a very clear outline of all the possibilities and where they fall in the ordinary residence judgment. What concerns me about the example that the noble Lord, Lord Moylan, gave, which we will come to on another group, possibly even today, is that if somebody has been living in Spain and wants to come back to their former country of ordinary residence for an assisted dying, if this Bill becomes law, it will prove extremely difficult to detect where there has been undue influence, particularly within a family. It would be extraordinarily difficult to investigate that evidence, whether it was done by a court or by a panel. I would be opposed to it on those grounds.

[Baroness Butler-Sloss (CB)]

I also entirely support, including the word “disastrous”, the points that the noble Lord, Lord Pannick, made. As he said, domicile is complex. You would end up in court dealing with the issue of domicile. It really is not a good idea.

Under Clause 1(1)(c), there are two requirements. One is “ordinarily resident”. I say to the noble Lord, Lord Moylan, that if I was trying the case I would have no problem at all. If it says “ordinarily resident”, that is what I would accept, so long as there was the evidence to support it. I do not think we need to be caught up in the Human Rights Act in dealing with such an issue. What worry me are the two requirements,

“ordinarily resident … and has been so resident for at least 12 months ending with the date of the first declaration”.

That seems to be a complete bar for someone who is in an embassy. It is very difficult if they are not ordinarily resident. It looks as though the noble Lord, Lord Carlile, does not agree.

[Lord Carlile of Berriew (CB)]

I hesitate to interrupt my noble and learned friend, whom I regard as being of almost biblical correctness in almost everything. If she were to take a look at the NHS tool that I referred to, which sets out all the requirements to prove ordinary residence, she would find that people who work in embassies, for example, are excluded because they are given fixed-term contracts for a certain time, even though that contract may be extended at some time. It also specifically refers to people who work for charities and who go to work abroad for a temporary period fixed by a contract. I do not think the issue that she has raised is very worrying.

[Baroness Butler-Sloss (CB)]

I am delighted to hear it in relation to embassies and charities, but the other example given was the person living in Spain who wants to come back to die here. It seems to me that needing to be resident in this country for the last 12 months would not allow that person to do so. The noble and learned Lord might just look again at that particular element of residence.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Berridge (Con)]

I will just reply to the noble Baroness, then, that within the Bill that is not necessary. I have outlined Clause 10. This applies to the people who are verifying in the process, not to the individual. It was not in the Motion your Lordships’ House approved that that evidence should be taken.

To continue, Dr Annabel Price said:

“Pressure has a broader definition of perhaps strong encouragement, expectation or the worry of letting somebody down”.


The noble Lord, Lord Patel, joined in this mini focus group and asked:

“If I were to use the word ‘pressure’ and if I were to use the word ‘coercion’, how would you interpret the two?”


Professor Mumtaz Patel from the Royal College of Physicians—again opposed to the Bill—said, “It is grey”.

Amendment 846 also reflects the view of the Law Society, which is neutral on assisted dying but opposed to the Bill. Kirsty Stuart said:

“I think it is really difficult because there is not a definition at the moment … in the Bill”.


That is why Amendment 846 is based on the statutory guidance principle from the offence of coercion under the Serious Crime Act. I note that the Home Office has recently had to issue 91 pages of statutory guidance on that offence. It seems the courts are struggling with it.

Even if Thomas Teague is right that you look at the dictionary, are we talking about economic pressure, emotional pressure, financial pressure, spiritual pressure, reputational pressure, internalised or externalised pressure, or pressure of circumstances—for instance, no one provides you with a hospice bed? As Dr Suzanne Kite, from the Association for Palliative Medicine, said:

“We know that there are pressures of, ‘Can we afford the electricity for the oxygen supply?’ … Yes, these are issues”


that people face “on a daily basis”. The Bill is silent as to what kind of pressure is meant.

To move from individual sources of pressure, there can also be group sources of pressure. Alasdair Henderson, from the Equality and Human Rights Commission, spoke to the Select Committee about

“this wider issue of coercion or pressure at a societal level or an attitudinal level”

and

“the broader trends or cultural issues”.

He said that

“pressure is not always applied directly by another individual, but can result from attitudinal barriers, particularly around disability, and lack of services and support in society as a whole”.

Could pressure come from NICE refusing you, on value-for-money grounds, the drug that you think will wipe out your metastasised cancer? Indeed, the pressure could emanate from the Chancellor of the Exchequer in her Budget, or from the Secretary of State for Health and Social Care, to encourage vulnerable people to take assisted dying, a matter I put to the Government Minister, Stephen Kinnock.

Caroline Abrahams of Age UK said:

“The context again for this is a system in which adult safeguarding is under acute pressure because local government is under such acute pressure”.


The British Association of Social Workers also said that unless these statutory services

“are adequately resourced, that may bend people’s decision a certain way … much of social care is self-funded now. If you are poor and you cannot have access to those personal resources, even more pressure is applied to you”.

I look to the noble Lord, Lord Pannick: how does a medical practitioner sign to say that this kind of pressure—from culture, society or attitudes, or lack of statutory services—is not being put on the individual?

There was unanimity in the Select Committee when we started asking the professionals about training. I said that pressure

“is not defined in the Bill, so I am afraid I cannot help you. We have no definition in the Bill. You are going to need training, though, in pressure. Has any of you received any training like that?”

Professor Nicola Ranger from the Royal College of Nursing, Professor Mumtaz Patel of the Royal College of Physicians and Dr Michael Mulholland from the Royal College of GPs all said no. So we now have additional costs added to the Bill, because we have to devise training in pressure and deliver it to a whole raft of professionals, care staff, et cetera, so that they understand it, in particular bearing in mind the vulnerability to criminal prosecution that exists in Clause 34.

I am going to give the noble and learned Lord, Lord Falconer, this opportunity to shorten Committee proceedings. Deleting “pressure” from the Bill, when it has not been consulted on and has not been subject to pre-legislative scrutiny, would aid the Committee in evaluating the Bill.

[Lord Carlile of Berriew (CB)]

My Lords, in a group such as this, which has so many conceptual, linguistic and semantic alternatives on offer, it is very difficult to see how a Committee stage such as this is going to help very much in determining a final solution to the matters under consideration. Therefore, it could become very tempting to enter into the nice and easy solution suggested by my noble friend Lord Pannick, to the effect that the Bill is quite enough and provides sufficient protection. It is right to say that the Bill certainly seeks to provide sufficient protection, and I do not in any way attribute anything other than good motives to those who sponsor the Bill, in particular the noble and learned Lord, Lord Falconer.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

If I could just finish. It has been a long time in this debate without hearing from my side—I want to come on to something that the noble Lord, Lord Deben, said anyway.

The amendments to this Bill are about coercion or pressure. As stated by the noble Lord, Lord Pannick, the situation at the moment is that people can go to Dignitas without even proving to a doctor that they are dying, and without any check as to whether there is coercion or pressure, or whether someone is going to inherit their house. They can go, and that is the way they end their life, and they feel it is not worth living any longer. On the definition of coercion, are we really content with continuing the status quo where there is absolutely no check—from a psychiatrist, a social worker, a lawyer, or anyone else—on whether they have been coerced? That is the alternative: allowing the status quo to continue with no checks whatever.

We have to ask, therefore, whether these discussions about definition are really about that, or whether they are about trying to stop the Bill. Perhaps we could discuss whether those who want the wording changed would then support the Bill. If they would, let us get down to discussing that, but if they are never going to, they are wasting the time of those who want it to go through.

[Lord Carlile of Berriew (CB)]

My Lords—

[Noble Lords]

Order!

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

I was not suggesting wasting time. I was asking whether, if these changes were agreed, people would then allow the Bill to proceed.

[Lord Carlile of Berriew (CB)]

Before the noble Baroness sits down, I have great admiration for her, but I and many others resent her waving her hands at us. The reason we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgment as to whether we are prepared to support the Bill, or to be silent on whether we support the Bill, or to oppose it at Third Reading. It is unworthy of the noble Baroness to allege that all of us here who are expressing concerns are wasting time. It is not true, and it is what she said.

[Baroness Hayter of Kentish Town (Lab)]

I never said that about wasting time. The words did not come; I did not say them. I was asking whether the people who want a better definition will then be able to support the Bill.

Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

My Lords, I do not know if I am alone in being frequently asked by people, from time to time, “What is the point of an unelected House of Lords?” I now have the absolutely mind-blowing answer, which is to refer them to these two days of debate on this really difficult subject and the range of expertise which we have heard.

I am speaking because I tabled an amendment. That was last Friday, so some noble Lords may have actually forgotten what it said. It called

“upon His Majesty’s Government, in the light of the 32nd Report from the Delegated Powers and Regulatory Reform Committee, to ensure sufficient time is available for consideration of amending stages of this bill, and to provide full support at ministerial and official level to the peer in charge of the bill for its remaining stages in the House of Lords”.

Despite the differences that we have heard in these two days of debate, there is a clear and absolute consensus across the House that the Bill is in need of amendment and further scrutiny.

I listened very carefully to the speech of the noble Baroness, Lady Berger, and I see her amendment. I am a little doubtful about how a Select Committee—which is not really a Select Committee because it is not going to produce a report; it is simply going to hear evidence—is going to change or alter the noble Baroness’s opinion on this matter, or indeed anyone else’s. However, it means we cannot actually start that task until 7 November, so we have lost some time.

As many speeches pointed out, none of us knows when and how we are going to die; none of us even knows when the end of the Session is going to be. So, between 7 November and the end of the Session, having listened to all the speeches and thinking of the number of issues that are going to have to be addressed, I venture to suggest that four Fridays for private Members’ legislation, unless we are going to completely destroy the prospects of other people with Private Member’s Bills, are not going to be sufficient time. It therefore seems essential that the Government provide time.

I understand why they do not want to do that: if I were in government and in the Prime Minister’s Office, I would be saying, “But that means we won’t have time for this, that or the other”. But this is an absolutely life-and-death issue and it is important that it is considered properly and put on the statute book, if it is to be put on the statute book, in a way that will satisfy my noble friend Lord Wolfson of Tredegar in his brilliant speech. He showed that what we are doing here is making legislation and we should put legislation on the statute book that has been properly thought through, which means that there has to be government time.

I happen to know that the Cabinet Secretary advised the Government that this should be treated in the way that all Private Members’ Bills dealing with matters of conscience are. Abortion, the death penalty and the decriminalisation of homosexuality were Private Members’ Bills that the Government took on board in order to ensure that they had proper time and were properly supported, and I do not—I was going to say “for the life of me”—understand why that should not apply to this Bill, having listened to these two days of debate. I suspect it might be because the Health Secretary and the Justice Secretary were opposed to the Bill—but we are told that the Government are neutral, and therefore I do not see why they should not provide that time in order to satisfy those people who have written to us on both sides of the debate.

I say to the right reverend Prelate the Archbishop of York, who threatened to vote down the Bill at Third Reading, that I hope he will think again about that. The expectations are sky high and to vote down a Bill that had not been properly considered or given enough time would put this House in a very awkward position, for no good reason. Our duty is to scrutinise the Bill, send it back to the House of Commons and ensure that we have the time to do a proper job.

[Lord Carlile of Berriew (CB)]

My Lords, noble Lords may recall—but I will remind them in case they have forgotten—that I tabled an amendment to amend the amendment from the noble Lord, Lord Forsyth, because it seemed to me that the noble Lord wanted to turn this Bill into a government Bill and give it all the authority of a government Bill, with a Minister in charge, or by putting the noble and learned Lord in the position of being a Minister. However, I have listened to the noble and learned Lord and he has said—absolutely rightly, and I totally agree with him and the noble Lord, Lord Wolfson—that this absolutely should be, and should remain, a Private Member’s Bill.

I have also looked at the potential effect of the amendment to the commitment Motion from the noble Baroness, Lady Berger, who I think has approached the Bill with great energy, superb intelligence and good judgment, and has done great credit to the House. Having considered that and the state of play as it is now, I think it is right that I should withdraw my amendment so that we can move quickly on to other, more substantive matters. I beg leave to withdraw the amendment.

Amendment (to the amendment) withdrawn.

Mental Health Treatment: Waiting Times

Lord Carlile of Berriew Excerpts

Monday 3rd February 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend’s assessment of the impact of what is a totally unacceptable situation, particularly for children and young people. On the point about ensuring delivery locally, I refer your Lordships’ House to the NHS planning guidance, published last week, which not only confirms our commitment to the mental health investment standard but sets out an objective to increase the numbers of children and young people under 25 accessing services in the forthcoming year compared to 2019.

[Lord Carlile of Berriew (CB)]

Does the Minister agree that the long delays experienced by released prisoners in accessing necessary mental health care simply oil the revolving door of their return to prison? Will the Government give high priority to dealing with that problem?

[Baroness Merron (Lab)]

We are extremely aware of the point the noble Lord helpfully makes. The matter of severe mental illness in prisoners has come up repeatedly in Committee on the Mental Health Bill, and we will continue to work to address the points he raised.