Terminally Ill Adults (End of Life) Bill

Debate between Lord Empey and Baroness Fox of Buckley

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Empey (UUP)]

My Lords, I will speak to Amendment 89. I think that everybody in the Committee is more or less on the same page in what we are trying to achieve here. This amendment would add,

“or withdrawing medication, hydration, or life-sustaining devices”

to Clause 2(2). This has perhaps been forgotten about, but people sometimes rely on ventilators and other equipment to sustain their lives, so it is not a big leap forward to add this to the legislation. It is simple and straightforward, and amending Clause 2(2) seems to make sense. I cannot think of any reason why the noble and learned Lord should not adopt the amendment as a sensible way forward. It indicates—we have had this conversation a number of times, but we have to bear it in mind—that there are still significant weaknesses. We have to make the Bill safe.

On the hostile reaction to what we are trying to do here, I gently remind the Committee that when we last discussed this subject on 22 October 2021, at the Second Reading of the Assisted Dying Bill that Baroness Meacher brought forward, her Private Member’s Bill had 10 pages and 13 clauses. The Bill before us has 51 pages and 59 clauses. People have to understand that this is a massive Private Member’s Bill and is not normal in terms of how we deal with such Bills—it is much bigger. With that, I hope that the noble and learned Lord will have no difficulty in accepting Amendment 89.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak to my Amendment 103. I thank the noble Baroness, Lady Hollins, for adding her name to it. It is a modest amendment simply seeking to ensure that a person is not categorised as terminally ill if they have refused life-saving treatment because they are influenced by a mental disorder. The noble Baroness, Lady Keeley, was perceptive in addressing some of the issues that concern me and are why I tabled this amendment.

We are talking about any individual who, in effect, voluntarily brings themselves within the definition of terminal illness as defined in the Bill. As we heard on the previous group, supporters of the Bill often present the six-month prognosis as clear-cut and argue that we all know what we mean by terminal illness. In public discussions, the example given is usually cancer, which again seems fairly clear-cut. But we heard on the previous group that life and death and diseases are rather more complicated. The noble Lord, Lord Moylan, raised some very thought-provoking issues around that.

I want to make a bit more concrete what terminal illness would mean in the examples that I talk about. I have noted that the noble Baroness, Lady Coffey, started this theme in the previous group, and I was very affected by the moving speech made by the noble Lord, Lord Farmer, which also pertains to this. Where someone suffers a serious depressive episode, perhaps related to a debilitating physical illness that is difficult but none the less treatable, what would happen if, in a temporary period of despair, they refuse treatments such as dialysis or HIV antivirals, therefore potentially leading them to a terminally ill prognosis? Would they be eligible for assisted death in that instance?

Or let us take the case of a suicidal person, perhaps a prisoner suffering mental distress, who has attempted to take his own life several times before but suicide prevention policies have saved him. I think in particular of prisoners I have long campaigned for who are on IPP sentences. Tragically, suicide figures among that group of prisoners are very high and suicidal ideation is a real factor for those prisoners. Our imagined prisoner is not just mentally disturbed but physically dependent on insulin for diabetes and needs to take it to remain alive. If that person refuses to take that treatment and becomes seriously ill, bringing upon himself the inevitability of having a progressive disease and it becoming terminal, would he be eligible for assisted death under this Bill?

This example would seem to contradict the slogan of many of the Bill’s supporters, which we frequently hear: “They’re dying anyway”. As it happens, it is a phrase that I find particularly chilling, but, in this instance, they would not be “dying anyway”; they would be dying in a self-induced way. How will the idea of terminal illness in such instances be weighed up? In the case of our IPP prisoner refusing to take treatment such as insulin—perhaps even refusing to eat or drink—this could lead to an inevitable assisted death, because he would meet the physical criteria of terminal illness when, actually, the root cause was not inevitably progressive.

I like to imagine that we as parliamentarians, along with campaigners, will be successful in ensuring that IPP prisoners are freed from the hopelessness of an abolished prison sentence that psychiatrists uniformly and consistently say is a major factor in making people suffer mental illness in prison. If the IPP was ended, that prisoner could resume their medical treatment and their mental ill-health would have changed because the social circumstances would have changed. Therefore, they could resume their treatment, start engaging again, feel that they have a reason to live and become treatable, with recovery possible—but not if it is too late as they have already had an assisted death. In other words, terminal prognosis is not inevitable in that instance but self-induced, driven by a disturbance of the mind.

The noble and learned Lord, Lord Falconer, has some insight into the issues in this amendment, as he has explained. He has tabled an amendment and talked about any disease caused by a person not eating or drinking when that occurs as a result of mental disorder. Obviously, the focus there is on anorexia and eating disorders, but is this not a similar example?

I raise these issues because this is a loophole that has been nagging at me. I cannot see anywhere in the Bill where safeguards exist to prevent such undoubted unintended outcomes. Without those safeguards, the drafting of the Bill could inadvertently incentivise self-destructive choices about treatments for illnesses that are treatable, and lead to irreversible early death facilitated by state medical services when life-saving medical treatments could have ensured that people lived and were not categorised as terminally ill. It is this confusion—about who defines terminal if you put yourself into that category—that I would like the noble and learned Lord to reassure me about and clarify.

Terminally Ill Adults (End of Life) Bill

Debate between Lord Empey and Baroness Fox of Buckley

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank the noble Baroness, Lady Monckton of Dallington Forest, for that excellently clear way of expressing some of the discomfort and what we would like to see. I would be much happier and feel that I did not have to speak too much if I was getting reassurance and seeing on paper what exactly will address our concerns. At the moment, we are not getting that. We wish the noble Lord, Lord Shinkwin, were here. The fact that he is not is a real shame for the quality of this debate.

Inside and outside this House, I know plenty of people who support assisted dying and this Bill, inasmuch as they know the broad sense of what it is about. I try to avoid living in echo chambers. Whenever we discuss why they support the Bill, and potentially have a bit of an argument, they invariably say, in a very humane and compassionate way, that they think it will help people who are suffering, and that anyone who says they are suffering should have access to assisted dying. It is assumed, therefore, that the motivation of illness-induced suffering is at the heart of the Bill. That is what most people think. It has come up a lot in this Chamber but, ironically, suffering is not mentioned in the Bill, and neither is there any reference to motivations in the way that one would imagine. That bothers me, because the Bill checks on capacity, prognosis and residence, but it does not enforce a check on motivation. It seems to me that we should ask somebody who says that they want assisted dying, “Why?” It is a crucial absence in the Bill, and I hope that the noble and learned Lord, Lord Falconer, might rectify that or explain exactly why the Bill does not think that doctors should ask, “Why do you want assisted dying?” I think it would throw up a whole range of red flags in relation to coercion.

I have added my name to two amendments in this group, Amendment 30 in the name of the noble Baroness, Lady Foster, so ably moved by the noble Lord, Lord Weir of Ballyholme, and Amendment 56 in the name of the noble Baroness, Lady Coffey. To save time,I will concentrate on Amendment 30, which seeks to ensure that those who seek assisted dying are not substantially motivated by a number of factors. I will focus on two of those—not wanting to be a burden on others or public services, and not being motivated by mental disorder, including depression.

This week was the 29th anniversary of the death of my father, John Fox. He was only 66. He was diagnosed with cancer and given three months to live, although he actually made it for four and a half months. When he was told, the whole family was devastated, as anyone would be. The one thing that really shocked me to the core, and stays with me, was that when I had that initial, very emotional father to eldest daughter conversation, my father kept apologising. Believe me, that was not usual. In our relationship, he did not say, “Sorry, Claire” lots of times. He was so distraught. He was convinced that he would be a burden on us, and that his daughters and my mother, in looking after him, would all have to miss work and all the rest of it. He kept saying, “I’m really, really sorry”. He was worried about how we would cope. He did not want to distress others—a point that the noble Baroness, Lady Lawlor, was making on her amendment to this amendment.

I also noticed that he kept saying sorry to the nurses and the doctors. To everybody, he kept saying, “I’m really sorry for taking up your time. I’m really sorry that you’re having to give me so much attention”. There were stories in the media at the time about bed blocking. He was a vociferous reader of newspapers, and I was hiding the newspapers because I thought he would say sorry even more, convinced that he was taking up NHS resources. It took some time and determination for the family to reassure him, but I kept thinking afterwards how sad it would have been if he had been on his own or in a care home or whatever. To be honest, if a GP had suggested that assisted death was a medical option, in today’s circumstances, I think my father would have said yes—not because he wanted it but because he felt he was a burden on the family. It would not be the GP’s fault, as it is an internal feeling of being a burden. That is not the same as choice.

I was struck by a letter from Lord Sumption in the Times that is worth reflecting on. He says:

“The current bill contains a number of provisions designed to ensure that patients are not ‘pressured by any other person’ into taking their own lives”—

that was in relation to something else. He continues:

“The real problem, however, is not the pressure applied by ‘other persons’. It is assumptions which many old and ill people spontaneously make about the attitudes of the society around them. They are afraid of being an emotional or financial burden”.

That is very important.

By the way, I had better say that, in the four and a half months following his diagnosis that my father lived, we had some of the most meaningful time of our lives with him. It was through a veil of tears, but there was love, joy and reconciliation, there were conversations that would never have otherwise happened, and so on and so forth. It was a time that was important to him and to us as a family in a way that I cannot really describe.

Another motivation that I feel strongly we need to explore is on the part of those with a mental disorder. As many noble Lords have noted, a number of mental health conditions have suicidality as a feature. Again, I am sorry to do the personal stuff, but the first time I encountered that was as a young mental health community worker. I met a young man who was bipolar. I and others—psychiatric medics and social workers—worked hard not just to prevent his suicide but, using all our skills in pharmacological and psychological interventions, to alleviate the terrible “black dog” of depression and the horror of the obsessive suicide ideation that that young man had. I have to ask, then, whether the Bill would allow such a suicidal person’s depression-induced desire for death, and whether all those who had worked with him would suddenly be expected not just to welcome it if this young man made the choice of an assisted suicide but to say, “Oh, look, a perfect exemplar of autonomy and choice”.

I was therefore a little taken aback that the noble and learned Lord, in his summation of the last group on eligibility, said in relation to those with a mental disorder that it is their choice, and that if they want it and they have capacity then that is all right. I point out that, for anyone who wants to commit suicide, it is their choice and they want it, but some of us spend a lot of time asking them please not to do it, not saying, “Yippee!” I cannot think that, in that situation, if that young man had said, “I’ve got a terrible story. I’ve got a terminal illness in addition to my bipolar depression, and I want your support and help in assisted dying”, I would say that it is all perfectly fine and he should get on with it, and be delighted for him being able to show that he is a free, autonomous individual. I would say, “Please don’t”. The four and a half months that we had with my father was the kind of quality time that I would want to ensure that young man had, every day of his life, even if he was terminally ill and dying. I would want to make sure that he was not depressed or suicidal during the time he lived.

[Lord Empey (UUP)]

My Lords, I am associated with some of these amendments. I do not think we want to get completely hung up on the minutiae of each particular line, because there are variations that one could make. I guess that when one is drafting a Bill there are choices to be made and language can be better if one gets professional assistance.

The fundamental point, as has been outlined by the noble Lord, Lord Weir, and the noble Baroness, Lady Fox, is that anyone here who has represented an inner-city, working-class constituency will know that the approach that a lot of people have towards doctors and the medical profession is perhaps different from the approach that we have. If we want medical assistance, I guess most people in this room can pay for it if they so wish. That is not an option that other people have.