Terminally Ill Adults (End of Life) Bill

Debate between Lord Falconer of Thoroton and Baroness O'Loan

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness O'Loan (CB)]

I thank the noble and learned Lord for yielding. I simply wanted to say that a number of Members of the other place have said that the Bill did not receive proper scrutiny in the other place. They have also said that they expected that it would receive scrutiny in this place because that is what we do. That is profoundly important, and I do not think that what the noble and learned Lord just said is actually correct. I would also say that there were a number of amendments tabled and a number of MPs who wanted to speak who were not permitted to do so. That is reflective of the fact that the Bill did not receive proper scrutiny in the other place.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness for her intervention. I have laid before the House the facts. I recognise that some Members of Parliament say that the Bill was not given proper scrutiny. I wonder if those were Members of Parliament who did not agree with the conclusion—I do not know. I have laid before your Lordships the time that was spent and the fact that it got more scrutiny than government Bills.

The essence of this Bill is that those who are terminally ill—and that means that they have a diagnosis that they will die within the next six months—should have the option, subject to safeguards, to be assisted to take their own life. One of the features of this debate was the personal experience that so many people have had of how, had that option been available, it would have ended terrible suffering. That suffering is not often about the pain but about the lack of dignity and the profound desire to keep control, because that is what people want.

I believe, from my own experience and from talking to so many people, that having that option is important. The points that have been made against it, which I have listened to incredibly carefully, are, in essence, not that people should not have that choice but that it brings dangers with it. The dangers are, first, that people will be overpersuaded and, secondly, that it will affect society in other ways.

On the idea that people will be overpersuaded, the Bill provides for the following: first, a conversation with the doctor in which all the options, including the palliative care options, are laid out; secondly, that a doctor decides that it is a free choice; thirdly, that a second doctor decides that it is a free choice; and, fourthly, that a panel, consisting of a senior judge or a King’s Counsel, a psychiatrist and a social worker, concludes that the person is not being coerced, that they are capable of making the decision and that it is their free choice. As it happens, that is probably the most safeguarded procedure in the whole of our healthcare system. It is certainly the most safeguarded process when compared with terminal illness Acts in other countries in the world.

I profoundly believe that people should have this choice—a profound belief that is based not on either my spirituality or my lack of spirituality, but on looking at the evidence from other countries that this will not lead to people being overpersuaded. I have in mind those countries that already have a terminal illness Act. The one that has been in force for longest is the one in Oregon, but there are many other states in the United States of America that have terminal illness Acts that have been in force for 20 years and more. They do not have those safeguards. They do have annual reports and record-keeping of the highest sort about assisted death. They show no evidence of the coercion that some noble Lords referred to in this debate.

I would have expected that, if there were real evidence of that, somebody in the course of the debate would have referred to a case from one of those countries where there is a terminal illness Act showing that there was coercion. There was none. I am convinced, first, that the Bill has had proper scrutiny in the other place and, secondly, that there is no real danger in relation to coercion. Thirdly, I completely accept the point made by noble Lords who said in this debate that they wanted more palliative care—I want more palliative care, and we should do everything we can to promote it. However, as so many people said, it is not either/or—it is both.

Some 75% of people in Victoria, Australia, who have had an assisted death came from palliative care, and 92% in Oregon came from palliative care. The Select Committee in the Commons to which I referred, which reported in 2024, said that palliative care in many jurisdictions went up in terms of its resources. In answer to the question that was raised about what the effect will be on palliative care: on the basis of other jurisdictions, it will get better. In fact, the debate here has provoked the Government to spend more money on palliative care.

Many noble Lords have talked about language. I take no point about language. I simply say this. For over 10 years of having been engaged in this debate, I have found that, for people who are terminally ill and want an assisted death, nothing upsets them more than saying that that is suicide. They hate that because of the impact it has on those they leave behind. What they feel is that they are dying anyway, and what they want is some degree of control over when and how it will happen.

I turn briefly to what happens next. I very much welcome my noble friend Lady Berger’s Motion to set up a Select Committee that can hear evidence. I very much welcome that it is time-limited, because, as my noble friend and I indicated in the letter we sent to every Peer, it allows for the Bill to go through all its phases after 7 November. I will therefore support my noble friend’s Motion to set up a Select Committee.

We have a job of work to do. I agree with everybody that, plainly, this House must give the Bill a Second Reading. We must listen to the evidence that my noble friend Lady Berger’s Select Committee will supply, and then we must do what we do so well, which is scrutinise and amend the Bill as necessary, and then send it back to the other place for a decision.

I have heard some noble Lords say, “Oh well, we can say no to this Bill”. Ultimately, on an issue such as this in our system, somebody has to decide. It is not the electorate because it is never in anybody’s manifesto, with the exception of the Greens. Therefore, Parliament has to decide. Ultimately, in our system, that means it will have to be those who are elected—not those who are unelected—who make that decision.

I end by expressing my profound gratitude to the House for the attention and quality of the debate it gave to the Bill. I commend this Bill to the House.

Assisted Dying Bill [HL]

Debate between Lord Falconer of Thoroton and Baroness O'Loan

Friday 16th January 2015 Lords Chamber

[Lord Falconer of Thoroton]

I could answer that, but the noble Baroness has tabled a later amendment. I am not at all unsympathetic to what she is saying—although I think that it is adequately dealt with by the Bill—but I do not think that it is appropriate to be taken into that debate when we are dealing with other amendments. I am sorry, but I do not think that that is an intervention to which I should appropriately respond, because other people have made contentions in the course of the debate. With respect, to hive off into the noble Baroness’s later amendment does not seem a sensible way to conduct our business. I am sorry.

[Baroness O’Loan]

I should like clarification from the noble and learned Lord. I think he said that Clause 2 required two practitioners, but on my reading it requires only one. If there is one practitioner and a person is diagnosed with a terminal illness, the terminal illness is, if you like, the gate into everything else in the Bill. That I have a terminal illness allows everything else to follow. If one doctor diagnoses a terminal illness, there is the possibility that that doctor may do so at the behest of relatives. The motives of those relatives may be benign or malign. If the person gets a diagnosis of that kind from a medical specialist, that may change their whole perspective on life. The mere fact that someone has said to them, “You are terminally ill. You are going to die in six months”, when that has not been said before, may lead them to think, “Perhaps I should seek assisted suicide”.

That may be quite an unintended consequence of limiting this, but at least if we have two doctors, in some form or another, as suggested by the amendment of the noble Lord, Lord Carlile, surely there would be some protection. As I read the Bill as it stands, there is very little protection for the vulnerable person who is lying in bed and seeking some way to find a way through this. Terminal illness and serious pain have a number of effects. One is to cloud judgment and another is to sap the zest for life. That zest, as the noble Baroness, Lady Finlay, and others have said, may well be restored by palliative care, which relieves the pain, as the noble Lord, Lord McColl, has said. This is such an unsatisfactory provision that I should like the noble and learned Lord to confirm whether I am right.

--- Later in debate ---

[Lord Falconer of Thoroton]

I think the noble Baroness is wrong. I thought that I had said Clause 3 but maybe I did not. Clause 3(3) requires two doctors to sign the person’s declaration that the person,

“is terminally ill … has the capacity to make the decision to end their own life; and … has a clear and settled intention to end their life which has been reached voluntarily, on an informed basis and without coercion or duress”.

If I inadvertently said Clause 2, I meant Clause 3 and I apologise. It involves two doctors. We could go into the debate about vulnerability again, but with regard to clarification on whether two doctors are required, I think the Bill is utterly clear.

[Baroness O’Loan]

I just want to understand which clause we are debating. I thought we were debating Clause 2, which refers to a registered practitioner. As I said, I know that there are other safeguards that the noble and learned Lord is trying to write into the Bill, but the reality is that the realisation of this clause in a person’s life may have significant unintended consequences. I simply wanted to ask the noble and learned Lord whether there is one doctor in Clause 2 or two.

[Lord Falconer of Thoroton]

It is obviously my fault for not properly explaining this. As I understand the noble Baroness’s point, she is asking whether only one doctor has to decide whether the person is terminally ill.

[Baroness O’Loan]

No, I am talking about the point at which we open the gate and make the Bill apply. I know that in subsequent situations the process develops. I think that one of the weaknesses of the Bill is that the processes are kind of confused. At this stage of the Bill, though, is there one doctor who will say to the person, “You are terminally ill, with six months to live”, so that all other discussions can then take place and you can move towards seeking the declarations and that sort of thing? I just thought it might be helpful to be clear in my mind what we are talking about.

[Lord Falconer of Thoroton]

That is a fair point. The process is that one doctor says the person is terminally ill. The patient declares that they want to take their own life and then the second doctor has to confirm both the terminal illness and the firm and settled intention, voluntariness and capacity. I am not quite sure what further point the noble Baroness is making. She is right that Clause 2 refers to the initial doctor and Clause 3 refers to the second, but the process involves two doctors. I can take it no further than that, I am afraid.

The next point that was raised about the safeguard was the suggestion that we reduce the period from six months to six weeks. I completely accept that there are uncertainties from time to time about diagnosis. A judgment has to be made as to whether someone is terminally ill and may be reasonably expected to die within six months. I do not believe that that is an impossible task for a doctor to embark upon. As the Minister said, a judgment has to be made on what the right period is. I anticipate that the mood of the Committee is that six weeks is much too short. As a matter of judgment, six months feels right after hearing considerable evidence in the commission, and it also feels right having heard the debate just now.

The fact that diagnoses and predicting the length of time that you have to live are difficult—they are difficult whether the amount of time is six weeks or six months—does not lead me to believe that the Bill should not go forward, or that we should vacate the field in giving people that right. As the noble Lord, Lord Berkeley of Knighton, said, in this area we are not dealing with certainty. The question is whether, in the absence of certainty—and no provision can give certainty—we should be saying that because you cannot have certainty you cannot have the Bill. In my view, the right conclusion is that even though you cannot have certainty—everybody agrees with that—you should nevertheless have the Bill. Having listened very carefully to the choice between six weeks and six months, and obviously having considered something in between, six months appears to be right in relation to this.