Terminally Ill Adults (End of Life) Bill

Lord Frost Excerpts

Friday 30th January 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 72 and 80 in my name. I will not say anything about autonomy other than to mention to the noble Lord, Lord Pannick, that although it is a philosophical concept which was drafted in recent centuries, academic philosophy is very divided on how worthwhile it is as a concept.

I begin with my Amendment 80, which would substitute some detail for the very vague requirement that death within six months can reasonably be expected. We have already heard in the Committee, from everybody—not only today but on other days—that certain diagnosis is a very inexact science, and that diagnosing someone as having six months is very inexact.

We have heard from the noble Baroness, Lady Finlay, in opening, that conditions can differ, patterns can differ and patients can differ—we also heard that from the noble Baroness, Lady Hollins. Therefore, each patient must be assessed on an individual basis.

Against that, my Amendment 80 proposes that the difficult job of assessment is done by two consultants specialising in the relevant area, and it pins down that the expectation should instead be an 80% probability. If the sponsors are in earnest that those eligible really should be those who are within six months of death, they should be pleased to accept an amendment that tries to overcome the inexactness of such judgments by requiring confirmation by two of the most qualified experts in the area, and they should accept that an 80% likelihood is what, in this context, can reasonably be expected.

I move on briefly to Amendment 72. The Bill already refuses eligibility for assisted suicide when a condition that in itself is diagnosed to lead to death within six months can be reversed. My amendment takes the next logical step by limiting eligibility to cases where the condition not only cannot be reversed but cannot be relieved, controlled or ameliorated; I am adding to what has already been proposed in that group. The amendment aims to substitute a constructive, optimistic approach to treating illness, rather than one that writes off the patient and points them on the path to suicide.

That requirement—that, when steps can be taken to relieve, control or ameliorate a disease, the patient can no longer be considered for assisted suicide—will remove many otherwise difficult cases from this murky area and allow the mechanisms to operate as best they can for those for whom the Bill, on its face, intends them: people whose deterioration is inevitable.

There is an even more pressing reason than those two to accept this amendment: unless we positively exclude from eligibility patients whose condition could be relieved, controlled or ameliorated, we set up the conditions in which the relief, control and amelioration of terminal illnesses will become increasingly rare. We have heard of some remarkable instances today, not least from the noble Baroness, Lady Campbell of Surbiton—whom I am delighted to see back. Why would an overburdened health service try to give some extra months of life, give a higher degree of relief of pain, or ameliorate or arrest the progression of the disease, when it is so much easier to direct the patient, either implicitly or by expectation, towards assisted suicide?

What about relatives—even no more than ordinarily unscrupulous or greedy ones, or merely selfish ones—for whom the speedy death of their loved one is likely to seem desirable? We may also reasonably fear an overzealous state service committed to the task of accelerating the pathways of such unfortunate cases to their ends. My amendment guards against those consequences—some of the worst of a Bill so rich and varied in its capacity for harm.

[Lord Frost (Non-Afl)]

My Lords, I rise to introduce Amendment 84, which has already been touched on by the noble Lord, Lord Farmer. I am grateful to, and thank, the noble Lord, Lord Carter of Haslemere, for his support.

This group, as we have heard, is primarily about the definition of terminal illness. My amendment in this group touches on a somewhat different but related and important point, which is whether the terminal illness criterion—the existence of terminal illness—is in itself sufficient as a criterion. I am doubtful that it is, and that is why I have proposed this amendment.

As your Lordships know, there are two different models around the world for the kind of law that we are considering. Both include a terminal illness criterion. One type also has a suffering criterion, and that is the model used, as has been said, in Australia, New Zealand and elsewhere. The second type does not; it rests entirely on the concept of autonomy—the belief that if you know or have been told that you are going to die soon, you have the right to ask the state to allow you access to assisted suicide. I will say more about this autonomy point in a moment.

To state the obvious, the Bill is based on the second of those two models, but one of the problems is that much of the campaign for it is based on the first model—the assumption of a suffering criterion. Hence my amendment would introduce the concept of unbearable suffering that could not be relieved by treatment. It is probing; it aims to test the reasoning behind the preference of the Bill’s supporters for that type of model.

My amendment would do four things, and some of what I am about to say has already been touched on, so I will be brief. First, it would align the legal test in the Bill with the public justification for the Bill. It is clear that the campaign around the Bill bases much of its work on the need to deal with suffering and, if suffering is the moral foundation offered to the public, it should be in any eventual statute. It is clear from all the discussion around the Bill that many voters believe it already is in the Bill, and it should be.

Secondly, it would stop drift and the slippery slope. The problem here is that, if the real justification for access to assisted suicide is autonomy, what is the justification for the robustness of the six-month limit? We have heard that provisions in the Bill are vulnerable to court rulings, judicial review and the existence of the ECHR—although there is, of course, a way of resolving that particular problem—other broader principles and specific legislation such as the Equality Act. A suffering-led criterion would help Parliament to draw and defend a clear and principled line.

Thirdly, it is relatively—not totally, but relatively—easy to identify unbearable suffering. As has been noted, it is usually obvious from demeanour and body language when there is frequent and unbearable pain. This helps distinguish between qualifying and non-qualifying reasons for access to assisted dying, such as social pressures. This is vital given that we have already heard from the sponsor how widely drawn some of those criteria might ultimately be.

Fourthly, it has to be noted that, with a small number of exceptions, most other jurisdictions that use these laws have a suffering criterion: Australia, the proposed legislation in France, now happily stalled for the time being, the Netherlands, Belgium, Luxembourg, Spain, Portugal, the rejected legislation in Slovenia, New Zealand, Colombia and so on all have a suffering criterion, and for a good reason.

He has touched on it before, but when the noble and learned Lord, Lord Falconer, responds to the debate on this group, perhaps he could explain in greater depth why he is so insistent on an autonomy-only Bill, whether he recognises any limits on autonomy, and whether and why he is content to rest on autonomy as a justification while allowing campaigners to make a case based on suffering.

I want to say a few words on the justification of autonomy because it is so crucial and the Bill’s sponsors have been clear on the importance they attach to it. The noble and learned Lord, Lord Falconer, has been quoted before but it needs repeating:

“the essence of the Bill is autonomy. You have a choice … Once you satisfy that requirement—obviously, the safeguards have to be complied with—that is the essence of the Bill. It is autonomy”.

We heard from the noble Lord, Lord Pannick, who is not in his place, about the importance of choice in this area. That is really another way of expressing the same issue.

Proponents of the Bill have, at times, been perhaps a little dismissive of those of us who have religious convictions and suggest that we should not bring them to this debate. But I suggest that the belief in autonomy is also an a priori conviction with no more or no less right be heard unchallenged. It is surprising perhaps to find Ayn Rand-like views of the importance of individual autonomy emanating from the Labour Benches. It is a view that one can have, but I suggest that very few people do in fact have such views in practice.

--- Later in debate ---

[Captain of the King’s Bodyguard of the Yeomen of the Guard and Deputy Chief Whip (Baroness Wheeler) (Lab)]

The noble Lord is over the 10-minute limit. Could he please wind up?

[Lord Frost (Non-Afl)]

I am coming to my conclusion. It is somewhat safer with the two criteria of autonomy plus life expectancy and of unbearable and irremediable suffering. It limits the scope of the moral and legal change, or regression as I would see it, that we are undertaking here. That is why I have tabled Amendment 84 and why I think it is so essential.

[Lord Carter of Haslemere (CB)]

My Lords, I added my name to Amendment 84 since I think the noble Lord, Lord Frost, has struck gold with this amendment. Requiring

“unbearable suffering … which cannot be relieved by treatment”,

raises four critical issues at the epicentre of the Bill. First, his amendment exposes the total unreliability of a six-month prognosis of a terminal illness, as we have heard from numerous noble Lords. Trying to predict life expectancy is a hopeless exercise, especially when medical advances are improving at such a phenomenal rate. As the noble and learned Lord, the sponsor, said in relation to a prediction of six months to live, we are not dealing with certainty. I am with him on that.

Let me give the Committee an illustration from a real case. I know of somebody who was given a 5% chance of living for 10 years because he was suffering from an advanced aggressive cancer. It is not exact, but a 5% chance of living for 10 years approximates broadly to a reasonable expectation of dying within six months. That was 21 years ago and, as far as I know, I am still here—noble Lords will correct me if I have got that wrong. It does sometimes feel slightly otherworldly, listening to these debates.

Secondly, the requirement in Amendment 84 for unbearable suffering that cannot be relieved by treatment would have the obvious merit of bringing the effectiveness of palliative care into play, which is not currently the case as the Bill stands. As we know, the experts say that palliative care relieves pain in most cases and can help people who want to die to want to live. That is why a full assessment by a palliative care specialist is so important, as earlier amendments sensibly proposed. But the noble and learned Lord has said he is

“incredibly opposed to unbearable suffering as the root”

of this Bill. His view is unsurprising since the effectiveness of palliative care would significantly reduce the Bill’s impact.

So the noble and learned Lord falls back on the personal autonomy argument, telling the Select Committee that the essence of the Bill is autonomy—you have a choice, it is autonomy—and it would give people the option of an assisted death if they have simply had enough of life. This is the third issue that would be resolved by Amendment 84. Should the National Health—health—Service really be assisting a person to kill themselves if they have simply had enough of life, whether or not they are in pain and whether or not their feelings relate to their terminal illness? Is that what a health service should be doing? That starts to look very much like assisted suicide.

Fourthly, I respectfully suggest that the noble and learned Lord gets on the Clapham omnibus and asks anyone who supports assisted dying the reasons why they do so. Overwhelmingly, they will say that people should not have to suffer unbearable suffering. Yet, astonishingly, you will not find the words “pain” or “suffering” anywhere in the Bill. I read it word for word last night at great length to check that point. I could not find those words. Without any reference to unbearable suffering, there will be a massive disconnect between the public’s expectation and the Bill’s contents.

Let us be clear: the vast majority of the public are not on the edge of their seats watching our deliberations. Very few indeed will have read the Bill. They will therefore have a view of the Bill based on the common-sense assumption that people seeking an assisted death will be suffering unbearable pain. The compelling amendment from the noble Lord, Lord Frost, injects that common sense into the Bill by providing for that, and I heartily support him and Amendment 84.