Terminally Ill Adults (End of Life) Bill

Lord McCrea of Magherafelt and Cookstown Excerpts

Friday 23rd January 2026 Lords Chamber

[Lord Markham (Con)]

I believe I am answering the question. Once I have finished answering, the noble Lord can intervene on me and say what he would like to say. If he is willing to wait a few moments, that would be the appropriate point.

We spoke earlier about how palliative care is a way for people to choose to ease the way they die. I would say that assisted dying is also giving people the choice to die in a way they want to. In birth services, people have a birth plan. I remember going through this recently and there was a midwife who played a role very similar to that of a personal navigator, helping us talk about what sort of birth plan we wanted: whether we wanted a home birth and what we wanted to do about pain relief. It was very similar to many of the things that the noble Lord, Lord Birt, was talking about. The fundamental point here—the noble Lord, Lord Winston, is free to intervene at any point now I have answered that—is that it is giving people choice and autonomy. I believe that choice in the way you wish to die and when you want to die, if it is certain that your diagnosis is that you will die within six months, is a fundamental choice and a health choice.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

Part of the noble Lord’s argument is based on assisted suicide being so popular with the general public that 70% of people want it. If that is so, perhaps he can help me to understand why none of the parties in this House put in their manifesto that they want assisted dying?

[Lord Markham (Con)]

Given that I did not write any of the manifestos, I am not sure I can say. If I was writing them, it is something that I would probably put in. It is something that everyone agrees is one of personal choice, like many other issues, and of course that is why everyone has a free vote in this matter. It is undeniable that there is overwhelming public support for this and, as it is “our NHS”, it is entirely fitting that if it is the decision that money is spent in this way, it should be directed towards this service.

The question becomes one of what I believe the noble Lords, Lord Birt and Lord Pannick, are trying to do in their amendments, which is to take what we know is a complex system and make it as easy to navigate as possible. We know that it is a time of great distress. In many cases you have just been diagnosed with a terminal illness, and sometimes you will be told straightaway that you have only a few months to live, so automatically you are within the six months and it is something you want to move on quickly. It is entirely right and proper that you want to ensure that it then happens as efficiently as possible. That does not mean you do not want other services to happen as efficiently as possible in the NHS. It is not a binary choice between one and the other.

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If these amendments are adopted, what families will see is that, while they are left in their anxiety, those who opt for assisted dying will be given a Rolls-Royce service. They will be given a personal navigator. They will be expedited through the process and have their hand held at every stage—something that the NHS simply cannot afford to do in the case of people who are suffering from cancer and want to live. I think there will be a profound sense of injustice, and indeed revulsion, if these amendments are carried and such a service is established. What is being proposed is simply unreal. It cannot advance.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, I listened carefully to what the noble Baroness, Lady Royall, said, but I believe it is important that Members who feel they have a contribution to make are able to make that contribution without being cut short.

[Baroness Royall of Blaisdon (Lab)]

Forgive me. I did not realise that there were other people who wished to speak. There was a pause.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I thank the noble Baroness for that.

This has been a telling debate thus far, because we are told that some of the points are based on opinion polls. We are not an elected Chamber and therefore we do not have to be swayed by how we are to get elected next time. Therefore, it is so important that we do not make laws on opinion polls. In fact, we have to debate the issues carefully—and trust that we are therefore making mature decisions—and seek to get the Bill right, because the issue that we are debating concerns life and death.

I have found something somewhat surprising whenever the cost has been talked about. Many people are rightly demanding an answer concerning the cost. The noble Lord, Lord Markham, mentioned it a number of times. I was in this House when he was a Minister, but he is not now answering for the Government; I believe it is important that the answer comes from the Government Minister, who should give us the up-to-date cost. For any of these issues, costs do not minimise over the years. In fact, they increase—we will find at the end of the day that the costs will escalate. We heard in the debate yesterday that the cost of the Chagos Islands will be £3.4 billion, yet it was suggested on the Opposition Benches that it will be £34 billion. I am sure Members realise that there is quite a difference between those two figures—there is a dot between £3.4 billion and £34 billion. Nevertheless, we are talking about massive sums of money. We are also talking about money that could be taken from another part of the health service, which in many parts of the country, and certainly in Northern Ireland, is crying out for money; it needs every pound it can possibly get.

I believe the Bill was defective as it came from the other House, but I also believe that what has been proposed by the noble Lord, Lord Birt, would make the Bill worse. The proposal here undermines choice even more. There is no equity of access under these amendments. What genuine choice is there if you can get an assisted death within 30 days but you have to wait months for the palliative care that you need? Palliative care is not available in many parts of the country; it is certainly not equally available right across the country.

Do the supporters of these amendments accept similar amendments that require palliative care treatment options to be made available and accessible within the same timeframe as this? They might say, “Yes, we would accept that”, but it is not a reality. There is no reality in which you will get palliative care within 30 days, because it is not available in many parts of the United Kingdom. How is it fair that terminally ill people get a personal navigator to support them through the process of getting an assisted death, but they do not get a personal navigator for gaining access to the palliative care they desperately need?

There are issues that need careful reflection. In the light of what the noble Lord, Lord Empey, said, I note the following. In our debates over the past few weeks, the noble and learned Lord, Lord Falconer, has said that he would reflect on some of the issues raised, but up to now I have not heard what that reflection has brought about in changes that need to be made to the Bill. Perhaps it would speed up the debate if we could get some knowledge about the reflections that he has had and some of the changes, in the light of the debates that have already taken place, that he will actually make in order to make the Bill more acceptable to many noble Lords.

The issue that we need to continue to reflect on is the extraordinary speed suggested by the noble Lords, Lord Birt and Lord Pannick. It undermines safeguards. Mandatory timelines force decisions without proper investigation. Panels must decide within two days of referral, even over weekends. I know of no other decisions made in the health service for which you can be promised that. There is also no judicial precedent for such haste, because courts take months for life and death decisions—yet this process is so fast.

Then we come to prognosis inaccuracy, which seems to be ignored. As I said to the noble Lord, Lord Pannick, in a previous debate, I have known people who were given a six-month prognosis but continued to live three years later. Therefore, there is no consideration of prognosis inaccuracy. Rushing assisted death risks premature deaths.

Then we come to mental health risks. Reflection periods would be cut to 24 hours. Experts warn that depression after diagnosis is often temporary and treatable. Why can patients get an assisted death in 30 days but have to wait months for palliative care? Also, the amendments erode protections rooted in law and ethics; suicide prevention remains government policy.

In conclusion, I ask the Minister these questions. How can panels make life and death decisions within 48 hours without sacrificing due process? What safeguards exist against coercion when timelines are compressed, as suggested by the noble Lords in their amendments? How will the National Health Service meet these demands when GPs and social workers are already overstretched? We had and have, in past debates and up to this moment, numerous questions, but, from the noble and learned Lord, Lord Falconer, the Front Bench and the Government, we have very few, if any, real answers that we can hold on to.

[Baroness Grey-Thompson (CB)]

My Lords, I read this group of amendments with a lot of interest, in terms of whether a different way would be possible. I thank my noble friend for tabling them.

I agree with the right reverend Prelate the Bishop of Newcastle that Australia is not an accurate comparative country to look at. Actually, it makes me feel even more strongly, and the Minister will have received a letter this week from many of us asking for the impact assessment to be looked at again. One of the reasons for that is that the impact assessment looks at about the first 10 years in Oregon. If we compare data between Oregon and the state of Victoria, it took Oregon 17 years to reach the same number of deaths that was hit in the state of Victoria—not Australia, but the state of Victoria—in the first 12 months of its Bill passing.

I accept that the first voluntary aided death in Victoria was described as beautiful, but in the time that that legislation has been enacted, it has thrown up many issues. In 2023-24, there were a number of complications with intravenous injections. There were technical problems in 5% of cases. In 10% of cases, the death took longer than expected—one person took seven days. In 29 responses, the death more than two hours. In seven reported cases, it took more than six hours, and the longest was 11 hours. So, we have to be really careful about painting other jurisdictions as the sunny uplands.

There was a case reported in the Times on 22 March last year, where a man had requested the drugs to end his life. He had decided that he wanted to have longer left to live, and his wife gave him the drugs anyway, because, I presume, she decided that it was his time to go. It is a very different jurisdiction, but it again raises issues of coercion.

We also have to note with Victoria that, since its legislation has passed, elder suicide has risen by 50%. These are the things that we must take into to account when we are looking at what happens in this country.

I thank the noble and learned Lord, Lord Falconer, for arranging a meeting last year, when we were able to meet some Australian medics, but that gave me even more cause for concern, because there was a story of man who had taken a while to come to a decision to have an assisted death. The day he finally decided to have it and started taking the noxious mixture, he did not want to carry on and his family said, “But, Dad, you’ve decided to die today, you need to keep taking the mixture”. All these things worry me when we look at the speed with which these navigators might be able to push someone towards assisted suicide. In principle, a navigator sounds great, but they are only pushing people one way. We do not know enough about the training or whether, potentially, an AI bot might be used at some points. As has been raised, this could potentially just be debated in a 90-minute debate on a statutory instrument. So we have to look much more carefully at these areas. I do not think these amendments are adequate for what we want to do.

My noble friend Lord Birt raised the extremely sad case of Nick Dimbleby. But, as far as I understand, with his condition, MND, he would be not eligible for assisted suicide under the Bill. I would welcome the noble and learned Lord, Lord Falconer, confirming that.

It has been raised in different ways and on different days that our experiences of pain are very different. In other debates, we have talked about incontinence: what one person thinks is awful, another might think “I can live with it, it’s okay”. My noble friend Lord Birt talked about someone being PEG fed. Unfortunately, there is an inequality of the system in this very Chamber. My noble friend Lady Campbell is not able to respond to this group of amendments because she can only speak at the start. She cannot intervene later, so she is not able to listen to the debate and pick up points. I am sure she will be able to raise it, and I beg your Lordships’ tolerance because she might have to raise this in another group. There has been talk about being PEG fed being awful, but being PEG fed has enabled her to survive and to contribute. I worry about the inequality of this Chamber in terms of people being able to contribute properly.

Amendment 223 looks at this happening in four days. I do not believe that there is any system that will be able to, in that period of time, assess whether somebody has been coerced. Amendment 336, which says that the second assessment could happen after a period of reflection of seven days, does not even vaguely take into account the five stages of grief. There are not that many papers on people with spinal cord injuries, but one that I have read says that it can take up to seven years for a wheelchair user to get over the experience of traumatic injury. If you take that into account, people will be forced very quickly to end their life, when the ability to deal with the issue that is in front of them has not been taken into account.

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[Baroness Finlay of Llandaff (CB)]

Of course patients are welcome to refuse. I am slightly worried by the noble Lord’s phrase “I just want the injection”. The Bill is very clear: this is about self-administration. The doctor has to discuss with the patient how they are going to inject themselves with the lethal dose of drugs, whether they will do it with different syringes, if there is a mixture in the syringe and the complications of trying to do that. In asking the question, the noble Lord has just illustrated the nub of the problem.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, on Friday 16 January 2026, the noble and learned Lord, Lord Falconer, defended the Bill’s provision for informed consent by arguing that the existing drafting already mandates comprehensive disclosure of information. He rejected Amendment 42 in the name of the noble Baroness, Lady Finlay, which would require patients to be fully informed. He argued that was unnecessary because the specific obligations listed in the Bill already ensure that the patient receives all necessary information. However, these amendments identify further gaps and the weakness in the noble and learned Lord’s reliance on the Bill’s current drafting to guarantee informed consent. Evidence of complications, lack of data, prolonged death risks—all these show that there are downsides and pitfalls, rather than simply a peaceful exit.

Proponents, some of whom we have heard today, tell us about prolonged and painful deaths from illness, but they seem to close their minds to long and potentially painful deaths for those who walk the path suggested by noble Lords. There are two mentions of complications in the Bill, but nowhere is there an explicit requirement to explain and discuss the risks of complications, despite this forming a standard part of GMC and NICE guidance on informed consent. I wonder why that is.

[Lord Scriven (LD)]

Will the noble Lord point out in the Bill any clause that moves away from the normal GMC duties of a doctor in terms of either consent or capacity? If the noble Lord could explain that, it would be very helpful when he continues his argument.

[Lord McCrea of Magherafelt and Cookstown]

I am very happy to address that matter. What the noble Lord, Lord Scriven, left out is as significant as what he said. I will come to that.

Clause 12(2)(d) requires a doctor to

“discuss with the person their wishes in the event of complications arising in connection with the self-administration of an approved substance”.

Notice that it says “the self-administration of an approved substance”. That is somewhat different to what was mentioned a few moments before—that they want the doctor giving the injection.

In Clause 39(1)(g), there is a requirement for the Secretary of State to issue a code of practice on

“responding to unexpected complications that arise in relation to the administration of the approved substance”,

and Clause 12(2)(c)(iv) requires the doctor to discuss

“the nature of the substance … (including how it will bring about death and how it will be administered)”—

but not that it may not be successful. The existing areas of medicine have guidance and case law on informed consent and risks, but the Bill creates an area of no guidance, no precedent and doctor confusion.

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[Lord Scriven (LD)]

I am not sure whether the noble Lord is aware that the GMC duties of a doctor are a legal requirement for a doctor to practise in the UK. The doctor therefore has to go through all those, regardless of what is in this Bill, to ensure that the patient is informed and understands the decision that is being taken by them.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

If that is so, then let us put it into the Bill. Let us be sure that it is in the Bill so there is no ambiguity. I notice that the noble Lord, Lord Scriven, does not want that. That is why I am wondering—

[Lord Scriven (LD)]

My Lords—

[Lord McCrea of Magherafelt and Cookstown (DUP)]

Unlike other Members, and unlike the mover of the previous amendment, I have given way. He did not.

[Lord Scriven (LD)]

Just to inform the noble Lord, I have tabled no amendments, I have made no point about what I wish or do not wish to see, and I am not the sponsor of the Bill. In relation to what the noble Lord has said about the legal requirements of the GMC, I am pointing out the duties of a doctor and how the GMC as the regulator applies those to the individual practice of a doctor in the UK.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

And I am responding by saying that if we want to be sure that there is no ambiguity whatever—we are talking about the issue of life and death and, by what was suggested earlier on, inside a matter of days this was all to be over—there should be clarity. I would have hoped that the noble Lord would want that too.

[Baroness Cass (CB)]

The GMC guidance would need to be amended because, at present, there is specific advice on guidance around supporting patients at end of life. It says:

“Where patients raise the issue of assisting them to end their own life, or ask for information that might encourage or assist them in doing so, respect for a patient’s autonomy cannot justify illegal action … Medical professionals should … be prepared to listen and to discuss the reasons for the patient's request”,


but

“limit any advice or information in response, to … an explanation that it is a criminal offence for anyone to encourage or assist a person to commit or attempt suicide”.

The current GMC guidance precludes all this and would therefore have to be changed should this Bill go through.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

That is very helpful, and I trust the noble Lord, who is now nodding, will take that into consideration.

[Baroness Coffey (Con)]

The points that the two other noble Lords have made are due to guidance in 2020 which was put in place only as a consequence of the 2015 ruling by the Supreme Court which we discussed earlier. The guidance before 2020 was not what is being said now, and that is part of my point about putting this in the Bill.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I thank the noble Baroness. I realise that my time is up, but I draw to a close by asking noble Lords to notice the emphasis on GMC guidance. Guidance is not the law. The GMC itself states in its preamble that its guidance is intended to help doctors

“practise ethically and in line with law”—

it cannot make the law. It goes on:

“If you’re not sure how the law applies in a given situation, seek advice through local procedures, consult your defence body or professional association, or seek independent legal advice”.


It says finally:

“The professional standards describe good practice, and not every departure from them will be considered serious”.


That is equally true for NICE guidance as well.

[Lord Carlile of Berriew (CB)]

My Lords, as a former, if somewhat historic, member of the General Medical Council, I can confirm that the GMC has no guidance relating to ending someone’s life because it is, at the present time, simply unlawful to end someone’s life.

I hope that I can try to simplify what is being discussed. I agree with the noble Lord, Lord Blencathra, that there is a need to add something, though possibly not very much, to this Bill to ensure that consent, as consent, is included. We are talking about four stages. The application is not consent; it is just an application. Capacity is measured and is not an application. The discussion described in Clause 12 is a discussion, and I say to the noble Lord opposite that it is most definitely not the obtaining of consent. Then there is the issue of obtaining consent, which includes the effect of any drugs to be used, and that is what I think the noble Lord, Lord Blencathra, is seeking to add to this Bill.

Let me briefly give an example from my own experience. I had an extraordinarily formidable and occasionally difficult mother, and on one occasion she had a heart attack, not long before her death. She was taken into a very good cardiology unit in Blackpool, so I rushed up to Blackpool at high speed and found myself on the ward with my mother—whose eyesight and hearing were not good, but her brain was as good as any in your Lordships’ House—and a consultant. The consultant explained that he could do an operation which he had done once on a male patient aged 91, but he was prepared to try it on my mother. She was very enthusiastic to have any medical treatment that might prolong her life, which, after all, had by then lasted for only 98 and a half years.

Once we had had the discussion, the cardiologist proffered a consent form to me. My reply, which I will abbreviate, went something like, “Not likely; she is perfectly capable of consenting herself. But it must be explained to her so that she can hear it clearly. So, why don’t you sit down while I explain what you have said to me, and you correct me if anything is wrong?”

In due course, she signed the consent form and had the operation. Happily, the operation was entirely successful. Sadly, the effect of the operation gave her such a pounding heart that the rest of her bodily functions could not cope with it. She died a few weeks later. When she said to me during the period before her death, “Darling, I never thought it would end like this”, I thought to myself, thank God she signed the consent form, not me.

Consent has a conspicuous and real meaning. It requires full understanding from the patient. It can go horribly wrong, as it unfortunately did for my mother. I wish we had been able to celebrate her 100th birthday. But that element of consent, consent, consent—a bit like “education, education, education”—is not clearly set out in the Bill. It is not a major change to be made, and I would invite the noble and learned Lord to incorporate it.