Terminally Ill Adults (End of Life) Bill

Baroness Berger Excerpts

Friday 13th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

If there are not enough people with the requisite expertise to people the panels then there will not be panels to do the job. That is why the broad categories have been adopted in the Bill. The Royal College of Psychiatrists has expressed views in relation to this, as has the British Association of Social Workers. However, it is necessary for us to find people to do this process, because the workability of the scheme depends on it, and we believe it is possible to do that. We recognise the concerns that have been expressed, including by the noble Baroness, who is right to say that if we do not have people who can people the panels then we cannot do the process.

On the broader issue of what happens if we have people in one part of the country but not another, it will be for the voluntary assisted dying commissioner to ensure that, when a panel is required, it can be provided.

[Baroness Berger (Lab)]

I have listened closely to all of my noble and learned friend’s responses and remarks on this sizeable group of amendments—by my count, there are 105 amendments. While a handful have been presented by the sponsor, my noble and learned friend, the overwhelming majority have been put forward by noble Lords on all sides of the Committee, largely informed by the evidence that we heard at the Select Committee and by representations made by professional bodies and medical colleges outside of this place that wish us to improve the Bill. That is the job we were tasked to do by the other place and by our colleagues.

I have listened closely to every single word of my noble and learned friend’s response and heard every reason why every single one of these amendments should not be accepted. I did not hear what could come forward to make the changes that people think should be made to this Bill to make it safe, particularly for vulnerable groups, and to ensure we do not see coercion. Reflecting on his response, does my noble and learned friend intend at a future moment to come forward with anything that would put in the Bill things that would make the material differences that are the reason and impetus behind noble Lords putting forward these amendments?

[Lord Falconer of Thoroton (Lab)]

I have thought very carefully about the amendments we have gone through. I am sure they are all based on attempts to improve aspects of the process, such as the appointment of the panels, how the panels operate and the privacy issues. I should say that very considerable thought went into those issues before the Bill was drafted and as it went through the other place. I have given detailed reasons as to why I think the amendments we have debated would not really improve the position. For those reasons, after giving it considerable thought, I think that the Bill probably reached a better conclusion on, for example, the “must” and “may” issue that the noble Baroness raised and the need for special extra expertise. I have given it careful thought, but I do not think any of the amendments we have gone through would improve the Bill.

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A multidisciplinary panel would give a clearer view of what the Bill claims to do. We must avoid doctor shopping. I think all of us would agree that palliative care is incredibly important. I wish that that had been part of the Bill, so we could have debated it in more detail. We have to look at the whole person. This is a model that we should at least consider.

[Baroness Berger (Lab)]

The noble Baroness, Lady Grey-Thompson, made some important points, as have been made by other noble Lords, about the drugs. Given the context of this debate, as we deliberate these amendments and later amendments, it is worth sharing that the Delegated Powers and Regulatory Reform Committee of this House, in its important report about the extension of delegated powers in the Bill—of which there are now 48—had specific concerns about substances, drugs and the detail missing from the Bill. In fact, the two specific themes that are relevant are the lack of specification of approved drugs and the lack of regulation of approved substances. The Bill currently uses two delegated powers for something that would usually be described in the Bill, but it is instead in delegated legislation. That perhaps provides some context as to why these amendments have been put forward.

[Lord Empey (UUP)]

My Lords, I want to deal with probing Amendments 887A and 888A, in my name. Throughout the process there has been a potential clash between what decisions might be made here and what decisions might be made in the devolved nations. In the other place, an amendment was introduced by the sponsor of the Bill as it progressed to extend certain parts of it to Northern Ireland and Scotland, as well as England and Wales. My colleagues at the other end tried to put an amendment down to probe why this was done. Unfortunately, it was not taken, so the matter was never really debated.

I remind the House that Clause 37 deals with the regulation of approved substances and devices for self-administration. It says that:

“The Secretary of State must by regulations make provision about approved substances”,


and that has the extent of the entire United Kingdom. These regulations also deal with

“the supply or offer for supply, or administration, of approved substances … the transportation, storage, handling and disposal of approved substances”,

and

“keeping records”.

It says provisions must be made

“about the manufacture, importation, preparation or assembly of approved substances … or in connection with the monitoring of matters”

and so on,

“requiring persons specified in the regulations, in specified cases, to give information to the Secretary of State”.

As things stand at the moment, there is no plan by the Northern Ireland Executive to introduce an assisted dying Bill, and there is no Private Member’s Bill currently in the Chamber. Some of these regulations would, in my view, cut across the role that is currently played by devolved Ministers and devolved departments.

This is what I am trying to get at and to probe. It does not, incidentally, confine the extent to Clause 37. In fact, other clauses extend the Bill’s extent as well—Clauses 43, 54, and 56 all apply to the whole of the United Kingdom. I do not understand that. If the noble and learned Lord could enlighten us, that would be most helpful. As I said, they are probing amendments. The point I am trying to tease out in Committee is why that was introduced if it was not in the original Bill and why that extension was made, because, as things stand, there are no plans for an assisted dying Bill in Northern Ireland—not from the Executive and there is no Private Member’s Bill currently.

I totally accept that this Parliament has the right to legislate for the entire United Kingdom, irrespective of devolution. But, at the end of the day, the Bill says:

“The Secretary of State must by regulations make provision about approved substances”.


There is no argument about it—this has to happen. The extent of those regulations would be the entire United Kingdom. Whether Northern Ireland and Scotland want it, it is going to happen, according to this clause. Why is that the case? If there is no assisted dying available—and in many cases, it would be a devolved matter anyway—why are we regulating for the provision of these substances in all parts of the United Kingdom? That is what I want to know, and I will be grateful for the noble and learned Lord’s contribution in the wind-up.

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[Lord Falconer of Thoroton (Lab)]

When I said that I am really focused on how to provide a proper assisted death and that that is not a technical question about whether the NHS will provide it, I did not mean to say that it is not important for this issue to be resolved. If I did, I misspoke, but please do not read me as saying that. That is an issue on the way to the Bill providing a compassionate and workable way of providing an assisted death to those who want it.

As to the second part of the question asked by the noble Lord, Lord Harper, about my view in relation to it, it is that it is ultimately for the Secretary of State for Health to decide how it is provided. The power is given to the Secretary of State to decide that in Clause 41, with the amendments that I have put down in relation to it. It gives him power to commission it himself or through a variety of other bodies. That might involve some body other than the NHS providing it. Ultimately, it is for the Secretary of State to decide how that is done. I think I have said enough on the scheme proposed by the noble Baroness, Lady Finlay.

I will go on to substances. There is a range of amendments in relation to substances. We shall come back to substances in relation to Clauses 27 and 37. They are in this group because they relate in part to the scheme proposed by the noble Baroness, Lady Finlay. She proposes designated pharmacies so that only particular pharmacies can do it. It is again—this is the wording of the Bill—for the Secretary of State to decide how substances are to be selected, how drugs and devices are to be approved, and then how they are to be dealt with. Subject to my amendments, which give more limitation to Clauses 27 and 37, I think the right principle in relation to that is that it is for the Secretary of State to decide how properly to regulate and choose the substances, and he or she is to do it only after taking proper advice.

[Baroness Berger (Lab)]

On that very point about Clause 37, I am sure my noble and learned friend is aware of the updated Delegated Powers and Regulatory Reform Committee report alluded to by the noble Lord, Lord Stevens, a moment ago. On that clause, it states that there are still “highly inappropriate” provisions in the Bill, particularly on Clause 37, specifically in relation to the substances that would be used for an assisted death. I heard what my noble and learned friend said, but it is the complete opposite of what the report released yesterday says and what remains in the Bill. The amendments that my noble and learned friend has brought forward do not yet address the concerns expressed by that very important committee in its report.

[Lord Falconer of Thoroton (Lab)]

I accept what my noble friend says. I hope she has read my note to the committee, which it published, in which I accept that further work is required, in particular on Clause 37. I accept in principle that I have to come back with further amendments in relation to Clauses 27 and 37.

The noble Baroness, Lady Hollins, has made a series of creative suggestions. She is addressing this in a way that is separate from the proposal from the noble Baroness, Lady Finlay of Llandaff. She says that her proposals on substances should apply irrespective of which scheme it is. I need to consider some of them in detail. My noble friend Lady Blake has indicated why some are difficult to integrate into substances for assisted dying. I am particularly interested in the relationship between the Medicines and Healthcare products Regulatory Agency and the approval of these drugs; that needs further thought on the sponsor’s part. In addition to the amendments that I am proposing to Clauses 27 and 37, I should consider them as I think they are valuable.

For the reasons given by my noble friend Lady Blake, I do not support the amendments proposed by the noble Baroness, Lady Grey-Thompson, in relation to clinical trials. Although the MHRA has a part to play, I also accept the limitations on that put forward by my noble friend Lady Blake.

I have seven amendments in this group: Amendments 624A, 708A, 708B, 710B, 862B, 877B and 878A, all of which relate to limiting the power in Clauses 27 and 37, and include a requirement for consultation in respect of the Minister. I do not think that they are contentious, although I accept that people think that I should go further. In the respect that I have mentioned, I am more than willing to think about going further. If and when we reach those amendments, I expect the Committee to agree to them.

I deal finally with the question from the noble Lord, Lord Empey, in relation to Northern Ireland. He asks why the Bill extends the power of the drug regulator in this respect to Northern Ireland. The noble Lord will know that drug regulation is a matter for the whole of the United Kingdom so must be dealt with by a statute in this House. We are not suggesting that Northern Ireland should change its current law, but if there was a law change then there would be no reason why the drugs authorised in whatever process the Secretary of State agrees to should not apply to Northern Ireland. That is why it refers to Northern Ireland.

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That is true in general, but, as the noble Baroness, Lady Monckton of Dallington Forest, so movingly, passionately and powerfully put it, people who have Down syndrome often want to keep people happy. What if they hear that suggestion? I am putting this very badly, but it is an abomination that it should even be there on the possibility list. I would like to hear the noble and learned Lord at least concede that point, if nothing else today. That would be worth coming for.

[Baroness Berger (Lab)]

It was so moving to hear the contribution from the noble Baroness, Lady Monckton, and the points that others made about the words that people may hear, including people with learning disabilities. I was reflecting on the evidence we heard at the Select Committee from the National Down Syndrome Policy Group. It is not just the words that people may hear; it is also what they see in front of them. In particular, what was really striking—I had not thought about this—was that even the uniform of the doctor who is having that conversation could suggest a position of authority that someone with a learning disability should show acquiescence to. I thought that was something for us to consider in the light of all these important amendments.

[Baroness Fox of Buckley (Non-Afl)]

That is very helpful. When I see a uniform, I get a bit quivery as well—