Terminally Ill Adults (End of Life) Bill

Baroness Brown of Silvertown Excerpts

Friday 9th January 2026 Lords Chamber

[Lord Carter of Haslemere (CB)]

My Lords, I speak to the six amendments in my name in this group. I do not need to explain what they say because they are all replicated by other amendments in the group, so I can be very brief. All these amendments are intended to ensure that a person seeking assistance to end their life first be referred to a registered medical practitioner who specialises in palliative, hospice and other care for the purpose of a full assessment—the operative word being “assessment”, not necessarily treatment. The Bill currently requires merely that a medical practitioner “offer” a referral to a specialist palliative care practitioner. This is inadequate in relation to such critical decisions as choosing whether to live or seek a state-assisted death.

It is important to note that all these amendments are based on evidence. In countries with assisted dying—Oregon has been referred to—experts say that patients who request help to die often change their minds if provided with proper palliative care. Yet the Government’s impact assessment confirms that fewer than half of dying people have input from a specialist palliative care team in the last three months of their life. It seems hard to dispute the case, therefore, for the Bill requiring that persons seeking a state-assisted death be given a full palliative care assessment, with the opportunity to choose to experience modern specialist palliative care at its very best. It is about doing everything humanly possible to keep people alive with as little pain and suffering as possible, and giving priority to life over death wherever possible.

Recalling our debate yesterday about which amendments the noble and learned Lord, Lord Falconer, might be prepared to accept, the amendments in this group are, like the previous group, pivotal to the decision a dying person will have to make if this Bill is enacted. It would save much time on Report if the noble and learned Lord could indicate now whether he can accept one or more of them. The Government would then have a responsibility to ensure that adequate palliative care specialists are available.

I recall, as I did at Second Reading, the wise words of the Minister, the noble Baroness, Lady Merron, who, in answer to an Oral Question in this House on 4 September 2024, said that the Government’s

“commitment is to ensure that any debate on assisted dying … takes place in a broader context of access to high-quality palliative and end-of-life care”.—[Official Report, 4/9/24; col. 1151.]

The amendments in this group would help to ensure that a person at least has a real choice of whether to access that palliative and end-of-life care or whether to seek a state-assisted death.

[Baroness Brown of Silvertown (Lab)]

My Lords, my Amendment 51 and others would require the providers of assisted dying services to ensure that all persons seeking such services have discussed the range of end-of-life options available to them with a palliative care specialist.

The Government and proponents of the Bill have promised that end-of-life care will not suffer in order to accommodate assisted dying. I have significant reservations about whether this would be possible, and I fear a push factor, particularly for those who are vulnerable, those who are without family and, to be absolutely frank, those who are poor and cannot fund their own care. When done right, as we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one’s death. Equitable access to options for end-of-life care must be a cornerstone for this Bill, which is why I have laid these amendments. I want to ensure, as far as humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life and to specialist teams to manage the symptoms and pain and to provide dignity.

This Committee must accept that equal access to these services, as for many public services, is not guaranteed and is rarely delivered. I give just one example, due to time. A Liverpool resident with the terrible asbestos-related mesothelioma cancer can undergo a specialist injection that has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are so few specialists trained to take this work on. Therefore, access is obviously limited.

Clauses 5 and 12 require doctors to have discussions about disease prognosis, treatments and symptomatic alleviation with patients. Clause 5 includes an offer to refer them to a specialist. Although these are important discussions, which must be had, they have to be conducted by somebody properly trained and experienced in such matters. For conditions that are specialist care cases, such as motor neurone disease, most doctors will have minimal involvement in the management of that condition and will likely not have the skills and training to adequately fulfil the duties that the Bill places on them. A specialist referral is absolutely necessary to that ensure patients are able to reach an informed decision about their care with somebody who properly understands the disease, how that disease will progress and what can be put in place to alleviate their distress and pain.

A person seeking assisted dying will be worried about their future, losing their independence and dignity and placing a huge burden on their families. A dedicated palliative care specialist would have the expertise, skill and training to provide the highest level of information and support, tailored to the individual needs of each patient, and have specialist knowledge of the condition that the patient is experiencing. Clause 1 requires that a person

“has a clear, settled and informed wish to end their own life”.

I believe that you can ensure a settled and informed wish and reach an informed decision only after properly exploring all available care and treatment options with dedicated palliative care specialists and having those options available to you. My amendment would therefore create a duty on all people involved in the provision of assisted dying services to ensure that those discussions have occurred, covering care options including symptom management and home care provision.

I welcome the amendments tabled by other colleagues that would ensure a dedicated palliative care assessment is part of the assisted dying process and I believe that my amendment can work alongside theirs. My amendment would also cover consultations with palliative care specialists that occur prior to a person seeking assisted dying, providing they cover the criteria outlined in the amendment. You can reach a clear, informed decision to end your own life only after having the advice and support to truly be able to weigh your options. That guarantee should absolutely be in the Bill.

[Baroness Hollins (CB)]

My Lords, when I first read this Bill, I realised that there was something important missing—a first stage, if you like. This group of amendments is probably one of the most important to address before the Bill can really make progress. Ther Bill, in its drafting, has perhaps failed to recognise the provisions of the Health and Care Act 2022, which my noble friend Lady Finlay referred to, with regard to the new obligations on integrated care boards to commission for the palliative care needs of their local populations.

There are several amendments in my name in this group. I have also added mine to my noble friend Lady Finlay’s amendment. The most important amendment is Amendment 221, and I will try to explain some of the rationale. The amendments are intended to ensure that specialist multidisciplinary palliative care is a mandatory, properly resourced and integral part of any assisted dying pathway. The central purpose is quite simple: it is that no person should progress towards assisted dying until their palliative, psychological and wider social care needs have been fully assessed and understood and, where appropriate, addressed. The medical royal colleges have endorsed this request.

Not all doctors are trained or equipped to provide comprehensive information about prognosis, symptom control or the full range of palliative care options at the end of life. This is not the remit of general practitioners or general physicians, nor should such complex and sensitive discussions be taking place in routine medical settings. For that reason, I disagree with the preliminary discussion clauses and the clauses about first and second declarations in the Bill as currently drafted. Instead, I propose that once a terminally ill person requests an assisted death under this Act, they must be referred for

“a multidisciplinary specialist palliative care assessment”

alongside a psychological assessment within established palliative care services. Given the urgency that often accompanies such requests, this assessment should be completed within seven days of referral. To ensure that any subsequent decision is genuinely informed, the individual must then be offered access to appropriate palliative care and psychological support

“within 48 hours of the assessment being completed”.

A person should not be eligible to proceed until their needs have been assessed, and the treatment and support options have been made available. That is why I propose that, before an application can proceed, there must be written confirmation from a consultant in palliative care medicine that all relevant specialist palliative and end-of-life care options have been discussed, offered and, where appropriate, tried.

Medicine routinely works in this careful, stepwise manner. It is entirely consistent with good clinical care that evidence-based palliative care should be fully explored before considering the irreversible act of ending a life. I have heard discussion in the media suggesting that these amendments would mean that people would be forced to have palliative care against their will. No, that is not their intention; the intention is twofold. First, it is to make sure that patients can make an informed decision. Secondly, it is to ensure that specialist palliative care services are available for people who want them, and that people are not choosing an assisted death because the NHS is not commissioning for the palliative care needs of the population.

Obviously, specialist palliative care itself needs to be properly defined, funded and made universally available and accessible. It is far more than the prescription of high-dose medications at the end of life. It is an active, multidisciplinary approach that supports patients and families at home, in hospital, in care homes and in hospices. That is why defining specialist palliative care, as set out in one of the amendments before us, is so important.

At present, access to such care is inconsistent and heavily dependent on charitable funding. Before introducing assisted dying on a national scale, we must ensure equitable access to high-quality specialist palliative care across the country. As part of the multidisciplinary palliative care assessment, I propose that every individual applying for assisted dying should be considered for NHS Continuing Healthcare through the fast-track funding process. This is an existing, well-established process, although perhaps not well understood within primary care or perhaps even within your Lordships’ House.

Continuing healthcare provides fully funded health and social care support, including assistance with medication, mobility and activities of daily living, but it can be slow to arrange. However, the fast-track pathway exists precisely to ensure that people with rapidly deteriorating or terminal conditions can access this support within 48 hours of their request. It works in practice. It is already there; the architecture already exists.

This can make an enormous difference, enabling people to choose their place of care, arrange nursing support, secure equipment or home oxygen, and relieving families of both emotional and financial burdens at a critical time. Encouraging fast-track access to continuing healthcare within the Bill would ensure that individuals receive timely, holistic support and are not driven towards assisted dying by unmet care needs. Furthermore, patients approved for fast-tracked continuing healthcare funding are more likely to have an accurate prognosis of six months or less. Taken together, these amendments would place specialist palliative care where it belongs: at the centre of end-of-life decision-making, ensuring dignity, compassion and genuine informed choice.