Terminally Ill Adults (End of Life) Bill

Baroness Coffey Excerpts

Friday 27th March 2026 Lords Chamber

This has been one of the most painful Bills that I have ever had the privilege to listen to the passage of, because of the pain that I have heard on all sides of the Chamber. If there is one thing that this House has been traditionally good at it is listening to each other, reducing the level of pain and actually being loving. One thing that has hurt is that this Bill has trespassed and hurt in a way that none of us has ever intended or would ever want. I want us just to remember that we actually like each other a lot.

[Baroness Coffey (Con)]

My Lords, I strongly support Amendments 169, 268 and 657. In my discussions with a variety of doctors’ representatives, two issues clearly came out straightaway. They volunteered them— I did not ask for them—and they were about how this must shift to being an opt-in process. As it stands, it still definitely feels like an opt-out process in this legislation. The other thing that they were absolutely clear about was that this should not in any way be considered a treatment, because it is not. I do not need to repeat some of the arguments that have already been well articulated by the noble Lord, Lord Stevens of Birmingham, and others.

On Amendment 169, it is sensible to have a register. The noble Lord, Lord Moore of Etchingham, explained one of the reasons why, but I think that it is just for straightforwardness, so that people who are considering this potential approach can do it. Although I disagree with the BMA, and we are not discussing the clauses today about whether things can be raised by judgment, it would be helpful to give confidence in this process.

The questions that I have are principally for the sponsor and the Minister. The noble Baroness, Lady Blake, knows that I value her very much, but I appreciate that she is not the policy Minister, so if she does not have the answers today I would be more than happy to receive a letter in this regard from the relevant Minister. I want to talk through some of the amendments that the noble and learned Lord, Lord Falconer, has tabled. On Amendments 422 and 423, there are other groups later when I think we will discuss replacement of doctors—it does not matter whether that is in this group or not. I would like to get a sense of why he feels the need to do that.

One of my broader concerns, more generally, about Amendment 669A is that, while I appreciate that the noble and learned Lord is trying to address a challenge that has been laid, it still feels as though it has either not gone far enough or is almost tipping it the other way. If we consider the impact assessment, the Government suggest that even by year 10, fewer than 8,000 people may have taken advantage of the Bill. That contrasts significantly with Marie Curie’s figures that over 300,000 people engage with hospice care and palliative care every year. It does feel, and part of the debate we had earlier almost suggested it, that doctors should do it unless they choose not to, and I strongly believe we should do it the other way. Some of the amendments to the Bill lend themselves to that opt-in register, in effect, and then providing the necessary training to support this approach. I think it is fair to say that Schedule 3 is comprehensive, but again, sometimes when you are relying on aspects, you end up becoming a minority, and that in itself can bring coercion to perhaps go against your own personal views.

A few weeks ago, we got into the whole issue of providing treatments and the legal ruling that led to the GMC changing its guidance, which was deemed enough. Actually, the GMC has just published new draft guidance tackling issues to do with personal beliefs and the like. In particular, I am concerned that, unless the Bill is explicit that this is not a treatment, with all the forward implications of the fact that it is not there, we may end up with a lot of case law, or a lot of rulings. Also, point 23, I think, of the draft guidance that the GMC has put forward suggests, basically, “If there’s no alternative, you’re going to have to do this. You’re going to have to offer it, whether you like it or not”. That is more or less what it says, so it would be useful to hear from the Minister what discussions have been had with the GMC in considering that approach in the guidance, because it is relevant to our consideration of the Bill.

Amendment 888, tabled by the noble and learned Lord, extends Clause 31 to everybody in Scotland. I have an amendment, which I did not talk to because Amendment 888 was in this group, which is just trying to understand whether it was the Government or the sponsors who had already started to expand a series of primary legislation issues, I guess, to practitioners in other countries where the Bill does not generally apply. We had a debate a while ago about Section 30 orders, which is now somewhat redundant given the decision by the Scottish Parliament not to proceed with the Bill that it was considering, but I want to get a sense from the Government of where they are on this. I thought that the issues proposed in Amendment 888 would have been covered by a Section 104 order if the Scottish Parliament had gone ahead, so I want to get an understanding of the reasons for tabling this. If the Bill is going further and trying to bring the Scottish medical profession into potentially providing services in this country, that opens up a whole new chapter of consideration. In asking these questions, I am just trying to deepen my understanding and get clarification, both from the sponsor and from the Minister.

[Lord Harper (Con)]

My Lords, I want to cover a couple of points and reflect on what the noble and learned Baroness, Lady Scotland, said, which was that, despite the debate, there is a sense that people are agreed that this should be an opt-in rather than an opt-out process. The problem is that the way the Bill is drafted does not make that clear, and that is not just my view but the view, as we have heard, of many of those who are going to be involved in delivering this service. I will not go into that in great detail because many people have done so, but the Royal College of General Practitioners thinks that there should be a register and a more explicit opt-in system. Some of the other royal colleges do too and, as I think somebody else said, the Royal College of Nursing thinks it should be very clear that no one should be forced to participate. Of course, I give way to the noble and learned Lord.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I honestly do not think that these are difficulties. There is absolute clarity in the Bill as to what the legal position is, and it is a very wide exception. It is more than sufficient to give protection to people who do not want to participate in the provision of assistance under the Bill. Pushing it wider and wider simply gives rise to uncertainty. The key thing is that there should be certainty and sufficient width, and I believe that is what Clause 31 has done.

[Baroness Coffey (Con)]

I do not think that the noble and learned Lord spoke to his Amendments 422, 423 and 888. It is possible that he could do that in another group at a later date, but I wanted to clarify whether he would make sure that he does that.

[Lord Falconer of Thoroton (Lab)]

Amendments 422 and 423 are to create a regulatory power to allow co-ordinating doctors or independent doctors when they step down in certain circumstances not to have to give notice; for example, if they are too ill. It is a practical drafting change.