Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, I declare an interest: my brother is a consultant in palliative care. Today, I want to speak in defence of palliative care and hospice support for people with terminal illnesses. It is deeply troubling that this Bill and the debate surrounding it, certainly before today, have given so little consideration to palliative care.

I oppose assisted suicide in principle and I oppose this Bill. It is poorly constructed and it was rushed through the Commons with inadequate scrutiny, with many amendments not debated. Crucially, it does not even require that those requesting assisted suicide are offered a palliative care assessment first, yet specialists tell us that palliative care can help people who wish to die to rediscover reasons to live. At a recent Lords briefing, palliative care practitioner Dr Lucy Thomas shared the story of a patient who had considered Dignitas but changed their mind after receiving hospice care. Within days of starting that care, they felt valued rather than abandoned.

Sadly, too many terminally ill people feel abandoned by the NHS due to the lack of palliative care. Sarah-Jayne Blakemore wrote movingly in the Times about her father, the neuroscientist Sir Colin Blakemore, and the palliative care he received. Diagnosed with motor neurone disease, he had planned to go to the Netherlands for euthanasia. He never did that, as at each stage of his illness he was supported by his family and paid carers to cope and to find enjoyment in life. When his wife died, he struggled with depression and feared losing control, a fear echoed in the debates on this Bill. But after a hospice doctor explained his palliative care options, his daughter says he became optimistic and hopeful again. He went to stay at the hospice after developing a chest infection. His daughter describes how, for the last 10 days of his life, he received

“the most gentle and attentive care from people who had dedicated their lives to end-of-life care”.

She acknowledges that her father was lucky to live near a hospice

“that enabled him to have a peaceful and dignified death”.

Ahead of this debate today, we have been privileged to have briefings from leading palliative care experts including Professors Mark Taubert, Katherine Sleeman and Fliss Murtagh. Those clinicians, with decades of experience, tell us that almost all patients offered high-quality palliative care benefit from it, but it is often too little and too late, or indeed not offered at all. We do not provide enough care and support for people with life-limiting illnesses or for their families. Over 100,000 people die each year with unmet palliative care needs. Indeed, a Marie Curie survey found that in only half of expected deaths did families feel that their loved ones received adequate support with health and care in their final three months. We should have invested in palliative care so that more people can benefit as Sir Colin Blakemore did. It is unethical to leave the needs of 100,000 dying people unmet. We must consider those who do not and would not choose assisted suicide and ensure that they are offered palliative care first.

I pay tribute to my colleague Florence Eshalomi MP, who tabled an amendment in the Commons to ensure that no care home or hospice should be obliged to provide assisted dying. Hospices exist to offer comfort, dignity and holistic support, not to facilitate premature death. Introducing assisted dying into hospices risks undermining their purpose and deterring those who seek life-affirming care. Hospices are places of hope and compassion; they should not be asked to become sites of medicalised death. We must protect the integrity of our care institutions. We must safeguard the vulnerable and uphold the rights of those who dedicate their lives to end-of-life care. This Bill is not the solution. We should start with investment in palliative care to make it available to all who need it, including care at home.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Coffey (Con)]

My Lords, I do not think I am confused at all. I know what Jess Asato tried to get into the Bill to give her assurances, and that something has changed. I had moved on to talk about the amendment from Jack Abbot, which was very important.

The issue of illness is an example of where the Government said they had worked with the Bill’s sponsor. The challenge of this group—I am thinking about what the noble Lord, Lord Birt, said earlier—is that we are covering multiple issues on the basis of drafting changes. I would rather get into the substance of some of this when we get to later groups. However, Clause 14 says that, in the very unlikely circumstances that the doctor who agreed to give a second opinion “dies” or “through illness” is unable to continue, the person has the right to seek a second opinion elsewhere. My point is about removing “through illness”, which was specifically included the Bill. I am trying to understand why the noble and learned Lord is seeking to do that. I have already heard him say that you can just find another doctor, but I am particularly keen to hear from the Government their view, because they worked with the Bill’s sponsor in the Commons to get this phrasing about illness in.

The sponsor’s Amendment 416 is to do with independent doctors and Commons Amendment 459, and there is more than one reference to this issue. There was significant debate when Sarah Olney introduced her amendment in Committee in the Commons seeking to reduce the possibility of abuse by making sure that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible. My interpretation of the amendment tabled by the noble and learned Lord, Lord Falconer of Thoroton, is that that goes away and there will not be two reports, and the amendment speaks further about aspects of the reports.

This amendment brought attention from other MPs. Lewis Atkinson talked about recognising that the provision of five different touchpoints of assessment—I appreciate the effort that has gone into trying to bring in safeguards around these matters—is one of the strengths of the Bill and that each assessment should be done in a way that can be progressed with more information. On the Bill’s record-keeping provisions, the assessment should become increasingly informed throughout the process, and therefore there should be an opportunity for a lot of those things to be shared with the panel, as the Bill proposes. Kim Leadbeater said that she was minded to support Sarah Olney’s amendment, but, again, some of those changes are being taken out.

I am not entirely clear about Amendment 417. I somewhat understand the disability definition, although there is only one reference to Section 6 of the Equality Act 2010 anywhere.

This group of amendments needs careful scrutiny as we go through the different groups for later discussion. One of the aspects that we need to make sure of is that the extensive concessions made in the other House do not all of a sudden, through just a few changes here and there, go away. In fact, as we know, in this House we are even considering what further safeguards there could be. One of my reasons for rising today was to bring this to the attention of the Committee. I am not suggesting that the noble and learned Lord, Lord Falconer of Thoroton, has done this in bad faith. He may well think that this is just being more efficient, but the extensive debate and the support in the other place—indeed, the support of Kim Leadbeater—for several of these amendments as they were originally drafted mean we should be asking him to think again. We will get into some of the detail in the debates on future groups. I beg to move.

[Baroness Keeley (Lab)]

My Lords, my Amendment 420 could sit beside Amendment 419 from my noble and learned friend Lord Falconer, but it has not been put in this group. This group is labelled “drafting changes” but, as we have just heard, the effect they would have goes further than that. I have tabled Amendment 420, to be discussed in a later group, to address a concern that the grounds on which a co-ordinating doctor can drop out are already too wide, but I see that the amendments in this group from my noble and learned friend Lord Falconer compound that problem by expanding the grounds even further. I therefore feel I must speak briefly in this debate, despite the fact that my amendment comes later, because your Lordships’ Committee needs to be aware of the concern I am seeking to raise, which the noble Baroness, Lady Coffey, also has.

My Amendment 420 highlights that these provisions should be limited to cases of death or illness. Clause 14 fails to define in which situations it would be acceptable for the state not to be concerned that the doctor is unwilling. As the noble Baroness, Lady Coffey, has highlighted in her Amendment 420A, the danger is that the current wording would allow the risk of changing doctors until the wanted answer is given. These probing amendments are going to be discussed later, and they will focus on the need to restrict the grounds for changing the co-ordinating doctor by excluding the word “unwilling”, which Amendments 420 and 420A both address.

It would be helpful if my noble and learned friend Lord Falconer could answer these questions on this matter. How do we distinguish between a doctor who is unwilling due to conscience and one who is unwilling due to suspicion? Without a requirement to record the specific reasons for unwillingness, is there a danger that we are creating a black box? If a doctor steps away because they are uncomfortable, for instance, with a family member’s influence, surely the system needs to capture that specific hesitation before a new doctor is appointed. Will my noble and learned friend Lord Falconer specify what circumstances cross the line where the state should be more curious about why the doctor is unwilling?

[Baroness Grey-Thompson (CB)]

My Lords, I originally requested that later amendments that I have on disability language, as defined under the Equality Act, be moved into this group, but they were not. I think it is important that we have a chance to debate them as well. Language is the dress of thought, and “person with a disability” is not language that is used in the Equality Act. However, if the noble Baroness, Lady Coffey, seemed to misunderstand these amendments, I think I have misunderstood them as well.

I am particularly concerned about Amendments 290, 366 and 931 around domestic abuse and coercive control, which I have spoken about in other debates. I believe that these amendments go beyond mere drafting changes. The wording as it now exists waters down what the training around domestic abuse is likely to be. For example, it could be a course on physical or sexual abuse, but that does not necessarily mean that it is as comprehensive as I believe it needs to be. I am conscious of time, but I would be interested to know whether the noble and learned Lord or the sponsor in another place, the honourable Member for Spen Valley, has spoken to the honourable Member for Lowestoft, Jess Asato, about the impact of these amendments on her work. It important that we understand the context of what we thought was coming from the Commons and what these changes might mean to the Bill.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Smith of Newnham (LD)]

My Lords, the noble Baroness, Lady Jay, just asked us to consider the circumstances of those who are seeking an assisted death, but I would like to give a salutary lesson—I am sorry to disagree with the noble Baroness, Lady Gerada.

My father was taken ill during the Covid pandemic. He did not have a smartphone and was not able to have an in-person consultation. He had jaundice. The message he came away with from speaking to a doctor on the telephone—the doctor had never met him—was, “It’s pancreatic cancer”. My father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he did not have pancreatic cancer.

That demonstrates one of the flaws of doing something remotely, which is: what are the messages? The doctors are not getting the cues and the patient is not necessarily hearing what the doctor is saying. I am sure that the doctor did not say, “Mr Smith, you have pancreatic cancer”—clearly, they could not have said that—but that was the message that my father heard. I therefore very strongly support the amendments in the name of the noble Lord, Lord Evans of Rainow, and two of the amendments from the noble Lord, Lord Blencathra.

However, I want to express one serious reservation about Amendment 406A from the noble Lord, Lord Blencathra. If the discussion has to be taken by video conference, it might not be appropriate to say that in every circumstance the only person who should be on that call is the patient. We all know that, when you go to the doctors, even if you are there in person, you have capacity, you are a rational person and you do not have any cognitive difficulties, you do not hear everything. Sometimes, if it is a difficult diagnosis, you do not take everything on board. For some people who are told that they have a terminal diagnosis and understand that that is the case—unlike in the false case of my late father, who did not have a terminal condition at that stage—we know what their settled will is. There are several people in your Lordships’ House who have what their settled will is very clearly on record, in the public domain. But there will be other people with whom the doctor has never spoken before, so they cannot know whether it is somebody’s settled will in a way that the legislation requires.

If, then, there has to be a video conversation, or indeed an in-person conversation, it might be appropriate for there to be an independent advocate or somebody else who would support that person and could say, “The doctor did not really say that, you know”. We need to think about real-life cases. Yes, we need to understand from the medical profession, and it needs to be from the perspective of somebody with a terminal diagnosis, but we also need to understand the reality for ordinary people who do not have the advantages of the internet or the accessibility that Members of your Lordships’ House have.

[Baroness Keeley (Lab)]

My Lords, I will speak on face-to-face consultation; my Amendment 483 on this is in a later group.

During the Covid-19 pandemic, it was briefly made possible for the making of a will to be witnessed by videolink rather than in person. This change could have been made permanent, but instead the Government decided that the videolink provision should cease from January 2024. The law is now again that the witness must have a clear line of sight of the person making the will. Are these precautions any less important when assessing whether someone truly wants an assisted death and is not being coerced than when establishing what should happen to their assets afterwards?

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Baroness, Lady Keeley, has already alluded to the issue of wills, so I will not go to that, but there is another legal precedent, Devon Partnership NHS Trust v the Secretary of State for Health and Social Care in 2021, when the High Court ruled that under the Mental Health Act, the phrases “personally seen” and “personally examined” require the clinician and approved mental health professional to be physically present with the patient for detention assessments. Following that, NHS England reviewed its guidance. That underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence.

Secondly, during Covid I chaired the National Mental Capacity Forum and ran fast-track online seminars for those who were doing remote assessments because of the problem of people in care homes. It was a very difficult time and that was a public health necessity. Since then, some remote consultations have certainly continued, as we have already heard. However, the qualitative studies of remote mental health care during the pandemic found that a lack of face-to-face contact compromised risk assessment and therapeutic insight.

Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes. They caution how remote assessments can be less effective in capturing complex, subtle behaviours, non-verbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and in detecting distress or coercion. Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations but also by video. Even when remote assessments were used only to triage risk, delaying face-to-face evaluation, the effects slowed down accurate identification of deteriorating conditions.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

Moved by

[Baroness Keeley]

87A: In subsection (2)(a), after “drinking,” insert “either voluntarily or”

[Baroness Keeley (Lab)]

My Lords, I am speaking on behalf of my noble and learned friend Lady Scotland, who made clear last Friday that she could not attend today’s Committee debate. I very much appreciate what my noble and learned friend Lord Falconer has just said, but it is worth me explaining Amendment 87A a little and making another couple of points.

The purpose of Amendment 87A is simple—to retain a safeguard that prevents a person becoming eligible for assisted dying by choosing to stop or limit their drinking. We have heard about what happens around that.

I certainly welcome the intention behind Amendment 87, which rightly seeks to protect people with anorexia nervosa, whose restricted intake cannot truly be considered voluntary. On that point, there is welcome consensus. But there are some points that are still worth making.

As drafted, Amendment 87 would inadvertently dismantle another essential safeguard that would ensure that people who are not terminally ill cannot make themselves terminally ill by deliberately ceasing food and fluids. This issue is entirely distinct from anorexia. The other place added Clause 2(2) specifically to prevent that.

Amendment 87A restores that protection so that Amendment 87 would safeguard both groups—those whose mental disorder limits eating and drinking and those who might deliberately restrict intake. This is not a theoretical concern. The case of Cody Sontag in Oregon shows us that what we fear may happen is already happening in one of the jurisdictions that we keep hearing has not experienced significant challenges with assisted dying. Cody was a woman with mild cognitive impairment who feared future cognitive decline after watching her father die of Alzheimer’s disease. After being advised by an end-of-life organisation that by voluntarily stopping eating and drinking she could bring herself within the eligibility for an assisted death without a waiting period, she did so. Within five days, her doctor concluded that she was terminally ill due to dehydration. Two days later, she died by assisted death.

The American Academy of Aid-in-Dying Medicine acknowledges that this loophole is a legal grey zone. I am sure that noble Lords agree there must be no grey zones when dealing with irreversible decisions about life and death.

Even if amended by Amendment 87A, Amendment 87 would not fully protect people with eating disorders, because many people with eating disorders do not restrict their eating and drinking. For example, people with type 1 diabetes and an eating disorder will manipulate insulin, and people with bulimia binge and purge. Both behaviours can be life threatening—particularly where treatment is refused or unavailable—despite being treatable conditions. Under Clause 2(1), such individuals could still meet the definition of terminal illness.

Throughout the Bill’s passage, as my noble and learned friend Lord Falconer acknowledged, concerns about protecting people with eating disorders have repeatedly resurfaced. Concerns were raised repeatedly in the other place, in oral evidence, in line-by-line scrutiny on Report, and at Third Reading, and we are raising them again here. It is abundantly clear that we have not yet got this right, so my noble and learned friend’s comments about accepting Amendment 87A are very welcome.

The Bill does not yet protect this vulnerable and growing group of people, illustrating how easily complex conditions can fall outside intended protections. For that reason, I support Amendment 101 in the name of the noble Baroness, Lady Parminter, which would explicitly rule out the physical effects of any mental illness, including eating disorders, from qualifying the person for assisted dying.

Evidence from other jurisdictions shows that more than 60 people with eating disorders have already died by assisted death—all women, and the majority aged under 40. We must not repeat those mistakes here.

I also support Amendment 92 in the name of my noble friend Lady Debbonaire, which addresses the serious risk posed when someone with a treatable condition refuses or withdraws consent to treatment. Long, difficult treatment journeys can leave people despairing. Under the Bill as drafted, refusal of treatment would become a straightforward route to eligibility. The amendment from the noble Baroness, Lady Parminter, would close that loophole for eating disorders, and Amendment 92 would extend protection to all treatable conditions. We should adopt both. This is fundamentally a matter of sequencing.

Someone who is terminally ill and chooses an assisted death is entirely different from someone who makes themselves terminally ill by refusing treatment due to suicidal feelings. The Bill was never intended to allow the latter.

Our purpose is to make the Bill safer, and adopting all these amendments is essential to doing so. There can be no grey areas in matters of life and death and the protection of vulnerable people.

[Lord Empey (UUP)]

My Lords, I will speak to Amendment 89. I think that everybody in the Committee is more or less on the same page in what we are trying to achieve here. This amendment would add,

“or withdrawing medication, hydration, or life-sustaining devices”

to Clause 2(2). This has perhaps been forgotten about, but people sometimes rely on ventilators and other equipment to sustain their lives, so it is not a big leap forward to add this to the legislation. It is simple and straightforward, and amending Clause 2(2) seems to make sense. I cannot think of any reason why the noble and learned Lord should not adopt the amendment as a sensible way forward. It indicates—we have had this conversation a number of times, but we have to bear it in mind—that there are still significant weaknesses. We have to make the Bill safe.

On the hostile reaction to what we are trying to do here, I gently remind the Committee that when we last discussed this subject on 22 October 2021, at the Second Reading of the Assisted Dying Bill that Baroness Meacher brought forward, her Private Member’s Bill had 10 pages and 13 clauses. The Bill before us has 51 pages and 59 clauses. People have to understand that this is a massive Private Member’s Bill and is not normal in terms of how we deal with such Bills—it is much bigger. With that, I hope that the noble and learned Lord will have no difficulty in accepting Amendment 89.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Farmer (Con)]

I speak in support of amendments on behalf of my noble friend Lady Maclean of Redditch, who unfortunately cannot be in her place at this hour on a Friday afternoon. I refer to Amendments 445, 483A, 495B and 941A. First, Amendment 445 would require the panel to consider signs of fluctuating capacity. That issue has been addressed in previous groups but needs raising again briefly here. As Professor Martin Vernon told the Lords Select Committee,

“fluctuating capacity is an extraordinarily common issue, but none the less somebody may retain capacity at some point during their dementia diagnosis sufficient to make a determination as to whether they wish to end their life”.

As has been stated, about two-thirds of people with dementia have never received a formal diagnosis, so it is incumbent on the panel to consider that possibility and take evidence on whether it could be the case. Given that the co-ordinating doctor is not required to be in the room at the actual moment of administration, fluctuating capacity could raise vital issues of consent.

Amendment 483A probes whether the panels have sufficient powers to gather all necessary evidence to decide on eligibility. It ensures that a panel can refer the patient for any further assessments that it considers necessary. Can the noble and learned Lord who is the sponsor explain why the panel does not sit within the usual tribunal structures, as doing so would give it more expansive powers to request further evidence where necessary? For example, the tribunal procedure rules for the First-tier Tribunal, in the Health, Education and Social Care Chamber, empowers the tribunal without restriction to give direction to matters such as,

“issues on which it requires evidence or submissions … the nature of the evidence or submissions it requires … whether the parties are permitted or required to provide expert evidence, and if so whether the parties must jointly appoint a single expert to provide such evidence … and the time at which any evidence or submissions are to be provided”.

It would be helpful if the Minister could confirm whether the powers given to the panel in Clause 17(4)(d) and (e) are as extensive.

Finally, my noble friend’s connected Amendments 495B and 941A would require the panel to provide a report to the person containing recommendations to address any unmet social and palliative care needs, in addition to determining whether an eligibility certificate should be granted. More fundamentally, these amendments probe what the panel is intended to be. The Bill’s sponsors previously have tried to argue that the panel is akin to a multidisciplinary team. My understanding is that on this point they have been rebuffed. After the noble and learned Lord cited the Association for Palliative Medicine’s Dr Sarah Cox in his defence on 9 January, the APM responded in a letter that the Bill’s sponsor had misrepresented Dr Cox’s position, saying:

“This panel fails to replicate a true multidisciplinary model and essential protection”.


Further, it says that the Bill’s current provisions render

“the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.

My noble friend’s amendments are intended to help the noble and learned Lord by providing ways for his panel process to be strengthened so that it operates more like a multidisciplinary team. An important first step would be to expand the panel’s scope so that it includes explicitly the ability to provide assessments of or treatments for unmet health and social care needs. This would enable each panel member to assess, individually and then together, the holistic needs of the patient and contextualise their decision around assisted suicide. My noble friend’s Amendments 495B and 941A build on this and a recommendation of the Royal College of Psychiatrists that the panel should be able to recommend interventions addressing potential drivers of a desire to hasten death, such as depression, social isolation or difficult physical symptoms.

It should be remembered that the Bill does not guarantee that the person will ever have met a psychiatrist or social worker before this stage in the process. We cannot deny the patient the benefit of their holistic experience and expertise in favour of a rubber stamp. My noble friend would also tie her amendments to the sponsor’s commitment to consider a requirement for the co-ordinating and independent doctors, although not the panel, to ask why a person has requested assisted suicide. Ultimately, what is the point of exploring motivation unless the intent is to establish whether drivers can be addressed in another way?

To conclude, the heart of the problem is that, due to the way it was added to the Bill in the other place, the panel process suffers from a fundamental identity crisis. Are the members trying to be a kind of tribunal, or are they designed to be a kind of multidisciplinary team? It would be helpful if the sponsor could enlighten us, because currently they fall short of both.

[Baroness Keeley (Lab)]

My Lords, I will speak briefly in support of my Amendment 483, which would ensure simply that in-person hearings remain the default when assessing applications under the Bill, with remote evidence via video or audio link used only where extraordinary circumstances make an in-person hearing wholly impracticable.

Given the gravity of the decisions involved, it is essential that scrutiny is of the highest standard. An in-person hearing allows the panel to observe the applicant fully, including their demeanour and interactions, and to look for any signs of pressure. This cannot be reliably assessed over a video link, and certainly not over the phone. Indeed, California’s assisted dying law requires assessments of coercion or undue influence to take place outside the presence of any other person, a safeguard that remote evidence cannot guarantee.

The Civil Justice Council’s review of remote hearings during the Covid pandemic found that the majority of respondents considered remote hearings to be worse than in-person hearings overall and less effective in facilitating participation, a critical component of procedural justice. Many respondents found remote hearings tiring, difficult to follow and more prone to misunderstanding. The Civil Justice Council found that nearly 13% of participants in remote hearings experienced significant technical difficulties, and in a process as sensitive as this one, even a small risk of technical or technological failure is a risk too far. There is also a contradiction in the Bill as drafted. It requires live evidence while simultaneously allowing pre-recorded testimony, so that a short, pre-recorded voice note could in theory constitute the entirety of an applicant’s oral evidence, with no opportunity for questioning from the panel, and that cannot be an adequate safeguard.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Berridge (Con)]

My Lords, probing Amendment 200C, in my name, would prohibit people from raising with children assistance in taking your own life, and deals with the method by which the issue of assisted dying can be raised with someone under 18. It particularly should not be raised online. The amendment seeks to extend Clause 6.

I first note my support for Amendment 210, just outlined by the noble Lord, Lord Rook, on the consequences for breaching Clause 6. Further, I wish to support Amendments 157 and 164, in the name of my noble friend Lord Ahmad and spoken to by my noble friend Lord Evans. It is entirely sensible to enable people to opt out of being offered such an assisted suicide service.

The Bill seems to have no limit, nor is it probably possible to place a limit, on the number of times assisted suicide could be raised with a patient, so it is surely consistent with autonomy to give the patient the right to opt out. One need think only of a GP surgery, and the number of GPs or nurses you see. If each of those people raises it with you, that could possibly even border on harassment. Conceptually, it is an extension of the freedom of conscience that we give to organisations and clinicians to opt out of the service. I hate to think that even dealing with a GP surgery could perhaps become part of Patchs.

This leads me on to the means by which issues can be raised, which has radically changed, and why my amendment includes online. I am grateful to the noble and learned Lord for filing comprehensive amendments in relation to advertising, but the issue of raising it with someone under the age of 18 is different. I would like assurance from the noble and learned Lord that this use of social media—for instance, someone sending a TikTok or something like that about assisted suicide—is covered by Clause 6.

That example may seem straightforward, but, once again, it brings into focus the analogue nature of the Bill. If ChatGPT, for instance, in response to a question which it mishears, tells someone under the age of 18 all about assisted dying in the Bill, is that covered by the amendments on the prohibition of advertising that the noble and learned Lord has raised? Could a bot or algorithm operate without direct human intervention and raise with a child the issue of assisted dying?

Noble Lords will be aware—the noble Baroness, Lady Berger, has spoken much on this—of the cases that are currently being taken against ChatGPT, in which OpenAI is the litigant. It is being sued for giving suicidal information to young people, who have, incredibly sadly, acted on that information. Has the noble and learned Lord spoken with technology experts about the Bill to ensure that all of these situations have been fully considered? By my reading, I do not believe that they are covered by the prohibition on advertising. As I say, advertising and raising it with someone seem to be two different concepts.

I used the word “person” in the amendment, not just “healthcare professional”, as there are numerous situations and relationships where children might have assisted dying raised with them—obviously that includes at school or college. Does the noble and learned Lord envisage that there will be guidance in this regard, and which one of the many delegated powers would be used under the Bill? What about youth groups, faith groups, sports clubs, carers or school transport? Parents need to know who is allowed to raise this potentially life and death issue with their children.

Assisted dying law will shape how children understand the value placed on life, disability and dependence. Vulnerable children may internalise the message that society is more willing to facilitate their death rather than fund their long-term care and inclusion. The concern of parents and carers around how this issue is raised with children could make the issue of PHSE teaching—namely, sex education—in schools look uncontroversial.

Although the scope of the amendment is wide—as I have said, it is probing—at least it is clear, whereas, alas, Clauses 6 and 56 are not. The phrase “No health professional” is in the title of Clause 6. It then uses the phrase:

“No registered medical practitioner or other health professional”


within the clause. This is a mixture of the definition of health professional in Clause 56. Usually, when you have an interpretation clause stating a definition such as “health professional”, you would then expect that term to appear consistently within the Bill. Nowadays, all you have to do is Ctrl+F to find every example to ensure that there is consistency throughout the legislation. Due to this mix of use of terminology, are physios or OTs included in these definitions and therefore within Clause 6? Although I accept that Clause 6 was added in the Commons, I am disappointed that the noble and learned Lord, the sponsor, has not got ahead of the curve here and laid his own amendment.

Finally, can we have clarification on whether the registered medical practitioner in Clause 5 can be a private GP or healthcare professional? People may have a financial interest as we believe there can be private providers of assisted dying services. It may be that I am correct in that understanding, and I presume the noble and learned Lord, Lord Falconer, will want to ensure that there is no conflict of interest or incentive in the matter. It is possible that the matter has been covered in the developments under the law since the medical devices report. However, due to the lack of pre-legislative scrutiny, it is not clear and I would be grateful if the noble and learned Lord could clarify that.

[Baroness Keeley (Lab)]

My Lords, I will speak to my Amendment 155, which is different to the amendments in the name of the noble Lord, Lord Ahmad, on patients who opt out. My amendment ensures that when a person has previously cancelled the process of obtaining assisted dying—having considered it as an option and then rejected it—they can continue to discuss their terminal illness freely with their medical practitioner without being pressed to reconsider assistance to end their life.

As we are hearing, we have had a great deal of evidence on this issue. In its written evidence, the Association for Palliative Medicine of Great Britain and Ireland observed:

“Doctors influence decisions made by their patients in conscious and unconscious ways and are themselves shaped by their personal and professional life experiences … if the patient clearly rejects AD, they may suspect that other treatments suggested by this doctor are driven by an agenda to shorten their lives or may otherwise result in this. This could lead to patients opting not to engage with palliative care or to the loss of trust in a medical practitioner or in the medical profession at a crucial time in people’s lives”.


There is a clear danger here. If a patient has already considered and rejected assisted dying and their doctor raises it again, it may appear as though the doctor is pursuing an agenda to shorten that person’s life. That risk to trust at the very moment when trust is most needed should not be created by the legislation before us.

I also want to refer to evidence given to the Commons by Dr Vicki Ibbett, an NHS specialty doctor in psychiatry with extensive professional and personal experience of suicidal ideation. She expressed serious concerns about the impact of the Bill on suicide prevention work and highlighted that the voices of people with lived experience of suicidal ideation were not heard in oral evidence sessions. Speaking about terminally ill people who may experience thoughts of not wanting to be alive, Dr Ibbett wrote:

“Thoughts of wanting to die have a known association with being given a cancer diagnosis and learning of being terminally ill … Suicidal ideation may have arisen as part of the response to a new diagnosis with a terminal prognosis. It may, therefore, be part of an ‘adjustment reaction’. Adjustment Disorder often settles without professional intervention. If it persists additional support may be beneficial. Assisted suicide should not be facilitated”.


My Amendment 155 therefore seeks to ensure that a doctor may not raise assisted dying with a patient whose medical records show they have previously cancelled a first or second declaration. When somebody has already walked back from that decision, the law should protect them from renewed pressure, intentional or not.

Finally, I will quote from a recent article by Jim McManus, national director of health and wellbeing at Public Health Wales, writing in a personal capacity. He wrote that

“no end-of-life decision happens in a vacuum. Choices are shaped by many things, and sometimes these are inequality, unmet need, patchy palliative care, and the grinding pressures of an overstretched NHS … People expressing a wish to die may be experiencing treatable depression, loneliness, or feelings of being a burden. The Royal College of Psychiatrists has raised concerns that the Bill’s safeguards are insufficient to protect people in exactly these vulnerable states”.


Amendment 155 is a small but vital safeguard, ensuring that when someone has stepped back from assisted dying, their decision is respected. At such a vulnerable moment, no patient should face renewed pressure; our priority must be to protect, trust and uphold compassionate, high-quality care at the end of life.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what influenced me to look positively at a number of amendments in this group, and to table Amendment 150, was that some jurisdictions with assisted dying legislation explicitly prohibit doctors from initiating assisted dying discussions. I know that there was a bit of a row earlier about Australia, South Australia and New Zealand, but the truth is that people who have this legislation thought it was important to say that if a doctor raised this with the patient, it would breach professional misconduct. In fact, South Australia even used the wording “must not … suggest”. That is quite hard.

However, it is very interesting that this group of amendments holds importance for all of us. In other words, it cannot be assumed to be either filibustering or messing around, because we are citing places that have assisted dying, and they think that this is a very good and important safeguard—or that it is at least worth debating.

One reason they do that is the issue of autonomy, which I know is very close to the noble and learned Lord. The concern is that, if a doctor initiates discussions about assisted dying, it undermines the very principle of the Bill’s supporters, which is to ensure that the decision regarding assistance to end your own life is yours taken freely; it is patient-initiated. I was rather surprised to hear the noble Baroness, Lady Blackstone, cite the BMA. What happened to the patient-centric approach? We now have the BMA versus the patient. If a patient wants an assisted death, good—well, not good, but they can initiate the discussion and raise it themselves, if they want to; it is an autonomous decision.

Terminally Ill Adults (End of Life) Bill

Baroness Keeley Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, on the same principle of making it safe, I will speak to my Amendment 219, which would open an extra channel of communication. It would require the person’s GP to disclose relevant information about the person’s eligibility for assisted dying. That information would be disclosed, first, to the doctor who conducts the preliminary discussion; secondly, to the co-ordinating doctor making the assessment; and, thirdly, if the GP believes that the person may not be eligible, to the commissioner.

The principle behind the amendment is simple. The doctors and the panel need to be as informed as possible about the applicant in those circumstances. A GP may well have crucial information and, at the moment, the Bill does not give a clear opportunity for that information to be shared. The GP’s only role in the Bill, as has been said previously, is to receive notifications. As my noble and learned friend Lord Falconer put it,

“the GP, in the structure of the Bill, is not somebody who has to be involved … the GP is somebody who is receiving information”.—[Official Report, 12/12/25; col. 478.]

This seems to be a missed opportunity. It is not hard to think of cases where a GP might have relevant knowledge. There are instances of fluctuating capacity, where a GP might well know more about the person and their mental capacity than the assessing doctors and the panel. There are cases of coercion, where the assessing doctors might miss the signs. Where there is doubt over the person’s illness and their six-month prognosis, a GP’s input could be essential.

The Bill requires the assessing doctor to make such inquiries of professionals who are providing, or who have recently provided, health or social care to the person, as the assessing doctor considers appropriate, but that is quite a broad provision. Crucially, it is a one-way process. The assessing doctor can make an inquiry with a person’s GP, but the GP is not supposed to offer helpful information unless they are specifically asked for it. That seems an obvious gap.

In a previous group, we discussed amendments that would give a greater role to the GP, but those amendments were criticised as being unrealistic. This amendment, by contrast, would make a small change, which would enhance the protections already in the Bill.

The report of the Demos commission, chaired by my noble and learned friend, said that a key element in the assisted dying regime was

“a doctor who, where possible, knows the person well”.

That doctor could be the patient’s general practitioner. The Bill does not guarantee that, but my amendment would ensure that, if the GP has significant, first-hand knowledge, that knowledge will be taken into account and not overlooked.

[Lord Harper (Con)]

My Lords, I will be very brief. I will speak to my Amendments 354A and 432A, which are both about making sure that relevant information from the preliminary discussion is made available to the commissioner and the panel. The reason why I can be brief is that they are similar in what they are trying to achieve to the amendments tabled by the noble Lord, Lord Rook. He set out clearly the rationale for doing so, and I can simply agree with what he said in support of my amendments.

I will comment on the amendments in the names of the noble Lord, Lord Shinkwin, and the noble Baroness, Lady Grey-Thompson. The theme behind all of them is to ensure that there is timeliness in reporting and sufficient clarity about what is recorded to give people confidence that the process has been carried out properly. The noble and learned Lord, Lord Falconer, has been very clear that there is a clear process set out in the Bill, but it is important to give people confidence that it is documented, comprehensively and on a timely basis. There is clearly a debate to be had about being too specific about the timeframe or what is recorded. However, ensuring that there is sufficient detail, and that it is done sufficiently quickly, is important. I commend those other amendments to the Committee.