Terminally Ill Adults (End of Life) Bill

Baroness Berridge Excerpts

Friday 16th January 2026 Lords Chamber

[Baroness Lawlor (Con)]

My Lords, I will speak to my Amendments 40 and 59. The changes I propose may seem puzzling or pedantic, but, when dealing with legislation about life and death, every word matters. My amendments aim to bring the same care for language to subsections (2) and (3) as is used in subsection (1), which sets out that only if the conditions in paragraphs (a), (b) and (c) are met then assistance to end a person’s life, in accordance with Clauses 8 to 30, may be provided. If any of these conditions is not met then the action is subject to the existing criminal provisions of the Suicide Act 1961.

As they now stand, subsections (2) and (3) do not set out conditions in this way. Rather, they describe other parts of the Bill. Clause 1(2) is framed as an observation about Clauses 8 to 30, and Clause 1(3) apparently sets out a geographical marker for the certain steps provided for elsewhere in the Bill that “must be taken”. Subsection (2) therefore seems entirely redundant, since it purports merely to note what is said elsewhere. Subsection (3) is puzzling. Is the “must” a mistake or should it be “may only”?

Perhaps more important than such redundancy, inelegance and imprecision in drafting is that, in their present form, subsections (2) and (3) do not deprive those who act in contravention of the paragraphs they contain of the protection of the law from assisting suicide. They fail to make it explicit that this remains prohibited and punishable unless it meets subsections (2)(a), (2)(b), (3)(a) and (3)(b). My amendments would remove this perhaps unintentional looseness—the sponsor may wish to comment on the intentionality or otherwise—by making it explicit that assistance to end a person’s life may not be provided unless subsections (2)(a), (2)(b), (3)(a) and (3)(b) are all met.

[Baroness Berridge (Con)]

My Lords, I support Amendment 38, which raises for the first time in your Lordships’ House the complex issue of those who may be physically terminally ill but also have long-standing mental illnesses. While the legislation cannot be used only for mental illness, under Clause 2(4), cases where there is physical and mental illness can be very complex and particular safeguards will be needed. My main questions around those safeguards are for those who may be detained under the Mental Health Act, and are matters more for the Minister than the sponsor.

I served on your Lordships’ Select Committee on the Mental Health Bill. A person detained under the Mental Health Act may yet still have capacity to make some or most of their own decisions. If someone has gone through the process in this Bill with a six-month prognosis but is outliving it, they can also have regular periods of being detained under the Mental Health Act. It is important that we are clear about the position legislatively for the patient, clinicians and their family. What is the position? Which of these statutes will make clear which piece of legislation takes priority, if it is the case, as I understand it, that there are scenarios where both pieces of legislation could apply to a particular patient? You can be terminally physically ill and detained under the Mental Health Act but still have capacity, so you would be under the TIA as well as the Mental Health Act.

For clinicians, this relates to the strident evidence given to the Select Committee of your Lordships’ House on this Bill by Professor Alex Ruck Keene KC. This was partly outlined by my noble friend Lord Goodman previously in Committee when he was speaking about teaching clinicians on capacity and the criminal law. He said:

“I need to be able to say, with crystal clarity, ‘You’re no longer in that zone”—


meaning the suicide prevention zone—

“you’re now in the zone of the Terminally Ill Adults (End of Life) Bill’”.—[Official Report, 14/11/25; col. 522.]

Obviously, the suicide prevention zone he was referring to is a general duty for clinicians to all patients, but it is highly relevant when there is detention under the Mental Health Act. When you are thinking of a patient under the Mental Health Act, it focuses that issue down.

It is important to know which regime takes precedence for the family. This Bill is about individual autonomy, so the family are irrelevant. The new Mental Health Act, however, has extensive powers for nominated persons—and that is often family members—to exercise certain powers and even to discharge the patient. It is also key for the patient who has capacity but is under the Mental Health Act and has a six-month prognosis. Under the Mental Health Act, they can be made to take treatment—treatment that may well then mean they do not want to take the action in their existing declaration under the TIA. Has the Minister considered how the new Mental Health Act relates to this situation?

This issue exemplifies that the Committee of this House is actually trying to provide a White Paper or consultation function. The problem I have outlined, and that Mr Ruck Keene outlined, stems from the different philosophy of each of these pieces of legislation. The terminally ill adults Bill is all about personal autonomy, but the Mental Health Act is about treatment of illness, prevention of harm and preservation of life. This Bill is the state enabling and enhancing autonomy to take your own life, but the Mental Health Act is the state taking away some of your autonomy to preserve your life and prevent you taking it. One of the guiding principles in the new Mental Health Act is enhancing choice and autonomy, precisely because the Act’s powers take away some of an individual’s autonomy, even when they still have capacity. Given that we have different philosophical bases for two pieces of legislation, no wonder there is not the crystal clarity needed, as Mr Ruck Keene outlined, by him and other clinicians.

In practice, there is a human face to this. Take, for instance, a young adult who lives at home. They have been out of secure care for decades, they have always been treated well, their suicidal ideations have been managed, and they are well known to the local services, but they now have a terminal physical diagnosis and a six-month prognosis. They have gone through the procedure in the Bill but are now outliving that prognosis. Under the powers of admission for mental illness, they are treated, and, having been treated on a number of occasions, no longer want to exercise their declaration. But their family carers go on an extended holiday, so they go to stay with other family in a different part of the country. They become mentally ill and they are admitted, and they have capacity under the Mental Health Act. Can their declaration under the TIA Bill be used in this situation, or do they have to be treated? Do the nominated persons have to be told? If you are exercising a TIA declaration, you are no longer under the Mental Health Act.

Could it be that the TIA Bill is actually used without the family being told, which we know is the scenario given by evidence from medical examiners? They come home and their relative has died, and no one knew they had just been accepted on a clinical trial at the local hospital.

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[Lord Markham (Con)]

What I am trying to come back to—a point that my noble friend Lord Deben was making—is that there are some valid criteria here. I am trying to build some flexibility into this system. Lots of eligibility criteria are being set out here, in all these different amendments.

[Baroness Berridge (Con)]

I believe that the noble Lord answered that intervention, so this is separate.

The noble Lord served on the Select Committee with other noble Lords. We heard clear evidence from Alex Ruck Keene and others that this is not about flexibility: you need to know which piece of legislation you, as a clinician, are applying. Are you acting under your general duty on suicide prevention or, as in the example I gave, are you acting under either the Mental Health Act or TIA? There is no flexibility. Clinicians are asking for clarity on this; with all due respect, that needs to be in the Bill.

[Lord Markham (Con)]

It is about whether we are trying to build everything in; I will try to make my point now that I have taken a few interventions.

The point I am trying to make in all this is that these groups of amendments set out lots of different eligibility criteria. Some are about nursing homes and whether you are a resident. Some are about whether you have ever had a mental health assessment. Some are about financial support. Everyone in every circumstance says that, in some people’s circumstances, these criteria are very relevant and should be the criteria set down for doctors. It should be very clear that, under those criteria, the doctors and the panel should be taking these things into account. The criteria might be totally irrelevant for other cases, too.

We are trying to give the doctors and panels the opportunity to make these decisions without being tied up in knots over black and white exercises around whether the law is applicable to someone according to this or that, so that we can have a workable set of rules that takes into account all noble Lords’ concerns to make it as safe as possible—quite rightly—and creates a process whereby, ultimately, it is the experts, doctors and social workers on panels who are best placed to make a decision.

--- Later in debate ---

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I thank all noble Lords for their contributions to the debate. As I have said previously, I will limit any detailed comments to amendments about which the Government have major legal, technical or operational workability concerns. To that point, I would like to clarify for the noble Baroness, Lady Berridge, that that does include interaction with other legislation, on account of the Government’s clear duty to the statute book. I heard the noble Baroness make a request for government engagement. Should Parliament choose to pass the Bill, we will work with stakeholders to design a robust and effective service, but in the meantime, engagement is a matter for the sponsor.

[Baroness Berridge (Con)]

The specific issue I raised relates to a different piece of legislation for which the Minister has responsibility. Once the legislation is passed, if it is not compatible, it is too late. May I make this request? I am not requesting a meeting under the TIA Bill; I am requesting a meeting for the Royal College of Psychiatrists and Professor Sir Alex Ruck Keene under the Mental Health Act. I do not understand why the Minister cannot grant that meeting.

[Baroness Merron (Lab)]

For the reasons I have already outlined. That is why I clarified that, when I say I am only speaking about where there are particular concerns, if I do not refer to them, there are no concerns to raise for the attention of your Lordships’ House, which I would always be very clear in doing.

The noble Baroness, Lady Finlay, asked about Peers’ access to technical drafting support. To reiterate, as we all know, it is the sponsor who leads on engagement with Peers on policy content. To meet our responsibilities as a Government, we have been working with the sponsor of the Bill on amendments to ensure operational workability, were the Bill to pass. It might be helpful for the noble Baroness if I say that, where amendments were passed in the other place, there was support for the sponsor to ensure that the amendments met the test of being fully workable, effective and enforceable. In those cases, it was for the sponsor to table amendments to address any workability concerns.