Terminally Ill Adults (End of Life) Bill

Baroness Blackstone Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Campbell of Surbiton (CB) [V]]

My Lords, I have added my name to Amendment 149 in the name of my noble friend Lady Grey-Thompson. I also support the principle underpinning Amendments 150, 151 and 154, all of which aim to prevent a medical practitioner initiating discussions on assisted dying under Clause 5 of the Bill.

Like the noble Lord, Lord Shinkwin, I thoroughly agree that doctors must not be permitted to initiate conversations about assisted dying to patients. Let me tell your Lordships why. Doing so would breach their fundamental duty of care to their patients at the very point when the patient may well be at their most fragile—newly diagnosed and frightened about what the future holds. It would not be a neutral clinical act but an intervention laden with power, meaning and consequence. The very suggestion of assisted death from a doctor at such times risks being heard not as an option but as a judgment.

Not long ago, during the scariest time of the Covid-19 pandemic, disabled people were contacted by their GPs to ask them to allow permission for DNR notices to be placed on their medical records should they be hospitalised after contracting the virus. Disabled people were horrified; many contacted me and other parliamentarians to know why they were being treated differently from non-disabled people. They said that it felt as though catching Covid would be a death sentence. Thankfully, the Secretary of State for Health rectified the issue, reminding doctors that their actions were in contravention of the Equality Act and the Human Rights Act, but the damage was already done. Disabled people who relied on their doctors for their health and well-being felt betrayed and unworthy of life-saving treatment.

If a medical practitioner raises the possibility of an assisted death, the patient’s feeling of security and trust will be damaged in the same way as during the pandemic. Your Lordships have often heard me say that I count my blessings every day because my doctors support and celebrate my life, however ill I become. I feel secure knowing that they will do their absolute best, however grim my prognosis may be. Reliance on that assurance is critical to the well-being of patients, especially those with long-term disabilities.

If assisted dying is to become an option, it must be one that is strictly patient-initiated, tightly defined and clearly demarcated from ordinary clinical care. It must sit within a system that prioritises palliative care, practical support and the affirmation of life; otherwise, it will be seen as the simplest and most straightforward option for the patient, their family and friends, the NHS and society as a whole.

The doctor-patient relationship is inherently unequal, and never more so than after a terminal or life-limiting diagnosis. When a doctor introduces the possibility of assisted dying, however delicately phrased, it carries weight. For many patients, particularly those who already feel themselves to be burdensome, costly or devalued, the message risks being internalised as a subtle signal that their lives are no longer worth living.

We must also confront the reality of acute vulnerability. A diagnosis of serious illness often brings shock, despair and temporary suicidal thoughts—feelings that, with time, treatment and compassionate support, frequently pass. This is why I support my noble friend Lady Grey-Thompson in her Amendment 149, which seeks to address this. Depression, unmanaged pain, fear and loneliness are not unusual bedfellows for people with a terminal diagnosis. Medical practitioners are not specialists in disentangling these states.

If we are serious about safeguarding autonomy, our first duty is to ensure that people are offered care, hope and practical support, not an expedited exit at a time when they feel most afraid. I therefore hope the noble and learned Lord will recognise this and come back with his own amendments on Report, to ensure that the subject of assisted dying is raised only by the patient and never by a medical practitioner. I would be very pleased to meet him between now and Report to explain further why this is so essential for the legislation to be safe in practice.

[Baroness Blackstone (Lab)]

It is with some trepidation that I speak, since I realise how passionately the previous speakers think about what they have said. The first small point I want to make is that the noble Baroness, Lady Campbell, referred to Report—we are not going to have a Report stage, because we have taken so long in dealing with all the many, many amendments that have been tabled.

Leaving that on one side, we have to realise that doctors’ main objective is to try to alleviate suffering. This is what those of us backing the Bill believe it does: it will alleviate suffering—sometimes terrible suffering—and torment by allowing people to choose the time of their death when they are already dying. We must not forget this. If we accept that this is the role of doctors, that this is what they try to do in their professional work, we must allow them to discuss at an appropriate point, in their judgment, all the possible options that are available to the dying person. If the Bill were enacted, one of the options would be an assisted death if they had reached that point. So to say that a doctor in a close relationship with his or her patient would be unable to raise this as a possible option would be entirely wrong.

I advise everybody, if they have not done so already, to look at what the BMA says about this. It has specifically briefed against prohibiting doctors from initiating discussion about assisted dying under the Bill, warning that it will be detrimental to patient care. I accept this piece of advice from the BMA. It is a view that many doctors, and some in this Chamber, too, would actually adhere to and agree with.

I very much hope that this group of amendments will not be accepted. It does not mean that at the end the patient is not the one who makes the decision about whether to request an assisted death—of course he or she does. But it just becomes one of the options that is available to them, and that is an option I believe we should allow them to be aware of.

[Lord Goodman of Wycombe (Con)]

My Lords, I will speak to my Amendment 151, which is supported by the noble Lord, Lord Carlile, and the noble Baronesses, Lady Fox and Lady Hollins. It was also referred to approvingly by the noble Baroness, Lady Campbell, in her earlier remarks. My amendment would prohibit medical professionals from raising assisted dying as an option, unless explicitly requested by the patient.

I will be very brief in introducing this amendment, by pointing out to the Committee that it goes to the heart of a juxtaposition suggested by the Bill. On the one hand, we have an increasingly large, frail, vulnerable, often elderly population, who may not have the full autonomy that the sponsor of the Bill suggests. On the other hand, we have a National Health Service that, by the nature of events, is almost always underfunded and feels that it will be underfunded. If you put those two things together, there will be an inevitable pressure to cut costs and present the cheaper option to the patient who is seeking guidance.

I have carefully read the sponsor’s words in Clause 5 and it is true that, on paper, the patient must be offered the option of palliative care as well as that of an assisted death. However, in these circumstances of financial restriction, I am concerned about the patient being steered in a certain direction. I will not regale the Committee with horror stories from abroad, usually from Canada, about precisely this taking place. Were I to do that, the sponsor of the Bill and others would, quite rightly, point out that there are safeguards in the Bill that are not present in Canada. I would point out in return that safeguards can be whittled away over time. In making that point, I mean nothing to the detriment of the sponsor of the Bill; I am sure that he does not mean it to happen but, over time, people can make amendments and changes to legislation.

I will step back from this amendment and look at it in this way. I believe that assisted dying is intrinsically problematic and, if the Bill ever got further, I would vote against it at Third Reading. However, my concern while we are here is to improve the Bill. If we are to have such a Bill, I want it to be in the best—I should say the least bad—condition possible. Noble Lords know that nothing in the amendment would alter the basic architecture and structure of what the sponsor of the Bill has proposed—in relation to the first doctor, the second doctor, the panel, proxies, the regime for regulating substances or any of that. The amendment would do nothing whatever to prevent anyone seeking an assisted death. All it would do is to prevent a medical professional raising it.

Therefore, I suggest to the noble and learned Lord the sponsor that, if he wants to make some progress with the Bill, he might accept this amendment or one of the many others in this group to a similar end. I look forward to hearing him when he replies but, whether he does accept it or not, this amendment would write a safeguard into the Bill that is not there, and I commend it to the Committee.

--- Later in debate ---

[Baroness O’Loan (CB)]

My Lords, I will speak to Amendments 150, 156, 166 and 205, to which I have put my name, and in support of other amendments in the group.

As drafted, the Bill would permit a discussion about assisted dying with the patient before any requirement to discuss expert palliative care. The noble Baroness, Lady Blackstone, said that it would be irresponsible not to allow this. In Australia and New Zealand, doctors are not permitted to initiate such discussions.

As drafted—

[Baroness Blackstone (Lab)]

Doctors in Australia are now allowed to do so. The law has been changed there.

[Baroness O’Loan (CB)]

I accept the noble Baroness’s intervention, but they certainly thought it was a bad idea, and there is further discussion in South Australia about the issue.

If I may go on: as drafted, the Bill will permit discussion about assisted dying before discussion about palliative care. It would come as something of a shock—