Terminally Ill Adults (End of Life) Bill

Baroness Blake of Leeds Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Kamall (Con)]

I have to be very careful because I am not answering for the Government; I am just trying to reflect that letter. However, the Minister did make it clear that the children’s hospice funding is over the next three years and that it will account for £80 million in total. We all know how Governments work, and I not sure that any Government could give a commitment beyond three or four years or beyond another election. To be fair to the Government, I believe that they have answered the question about how much resource they will be allocating. It is up to noble Lords to decide whether they believe that that is sufficient, but if, whichever side of the debate they are on, they feel that the Government have not answered those questions, it is up to them to come back in future weeks and press the Minister on duty.

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

I thank noble Lords for their thoughtful comments, particularly those on the amendments proposing an assisted dying help service and a minimum timeline for the assisted dying process. I thank the noble Lords, Lord Birt and Lord Mackinlay, and the noble Baroness, Lady Coffey, for their amendments in this group.

I also thank the noble Lord, Lord Kamall, for his helpful comments on the detailed letter that has been sent to noble Lords. I hope that noble Lords can therefore accept that that is in train and that they will refer to the letter. Of course, there will be other opportunities to come back on particular details if required.

The amendments tabled by the noble Lord, Lord Birt, aim to set up a new statutory body entitled the assisted dying help service, which would be part of the National Health Service. From a workability perspective, these amendments would create many new concepts and relationships that would conflict with the current provisions of the Bill. I note that considerable further policy development and legal drafting would be required to create a workable system should noble Lords support these amendments.

Amendments 287A and 287B tabled by the noble Baroness, Lady Coffey, would create a new role for the General Medical Council—GMC—to set the requirements for training, qualifications and experience, and introduce new licensing, for assisted dying. Although the GMC has a function to set standards for doctors and recognise specialisms, it does not set requirements for training and qualifications for specific services, or license doctors to provide them. This would be a significant departure from the way that the GMC operates and would require it to identify a new process to identify the doctors on this register who are licensed to provide this service.

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[Lord Deben (Con)]

My Lords, we have asked the Minister on several occasions to give us the information that I think the Government still need to give us: what is the cost of doing these things? The letter does not meet that. She has just said that there would be difficulties, but we want to know the cost in detail, because it is for the Government to help the Committee to make decisions. Could she please say now, and, if not now, give the undertaking that she will investigate the cost, so we know how to make a decision?

[Baroness Blake of Leeds (Lab)]

My Lords, I was just about to go on to the whole issue of funding, which many noble Lords have raised throughout this morning’s debate. The Government’s position is absolutely clear on this. Should Parliament pass the Bill, the Government would work to undertake development of the delivery model. Until the parliamentary process is complete, we are making no assumptions as to what the delivery model for an assisted dying service would be or what the role of specific departments in delivering the service would be.

[Lord Harper (Con)]

My Lords, may I ask the Minister something that I do not think is an operational decision but a decision in principle, as mentioned by the noble Lord, Lord Stevens, and does not require the Government to take a view on whether they support assisted suicide or not? Is it the Government’s view—do they agree with the noble Lord, Lord Stevens—that we would have to change the founding principle underpinning the National Health Service to put this service in the NHS? If they agree with him, is that something the Government support? The Government can remain neutral on the principle of assisted suicide, but I want to know whether they think it should be inside the NHS or not.

[Baroness Blake of Leeds (Lab)]

My Lords, I am very aware of the repeated requests and comments. I come back again to the point that we have been making throughout the debates on these amendments, and throughout the process: until the parliamentary process is complete, we are making no assumptions as to what the delivery model will be. That is absolutely clear and straightforward, and has been emphasised by other Ministers before me.

[Lord Harper (Con)]

My Lords, I do not want to unfairly ascribe views to the Minister on behalf of the Government, but, just so I understand this, is she saying that the Labour Government do not have a view at all on whether we should change the founding principles of the National Health Service away from it being one that delivers medical treatment to save lives to one that also helps people to die? Is she really saying that they do not have a view?

[Baroness Blake of Leeds (Lab)]

I am saying that, at this point, the Government are neutral on the whole area.

[Lord Harper (Con)]

That is extraordinary.

[Baroness Blake of Leeds (Lab)]

I do not think it is extraordinary, but I am sure the noble Lord will keep expressing his point of view.

[Lord Deben (Con)]

The Government can perfectly well say that they do not have a view on this, but, for Parliament to make a decision, surely they have to tell us whether, if we made this decision, they would have to change the basic principles of the National Health Service. That is the only question that we must ask. The Government must be able to tell us whether, if we make this decision, that is inevitable.

[Baroness Blake of Leeds (Lab)]

I am sure that the noble Lord and others will find other ways of asking the same question. I refer to my earlier answer.

[Baroness Fox of Buckley (Non-Afl)]

I honestly believe that noble Lords are asking this question in good faith. I reiterate to the Minister—maybe she can think about this and come back—that we are being asked to make a decision about a huge change in healthcare provision, staffing and money, and the nature of what the NHS is. We are not trying to catch the Government out. We simply want to understand. Nobody could vote for this—even if you supported it, you could not vote for it. Can the Government please tell us, even if not now, what the implications will be if we vote for the Bill?

The Labour Government would say that the NHS is the most important, precious jewel in the crown, that nothing should damage it, and that we had to sacrifice an awful lot to save it only recently. I do not then want to vote for a Bill that is going to upturn the nature of the NHS inadvertently because the Government say they are neutral and cannot tell us otherwise. That is a big risk—risking the NHS, so that they do not have to answer. Even if the Minister cannot answer, we have to have that question answered; otherwise, we cannot seriously be asked to vote for the Bill.

[Baroness Blake of Leeds (Lab)]

I repeat that I am happy to write to noble Lords further on this point. I do not think that Members are going to move away from this point, so I am very happy to do that.

The noble Lord, Lord Gove, asked whether the assisted dying help service could be set up through statutory instrument, and I am happy to write to him to clarify that point. I will write to the noble Baroness, Lady Finlay, on the point of the constitution. That is the most straightforward way to deal with this.

With the undertaking that the Government will write on the points that have not been addressed, I hope noble Lords will understand that, on the areas that I have not raised, we cannot confirm that the amendments are workable. That is the point I must make. With those comments, I hope that the noble Lord will withdraw his amendment.

[Lord Falconer of Thoroton (Lab)]

I thank everybody who has contributed to this debate, in particular my noble friend Lady Blake, who ended up caught up in the eye of a storm that was not of her own making. I very much sympathise with her. I thank the noble Lord, Lord Kamall, for his mature and helpful interventions.

The amendments from the noble Lord, Lord Birt, would, as he said, effectively do three things. First, they would introduce a new organisation called the assisted dying help service that would be responsible for providing both the judgment and the navigation through the process of assisted dying. Secondly, they would give the assisted dying help service specific power and a timeline that is much shorter and more flexible than the one in the existing Bill. Thirdly, the noble Lord insisted that the commissioner not give guidance, provide leadership, collect information and make assessments as to what is going on. Instead, the commissioner would be solely a regulator, without monitoring and other functions.

As I have indicated, I do not support those amendments. In relation to the key point, the safeguards in the Bill at the moment, as the noble Lord indicated, consist of three doctors, including the preliminary doctor, the panel, the periods of reflection and the doctor who gives the assistance at the end having to be satisfied that all the requirements are still in place and operative. That structure is the one we support, and we stick by it, because we think it provides a safeguard. We are not in favour of changing that.

Separately, in relation to the assisted dying help service, I am strongly in favour of the basic principle outlined by Stephen Kinnock, when he gave evidence to the Lords Committee, and of the points made by the noble Lord, Lord Markham, and my noble friend Lady Blake. The Bill gives the Secretary of State the power to determine how it should be delivered. I accept that Clause 41, which was criticised by the deregulation committee in this House for being too vague, needs more detail. I said that I would come forward with more detail, so let me indicate what sort of detail, because people have indicated that they want that. I particularly isolate the noble Lord, Lord Goodman, whose speech was effective in that respect.

It will name as the possible commissioners ICBs, the National Health Service England—which I appreciate is itself in a terminal condition and will shortly be abolished, but it has to be kept there—or the Secretary of State. Picking up the regulation point, it will specify that the services will have to be regulated by either NHSE or the CQC. It will specifically impose duties that currently reside with the NHS commissioners on the people who can make the commission. It will indicate the principles that the Secretary of State has to provide in doing the commissioning and it will limit the Henry VIII power in Clause 41(6), which is currently very wide and, as the deregulation committee said, needs to be limited. We will make considerable progress on that. I apologise for that not being available at the moment, but there are a number of amendments to be dealt with. I hope that is helpful. That deals with the essence of the points that have been made.

The points made by the noble Lord, Lord Harper, and the noble Baroness, Lady Coffey, were in effect about the problems with the amendment from the noble Lord, Lord Birt. Because I do not support that amendment, it would be otiose and time wasting for me to go through them.

I will deal with two other points: how much it is going to cost and where it is going to come from. There is an impact assessment that, as the noble Lord, Lord Markham, said, suggests that in year 10 the annual cost will be something under £30 million. It is ridiculous to suggest where that money is going to come from in 10 years. The noble Lord, Lord Deben, says that we need to know where the money is going to come from and how much it is going to cost.

The noble Baroness, Lady Grey-Thompson, says that maybe the money will come from somewhere else. The noble Baroness criticises the impact assessment because she says it is based on Oregon, not on greater experience. If the Government take the view that they cannot rely on the impact assessment for the points that she makes—it is not a promoter view; it is a government view—then no doubt the Government will have to make a decision about whether they need a new impact assessment. For my part, the impact assessment looks careful and rigorous. When we make the decision about assisted dying, we know how much it will cost on the basis of the impact assessment. We have to make a decision as a Parliament as to whether, in the light of that cost, we think it should go ahead. It is true to say that it is a very small part—a tiny part—of the total budget for the NHS.

Terminally Ill Adults (End of Life) Bill

Baroness Blake of Leeds Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, these amendments make fundamental changes to the process by which a person is able to access assistance with ending their life under the Bill. It is clear that the noble Baroness, Lady Finlay, has put great care and thought into these proposals, drawing on her decades-long, extensive experience in medicine. The noble Baroness, Lady Hollins, put it so well when she said that “years of work” and thinking on how this will work have been done by the noble Baroness, Lady Finlay.

Amendment 333 replaces the doctor’s assessment with the multidisciplinary panel process, bringing skills and knowledge from the health sector, the social work sector and the justice sector, including 10 years of minimum relevant experience. Our understanding is that the noble Baroness, Lady Finlay, is seeking to strengthen the safeguards for people who are seeking an assisted death, which was also referenced by the noble Lord, Lord Harper.

We know from previous groups already debated, and indeed this very group, that many noble Lords are profoundly concerned about vulnerable individuals. On the basis of what appears prima facie to be a widespread sentiment in your Lordships’ House, may we ask whether the noble and learned Lord, Lord Falconer, agrees that potentially more can be done to safeguard those vulnerable people and ensure that they are not pressured into seeking assistance under the Bill?

If the noble and learned Lord were to acknowledge these concerns and accept relevant amendments, will the Minister, the noble Baroness, Lady Blake, please set out any assessment that the Government may have researched regarding the practical solutions required to implement the proposals of the noble Baroness, Lady Finlay—points touched on by the noble Baroness, Lady Cass, and the noble and learned Baroness, Lady Butler-Sloss? Will the Minister also give your Lordships’ House a sense of the Government’s view on the balance that they will need to strike between the risks of a vulnerable individual dying in a circumstance where their capacity, understanding or will might be in doubt versus the practicality of delivering an assisted dying service?

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I thank all noble Lords for taking part in the debate so far today. As we know, this group of amendments focuses on two core subjects: first, adding a new multidisciplinary panel process into the Bill, tabled by the noble Baroness, Lady Finlay, and secondly, amendments in relation to approved substances. This is a large group of amendments. As ever, my comments will be limited to amendments where the Government have major legal or technical workability concerns.

On the suite of amendments tabled by the noble Baroness, Lady Finlay, it is the Government’s view that, logically, these amendments stand or fall together, as they are a systemic change to the Bill. The amendments would introduce a new system of “assisted dying panels”, distinct from the existing assisted dying review panel in the Bill. These panels would receive and consider requests for assistance as part of the first declaration process, replacing the role of the co-ordinating doctor. The amendments would also introduce the concepts of “licensed assisted dying services”, “navigators for assisted dying”, and “designated” pharmacies. These are rightly policy choices and matters for the sponsor and for Parliament to decide on.

However, noble Lords may wish to note that it is the Government’s view that this package of amendments would lead to major technical, legal or operational workability concerns. The amendments introduce new concepts that would require significant further work to ensure that the policy intent was clearly understood and could work with the rest of the Bill.

[Lord Deben (Con)]

The point about the drugs and their control will surely have to be dealt with by the Government, whatever happens. What assessment have they made—surely they ought to make it in any circumstances—about how that should be done, what it would cost and how one can protect people from dangers which have happened? It seems to me that that is not a policy matter but a practical matter which we ought to understand from the Government.

[Baroness Blake of Leeds (Lab)]

I can only refer the noble Lord to previous comments that the details around these matters will be considered when progress is made. It is not appropriate for those matters of detail to be considered now. The noble Lord is shaking his head, but I think we are very clear about the responsibility of government at this moment in time, and it will be for my noble and learned friend to respond to the detail of policy as we go forward.

[Lord Deben (Con)]

If the Minister does not mind me saying so, this is a real problem. If we do not know—because only the Government can tell us—what the mechanism whereby drugs would be dealt with would be, how can we make decisions about this? We really need to know from the Government, under the present Bill, what in general the way in which they will deal with this is, otherwise we will have to put it into the Bill because we do not know. It really is important for the Government to help us.

[Baroness Blake of Leeds (Lab)]

I completely recognise the noble Lord’s strength of feeling, which he has expressed on many occasions. However, I just reaffirm that we would go through a process for determining the mechanism around the matters that he raises should the Bill progress, and that is a clear point from the Government in response to his—

[Lord Winston (Lab)]

I wonder whether my noble friend the Minister might be able to help me. I presume that the Government would look at the extensive literature that is available in medical and scientific journals on the action, tests and usage of these drugs in a number of sovereignties where they have been used successfully for assisted dying.

[Baroness Blake of Leeds (Lab)]

As always, my noble friend raises an important point. I will go on to talk about the whole issue of substances, so if I do not address the points he raised, I will be happy to speak or write to him afterwards to make sure that he has had the clarification he requires.

[Lord Harper (Con)]

I want to press the Minister a little for an answer, not necessarily this minute, on the point that my noble friend Lord Deben makes. It is perfectly proper for matters of genuine detail to be dealt with after Parliament has passed primary legislation; there are many pieces of legislation where we do that. However, there are quite a lot of issues which are not set out in the legislation—this is part of the concern that the Delegated Powers Committee set out—and they are not, by any stretch of the imagination, details. They are fundamentally important issues around, in this case, the substances. Can the Minister therefore take away the idea that if the Government cannot answer on some of these really big issues that are left not set out in the legislation, it will make it incredibly difficult, even for people who support the principle of the legislation, to support it in practice? It would be more helpful if, on these bigger issues, the Government could set out what their position is.

[Baroness Blake of Leeds (Lab)]

I just reinforce to the noble Lord that it would be completely wrong to pre-empt the decisions of Parliament—I am sure he is fully aware of that. I just want to give reassurance that, across all these issues, evidence would be considered in the usual way in considering the substances to be used should the Bill pass. I think I have been exceptionally clear on this, and we need to move forward.

Given the size of the group, I reaffirm that it would be impossible to address each amendment specifically, but the broad thematic workability concern is that the use of unclear and ambiguous language could result in unworkable duties and increased risk of legal challenge.

I turn to amendments tabled in relation to the regulation of approved substances and clinical trials. Many of these amendments are policy choices and are therefore a matter for the sponsor and for Parliament. However, noble Lords may wish to note that many of these amendments also introduce new concepts that would require significant work to ensure the policy intent is clearly understood and that they are coherent for the rest of the Bill. I draw noble Lords’ attention to a number of amendments where the Government have major workability concerns.

Amendments 701 and 713, tabled by the noble Baronesses, Lady Grey-Thompson and Lady Hollins, relate to clinical trials for approved substances. First, these amendments could delay implementation of the Bill until a clinical trial or evidence-gathering study is completed, which could make implementation within the four-year timeframe difficult. Noble Lords may wish to be aware that these amendments could create workability concerns relating to the ethical and regulatory challenges for clinical trial processes for approved substances.

[Baroness O’Loan (CB)]

Does the Minister think it is ethical and right to administer drugs that have not been cleared through a normal process and to expedite their use? Surely we have to wait until the drugs have been properly tested.

[Baroness Blake of Leeds (Lab)]

I do not think it would be appropriate to comment on that level of detail at this point.

[Noble Lords]

Oh!

[Baroness Blake of Leeds (Lab)]

I hope that noble Lords can listen to what I have to say. The clinical trial processes for approved substances are, of course, an essential part as we move forward.

Amendment 703, also tabled by the noble Baroness, Lady Grey-Thompson, would not be workable in its current form. It would require a clinical trial process that would delay implementation. The effect of the amendment is unpredictable as it is unclear whether the intention of proposed new paragraph (d) is to regulate the substances themselves, the approval process or the body responsible for oversight.

Amendments 704, 705, 698, 708 and 710 were tabled by the noble Baroness, Lady Finlay. Amendments 704 and 705 seek to amend the powers under Clause 37. These amendments would limit Clause 37(4), so that regulations may apply only to substances that have received approval in the Human Medicines Regulations 2012—the HMRs. Those regulations provide for licensing, which is a marketing authorisation of medicinal products and not approval. This is a different legal concept. Additionally, if the amendment is read as requiring licensing under the HMRs specifically for assisted dying, this would be operationally complex to design and implement.

Amendment 698 would require any regulations made under Clause 37 to be consistent with the existing rules for medicine overseen by the MHRA and for controlled drugs overseen by the Home Office. We believe that this requirement, in practice, is unworkable. The substances that may be approved under Clause 27 will not necessarily be medicines licensed for this indication or controlled drugs. If a substance falls outside those regimes, it would be impossible to make regulations that are genuinely consistent with them. This amendment may therefore place requirements on the Secretary of State that cannot be met.

Amendment 708 would require that, for the Secretary of State to make provision by regulation to allow for the use of devices to enable assisted dying, such devices must have Medicines and Healthcare products Regulatory Agency approval. This approach does not align with how much the regulatory system for medical devices currently operates. Although the MHRA is responsible for regulating the UK medical devices market and requires such devices to be registered with the agency, it does not approve or license medical devices individually. Medical devices are placed on the market following conformity assessment under the UK Medical Devices Regulations 2002, usually carried out by independent approved bodies.

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[Baroness Lawlor (Con)]

May I just clarify? I think that response was in response to my amendments to Clause 37 for the manufacture of these products. However, Amendment 552B is in respect of the limited number of designated pharmacies which were distributing these drugs. In Amendment 552, the noble Baroness, Lady Finlay, referred to three designated pharmacies. The noble Baroness, Lady Hollins, wanted those three pharmacies to be limited to dispensing and storing but not supplying. Mine was simply an amendment to that from the noble Baroness, Lady Hollins, to say that they should be ordered in on a case-by-case basis; it was not an amendment to Clause 37 at this stage.

[Baroness Blake of Leeds (Lab)]

Apologies; I thank the noble Baroness for her clarification on that point. I was mid-sentence, so forgive me if I repeat myself. Limiting the number of manufacturers based on prior prescriptions is operationally impractical and could risk supply shortages.

I turn to Amendment 713A from the noble Baroness, Lady Hollins. This amendment appears to seek to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power.

[Baroness O’Loan (CB)]

I just want to ask the Minister about her response to the noble Baroness, Lady Lawlor. She was, I think, saying to the Committee that limiting the places at which you can get the lethal drugs that will be required for death would inhibit the process. I say to her that there are situations in which the supply of medication is limited in exactly that way. Some years ago, I had toxoplasmosis, and the only place the drug could be administered then was Scotland. So it is possible; such systems exist now. I do not quite understand why drugs to treat toxoplasmosis have to be controlled, but the suggestion is that drugs that will kill people do not.

[Baroness Blake of Leeds (Lab)]

I would be happy to write to the noble Baronesses with clarification on that point; I thank them for their interventions.

As I was saying, Amendment 713A appears to introduce a parallel approvals regime, but it does not specify how that should relate to the Secretary of State’s separate power under Clause 27 to specify the list of approved substances. This could lead to operational uncertainty. Although the amendment could be delivered, establishing a dedicated regulatory pathway would likely require adjustments to the MHRA’s remit and internal processes.

I turn finally to Amendments 887A and 888A from the noble Lord, Lord Empey, which would amend Clause 57 by removing the reference to Northern Ireland. This would mean that regulations made under Clause 37 would not extend to or apply in Northern Ireland. As medicines regulations are UK-wide, should this amendment be accepted, it might create legislative divergence across the UK. This does not mean that assisted dying would be legalised in Northern Ireland.

As noble Lords will be aware, many of these amendments have not had technical drafting support from officials. If your Lordships support these amendments, the Government will need to revisit the drafting of amendments and the Bill as a whole to ensure that they are workable and coherent, both internally and with the wider statute book.

[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful to the noble Lords who have participated in this debate. I will divide my responses thematically under four headings.

I turn first to the new scheme proposed by noble Baroness, Lady Finlay of Llandaff, in relation to how one deals with safeguarding here. The scheme would involve not having two doctors, then the panel, and then a doctor again at the point of administration; instead, the person who wants an assisted death would have to apply to a separate organisation, where a panel of up to seven people would consider their application. That panel would consider whether the safeguards are satisfied, as well as a number of other questions. If it were satisfied, it would give a provisional certificate of eligibility. The drugs could not then be delivered—I use that word without meaning “delivered to the person”—because an application for fast-track care and support would have to be made. If that application were granted, then—and only then—could the drugs be administered.

If there were doubt in the mind of the seven-person panel, the matter would be referred to the High Court. The provisions put forward by the noble Baroness do not specify what the role of the High Court is. The panel has to satisfy itself that a number of questions have been addressed, although those questions do not determine whether or not somebody is entitled to an assisted death. That is the proposal from the noble Baroness, Lady Finlay. The current proposal in the Bill is that the co-ordinating doctor has to satisfy themselves of seven or eight strict matters, and then the panel considers the case. The co-ordinating doctor then, satisfied that the conditions have been met, provides assistance to the person who wants to die.

Underlying the distinction between the two proposals is the wish of the noble Baroness that the whole process of assisted dying be kept completely separate from the care that is being given to the patient. I am sorry that neither the noble Baroness, Lady Cass, nor the noble and learned Baroness, Lady Butler-Sloss, is here, for they both highlighted that, under the scheme in the Bill, the people who will be going through the checks—the co-ordinating doctor and the independent doctor—will have to have opted in to specialist training. To some extent, they will be specialists themselves in assisted dying.

If one wants to give as much help as possible to the person who wants an assisted death, it must be better that the person providing the assistance can work within the team that is already providing care. It does not mean that they should be in any way pressing for a particular result. But, if we introduce assisted dying, and we want somebody to do the assessment and give the assistance, we are probably going to have ask somebody with some experience. We do not want to force the patient into an over-complex, entirely separate process.

I note that the noble Lord, Lord Stevens of Birmingham, said that he wants the process kept separate from the NHS, but I am absolutely sure that he does not want the patient to embark on a very complex bureaucratic procedure. He has given reasons why he wants it kept separate from the NHS. As sponsor of the Bill, whether it is precisely separate or not is, for me, not the key question; the key question is whether, if a patient wants an assisted death, there is a practical and safe way of doing it that does not place an undue burden on them.

The proposal from the noble Baroness, Lady Finlay of Llandaff, is overengineered and much too separate from the care of the patient. It leaves out so many aspects. In particular, the drafting of her proposal does not indicate what her seven-person panel has to be satisfied of. The idea that seven people have to be satisfied is, in my respectful submission, much too onerous. Having two specialist doctors and a panel of three examining the case is, with respect, a much better proposal. I have thought very carefully about the noble Baroness’s proposal, but I have to say that the proposal in the Bill is so much better, so much more workable and so much more focused on the patient.

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[Earl Howe (Con)]

My Lords, the sheer number of amendments from noble Lords on all sides of the Committee that are seeking to prevent medical practitioners initiating a conversation about assisted dying with a patient demonstrates how strongly noble Lords feel about this issue. As a minimum, it is clear that many noble Lords do not feel that the Bill’s current drafting is sufficient. Although we have heard some counter-arguments during the debate, it is now incumbent on the noble and learned Lord, Lord Falconer, to set out in some detail his reasons for allowing registered medical practitioners to initiate these discussions.

Following on from that, there was one particularly moving contribution to this debate: the speech from my noble friend Lady Monckton. The case she made from her own family perspective in support of my noble friend Lord Shinkwin’s Amendment 162—to prohibit the topic of assisted dying being raised with someone with Down syndrome or a learning disability—was one I found especially powerful. I hope that the noble and learned Lord, Lord Falconer, will acknowledge that this is a particularly sensitive aspect of the issue which needs to be addressed.

There are two additional issues I should like to pick up. I was particularly interested in the amendment tabled by the noble Baroness, Lady Grey-Thompson, which requires a minimum 48-hour delay between diagnosis and any conversation about assisted dying. Given the shock that a patient will feel when receiving a diagnosis that could make them eligible under the Bill, it seems right and appropriate that they be given the space and time to process the news before facing the question of potentially ending their own life. Is the noble and learned Lord, Lord Falconer, willing to consider how that degree of sensitivity might be incorporated into the Bill—or, failing that, into guidance—to ensure that patients who receive some of the worst news they will ever hear do not immediately feel the need to address a choice as momentous and emotive as whether they wish to end their own life?

Finally, the amendments in respect of persons aged under 18 are worthy of the noble and learned Lord’s careful consideration. The Bill is designed to create a legal right for those aged over 18, not for children, so surely it follows that its provisions should not be raised with children. I therefore hope the noble and learned Lord will carefully consider the protections for children that the Bill could usefully incorporate.

[Baroness Blake of Leeds (Lab)]

My Lords, I thank all noble Lords who have contributed to this very important debate. As usual, I will limit my comments to amendments on which the Government have major legal, technical or operational workability concerns.

To begin, key concepts in Amendment 149, moved by the noble Baroness, Lady Grey-Thompson, are unclear. It will therefore be difficult to assess whether the duties have been discharged. For example, it is not clear who must co-ordinate and undertake the suggested multiagency assessment of support needs and who is responsible for ensuring that those needs are fully funded, so it may be impossible to demonstrate that these criteria have been met.

Amendment 152, tabled by the noble Lord, Lord Moylan, seeks to prohibit registered medical practitioners or any other health professionals from raising the subject of provision of assistance under the Bill. If passed, this would be inconsistent with the discretion currently afforded to the registered medical practitioner in Clause 5(2), which makes it clear that a registered medical practitioner may exercise

“their professional judgement to decide if, and when, it is appropriate to discuss the matter”.

This amendment would therefore create conflicting duties and may lead to confusion about whether a registered medical practitioner can raise the issue of assisted dying.

[Lord Moylan (Con)]

Briefly, as it is of no interest to other Members of the Committee, but it is surprising that, with all the legal advice offered to her, the noble Baroness has not noticed that there is a consequential amendment in my name in the same group—which I referred to—which deletes subsection (2), since I too have spotted that there is an inconsistency and I have dealt with it.

[Baroness Blake of Leeds (Lab)]

I thank the noble Lord for his comments. It is still worth raising these matters in this context to avoid any confusion.

Amendment 162, tabled by the noble Lord, Lord Shinkwin, would mean that a registered medical practitioner could not raise assisted dying with any person with a learning disability, including people with Down syndrome, unless they raise the subject themselves. This restriction would apply to all persons with a learning disability, including where the person has the capacity to make a decision to end their own life.

The purpose of Amendments 205, 207 and 207A, tabled by the noble Baronesses, Lady Monckton and Lady Grey-Thompson, appears to be to prevent a healthcare professional raising the subject of the provision of assistance with a person who has a learning disability or autism, unless that person has a family member, independent person or guardian present. Under Amendment 207A, both a family member and an independent person would need to be present. These amendments do not draw any distinction between varying levels of individual need. As drafted, a registered medical practitioner would be required to establish in all cases that the person does not have autism or a learning disability before raising the subject of an assisted death, unless a family member or independent person is present.

Amendment 200C, tabled by the noble Baroness, Lady Berridge, would mean that no person could raise the provision of assistance with those under the age of 18, whether online or otherwise. Amendment 209, tabled by my noble friend Lady Goudie, prohibits any adult with a duty of care or responsibility for a person under 18, including but not limited to guardians, social workers, educators or carers, from raising the subject of assisted dying “with such a person”. These amendments would be extremely difficult to enforce, due to their breadth and ambiguity. They may, for example, prohibit parents or guardians from discussing the broad issue of assisted dying with their children.

Finally, I bring to noble Lords’ attention that amendments discussed here, including Amendments 149, 162, 200C, 205, 207, 207A and 209, could give rise to legal challenge on ECHR grounds, in particular challenges brought under Articles 8, 10 and 14. These amendments would require reasonable and objective justification to comply with ECHR obligations.

I make no comment on the other amendments in this group. However, as noble Lords will be aware, the amendments have not had technical drafting support from officials. Therefore, further revision and corresponding amendments may be needed to provide consistent and coherent terminology throughout the Bill.

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, for the benefit of the Committee, I will let noble Lords know that when we have heard from my noble and learned friend Lord Falconer of Thoroton, I intend to bring the Committee to a conclusion. It would be wiser to wait to start the next group next week, rather than to get half way through it and have all the problems about who was or was not here, and so on. If colleagues are thinking ahead to the next group, it will not be called until next week.

Terminally Ill Adults (End of Life) Bill

Baroness Blake of Leeds Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

[Noble Lords]

Minister!

[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

Apologies, I was taken by surprise by the lack of an Opposition Front Bench. I thank noble Lords for another important debate on opting into and out of providing assistance and various functions under the Bill. As I have already made clear, I will keep my comments limited to amendments on which the Government have major legal, technical or operational workability concerns.

I first turn to Amendment 189, tabled by the noble Baroness, Lady Fraser. This amendment may give rise to Article 8 ECHR issues, as publishing a register of professionals willing to participate in voluntary assisted dying could expose those individuals to intrusion or a risk to personal safety.

Amendment 657, tabled by the noble Baroness, Lady Fox, seeks to specify:

“The provision of assistance under this Act is not to be regarded as a medical treatment”.


The Government have made no decisions on what a service delivery model would look like. The Committee may wish to note that this amendment may impact the possible service models for voluntary assisted dying by limiting what the Government can achieve through Clause 41 regulations. Clause 41 currently enables the Government to make amendments to legislation, including the NHS Act 2006, to ensure that assisted dying could be delivered as part of the health service, which may require amending or modifying definitions of “treatment” to include assisted dying.

Amendment 664, tabled by the noble Baroness, Lady Lawlor, would allow health and social care professionals to opt out of all training in relation to the Bill.

[Lord Harper (Con)]

I am sorry to interrupt the Minister, but I am grateful that she has allowed me to do so. I want to make sure that I understand correctly what she has just said. I think she just said that, at the moment, the NHS would not be able to deliver this service unless there were some amendments made to make it clear that this was indeed a medical treatment, and it would therefore be necessary to make those amendments to explicitly define it as a medical treatment. I wanted to check I have understood her because, if that is what she is saying, it then opens up the very complex and difficult issues that the noble Lord, Lord Stevens, so ably set out a short while ago.

[Baroness Blake of Leeds (Lab)]

I confirm that it is “may require”: that is the response I wish to give him on that. Again, it is pushing the limits of what I am able to say at this point, in terms of future policy.

[Lord Harper (Con)]

I absolutely accept, as my noble friend Lady Coffey said, that the Minister does not have the policy responsibility, so I am absolutely not going to press her for an answer now. However, it would be helpful if we were to get a written response from the policy Minister that clarifies this point about whether it would be necessary to amend the law so that it was explicitly a medical treatment for the NHS to be able to provide this service. That would be helpful, but I am not going to press her on this. That would be most unfair.

[Baroness Blake of Leeds (Lab)]

I am certainly happy to take the noble Lord’s comments to my noble friend Lady Merron and see whether it is appropriate for her to respond in the way that the noble Lord suggests.

Perhaps I could start again on my response to the noble Baroness, Lady Lawlor. Her amendment would allow health and social care professionals to opt out of all training in relation to the Bill. It would require that, where a health and social care professional agrees to training, written consent must be given. The amendment also creates an obligation to provide official guidance on training in relation to the Bill on the day it receives Royal Assent. The requirement to publish official guidance on the day of Royal Assent may be unachievable, given the work on implementation that must be undertaken before such guidance can be published. It is also unclear how this interacts with other requirements in the Bill, such as the duty to consult various persons before any guidance is issued.

I turn to Amendments 667A and 848C, tabled by the noble Baroness, Lady Hollins. Amendment 667A would require the Secretary of State to make regulations to provide for a specialist register of assisted death practitioners and the criteria for entry in that register. As the Government would begin work on regulations only after the Bill receives Royal Assent, the requirement to make regulations within one month of the day on which the future Act is passed may be unworkable. In addition, significant policy work would be required to understand what a specialty for assisted dying would look like.

Amendment 848C would additionally prevent registered medical practitioners performing functions under the Bill if they are not included on the GMC’s existing specialist register with a primary specialty in geriatric medicine, palliative medicine, medical oncology or clinical oncology. My noble friend Lady Blackstone referred to that. The effect of this amendment would be to exclude clinicians who may have relevant experience and qualifications. This may limit the Government’s ability to design an optimal service.

Amendments 681 and 864, tabled by the noble Lord, Lord Goodman, give rise to two key workability issues. First, they duplicate matters largely covered in Clause 31 and Schedule 3. Secondly, Amendment 681 would introduce a complete right to conscientiously object to taking part in the provision of assistance. This conflicts with Clause 31(7), which contains a small number of duties that cannot be opted out of—for example, recording the cancellation of a first declaration, or passing on or recording information about a person in their medical records, which may be relevant to their eligibility for assisted dying. If a person is able to opt out from participating in any aspect of the Bill, without any exceptions, this may render the Bill unworkable.

I turn to Amendments 668 and 670, tabled by the noble Lady, Baroness O’Loan. Amendment 668 seeks to replace “registered medical practitioner” with “person” in Clause 31(3). This would widen the provision, so that individuals with express statutory duties in the Bill would not be obliged to perform any function under the Bill. This would include, for example, the Secretary of State, Welsh Ministers, the assisted dying commissioner and members of an assisted dying panel. Allowing opt-outs for these roles could make the Bill unworkable. Amendment 670 also seeks to provide an opt-out for ancillary functions, such as administrative tasks or the supervision of staff. This could broaden the range of activities that a person can refuse to carry out and give rise to significant operational issues.

Amendment 679, tabled by the noble Baroness, Lady Grey-Thompson, could limit the places where assistance could be provided. It could, for example, preclude access to an assisted death for those residing in some private hospices or care homes. The Committee may wish to note that this amendment may result in inconsistent treatment for patients when seeking to access an assisted death and could give rise to Article 8 ECHR issues, unless a reasonable and objective justification were provided.

As noble Lords will be aware, the other amendments in this group have not had technical drafting support from officials. The issues raised by these other amendments are rightly matters for noble Lords to consider.

To respond to the direct question from the noble Baroness, Lady Berridge, no civil servant working on the Bill was put under any pressure to work on it.

In response to the noble Baroness, Lady Smith of Newnham, policy decisions regarding opt-outs within the Bill are for the sponsor. However, once legislation is passed, the Government as a whole are expected to implement it. If an individual had an objection to working on assisted dying policy due to a personal conscience objection, issues would be handled case by case, through discussion.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

What assessment was made by the Government when saying that the proposals in these amendments would limit the ability to design an optimum service in relation to the Bill, given the system in the Netherlands where SCEN doctors—the second opinion doctors—have specific training and are specifically listed as being able to provide that information? That is a nation where the number of people euthanised is very much higher than suggested in the impact assessment. Having a group separately trained and listed, who are deemed to be specialising in part of this, seems to work in the Netherlands. I would be interested to know what assessment the Government made of that in formulating their response to this group of amendments.

[Baroness Blake of Leeds (Lab)]

I cannot answer that specific question, and I am not sure it would be appropriate for me to do so. We note the comments that the noble Baroness made.

[Lord Falconer of Thoroton (Lab)]

My noble friend loves sometimes to overstate it, I have to say, but we should do our best to try to co-operate and reach agreement. I express my gratitude to the Committee for all the opportunities they have given me to listen over the past 15 days, with two more days to come.

I will deal with the issues that have been raised under four headings. First, is this an opt-in or opt-out system, and, if it is not an opt-in system, do we need to change it to make it one? Secondly, is the width of the opt-out in Clauses 5 and 31 wide enough? Thirdly, what should we do about the suggestion of the noble Baroness, Lady Fraser, and others of a register? Fourthly, the suggestion of the noble Baroness, Lady Cass, was significant, and we should think about whether that is workable in a variety of ways.

Is this an opt-in or opt-out system? I have spoken to a lot of people on this, in particular the BMA. It is not happy that the Bill in its current draft is adequately clear that it is an opt-in system. In accordance with the wishes of the BMA, and after considerable discussions with it, in Amendment 669A we have included a requirement that everybody who has the specialist training—which is a necessary requirement before you can participate as a doctor under the scheme—has opted in to the specialist training. The BMA was very clear, and I accept this, that opt-in should be in the Bill so that there can be no doubt about that. We have done that and I hope that everybody will agree with it.

--- Later in debate ---

[Lord Wolfson of Tredegar (Con)]

My Lords, I hope the Committee will forgive my brevity—I will focus on the few amendments I have tabled in this group.

As the Committee has heard, many of the amendments relate to the preliminary discussion or to recording general medical information as the patient progresses through the procedure. However, as indicated by the noble Baroness, Lady Grey-Thompson, to whom I am grateful for her kind words, my amendments focus on a particular, very important issue.

My Amendments 562A, 563A and 564A seek to probe the circumstances in which it would be appropriate for a patient’s decision to cancel their first or second declaration not to be recorded immediately. There is a point of principle here. While I understand that there can be a genuine debate about whether a decision to initiate the procedure should be recorded and, if so, how quickly, I am concerned that a decision to pull out—which is what a decision to cancel is—whether after the first or second declaration, should not be left hanging there. I do not understand why that should be recorded only as soon as practicable and not immediately.

As the noble and learned Lord will be aware, and for the benefit of the Committee, “immediately” in English law generally means forthwith—as quickly as possible. You will not be in breach of the statute if you do not record it within three and a half seconds. The courts will always take circumstances and context into account. However, “immediately” gives that sense of urgency, which is very important. It is particularly important—this is why I tabled these amendments—when somebody is cancelling or pulling out. We must not have any risk whatsoever that another medical practitioner or healthcare professional might think that the person is still in the system, so to speak, when they have in fact cancelled their first or second declaration.

Also, without too much threshing through the undergrowth on a Friday afternoon—although it always is a Friday afternoon for this Bill—this is particularly important in Clause 24(3). Clause 24(2) deals with when

“the notice or indication … is given to a registered medical practitioner with the person’s GP practice”.

“Immediately” is appropriate there, for the reasons I have given. It is all the more important in Clause 24(3), where

“the registered medical practitioner to whom notice or indication of the cancellation is given”

is not within the practice. The problem there, as drafted, is that you have two uses of “as soon as practicable”. First, the practice must be notified “as soon as practicable”, and then the practitioner notified must “as soon as practicable” record the declaration. That doubling is problematic as well. “Immediately” in this circumstance ought to be the key test.

Therefore, I invite the noble and learned Lord, Lord Falconer of Thoroton, when he replies, to explain whether he believes, as I do, that the failure to record a declaration cancellation immediately might result in harm coming to a patient, and how, if not by way of my amendment, we mitigate that risk.

We are repeatedly told by the Ministers at the Dispatch Box that the focus of the Government’s position is whether this is workable or practicable. Have the Government looked at whether immediate recording is practicable? I would be interested in knowing the Minister’s thoughts and the Government’s position on that point.

[Baroness Blake of Leeds (Lab)]

My Lords, I thank noble Lords for an important and thoughtful debate this afternoon. As I have already made clear, I will limit my comments to amendments about which the Government have major legal, technical or operational workability concerns. I will speak first to Amendments 212, 215, 217, 218, 214, 557 to 559, 562, 563, and 564, tabled by the noble Baroness, Lady Grey-Thompson, which would introduce specified time limits for when duties in the Bill must be undertaken. Similarly, Amendments 212A, 212B, 215A, 217A, 218A, 218B, 320C and 321A, tabled by the noble Baroness, Lady Lawlor, specify a timeframe by which records of a person’s preliminary discussion and first assessment must be recorded in their medical notes.

As drafted, the Bill requires this information to be recorded “as soon as practicable”. As the Government have not developed a service delivery model, I cannot confirm that the timelines proposed in these amendments are workable. Amendments that change the duty to record information from “as soon as practicable” to “within 24 hours”, or that require the co-ordinating doctor to make a report on the same day they see the person, may result in a duty that is difficult or impossible to discharge. As drafted, these amendments may increase the risk of practitioners facing legal or professional action. For example, if they fail to comply with this mandatory duty due to being sick or on leave, the amendments do not afford any discretion or flexibility.

Amendment 219, tabled by my noble friend Lady Keeley, says:

“The registered medical practitioner with the person’s GP practice must disclose to the medical practitioner conducting the preliminary discussion any information in their possession that may affect the individual’s eligibility for assisted dying and such information must be taken into account by the co-ordinating doctor”


when undertaking the first assessment. Proposed new subsection (5) would require a registered medical practitioner with the person’s GP practice to notify the commissioner if they have

“reasonable grounds to believe that an individual does not meet the eligibility”

requirements for an assisted death.

The amendment is not clear on a number of key details, such as who in the GP practice is subject to these obligations, when the information must be sent, how the information is to get to the co-ordinating doctor for the first assessment, whether it is a continuing or a one-off obligation, and how the duty is intended to operate with Clause 31. This duty may also mandate information sharing with the commissioner in relation to people who are considered by a registered medical practitioner within a GP practice to not be suitable for an assisted death, even if the person in question is not actively seeking an assisted death under the Bill. My noble friend Lord Rook’s question about whether the powers in the Bill are sufficient for the commissioner, or whether further powers should be granted, is one for Parliament to decide in the eventuality.

Lastly, Amendment 561, tabled by the noble Baroness, Lady Grey-Thompson, would amend Clause 24 to require any preliminary discussion, first discussion and second declaration to be recorded in a person’s medical records, including the reason for not continuing to the next stage. It is not clear who must undertake these duties or what would happen if the person seeking assistance did not give a reason for why they did not wish to proceed. Where legislation seeks to impose a duty, it must specify who that duty is placed on. That is particularly important, given that an intentional or reckless failure to comply with the duty under Clause 24 is a criminal offence. The amendment would require further policy and legal work to clarify the intent and ensure that the drafting was workable.