Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, as legislators, all sorts of laws pass through our hands—the good, the bad and the ugly. All are consequential for our fellow citizens, but rarely does a Bill weigh as heavily as this one. Wherever we stand, this law change could have a seismic impact on social attitudes to life, illness and death. Our task is formidable because of how many norms the Bill will overturn; I will mention a few.

The Bill unsettles centuries-old medical ethics. It rebrands assisting someone to die as a medical treatment, upending its understood meaning. The Bill rewrites the role of doctors. They will no longer be guided by the “Do no harm” ethos of preserving and protecting life; instead, the Bill mandates that they actively engage in taking a patient’s life by supplying lethal drugs that will kill them. The Bill especially shakes the foundations of society’s attitudes to suicide—and, yes, that is the accurate word; we know this because, at present, intentionally assisting someone to end their life is a criminal offence. So the Bill is forced to amend the Suicide Act 1961 to allow medical professionals to plan, prepare and assist in intentionally ending the lives of a particular group of citizens.

My greatest dread is that this state licensing of suicide could unleash a regressive culture change. For decades, we have made concerted efforts to deter people from taking their own life; this was brilliantly documented last week by the noble Baroness, Lady May, and the noble Lord, Lord Jackson.

Now, I pause. Any of us who have known family or friends who have committed suicide know that it is gut-wrenchingly tragic; it brings an especially visceral, raw grief. This is compounded by guilt as loved ones endlessly soul-search, totally unfairly blaming themselves: “What more could we have done?” This is why, if we see someone about to jump from a bridge, even if they give us 100 objective reasons why their life is not worth living or even if they have only a few months to live, we do not just shrug and walk on—we cling on to them and plead, “Don’t do it. Don’t jump”. All this reflects our deep humanistic intuition that, when a person acts to end their life, it should be resisted with all the energy society can muster. What happens culturally, though, when the state shouts, “Jump”, or agrees with those who say that ending their life is a compassionate choice?

I worry especially about what message this sends to the young, who are already often nihilistic and prone to anxiety, self-harm and mental health problems. When we debated the censorious Online Safety Bill, those of us who raised its negative impact on free speech were metaphorically slapped down and hectored. The one indisputable reason for that law was to close down suicide sites—something echoed by the Prime Minister only yesterday. We had to protect the young from malign online suicide influencers, but I worry that this Bill is the legislative embodiment of a suicide influencer. What do we think will happen when we tell newly franchised teens that, in some instances, taking your own life equates to dying in dignity? Saying that it will be restricted to those with a terminal illness just will not wash with a generation immersed in the language of rights and entitlements: “Why not assist me when I am suffering so much? Why am I being discriminated against?”

That brings me to my final point. We have heard some fine speeches from supporters of the Bill, stressing the importance of autonomy and giving people control of their life. I usually champion such sentiments in a political sense, but not when they are used to justify the state having a role in ending human life—forgive my squeamishness. For those who state passionately, “My body, my life, my choice”, why back a Bill that limits that choice to the terminally ill? Surely logically that right should apply to anyone who wants to kill themselves. No doubt this logic will lead to demands to expand the law—God help us once human rights lawyers get involved. As I say, we have a weighty responsibility to ensure that such nightmarish unintended consequences do not become a reality.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I will deal first with the central issue in this debate, which is the amendment from the noble Baroness, Lady Finlay. The wording currently mentions:

“A terminally ill person in England or Wales who … has the capacity to make a decision”.


The noble Baroness proposes that “capacity” should be changed to “ability”. From what the noble Lord, Lord Wolfson, says, I understand that we should read that with Amendment 115, although there is another amendment that the noble Baroness proposes in relation to Clause 3. But I accept what the noble Lord says in relation to Amendment 2.

With the greatest respect to the noble Baroness, Lady Finlay, she is suggesting that we remove “capacity” and replace it with “ability”. The noble Lord, Lord Sandhurst, put his finger on it when he said that “capacity” is well known to the law. You could not possibly have a Bill that did not refer to capacity because what it means, in the eyes of the law and of people in practice, is the ability to make the decision. As the noble Lord, Lord Blencathra, said, if you do not have capacity, you cannot make the decision. That applies right across the doings of human beings, and the law recognises that. If, therefore, you replace “capacity”—

[Baroness Fox of Buckley (Non-Afl)]

On a point of clarification, I thought that the idea of adding both words was very helpful, but when the noble and learned Lord says that you cannot make the decision without capacity, it is not any decision but this particular decision in this Bill. Can he reflect on a point that was made very well by one of his noble friends on something that happened in my family as well? Somebody with dementia was said to have capacity for a particular decision, but I would not have wanted my mother to have been trusted as having the capacity to decide whether to ask for assisted death.

The Mental Capacity Act is fantastically important, but is it appropriate for this decision—not any old decision but this decision—which is a bit more challenging than some of the decisions that the Mental Capacity Act is used to decide on?

[Lord Falconer of Thoroton (Lab)]

That is very well put and is exactly the question. Is it appropriate to bring the Mental Capacity Act into this Bill? I understand that whether you have an assisted death is an incredibly important decision. You cannot remove the word “capacity”, so you have to reject the amendment from the noble Baroness, Lady Finlay.

Her Amendment 115 effectively draws on how the Mental Capacity Act 2005 is currently drafted, except it adds two things. It removes the presumption of capacity and, separately, it requires the person making the decision to be aware of a variety of things that are connected with their illness. To summarise, the way the Mental Capacity Act operates at the moment is that if you are unable to understand information relevant to the decision, to retain that information, to use and weigh that information or to communicate your decision, you do not have capacity under the current Mental Capacity Act. The extent to which the things that the noble Baroness, Lady Finlay, has referred to in her amendment would be relevant would have to be weighed in the context of the decision that has to be made.

I am more than happy to debate whether we need to make the changes to the Mental Capacity Act that she is suggesting. For my part, I do not think we do. One thing that is absolutely clear is that the amendment proposed, as the noble Lord, Lord Sandhurst, identified, is completely ridiculous. You cannot remove the question of capacity from this choice. Putting aside some detail hurdles, there are two hurdles that need to be overcome in how this Bill is constructed. You have to be capable of making the decision, as the noble Lord, Lord Wolfson, said, and—completely separately—you have to make that decision completely voluntarily. It has to be your own decision, not the product of pressure.

We have had—and I say this with warmth and respect—a rambling debate going over a whole range of issues, miles away from the question of whether one should remove the word “capacity” and put in the word “ability”. If this House wants to make the law completely confused in this area, either put in the word “ability” or put in “capacity and ability”. I echo the speech of the noble Baroness, Lady Hayman, when she says we have to approach this in a grown-up manner, and to remove the word “capacity” is not a sensible way to deal with this.

I also echo those who have said that the idea of running two systems at the same time—the Mental Capacity Act system and the separate system proposed by the noble Baroness, Lady Finlay—is wrong and confusing. I congratulate the noble Baroness, Lady Fox, for spotting what the right decision is. Of course, under the Mental Capacity Act some unimportant decisions are taken, but a decision such as whether to have the ventilation removed from you if you have motor neurone disease, that will almost certainly lead to your death, is without a shimmer of a shadow of doubt a life and death decision.

The Chief Medical Officer of England and Wales, in evidence to the Lords Select Committee, said:

“it is far better to use systems that people are used to and that are tested both in practice and, where necessary, in law”.

He went on to say:

“I have a concern that you could have a conversation in one bed in a hospital where someone is talking about, for example, an operation where they might well lose their life, because they are frail and there is the operative risk, done under the Mental Capacity Act, and, in the next-door bed, someone is trying to do the same process of having a difficult conversation about someone who might die, or could definitely die, as a result of that decision, but using a different legal framework. The risks that that could lead to confusion are not trivial”.


I also echo what the noble Baroness, Lady Browning, who sadly is not in her place, said. There are problems about practically every aspect of how various parts of the health service work, but she was part of a process that considered how the Mental Capacity Act worked. The broad conclusion was that it was a good, workable Act, and we should not stray from it in this particular case. I invite the noble Baroness to withdraw her amendment.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord Farmer (Con)]

My Lords, I rise in support of Amendment 118 tabled by the noble Lord, Lord Hunt of Kings Heath, and I am introducing Amendments 118A and 118B which follow it. I also support Amendments 45, 46, 47, 49 and 58.

This is an atheist Bill that assumes there is nothing after death, which is not a neutral but an ideological position. To those without an active belief that there is something after death, I would say, “How can you be so sure?” What makes the point that it is an atheist Bill? It is that it desacralizes death and by so doing it opens the door to very many evils including coercion and pressure, the subject of this group. The Bill is coercive: it gives oxygen to dark thoughts which can loom especially large when our best days seem to lie behind us, and when we are no longer contributing to family and society in the way we once did. Culturally and societally, it encourages and influences them as much as any person referred to in Amendments 45 and 46. Two of my friends with terminal conditions both followed earlier stages of this Bill in the other place and told me the subject’s very airing made them feel that they were a burden. The message that legislation and policy should amplify is, “You will not walk the valley of the shadow of death on your own”. We should encourage people to make and keep those relationships that will carry them through life and through that dark valley.

Others might also have dug out the words of the Times columnist Matthew Parris, quoted in a debate on assisted suicide in the other place in April 2024. He said that although

“‘Your time is up’ will never be an order”

to the elderly, disabled, severely ill and the others to whom assisted suicide will, inevitably, be extended eventually, it

“may one day be the kind of unspoken hint that everybody understands. And that’s a good thing”.

As the right honourable Stephen Timms said in that debate:

“I cannot see that that would be a good thing. It seems to me that legalising assisted dying would impose a terrible dilemma on frail people, elderly people and others when they are at the most vulnerable point in their lives, especially on conscientious frail people who do not want to die but do not want to be a burden. I do not think that there is any way to avoid imposing that dilemma”.—[Official Report, Commons, 29/4/24; col. 18WH.]


We have heard from the noble Baroness, Lady Finlay, about the data from Oregon, where over half the people who have applied for assisted dying since 2017 did so not because they wanted to die but because they felt that they were a burden. Amendment 47 from the noble Baroness, Lady Coffey, would guard against this “internal coercion”, to use the Royal College of Psychiatrists’ phrase. Further, her Amendment 49 includes,

“body corporate, institution or organisation”,

alongside “person”, which would of course catch the Government themselves. Tragically, and I declare my interests as a Hampshire farmer, there are farmers who have committed suicide ahead of the imposition of the family farm tax, choosing to die early so their land is passed on intact. Law and policy starkly influence personal decisions, hence our responsibility as lawmakers to take these unforeseen consequences into account and not brush them aside.

In her Amendment 58, the noble Baroness, Lady Grey-Thompson, is right to focus on lack of care as a disadvantage that pressurises. If death looks as if it might be painful and protracted then going through it alone, unmissed and uncared for, is too terrible to contemplate, but surely we can do better than help someone act on that dread thought, “No one would miss me; no one cares”.

Amendments 118A and 118B, which are my amendments to Amendment 118 in my name and that of the noble Lord, Lord Hunt, would ensure that wills were scrutinised and the backgrounds of friends, as well as family, were not overlooked if sinister motives suggesting financial abuse were not assumed but at least considered. Legislating for motivation is notoriously difficult, because motives are private, subjective, and easy to disguise. Instead, assisted dying legislation must use clear, objective safeguards to remove the possibility of improper motives influencing the process.

As an aside, I am not sure the Bill prevents any doctors involved profiting from early death, but Dr Harold Shipman did of course inveigle himself into the wills of some of his victims, and that would also be a red flag if found in the commissioner’s checks on wills.

Therefore, I ask the noble and learned Lord, Lord Falconer, why the Bill does not do more to exclude anyone with a financial or personal interest, and by extension anyone who might have been under their influence. We cannot draft either for compassion or for malice, but we can protect applicants by making it clear from the outset that if anyone with suspect motives has any involvement, their application will fall.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I, by contrast, speak as an atheist and humanist, mainly to address my Amendment 45, which would add the word “encouraged” after “coerced”. I support the general theme of the other amendments in this group, which largely tackle the need to strengthen safeguards against patients being indirectly influenced into opting for assisted death—often coerced, in all but name. All these loopholes undermine any certainty that the “choice”, in inverted commas, is made autonomously.

My amendment, supported by the noble Lord, Lord Goodman of Wycombe, may appear to be a small change, as it would add just one word. But before anyone concludes that I am tabling trivial amendments to waste time, I note that, when dealing with a fundamental change in the state’s relationship with its citizens and the NHS’s relationship with patients, and life and death decisions, the specificity and appropriateness of the words in the changed law matter.

At present, the Bill requires doctors to ascertain only coercion or pressure. They are the only two words given in Clause 1; there is no duty even to probe or ask broader questions about more subtle, insidious influences that could affect a person’s decisions. I note that the concept of encouragement is not arbitrary; the encouragement of assistance in suicide is illegal under the Suicide Act but would not be in this Bill. Indeed, CPS policy guidance on prosecuting those who have assisted suicide acknowledges “encouraging”—it uses that word—the victim as a factor in favour of prosecution. It is also criminal to encourage a person to commit an offence under the Serious Crime Act. Therefore, the question is less about why I am bothering to table an amendment to add just one word; the question is why the sponsors of the Bill left out that word “encouragement”.

Adding the word “encouragement” would allow a shift in perception about what undue influence could look like. Even though there are real problems in spotting coercion or pressure—we have heard many examples of that—the concepts at least have a hard edge or overt sense, at least in everyday parlance, that you are talking about people doing something that they really did not want to do. You do not say, “I had a really lovely day today; my husband coerced and pressurised me into doing” something. There is a grey area of much more subtle intervention; an individual could motivate, lead on or nudge someone into opting for an assisted death, rather than making that person aware of all the ways that they might live out their limited time as comfortably as possible. This amendment is trying to get at that sort of encouragement.

As I explained at Second Reading, one of my big dreads is that, once assisted dying is normalised as a positive treatment option, that vibe shift will not be confined to medical scenarios. It can and will mean that it is popularised as a go-to option in broader society. Consider this scenario: you have just received the news that you have a terminal diagnosis and have about six months to live. You are frightened, shocked and seeking reassurance. It is a bleak time and you are depressed because you do not want to die.

But then a third party—a family, carer or friend to whom I ascribe no motivation—says, “Have you thought about asking your GP for an assisted death? I’ve been reading about it all over the place and you can do that now. At least that way you’d have dignity in dying. You know how much you hate hospitals and all those doctors fussing about you, and we all know that you are not good with pain. How would the kids cope with running around having to visit you when you’re in and out of hospital? Wouldn’t it be so lovely to choose when you go, then we could all be with you at the end?” All of this is said in soothing, kind tones. Therefore, you think, “Well, I really don’t want to die. My instincts are to

‘Rage, rage against the dying of the light’,


but I don’t want to be a nuisance either, and they know me so well. They know what I’m like and that I won’t cope. They have my best interests at heart, so I suppose so”. It does not sound exploitative or coercive, but it is an iron fist in a velvet glove.

We have some cultural reference points here. In discussions about how the Online Safety Act will tackle suicide sites, there is consensus about the problems of online influencers encouraging vulnerable people into believing that suicide is a positive way out of their suffering. There is widespread revulsion at those cajoling siren voices encouraging death as an attractive option. In that context, none of us concludes that this encouragement is not problematic because it is not explicitly coercive.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The Bill makes it absolutely clear that it must be your own decision. Let us suppose that your views of the world are affected by the internet and that you are ill and an organisation is urging you to commit suicide, that organisation should be liable if that happens.

In Amendment 49, the noble Baroness, Lady Coffey, wants “person” to include a body corporate or an organisation in relation to pressure. If an organisation or a body corporate is putting pressure on a group of people or on individuals and that makes them do it—this is putting it crudely, but if an organisation says, “Do have an assisted death; it is the right thing for everybody or for you”—that should be covered by the Bill. The noble Baroness adverted to how “person” can generally include both corporate person and human person, but I can talk to her separately about that to make sure that it is covered.

[Baroness Fox of Buckley (Non-Afl)]

Some clarification is needed in relation to a number of points that you have made. How does anybody know, how does the doctor know, whether any of these scenarios have happened? Is there anything in the Bill that makes the doctor ask and explore? The word I proposed was “encouragement”—that you would ask not just “Were you coerced or pressurised?” but “Were you encouraged?”—because it would develop a richer conversation. Is there anywhere in the Bill where all the things that you have just said—apologies; I should not have said “you” but “the noble and learned Lord”—can be fleshed out, discussed and teased out?

Maybe I have got this wrong, but at the moment as I understand it, you fill your form in, somebody might even ask “Were you coerced?” and you say no, and that is that, out the window and then, Bob’s your uncle, you are eligible and off you go. It does not matter how often that process happens. The noble and learned Lord spoke about “first doctor, second doctor”, but if they do not all explore it, how will we know whether it was anything other than a yes/no? The noble and learned Lord has given a very rich explanation of what could have happened, but the Bill does not allow us to find out whether any of that will have occurred before the assisted death is enacted.

[Lord Falconer of Thoroton (Lab)]

I do not feel insulted by being called “you”, but I do not think that the noble Baroness, Lady Fox, properly understands how the Bill operates. The two doctors and the panel have to be satisfied that the person is reaching a voluntary decision of their own, uncoerced and unpressured. Codes of practice will determine how that is done and, what is more, the panel with the three experts on it also has to be satisfied. The noble Baroness, Lady Fox, is saying that that is a tick-box exercise. With respect, no: this is obviously a very serious matter. I expect the doctors and the panel doing it to take it seriously.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I have an amendment in this group and I support the noble Baroness, Lady Berger, in this. I just want to add to earlier comments. The transition from children’s to adult services at 18 is well known to be a very confusing and destabilising period during which key clinical relationships are lost and important elements of a young person’s history may not be carried forward. These factors are directly relevant to assessing decision-making capacity and identifying safeguarding concerns for individuals aged 18 and above who may seek assisted dying. I think that raising the minimum age would allow for any medical advances—for example, with emerging new treatments that might change a young person’s prognosis. It is important not to be too hasty.

I also want to comment on the Scottish Sentencing Council and to add that, again, there is something about the developmental process which is still under way which can increase susceptibility to influence, vulnerability to risk-taking and the likelihood of short-term, emotionally driven decision-making. We have only to think about the fact that in that age group, the biggest cause of death is actually accidental death. Research done by the Sentencing Council and other research shows that maturity may be delayed by adverse childhood experiences. It is therefore reasonable to assume that some young adults with serious illness may carry such developmental vulnerabilities into their decision-making around the end of life. The Sentencing Council guideline suggesting lower culpability and a greater capacity for change than in older adults endorses the suggestion that we should change the minimum age to 25. This is an irreversible decision. We need enhanced safeguards for this age group, and I support the amendments.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, let me just state that, for very different reasons, although I have a great deal of respect for both the noble Baronesses, Lady Lawlor and Lady Berger, in this instance I have serious qualms about these amendments in relation to raising the minimum age for receiving assistance to end one’s own life to either 21 or 25. I think we need to hold on to the standard age where we consider adult responsibility to begin—that is 18—as the Bill does. I worry that we are already getting ourselves into a tangle on age issues. For example, the proposal is now to lower the voting age to 16. I wonder how the sponsor of the Bill will hold the line at 18 when those newly enfranchised 16 to 18 year-olds start demanding equal entitlements from 16. Logically, those teens will have a point when they argue, “If you trust us to decide on the future of our country, why not trust us to decide on the future of our own fate if we fit the other eligibility criteria?” I would like some reassurances from the noble and learned Lord, Lord Falconer, that this age slippage will not happen, but also that 18 is a watertight age in terms of eligibility, and there are other amendments later on.

Conversely, I ask the noble Baronesses whether there is a danger of unintended consequences in using the argument that the young brain has not developed sufficiently at 18 to make such important decisions. It makes me anxious when neurodevelopment research is cited about cognitive development and a lack of maturity about anyone under the age of 25. That is used to challenge the decision-making capacity of anyone below the ages of 21 or 25. I fear that it could be used regressively. How can we trust 18 to 25 year-olds to vote, or be asked to take on any adult responsibilities, if their brain is still developing? Where are we going to end up? I think we need to avoid unintentionally institutionalising state paternalism that robs young adults of their individual rights and limits the choices on their own fate in various ways. The cultural shift to infantilise the post-18 cohort, which is a broader problem, is, in my opinion, regressive.

Finally, I am very sympathetic to the concerns that have been raised here already. It might be worth considering some kind of carve-out for 18 to 25 year-olds on EHCPs, but that would be an exception, not a rule. Viscerally, the idea of any young person of 19 or 20 having a terminal diagnosis and then being offered the choice of an even earlier death fills me with horror, gives me the chills and is tragic. But I still think that 18—if tightly protected by the sponsors of the Bill—is adequate in relation to age safeguards. There are plenty of other safeguards that I am worried about without adding to them.

I also think that there is a problem of the Bill creating a culture, for the young in general, of suicidal ideation. However, these amendments do not resolve those broader problems.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

On the comments that the noble Lord refers to, in relation to whether you should impose a whole-life term on somebody under 21, I recognise, as the Sentencing Council does, that issues of immaturity might make that inappropriate in certain cases. However, on this position, the question is: what is the age at which you might be capable of taking a settled decision? The concerns that the Committee has expressed about people aged between 18 and 25 make me think that the right course is to consider whether there are ways to deal with that that the House would feel are satisfactory on Report. I think that is the right course.

[Baroness Fox of Buckley (Non-Afl)]

Could I have some reassurance that with changing the franchise to 16, there will not be any slippage in relation to this Bill from 18 downwards? That is a reasonable question because, according to some people, 16 is now mature enough and adult enough to decide the fate of the country and decisions made here. Is there not a danger? Can he guarantee that this will not happen?

[Lord Falconer of Thoroton (Lab)]

I guarantee to the noble Baroness that the age is not going to go down from 18 as far as this Bill is concerned. The future is not in my gift, unfortunately. However, as far as the future is concerned, it is extremely unlikely that a subsequent Parliament is going to reduce that age.

--- Later in debate ---

If those under the age of 18—or better, a higher age—are to be properly protected, will the Bill not state unambiguously that no discussion involving the revelation of assisted dying is permitted, even if those people raise the subject, on pain of practitioners being made ineligible under the Bill?

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the noble Baroness, Lady Keeley, explained some of my concerns, which I found very helpful. I have a couple of questions for the noble and learned Lord, Lord Falconer.

Why does an independent doctor’s report no longer have to say why there was a refusal? I do not understand why the words “reason for refusal” have been omitted; could that be clarified? One of the things that will be very important in reassuring those of us with concerns about safeguarding being taken seriously is having as much transparency as possible in the process and ensuring the constant recording of information.

I am troubled by Amendment 418 and the word “unwillingness”, and not understanding, probing or having any way of finding out why somebody is unwilling. I understand that unwillingness might well refer to not being available or not being able to be so. However, if a doctor steps away, maybe because they feel uncomfortable about family members, undue influence or some kind of coercion taking place—all the things we have heard about—it seems relevant that that information be recorded somewhere, because it is a red flag and an early warning. That doctor’s opinion is only an opinion—the second doctor does not need to take any notice of it—but it would at least say that something is wrong; whereas, if the information just says that the doctor is not doing it because he is unwilling, we do not know anything.

In this process, there surely has to be a way of checking all the time that everybody knows that things are being done in good faith. I am afraid that some of these drafting amendments seem unintentionally to make things more obscure. The wording does not help to give us more information; rather, it removes information. Therefore, I would like the noble and learned Lord to look at redrafting his redrafting, so that we can have a bit of clarity.

--- Later in debate ---

[Baroness Fox of Buckley (Non-Afl)]

I think I understand what has been said there but, for clarification, is the withdrawal explicitly queried anywhere? I am under the impression that there is nowhere where you say, “Why are you withdrawing? Is it for this reason or that reason?”. I am delighted that the noble and learned Lord agrees with me that certain withdrawals suggest something that should be noted down. Where in the Bill—forgive my ignorance—does that happen? I do not see it anywhere and I would be grateful if he could refer me to it.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness O’Loan (CB)]

My Lords, it is very regrettable that the noble Lord had a patient in an abortion situation. We are not, in this group, discussing the doctor’s wishes or otherwise and his views about abortion. I ask the Minister, because I can hear mutterings here, what provision says that you cannot intervene in a debate where you have not been present, perhaps, at the very first moment of the debate? What is the section in the Companion that provides for that?

[Baroness Fox of Buckley (Non-Afl)]

My Lords, returning to the amendments that we are discussing, I want to commend the sponsors of the Bill in the sense that, when I read the Bill, multiples clauses referred to the applicant’s GP. There is an assumption, however, of an ongoing relationship with that GP. If there is not, we can come back to that. I had assumed that there is an ongoing relationship. The noble Lord, Lord Rook, has raised some of the real challenges to why that might not be realistic.

The problem is that, if there is no assumption of an ongoing relationship but simply a visit to a GP, it seems to me completely meaningless. You go in for a 10-minute meeting with a GP, which is transient and patchy at best, as they are unlikely to be able to make any clinical assessment of great merit. The noble and learned Baroness, Lady Butler-Sloss, referred to the real-life situation of not seeing a GP but how pleasant it was.

--- Later in debate ---

[Baroness Lawlor (Con)]

My Lords—

[Baroness Fox of Buckley (Non-Afl)]

I will just finish, because it relates to this. I appreciate that, once given a terminal diagnosis, that might be true, but not necessarily. That is the honest reality of the situation.

We have a moral dilemma here. GPs are being called on as though they are important to this Bill, but if they are just passing and you do not have continuity of care, they are actually being treated with contempt. On the other hand, in truth, the demand that you have to have continuity of care before you can ever be offered assisted dying seems unrealistic in today’s modern health service.

[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 30B, 220 and 265A in my name. They share the aim of other amendments in this group to ensure that the GP knows and has looked after the person who wants to end his or her life, but go beyond them in proposing the extent and length of the relationship needed and in requiring a letter from the GP to provide important additional safeguards. I will explain the amendments.

First, I propose that the patient be known personally to a doctor for two years through having been seen for at least six appointments. Secondly, I propose that the doctor submits a letter to the assessment panel on the patient’s physical and mental health during that period, and a prognosis. Thirdly, I stress that the doctor, as we see their involvement in this Bill, may be the patient’s GP, but that is not required; the doctor may be the first doctor, but, given Clause 11(8), this is unlikely, and it will probably not be the second doctor. The important point is that a medically qualified practitioner knows the patient over time and can write an assessment for them.

Why does this matter? Advocates of and those concerned about the current arrangements in the Bill want adequate safeguards. We all do. We want to protect the weak, the elderly and people with physical or mental health conditions from being influenced, pressured or coerced into wanting to end their own life. But if the request for assisted suicide can be accepted without a doctor who knows the patient personally over time, there will be no such safeguards. “Knows” does not mean a fleeting acquaintance but a professional knowledge of the patient built up over years. That is the aim of my amendments. By contrast—

--- Later in debate ---

[Baroness O'Loan (CB)]

I thank the noble Baroness for her intervention. I also want to raise the risk of domestic abuse, which is much higher during pregnancy. The Maternal Mental Health Alliance says that up to 30% of domestic abuse cases begin during pregnancy.

Ending someone’s life with lethal drugs while they are pregnant raises additional layers of moral, legal and medical concern—for example, consent, the viability of the baby, conflicts of interest, et cetera. Pregnancy causes drugs to be processed differently. The rate of absorption is affected by physiological changes. That could mean a slower or more prolonged death from the approved substances for both mother and child. Women are particularly vulnerable, and the safeguards just do not seem to be in the Bill at present.

The amendments from the noble Baroness, Lady Berridge, in this group relate also to those up to the age of 25 who have an EHCP, which may be provided to vulnerable children, including those with special educational needs and mental health concerns.

Finally, the noble Baroness, Lady Hollins, has told us that young people with complex needs may be at a higher risk of internalising negative societal values about their disabilities. The National Down Syndrome Policy Group states that people with learning disabilities can be highly suggestible and prone to acquiescence bias, agreeing with authority figures to please them.

There may also be diagnostic overshadowing, the risk that a young person’s desire to die might be as a consequence. In this context, a young person with an EHCP, for example, might request assisted dying not because their condition is intolerable but because the social care and support legally promised to them has failed to materialise, making their daily life situation unbearable. That could be misinterpreted by clinicians as a rational choice due to their disability. It is therefore the case that special provisions, such as those identified in these amendments, are necessary to ensure proper support, and that the various vulnerable groups of people do not feel that they have no choice.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I want to speak specifically to Amendment 22, about why prisoners should not be eligible for assisted dying. The amendments from the noble Lord, Lord Farmer, are also pertinent here.

The right reverend Prelate the Bishop of Gloucester raised the real and specific safeguard issues from the lack of medical records of prisoners, and I am sure we will hear more about the problems of medical care for prisoners. The terrible terminal diagnosis that one might get as a prisoner would be particularly frightening, I would think, because of the lack of medical care.

That is actually not my concern. Regardless of where one stands on assisted dying in general, I really hope that, when it comes to this Bill, noble Lords will consider the very particular circumstances of those incarcerated by the state. I hope the sponsors of the Bill will still be open to excluding prisoners and keeping them out of the Bill, on the basis, if nothing else, of their lack of autonomy.

I have to confess that I was rather taken aback when I heard Minister Stephen Kinnock in the other place state that excluding prisoners from this Bill would lead to a difference in treatment between prisoners and non-prisoners, an inequality, citing Article 8, private life, and Article 14, discrimination, of the ECHR. He noted that differential treatment would require objective and reasonable justification. It seems a bit shocking to me to have to explain this to a Minister, but my objective and reasonable justification is that, if you are in prison, you do not have the same rights as if you are not in prison. I did not make that up—although I know the Sentencing Bill has gone a bit liberal.

Actually, I think that, you know, you are deprived of your liberty. Many of the arguments made by the advocates of the Bill about autonomy and giving people choice towards the end of life, in particular circumstances —which I completely understand, philosophically and politically—are entirely appropriate for free people. But when you are not free and do not have autonomy, it brings with it a whole new range of ethical dilemmas.

The purpose of prison is, as I have said, to suspend certain rights from people to protect the public, to ensure deterrence and to uphold a sense of justice in society—I could go on. When the state has deprived an individual of so much autonomy, for all the criminal justice reasons we know, offering the option of an assisted death does not increase their autonomy in a meaningful way. It is saying, “Oh, well, we’re giving them choice”—but their real choice would be being able to leave. In other words, we have limited their choices.

Why does this matter? It is because, when the state decides to deprive somebody of their liberty, it is a very serious decision. For me, it is the worst possible punishment you could give: you are limited in being free, which I obviously consider to be very important. Prisoners, inevitably, are depressed: and often they are vulnerable in the first place. That is why they are prone to suicidal ideation.

Those of us who have had the privilege of doing some work with prisoners will know that we spend a lot of time tackling self-harm, with people hating themselves and the circumstances they are in. We do a lot of work on that. I and many others have worked on IPP prisoners, who are, ridiculously unfairly, still in prison indefinitely based on an abolished sentence, often for minor breaches of the law in the past. It is always shocking when you hear of another IPP prisoner who has taken their life. It is particularly horrible, as many noble Lords here have articulated far better than I can, because it is almost like it is on the state’s conscience. That is the reason why coroners make such a fuss about it. Those prisoners should not be there; they are in prison because the state made a mistake with the sentencing regime that it will not resolve and then they take their life. The state is somehow implicated in those suicides and we make a particular point of that.

Those of us who have worked in prisons will also know that suicide prevention is something we take very seriously. It does not matter how heinous the prisoner’s crime is. They could be a child abuser, a rapist or a murderer, but, if there is even a hint that they might commit suicide, there is suicide watch. We do all sorts of suicide prevention. The reason is that, as a humane society, we do not think that people should be allowed to take their own life, if at all possible. We have suicide watch in prison because the state has somebody incarcerated. Therefore, as a humane society, you take seriously not letting them kill themselves: otherwise, you could just say, “Carry on boys, it doesn’t matter”. We do not do that because we think that we have to protect those prisoners in the state’s care.

Right, I will finish. Letting prisoners have access to and be eligible for assisted death would be very close to reckless state abandonment of those prisoners to something very deeply dark. Philosophically, if a penal sentence in Britain ends up with the state effectively putting a prisoner to death via lethal drugs—I do not want to go on, but that is what would have to happen: they would be locked up in a prison, in the state’s care, the state would then make them eligible to ask for assisted dying, with limited autonomy, and would then hand them lethal drugs—that is far too like capital punishment, which I have long opposed and do not approve of. Therefore, even if you do not agree with me on the rest of the Bill being a completely difficult challenge to humanity, which I think it is, I none the less suggest that, if we pass it, we should absolutely exempt prisoners from it.

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I support these amendments, particularly those relating to prisoners and, indeed, what the noble Baroness, Lady Fox, so eloquently expressed. Just before I do, I will also support something that the noble Lord, Lord Blencathra, who is now not in his place, said earlier, when he complained about some of the exterior noise around those of us who are debating this Bill.

I declare an interest as a general practitioner, not of medicine but of journalism. I know very well what happens and how to recognise when we are being pushed to do a story. In the past two weeks, all the British media have been pressed very hard by lobbyists in favour of this Bill to produce a series of highly contentious arguments that attack anybody who tries to debate the Bill fully. This is very much at odds with the spirit of legislation of this sort, and with what the noble and learned Lord, Lord Falconer, keeps trying to do. He says at the end of each group what a valuable debate it has been. He does not say, “What a waste of time this debate has been”; he says it has been valuable, which it has been. I have learned a lot today, for example, about GPs and their difficulties, and we are learning more about prisoners. There was a virulent article in the Times by Nicholas Boles, who was an informal—

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

I once asked palliative care experts what the longest time was that it had taken them to bring what seemed to be untreatable pain under control when a patient was admitted to a hospice. They told me the longest it had taken them was 12 hours. Now, the Bill does not require that a patient is suffering pain for the system to operate, but those who are scrutinising how it would work in practice have been repeatedly accused of making people suffer unbearable pain. Treatment for pain is almost invariably available from experts, provided those experts are provided by the state. Our failing as a country is that we do not provide the expert palliative care to those who need it—my emphasis is on the words “expert palliative care”. I ask the noble and learned Lord, Lord Falconer, this: does he still accept that all options for end-of-life care should be fully explored? He once described this as a prerequisite for assisted dying. Again, can he share with the Committee any assessment of the cost or logistics of making further provision for access to palliative care experts? Will the Minister share any information as to the real costs of extending provision for palliative care and the savings from assisted death which may inevitably result if this is not done?

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I have added my name to two amendments in this case.

[Lord Blencathra (Con)]

My Lords, could we please first hear from those noble Lords who have tabled and signed amendments before the rest of us speak? I apologise if the noble Baroness is a signatory, but I did not think she was.

[Baroness Fox of Buckley (Non-Afl)]

I have my name on a number of amendments. I did not know that those rules applied—anyway, they do not.

I have added my name to a number of amendments from the noble Lord, Lord Carter of Haslemere, in this group.

In general, I am glad to support many of the amendments on palliative care in this group. The Bill asks us to accept that assisted dying is a medical intervention, albeit an irreversible life-ending one, which is something I am not entirely happy with. It seems obvious to me that there must be guaranteed input from the best-placed medical experts in end-of-life care: that is, palliative care specialists. That is essential for the informed consent of the patient.

I imagine and hope that the noble and learned Lord, Lord Falconer, is very sensitive to the importance of palliative care. I know that he is in the much-cited Demos Commission, which I will not bother quoting again, and I am hoping that he has not changed his mind. I think the noble Lord, Lord Carter, made a very important point earlier to the sponsor of the Bill about the number of amendments, for which we have all been chastised and finger-pointed at and tut-tutted at. I kept my patience last night, although my blood pressure did go up.

None the less, I genuinely think that the number of amendments could be really slimmed down if the sponsor of the Bill were to go through, for example, all the amendments on palliative care and say to us, “I accept the principle of this and I will come back with my own amendment” or what have you. We would then not have this issue. We are not an organised political grouping; people table amendments and add their names to them in good faith, which is what I have done, and they then speak in good faith. We are not trying to repeat things for the purpose of delaying the Bill but because we think that it matters and is important. That is what we are doing here.

On this group, and the concept of 10 important themes, we need an assurance that real choices will be offered to a patient with a terminal illness and they will be given the option of a palliative care assessment and, hopefully, then, possibly palliative care. That safeguard would really reassure us, and it is a key theme, and so on. One of the reasons why I say that is, under the Bill, GPs can mention palliative care to a patient. I am a great fan of GPs; they are fantastic generalists who do a good job. But very often they do not have all the expertise of a palliative care specialist in knowing how precisely medical intervention can improve a patient’s condition, or indeed change their will to live.

It is important for the Committee to note that research has shown that those who wish to hasten their own death often change their mind when they receive more information. Palliative care can mean that people who want to die then want to live, and that is important if we are going to talk about choice. It is possible that you might want to die, that you are determined you want to die in assisted death terms, having had your terminal diagnosis. But why is it that you want to die? That is the motivation behind the discussion in this group.

One of the things that happens is that many people are frightened and fearful, and one of the things they are fearful of is pain and terrible symptoms, which by the way are often graphically described by supporters of the Bill, and I think that they can scare people. It is the idea that your pain and symptoms cannot be controlled. When I talk to supporters of the Bill—some of my friends, colleagues and members of the public—they are completely compassionate in talking about how the Bill will help people who are suffering intolerably and in excruciating pain. None of us wishes that on anyone—or, indeed, on ourselves. It is a frightening prospect.

That is actually often a fear and a dread that the right kind of care can mean will not be realised. Patients are understandably frightened of being in that kind of pain, so they need to know that. Toby Porter, the CEO of Hospice UK, summed up the way I feel about this. He said:

“An outcome in which someone chose an assisted death because of a real or imagined fear that they could not get pain relief or other symptom alleviation, or because their family would not get support through their illness, would clearly be a moral and practical disgrace to any country”.


That is absolutely right.

We all know family and friends and so on who have died and who have had terminal illnesses. People will say that morphine is simply not enough to control the pain. That is the kind of thing that I would say, because I know nothing about medicine. So, it is a great relief to discover that palliative medicine resident doctors say that morphine is the tip of the iceberg for pain management. There are countless other options available, but to know this requires training and experience, which I have not got. When you are having a chat in the pub with mates—or indeed, when I was in hospital pumping in the morphine—it is good to know that somebody, somewhere, has got the experience. That is the palliative care specialist and every terminally ill patient should at least be offered the option to go to see one. This is a modest but meaningful addition to the Bill and I hope that the noble and learned Lord, in the spirit of listening, accommodating and compromise that we heard about last night, will make changes to the Bill accordingly.

There is also a question for the Government and the Minister here. The noble Baroness, Lady Smith of Newnham, explained this very well. In relation to the point made by the noble Lord, Lord Stevens, yesterday, it was a shocking revelation that the Minister responsible for palliative care said that the Government would not publish their modern framework until after the Bill had passed through Parliament. The noble Lord, Lord Stevens—

[Lord Rooker (Lab)]

With respect, he did not say that. The noble Lord, Lord Stevens, said it would not be done “in effect”, the implication being—I do not disagree with what the noble Baroness is saying—that the Government have given a date which is beyond when this is expected to be law. The Minister did not say, “We’re waiting until after the Bill”. The crucial words of the noble Lord, Lord Stevens, were “in effect”. He was very careful in what he said.

[Baroness Fox of Buckley (Non-Afl)]

I had thought I was implying that. I was not trying to imply some conspiratorial holding back; it is just that the noble Lord, Lord Stevens, said this was

“a dangerous reversal of the timetable we require”.—[Official Report, 8/1/26; col. 1416.]

That is the point I was really getting to. That is shocking: not because anyone is malignly behaving in this way but because the Government therefore need to commit to bringing forward that report, so it is available before we reach Report. I urge the Minister to reassure us that that is the case.

I will finish off by saying that the noble Baroness, Lady Brown of Silvertown, explained excellently that, for all of the importance of palliative care, hospices and so on, not everyone has equal access to them, which is well documented. I want to see that framework, because this is one of the chilling aspects of the Bill. For those of us who campaign to raise money for hospices, and who are desperately keen that palliative care is well resourced, to hear, as we heard earlier today, from the noble Lord, Lord Carlile, who stated baldly and perfectly reasonably that whichever choice we had in the previous group would cost a lot of money, makes me think, “Oh, spend the money somewhere else”.

[Baroness Watkins of Tavistock (CB)]

My Lords, I had not intended to speak on this group but, as the only nurse present, I want to say that nobody could deny the principles of the amendments that are being discussed today. They are right and proper in respect of good health care for the nation.

I have two concerns, however. One is that we have talked considerably about my medical colleagues, who are absolutely essential, but the vast majority of palliative care is delivered by specialist nurse practitioners. I feel that it is essential I draw the Committee’s attention to that. I want to read from the ICN Code of Ethics for Nurses, which says that nurses—and, I believe, other healthcare professionals—have four fundamental responsibilities, including

“to promote health, to prevent illness, to restore health and to alleviate suffering”.

What we are talking about today is alleviating suffering.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, all these amendments address motivation, one of the areas that the noble and learned Lord, Lord Falconer, identified as a key area in his email sent to some noble Lords on Wednesday. This therefore feels an appropriate moment to make some short observations on general matters arising from that email. My amendments focus on risks to people with learning disabilities and autism, and there is also an amendment to exclude hospices that provide palliative care, which is, I believe, true assisted dying.

As I understand it, the email’s proposal has two parts: first, that we move away from this House’s established line-by-line scrutiny and condense 74 groups into 13 areas; and, secondly, that any concessions will be limited to those areas. My question is straightforward and has been asked in various ways by my noble friends Lord Harper, Lord Deben and Lord Blencathra. When will we see the detail? What amendments will the noble and learned Lord make to address each of the areas of concern he has identified as key in the Bill? What are the terms of the noble and learned Lord’s proposals to address the concerns raised by the Delegated Powers and Constitution Committees?

We are told that amendments will be brought forward on Report to address a limited number of these concerns: advertising, independent advocates and some regulation-making powers, but we have not been told which ones. There are now 42 such powers and a further seven Henry VIII powers, but no detail has been provided. Commitments to respond to these reports were made months ago. We need to know.

The email identifies only three further changes: on the position of those aged 18 to 25, those deprived of their liberty through the Court of Protection, and the role of multidisciplinary teams. These are important but they do not go very far. Nor is there any reference to excluding hospices, as suggested in the email from the noble and learned Baroness, Lady Butler-Sloss. Finally, there is no mention at all of the serious concerns raised by five major royal colleges. They were flagged as long ago as May.

To conclude, we need answers long before Report so that all Members of this House can properly consider what is proposed.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank the noble Baroness, Lady Monckton of Dallington Forest, for that excellently clear way of expressing some of the discomfort and what we would like to see. I would be much happier and feel that I did not have to speak too much if I was getting reassurance and seeing on paper what exactly will address our concerns. At the moment, we are not getting that. We wish the noble Lord, Lord Shinkwin, were here. The fact that he is not is a real shame for the quality of this debate.

Inside and outside this House, I know plenty of people who support assisted dying and this Bill, inasmuch as they know the broad sense of what it is about. I try to avoid living in echo chambers. Whenever we discuss why they support the Bill, and potentially have a bit of an argument, they invariably say, in a very humane and compassionate way, that they think it will help people who are suffering, and that anyone who says they are suffering should have access to assisted dying. It is assumed, therefore, that the motivation of illness-induced suffering is at the heart of the Bill. That is what most people think. It has come up a lot in this Chamber but, ironically, suffering is not mentioned in the Bill, and neither is there any reference to motivations in the way that one would imagine. That bothers me, because the Bill checks on capacity, prognosis and residence, but it does not enforce a check on motivation. It seems to me that we should ask somebody who says that they want assisted dying, “Why?” It is a crucial absence in the Bill, and I hope that the noble and learned Lord, Lord Falconer, might rectify that or explain exactly why the Bill does not think that doctors should ask, “Why do you want assisted dying?” I think it would throw up a whole range of red flags in relation to coercion.

I have added my name to two amendments in this group, Amendment 30 in the name of the noble Baroness, Lady Foster, so ably moved by the noble Lord, Lord Weir of Ballyholme, and Amendment 56 in the name of the noble Baroness, Lady Coffey. To save time,I will concentrate on Amendment 30, which seeks to ensure that those who seek assisted dying are not substantially motivated by a number of factors. I will focus on two of those—not wanting to be a burden on others or public services, and not being motivated by mental disorder, including depression.

This week was the 29th anniversary of the death of my father, John Fox. He was only 66. He was diagnosed with cancer and given three months to live, although he actually made it for four and a half months. When he was told, the whole family was devastated, as anyone would be. The one thing that really shocked me to the core, and stays with me, was that when I had that initial, very emotional father to eldest daughter conversation, my father kept apologising. Believe me, that was not usual. In our relationship, he did not say, “Sorry, Claire” lots of times. He was so distraught. He was convinced that he would be a burden on us, and that his daughters and my mother, in looking after him, would all have to miss work and all the rest of it. He kept saying, “I’m really, really sorry”. He was worried about how we would cope. He did not want to distress others—a point that the noble Baroness, Lady Lawlor, was making on her amendment to this amendment.

I also noticed that he kept saying sorry to the nurses and the doctors. To everybody, he kept saying, “I’m really sorry for taking up your time. I’m really sorry that you’re having to give me so much attention”. There were stories in the media at the time about bed blocking. He was a vociferous reader of newspapers, and I was hiding the newspapers because I thought he would say sorry even more, convinced that he was taking up NHS resources. It took some time and determination for the family to reassure him, but I kept thinking afterwards how sad it would have been if he had been on his own or in a care home or whatever. To be honest, if a GP had suggested that assisted death was a medical option, in today’s circumstances, I think my father would have said yes—not because he wanted it but because he felt he was a burden on the family. It would not be the GP’s fault, as it is an internal feeling of being a burden. That is not the same as choice.

I was struck by a letter from Lord Sumption in the Times that is worth reflecting on. He says:

“The current bill contains a number of provisions designed to ensure that patients are not ‘pressured by any other person’ into taking their own lives”—

that was in relation to something else. He continues:

“The real problem, however, is not the pressure applied by ‘other persons’. It is assumptions which many old and ill people spontaneously make about the attitudes of the society around them. They are afraid of being an emotional or financial burden”.

That is very important.

By the way, I had better say that, in the four and a half months following his diagnosis that my father lived, we had some of the most meaningful time of our lives with him. It was through a veil of tears, but there was love, joy and reconciliation, there were conversations that would never have otherwise happened, and so on and so forth. It was a time that was important to him and to us as a family in a way that I cannot really describe.

Another motivation that I feel strongly we need to explore is on the part of those with a mental disorder. As many noble Lords have noted, a number of mental health conditions have suicidality as a feature. Again, I am sorry to do the personal stuff, but the first time I encountered that was as a young mental health community worker. I met a young man who was bipolar. I and others—psychiatric medics and social workers—worked hard not just to prevent his suicide but, using all our skills in pharmacological and psychological interventions, to alleviate the terrible “black dog” of depression and the horror of the obsessive suicide ideation that that young man had. I have to ask, then, whether the Bill would allow such a suicidal person’s depression-induced desire for death, and whether all those who had worked with him would suddenly be expected not just to welcome it if this young man made the choice of an assisted suicide but to say, “Oh, look, a perfect exemplar of autonomy and choice”.

I was therefore a little taken aback that the noble and learned Lord, in his summation of the last group on eligibility, said in relation to those with a mental disorder that it is their choice, and that if they want it and they have capacity then that is all right. I point out that, for anyone who wants to commit suicide, it is their choice and they want it, but some of us spend a lot of time asking them please not to do it, not saying, “Yippee!” I cannot think that, in that situation, if that young man had said, “I’ve got a terrible story. I’ve got a terminal illness in addition to my bipolar depression, and I want your support and help in assisted dying”, I would say that it is all perfectly fine and he should get on with it, and be delighted for him being able to show that he is a free, autonomous individual. I would say, “Please don’t”. The four and a half months that we had with my father was the kind of quality time that I would want to ensure that young man had, every day of his life, even if he was terminally ill and dying. I would want to make sure that he was not depressed or suicidal during the time he lived.

[Lord Empey (UUP)]

My Lords, I am associated with some of these amendments. I do not think we want to get completely hung up on the minutiae of each particular line, because there are variations that one could make. I guess that when one is drafting a Bill there are choices to be made and language can be better if one gets professional assistance.

The fundamental point, as has been outlined by the noble Lord, Lord Weir, and the noble Baroness, Lady Fox, is that anyone here who has represented an inner-city, working-class constituency will know that the approach that a lot of people have towards doctors and the medical profession is perhaps different from the approach that we have. If we want medical assistance, I guess most people in this room can pay for it if they so wish. That is not an option that other people have.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

It is very difficult and would be inappropriate to try to examine exactly why people make particular choices. Look at the first Amendment 30 proposal:

“not wanting to be a burden on others or on public services”.

Why does the thought that they are going to be a burden on their children become an unbearable thing for some people to go through? They might make that choice because of what has gone on in their lives, but it is totally inappropriate, impossible and wrong in a Bill such as this to say that we have to ask why they are in that position.

The next proposal refers to a mental disorder—

[Baroness Fox of Buckley (Non-Afl)]

If the doctor was required to ask what someone’s motivation was, and the patient said, “I just really don’t want to be a burden on my family; it’s too intolerable”, but they have been told they are terminally ill relatively recently, is it not possible that there could be an intervention that would say, “Maybe you won’t be a burden” and to go and talk to their family? One of the problems is that it is assumed the endpoint is there already, whereas if you ask the question, there is a possibility that you could offer an alternative. If somebody says, “I can’t face the pain”, you can tell them there is pain relief available. This is not trying to undermine the Bill totally, but it is possible that if the doctor responds with some options, the patient would be on their way. Why not ask for the motivation? That would surely be positive.

[Lord Falconer of Thoroton (Lab)]

That is a very important question. There is a difference between excluding certain motivations, which is what Amendment 30 would do, and asking why, which the noble Baroness, Lady Smith of Newnham, raised. I see force in the proposition that somewhere in the Bill, somebody has to ask why—for two reasons. First, as was raised previously, if you ask why, it might throw some light on circumstances that suggest classic coercion. Secondly, and separately, it might deal with exactly what the noble Baroness, Lady Fox, is referring to.

Take an utterly absurd example: someone says, “I want an assisted death because I cannot deal with the noise that’s going on in my head”. The doctor could then reply, “Well, actually, that’s a building site that will stop tomorrow”. If it is something like that, one should know.

I am attracted by the idea of something in the Bill that says why. That has to be asked somewhere down the line. This also connects with our previous discussions about the multidisciplinary team engaged in looking after the person, which might well have a much better view about why.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I am saying that everybody should have the choice. The way that one makes the choice is inevitably determined by how one got to the point where one had to make it. It is an impossible question. Why do we all make choices? They are all affected. Some people make them because they are richer or poorer than others, but I am not in favour of drawing financial distinctions. I hope that, in the light of my remarks, the noble Baroness— I cannot remember who started this—will withdraw her amendment.

[Baroness Fox of Buckley (Non-Afl)]

I blame myself for this, but the noble and learned Lord was about to say something about the mental health issue when I made a point, and we have not gone back to it. That is a very distinct question, so will he reflect on it?

[Lord Falconer of Thoroton (Lab)]

This is not a technical point, but the way the amendment is drafted is very confusing. If your mental illness makes you come to this conclusion, that may well go to capacity. I am not clear what is being got at in relation to the mental health issue. However, if the position is that you may have a mental health condition but are perfectly capable of making a decision, you should be allowed to make it.

--- Later in debate ---

[Lord Shinkwin (Con) [V]]

My Lords, I begin by quickly welcoming back the noble Baroness, Lady Campbell of Surbiton, and thank her for reminding us so eloquently why we have missed her contributions.

I rise to speak to Amendment 34, and I thank my noble friend Lord Frost for tabling it and for his excellent speech. I also thank the noble and learned Lord, Lord Falconer of Thoroton, for his past commitment to ensuring the law is communicated as clearly as possible by removing the Latin names of the prerogative writs through the Civil Procedure (Modification of Supreme Court Act 1981) Order 2004. Can he explain in his closing remarks why, 22 years later, he appears to have changed his mind on the guiding principle, which I assume informed his earlier decision, that the law should be accessible and unambiguous? Perhaps, and maybe he could clarify this in his closing remarks, he now believes it should be accessible only to some, and that for others it is fine for it to be clouded—or shrouded might be more appropriate, given the fatal consequences of an ill-informed decision on assisted death—in euphemism, nuance and even deceit.

After all, those with a learning disability or Down’s syndrome, for example, are only disabled people, are they not? What does it matter if their disability means they cannot quite grasp the enormity, finality and irreversibility of the decision to seek, as my noble friend’s amendment states,

“help to commit suicide by provision of lethal drugs”?

We know that language matters, but do we know how much it matters to those whose disabilities make them understand less or make comprehension challenging, and, in the case of Down’s syndrome, those whose innate desire to please makes them more prone to agreeing with the question, especially when its implications are not fully grasped?

I hope the noble and learned Lord will accept this amendment and thereby protect not only those whose disabilities make full comprehension difficult but the reputation of your Lordships’ House. Let it never be thought that we do not care if those whose disability-related need for the clarity provided in my noble friend’s amendment are somehow misled to death because of nuance. I hope the noble and learned Lord will show, by accepting this amendment, that those whose disabilities make them particularly vulnerable to ambiguity must not be treated as unfortunate collateral damage.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I signed the amendments from the noble Lord, Lord Frost, which seek to probe the ways that we can make this Bill more transparent to the public. That is my main driver—I believe in plain speaking. The public deserve to know what this Bill involves.

As it happens, I think the noble Lord’s wording would add clarity. His proposal is to replace

“assistance to end their own life”

with

“medical help to commit suicide by provision of lethal drugs”.

That wording is factually accurate, even if it makes you gulp. The reason it makes one gulp is because it is factually accurate, and we do not often recognise what is being advocated here. There is a danger that the Bill’s terminology creates ambiguity rather than clarity, and it is important that we are frank and open.

Why use the word “suicide”? As has already been explained, the Bill needs to amend the Suicide Act precisely to carve out the legal space to allow this type of assisted suicide, as mentioned in the Bill, to be within the law. That is accurate. But I am wary of having a culture war over the word “suicide”—I use the term “assisted dying” all the time, so I do not want to be called out for hypocrisy here—because I am aware of the fact that suicide as an issue is far too serious and tragic to be glib about or to have verbal ping-pong over.

On the other hand, I am worried that avoiding the word “suicide” in this debate, and making it verboten, might desensitise public debate. Let us be honest, language choice can influence opinion. “Assisted dying” sounds softer, palatable and more sympathetic. It is interesting that evidence shows that support for assisted dying changes if you call it “assisted suicide”; it drops significantly when the terms are plainly defined.

Some may flinch at the proposed words used by the noble Lord, Lord Frost—

“medical help to commit suicide by … lethal drugs”.

As I have said, it is hard to accept that. It makes you think. Is there going to be a complete change in the way medicine is operated, so that medics could hand you poison and lethal drugs? The answer is yes. When people hear that phrase, it might hit them what a fundamental shift this will be for medical professionals and so on. That is exactly why a number of us are not prepared to nod this Bill through. It is perfectly reasonable to completely disagree with what I have just said, but I want everyone to know what the Bill is about and why it is a very big change in our society, causing all sorts of ethical discussions. The public deserve to know that, and therefore we should be as clear as possible.

I recall that, on the first day in Committee—and subsequently, but particularly on the first day—there was a lot of tut-tutting and reprimands, with a lot of people being shouted at when Peers used the term “assisted suicide”. A lot of people stood up, saying, “You can’t say that. You’re just being emotional, manipulative and so on”. But clear language promotes public and patient understanding. In a way, I advocate a patient-centric approach rather than a euphemistic approach, which could, arguably, be seen as an act of misinformation in some instances.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I ask the noble Lord, Lord Birt, to reflect on the equality implications of this suggestion of a special treatment service for those seeking assisted death. Following on from the previous contribution from the noble Baroness, Lady Royall, it seems to me that everybody would want, if they are a patient or for their loved ones, a personal, state-funded navigator. But maybe for care, those people on trolleys, waiting for operations, or trying to find their way into the care system would all say, “Can we all have one?” If we do not afford every patient in the country a personal navigator, is that not an unequal access to services? It seems a two-tier system, and one that I think the public would not approve of.

On another issue, I ask the noble Lord, Lord Birt, to detail the workforce demands that this service would require from the NHS, following on from the excellent contribution from the noble Lord, Lord Stevens. I note that the assisted dying help service—which, by the way, would be awarded significant regulatory powers by these amendments that would not be subject to approval by Parliament—would have the power to set training and qualifications for practitioners. That seems like a blank cheque. I would like to know what the skill set of a navigator would be and who decides that. In all seriousness, this whole new shadow service being set up, with its own qualification system and recruitment, is a bit worrying. We are not sure who they are going to be.

My final query is that I know that a lot of the Bill’s supporters are frustrated and have raised problems with some of the amendments that have been tabled on the basis that they would somehow create bureaucratic, preventive barriers to people who genuinely want to afford themselves an assisted dying service. In other words, there is an attempt to overengineer the process. Therefore, I commend the noble Lord, Lord Birt, on this creative attempt at cutting red tape. However, on these amendments, we all know that mandated timelines can mean shortcuts that could make the process unsafe. Could he comment on that?

Speed and process-driven decision-making are risky in any instance but, where careful assistance and safeguarding are contested, it seems rather dangerous that panels would have to decide within two days of referral, even sitting over the weekend or bank holidays to make decisions. By the way, I think we should apply that to everyone in the NHS: they should do operations and doctors’ surgeries should be open over weekends and bank holidays. I wish the courts would sit over bank holidays and weekends, because then we would not have to get rid of jury trials, allegedly. That would mean that a referral on a Friday evening would have to be decided by a Monday. How would a panel have time to investigate and read everything thoroughly? Surely it would just end up skimming things.

I also really worry about the reflection period being cut to 24 hours, when experts warn that initial depression after diagnosis, which is completely understandable, might well be temporary, treatable and certainly remedial. It could last a few weeks but then be replaced with a more positive attitude. In fact, the CEO of Mind told the Lords Select Committee that they have

“gone to the brink, have come back and have then been able to say three or six months later, ‘I’m so glad that that did not happen’”.

All I am saying is that saying, “Oh we’re being really efficient; we’re going to make sure that your reflection is cut to 24 hours so that you can get what you want”, might well mean that you do not get what you would have wanted if you had had a bit longer to reflect.

[Lord Goodman of Wycombe (Con)]

My Lords, there is an unreality about this debate that gives rise to a question for the sponsor of the Bill and the Minister. The unreality is this: the noble Lord, Lord Birt, has made the case for his amendments, and my noble friend Lord Harper and others have made the case against them, but there is hung on this whole debate an assumption that the NHS will deliver assisted dying. I remind the Committee that there is no guarantee of that in the Bill.

If noble Lords would kindly turn to Clause 41(4), they will see that the only reference to the National Health Service is:

“Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued”,


et cetera. That is the only reference to the NHS in the Bill. We do not know whether the NHS will or will not deliver assisted dying services. It is an extraordinary weakness in the Bill.

--- Later in debate ---

[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.

--- Later in debate ---

[Lord Birt (CB)]

The one issue that unites the whole Committee is that we have to have an effective service of palliative care in this country. The data in Australia, which varies from state to state, tells us that somewhere between 70% and 90% of people who come forward already have palliative care.

The noble Baroness, Lady Fox, talked about navigation. It is a complex process, even in the Bill as it stands. If you analyse the likelihood, you will find that it will probably take, without the right process involved, 30 to 60 days, which is completely inappropriate in the context of the Australia experience. By the way, the navigator is an administrative role to help the person manage a complex system with multiple practitioners, who themselves have real authority.

[Baroness Fox of Buckley (Non-Afl)]

To clarify, I am sure the noble Lord knows people who have tried to get a hip replacement or a wide range of other medical treatments. It is the most complex process that you could ever go through. Many people are vulnerable and could do with a navigator. Does he understand the two-tier nature of appointing a navigator in one instance and not in another? This follows on from the earlier question from the noble Lord, Lord Moylan. Can the noble Lord see that anything that seems to give preferential treatment to those seeking assisted dying over those who are suffering pain from a bad hip or who have a rare cancer and are terminally ill would cause political problems? Immorality might be part of the issue there.

[Lord Birt (CB)]

Believe it or not, I have had cause, at various times in my life, to navigate the NHS, as probably everybody in this Committee has, and of course it is very difficult. However, when you go into A&E, you effectively do have a navigator. I do not think this is about the hip operation example; it is about people in a genuine emergency situation.

--- Later in debate ---

[Lord Markham (Con)]

As I said, these are not people who want to die; they are people who absolutely want to live. The only reason they are entering into this process, and the only reason they would be eligible—

[Baroness Fox of Buckley (Non-Afl)]

I completely sympathise with the point made by the noble Lord, Lord Markham, that these people do not want to die; they want to live. Would he then agree with some of the amendments that I tabled last week and spoke on? If, for example, they want to die and are then diagnosed with a terminal illness, that would be relevant to not allowing them into the process; that is, they want to die, and then the trigger of terminal illness allows the state-sanctioned administration of lethal drugs so that they can commit suicide, which is why people have raised problems about suicide ideation and mental illness. I therefore hope that the noble Lord will back some of the amendments on safeguarding that I tabled.

[Lord Markham (Con)]

The noble Baroness is talking about a slightly different circumstance where there are prior reasons, which could be mental health or other reasons, and why that could be a cause. What we are talking about here is basically the criterion on which you can first be assessed for assisted dying, which is, of course, that you have been diagnosed in the first place. To the point that, of course, people might then live longer, my experience is that they are delighted by that. Just because they have been assessed as being able to have assisted dying does not mean that they will take the medication. Again, evidence shows strongly that they will take the medication only right near the end when the pain, the loss of dignity or whatever the reason is becomes unbearable. My experience is that those people would be delighted if it was a misdiagnosis, and if they are fortunate enough to be living 30 years later, as per some of these examples, that would be fantastic. Of course, they will not have taken the medication. The point is that they take it only right at the end where there is no other choice, so to speak.

Within that, accepting that these are the people we are talking about, of course there are all sorts of different motivations why, when they are unfortunately at the point where they are looking at such a death, they might want to go ahead with it. Research shows that there are multiple reasons; it is impossible to put it down to just one. Loss of autonomy, less ability to engage in enjoyable activities, loss of dignity, loss of control of bodily functions, burden, inadequate pain relief or finances are all part of the reasons. They are all part of the research, and, on average, you will find that there are three or four reasons to do it.

So it is quite wrong to say, “No, we’ll only allow you to go ahead with this if you only have that single motivation”. As I said before, they would rather not be there in the first place, but given that they are in that unfortunate circumstance, surely they should be allowed the choice of why they wish to die.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

The way the noble Lord has put the question to me means that, plainly, this would be because of the illness, would it not? I want an assisted death because the illness is going to kill me. That seems quite a bad example.

[Baroness Fox of Buckley (Non-Afl)]

I appreciate that the noble and learned Lord is saying that we have covered a lot of this ground before, but there is one reason that people keep coming back to similar threads. The noble and learned Lord has in many instances said, “I’m listening to you. I’ll think about that”, and nothing happens. It is not reassuring and there are different ways of approaching this. I thought I had made some inroads. The noble and learned Lord was quite positive about the question of motivation being relevant.

A patient arrives at the doctors and says, “I’ve got a terminal illness”. The doctor says, “Why do you want an assisted death?” The patient says, “I’m costing my kids a fortune—their inheritance. The care home costs tens of thousands of pounds. I’m a burden”. The noble and learned Lord just suggested to the noble Lord, Lord Deben, that you would say, “That’s your choice”. As in an earlier discussion in relation to the NHS, we are talking about NHS doctors, whom you would think would say, “Let me have a chat with you about that” and challenge them. They cannot just say, “If that’s what you want, carry on”.

All those examples I gave—I will not go over the millions of better ones used in the past—show that this undermines autonomy and suggests that the state is indifferent to somebody, in effect, asking for help in a different way but the form it takes is, “I might as well have an assisted death”. If you listen to them, they might be asking for something else that the state can intervene and help them with, whereas we just go, “Assisted death? We can provide that. Any of that other stuff you want, like financial help or help with loneliness and all that—we can’t afford that. That’s not happening, but assisted dying? You’re on your way”. That is why we are worried, and it is why these amendments are worth taking seriously. The noble and learned Lord needs to come back with written amendments that will reassure some of us so that we do not keep repeating ourselves.

[Lord Falconer of Thoroton (Lab)]

That was not really an intervention; it was just a statement. I should have said to the noble Baroness, Lady Fox, that, as I said last week, I will make an amendment so that the question of why will be asked, but I do not depart from the proposition that autonomy should be the leading reason for it. We disagree about that, and the House can reject that view on Report, but I am explaining what my position is.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Pidgeon (LD)]

I am coming to the end of my speech; I do not think I have to take an intervention, so I would like to finish my point.

It seems to me that this is about making the choice of an assisted death difficult or impossible. We need to think carefully about the checks that we are putting in place for people in the last six months of their lives. We need to make sure that the system really will work for them.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, we should thank the noble Baronesses, Lady Gerada and Lady Pidgeon, for raising important counters to a lot of these contributions, because it is important that we do not fetishise face-to-face communication as infallible. It offers no guarantee that comprehension happens, that people listen and that there is no misunderstanding. We should know that because we sit face to face in this Committee every Friday and goodness knows it has not guaranteed much of that.

I have put my name to several of the amendments in this group because, despite what the noble Baroness, Lady Pidgeon, just said about how we must make this as easy as possible for people with six months to live, the Bill’s sponsors have rightly built the need for eligibility into the Bill. You cannot just wander in and say, “I’ve got six months to live, get rid of me”; you have to pass the eligibility assessment. We are trying to work out whether face to face as the default would be a better way of guaranteeing that there is no abuse, which is reasonable.

I remember the ITV documentary referenced by the noble Baroness, Lady Coffey, in which I heard the Bill’s sponsor in the other place, Kim Leadbeater, admit that she was uncomfortable with what has been labelled “death by Zoom”—the model that she was watching in Oregon. Despite what the noble Baroness, Lady Gerada, said, it was actually Kim Leadbeater who rightly noted that it looked too much like a tick-box exercise. We need to be wary of anything that goes in that direction, but, because this is what I saw in that documentary, I expected a basic requirement in the Bill for face-to-face assessment, except in exceptional circumstances. So I ask the noble and learned Lord, Lord Falconer, to respond on why the Bill still permits so many encounters with doctors, including the panel, to be conducted remotely, meaning that somebody may access assisted death without having seen a doctor face to face. One might pause on that, at least.

Despite the virtues of telemedicine, of which there are many—we can all see the reasons why, on occasion, it is important, just as we all use Zoom for meetings and so on—this is a question of whether it is superior and whether it can be relied on. The noble Baroness, Lady Smith of Newnham, gave a vivid example in response to the contribution from the noble Baroness, Lady Jay, in which she said, “At least the noble Baroness, Lady Gerada, knows what it is like to be the doctor doing the consultation”. Well, some of us know what it is like to be the patient on the other end of it. To be honest, it is not always a case of “trust the expert” and all that, because there absolutely may be crossed wires, hanging around, frustration and all sorts of things going wrong.

Professor Martin Vernon, who chairs the ethics and law special interest group at the British Geriatrics Society, said:

“Assessing somebody remotely, digitally, without a face-to-face assessment, particularly if they have complex health and social care needs, is nigh-on impossible”.


There is something in that, too, which we should consider. Non-face-to-face Zoom or phone encounters are particularly challenging for certain groups, such as people with communication difficulties. The noble Baroness, Lady Nicholson, reminded us of the issues for people with hearing difficulties in our debate on a previous group. We all know that there are difficulties of language.

Of course, older people are likely to make up the majority of those being assessed for assisted dying. Without wanting to caricature oldies as being technically illiterate—although there is a smidgen of truth there—there is something else to consider. Older people sometimes present their best selves on the phone. They put on their best voice. There is nothing wrong with that, but they chat away as though everything is fine and, even on Zoom, they sit there looking their best.

However, when you see them face to face—I am not now talking about a doctor assessing them—they are dishevelled, pale and frail. Something else happens. Because the assisted dying decision involves highly emotional and existential issues, purely remote assessments potentially undermine the relational aspects of care that will help ensure that decisions are well considered and autonomously made. We have to think about those direct, personal interactions. The noble Baroness, Lady Jay, is right: these are the last six months of your life—allegedly; that is what you have been told. People are vulnerable, distressed and not quite sure. All these amendments are suggesting is that it would possibly be better to see the doctor. If you cannot get there, that is all fine, nobody is being inhumane; but the doctor sees you and assesses what is going on. It is a necessary if not sufficient way of establishing the eligibility criteria.

Finally, the noble Lord, Lord Empey, talked about how this might be appropriate for online legal proceedings. I am sure that the noble and learned Lord is aware of the evidence on the use of video links in court proceedings and trials. In Transform Justice’s survey of court users, 70% of respondents said that it was difficult to recognise whether someone who was on video had a disability, while 74% believed that those who had no legal representation were disadvantaged by appearing on video; in other words, the vulnerable always suffer in those instances.

The report similarly found that there were significant issues in assessing evidence and character. We can learn from other areas, but the main thing is that the default should be face to face. That should be in the Bill. I agree with Kim Leadbeater on that one—that is a headline. I do not understand why, Kim Leadbeater having noted that, it is not in the Bill. There should be exceptions if people are too ill, too far away or having a ball in Tenerife for their last six months. Yes, we get all that, but the default point is: face to face, where possible, as much as possible.

[Baroness Coussins (CB)]

My Lords, if we are to have remote assessments, it is very important that we have an exception for one group of people who might be seeking assisted dying: those who require the services of a public service interpreter. Elsewhere in the Bill, the provision of interpreters is acknowledged and provided for. This is one situation where face-to-face consultations are essential. During Covid, there was a huge rise in remote interpreting in the criminal justice system. A number of studies, including a very robust piece of research by the Magistrates’ Association, showed that there were problems with remote interpreting, for reasons ranging from dodgy technology to missed cues because of missed body language.

In these circumstances, more than anything else, a face-to-face consultation or assessment is right and appropriate, where the services of a public service interpreter are needed for the benefit of the person seeking help.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, in the previous debate we had an interesting discussion about the importance of face to face. I think the conclusion was that the noble and learned Lord, Lord Falconer, should bring forward amendments that would make face to face the default mechanism, while accepting that there would be exceptions. At that point, I raised the question of recorded statements made by someone who then could not speak. It is important to remember that speech can now be faked and can sound exactly like the person. I hope that, in drawing up those amendments, the noble and learned Lord will be able to encompass some protection to ensure that, when a presentation is made of a recording that seems to be in somebody’s voice and in their words, we are still protecting against abuse and coercion and against those with malintent who may have faked that. Unfortunately, we are already hearing stories of criminal activity where such fake voice recordings are used, and we find that people believe them as being from the person, when actually they have been part of a criminal activity. This amendment has been important—although I accept, of course, that it is only a probing amendment—because it has actually made us think on a much wider scale.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, the Government’s 10-year health plan for England seeks to

“make the NHS the most AI-enabled health system in the world”.

Like others, I think that is an incredibly exciting prospect. I do not want it to be dystopian. I think that the right reverend Prelate the Bishop of Hereford makes an important point in warning us against going completely over the top. I think it is important that this amendment has been tabled, because it makes us think about what the possible problems are, which have been well expressed by others. Despite my excitement about what AI might do, even in terms of treatments—there are wonderful possibilities in terms of helping people to walk, what is happening with the brain, and so on—we do not want to be naive.

The question for the noble and learned Lord, Lord Falconer, is: as the NHS digitises and doctors become increasingly reliant on AI for notes and diagnostics, given that the diagnosis is so important in a life-or-death situation in this instance, how can we ensure that a time-poor doctor does not use AI as an assessment tool or a shortcut? We would be naive to imagine that that does not happen elsewhere; we would only have to think of politics. People now use AI to avoid doing research, in a wide range of instances, and I do not want that to be translated over.

As for the patients, algorithms are supremely impressive and can take things that have happened on Facebook or TikTok, from when you have been on a Teams meeting or Zoom—all sorts of indications—and detect chronic illness conversations. The algorithms can then push pro-assisted dying content such as the Switzerland adverts or positive end-of-life options. Interestingly, when discussing banning social media for under-16s, which I completely disapprove of, or bringing in the Online Safety Act, which I argued against, everybody kept saying, “Algorithms, oh my goodness, they can do all these things”. We should consider not that chatbots are malevolent but that AI tends to agree with people via the algorithms; to quote the title of a piece in Psychology Today, “When Everyone Has a Yes-Man in Their Pocket”. If you say that you are interested in something, they will just say, “Yes, here are your options”. That is something to be concerned about, and it will come up when we discuss advertising.

I finish with that BBC story from August of a Californian couple suing OpenAI over the death of their teenage son. They allege that ChatGPT encouraged him to take his own life, and they have produced the chat logs between Adam, who died last April, and ChatGPT that show him explaining his suicidal thoughts. They argue that the programme validated his most harmful and self-destructive thoughts. I am just saying that AI is a wonderful, man-made solution to many problems, but if we pass a Bill such as this without considering the potential negative possible outcomes, we would be being irresponsible.

[Lord Hamilton of Epsom (Con)]

My Lords, I have supported AI for as long as I can remember, and I think it is the future for this country. If we are looking for improvements in productivity, there is no doubt that we should look to the National Health Service and the public sector, where we can see AI having its greatest effect and improving the health of the economy of this country.

However, we are in early days with AI, although it has been with us for some time. We must be very careful not to rely on it for too many things which should be done by human beings. The noble Lord, Lord Stevens, has already referred to the appalling rate of misdiagnosis. We can look at these statistics and say, “Well, it is only a small number who are misdiagnosed”. Yes, but my noble friend Lord Polack was misdiagnosed as only having six months to live and he is still with us 32 years later. You must think about this, because if you get the situation with misdiagnosis badly wrong, it undermines the basis of this Bill. Therefore, we must be very careful that AI does not contribute to that as well.

I pay tribute to the right reverend Prelate. AI is having a tremendous effect in the health service and helping a large number of people to get better, and it may well be that AI introduces cures for people who are being written off by their doctors—perhaps wrongly. We must not dismiss AI, but we must be very wary about where it leads us. There will be an awful lot of bumps in the road before AI is something in which we can all have complete confidence and believe will deliver better outcomes than human beings.

Terminally Ill Adults (End of Life) Bill

Baroness Fox of Buckley Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[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.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak to my Amendment 103. I thank the noble Baroness, Lady Hollins, for adding her name to it. It is a modest amendment simply seeking to ensure that a person is not categorised as terminally ill if they have refused life-saving treatment because they are influenced by a mental disorder. The noble Baroness, Lady Keeley, was perceptive in addressing some of the issues that concern me and are why I tabled this amendment.

We are talking about any individual who, in effect, voluntarily brings themselves within the definition of terminal illness as defined in the Bill. As we heard on the previous group, supporters of the Bill often present the six-month prognosis as clear-cut and argue that we all know what we mean by terminal illness. In public discussions, the example given is usually cancer, which again seems fairly clear-cut. But we heard on the previous group that life and death and diseases are rather more complicated. The noble Lord, Lord Moylan, raised some very thought-provoking issues around that.

I want to make a bit more concrete what terminal illness would mean in the examples that I talk about. I have noted that the noble Baroness, Lady Coffey, started this theme in the previous group, and I was very affected by the moving speech made by the noble Lord, Lord Farmer, which also pertains to this. Where someone suffers a serious depressive episode, perhaps related to a debilitating physical illness that is difficult but none the less treatable, what would happen if, in a temporary period of despair, they refuse treatments such as dialysis or HIV antivirals, therefore potentially leading them to a terminally ill prognosis? Would they be eligible for assisted death in that instance?

Or let us take the case of a suicidal person, perhaps a prisoner suffering mental distress, who has attempted to take his own life several times before but suicide prevention policies have saved him. I think in particular of prisoners I have long campaigned for who are on IPP sentences. Tragically, suicide figures among that group of prisoners are very high and suicidal ideation is a real factor for those prisoners. Our imagined prisoner is not just mentally disturbed but physically dependent on insulin for diabetes and needs to take it to remain alive. If that person refuses to take that treatment and becomes seriously ill, bringing upon himself the inevitability of having a progressive disease and it becoming terminal, would he be eligible for assisted death under this Bill?

This example would seem to contradict the slogan of many of the Bill’s supporters, which we frequently hear: “They’re dying anyway”. As it happens, it is a phrase that I find particularly chilling, but, in this instance, they would not be “dying anyway”; they would be dying in a self-induced way. How will the idea of terminal illness in such instances be weighed up? In the case of our IPP prisoner refusing to take treatment such as insulin—perhaps even refusing to eat or drink—this could lead to an inevitable assisted death, because he would meet the physical criteria of terminal illness when, actually, the root cause was not inevitably progressive.

I like to imagine that we as parliamentarians, along with campaigners, will be successful in ensuring that IPP prisoners are freed from the hopelessness of an abolished prison sentence that psychiatrists uniformly and consistently say is a major factor in making people suffer mental illness in prison. If the IPP was ended, that prisoner could resume their medical treatment and their mental ill-health would have changed because the social circumstances would have changed. Therefore, they could resume their treatment, start engaging again, feel that they have a reason to live and become treatable, with recovery possible—but not if it is too late as they have already had an assisted death. In other words, terminal prognosis is not inevitable in that instance but self-induced, driven by a disturbance of the mind.

The noble and learned Lord, Lord Falconer, has some insight into the issues in this amendment, as he has explained. He has tabled an amendment and talked about any disease caused by a person not eating or drinking when that occurs as a result of mental disorder. Obviously, the focus there is on anorexia and eating disorders, but is this not a similar example?

I raise these issues because this is a loophole that has been nagging at me. I cannot see anywhere in the Bill where safeguards exist to prevent such undoubted unintended outcomes. Without those safeguards, the drafting of the Bill could inadvertently incentivise self-destructive choices about treatments for illnesses that are treatable, and lead to irreversible early death facilitated by state medical services when life-saving medical treatments could have ensured that people lived and were not categorised as terminally ill. It is this confusion—about who defines terminal if you put yourself into that category—that I would like the noble and learned Lord to reassure me about and clarify.

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[Baroness Hayman (CB)]

My Lords, the noble Lord says that we should understand the ordinary meaning of words, and I agree with him. I must say to him, however, that my own mother—who turned her face to the door and stopped eating and drinking—did not commit suicide. We did not feel that. She was at the end of her life, she was terminally ill and she decided that she had had enough. She did not want the next blood transfusion, and she did not want any more time. I find it really offensive to be told that she committed suicide.

[Baroness Fox of Buckley (Non-Afl)]

I also want to respond to the noble Baroness, Lady Gerada. Words do matter, which is why plain speaking matters. Being told that you cannot say certain words because they might offend someone is unhelpful. Can the noble Baronesses respond to the fact that, in opinion polling, if people are asked whether they support assisted dying, many will say yes? If they are asked whether they support assisted suicide, they say no. In other words, calling something what it is—namely, suicide—is not necessarily something that the noble Baronesses should be frightened of. They cannot instruct us as legislators to do the job of spin doctors in trying to make something more palatable by using kind words. We have to be honest with the public and then they will decide; it is up to them.

[Baroness Whitaker (Lab)]

Does the noble Baroness, Lady Gerada, agree that the cardinal difference between suicide and voluntary assisted death is that voluntary assisted death applies to people who are already dying? There is no way that they are going to survive, and that seems to make the whole difference. What we seek in this Bill—and I very much support the safeguard proposed by my noble and learned friend in Amendment 87—is that the process of dying should be free from terror, pain and humiliation. It will not stop the person dying. Therefore, it is not suicide.

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[Baroness Smith of Newnham (LD)]

I can see a point to that, but the message I was given by the mental health practitioner who rang me from the mental health team—I think he was a psychiatrist—was basically that once somebody is in a home, these tests become much more difficult because of the nature of the environment. That may differ from home to home—and yes, when my father had pneumonia and was clearly delirious, he was at home. If there are concerns, we should surely make sure, if people have a cognitive impairment, that we know that is the case, but if somebody does not—if there are the short-term issues that are being discussed in the amendments, in particular Amendments 111 and 112—then surely those people who want an assisted death would want it ruled out that they had some sort of cognitive impairment if it were temporary and reversible. That is the sort of thing we really need to get right, not only for those people who have an impairment but for those who actually do not have one but would not then be able to have the assisted death that the noble Baroness, Lady Hayter, and others might wish them to be able to avail themselves of.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, this small group, which I did not expect there to be so much rich conversation about, indicates why care homes really are an important focus for the Bill. I absolutely want to echo the points made by the noble Baroness, Lady Finlay, about care home workers: they have not been consulted. Might the noble and learned Lord make a commitment to meet up with representatives of the care sector to discuss the very real issues that the Bill will create for them if it passes? We can recognise that many of the people in society who will, at some point, be eligible for assisted death if the Bill passes will probably be in care homes, because that is where elderly people are, who might well get terminal diagnoses—rather than 14 year-olds. We are talking about a different cohort; that has at least to be considered. Some of the previous contributions have therefore been very helpful. I really thank the noble Lord, Lord Blencathra, for laying out so clearly why this should matter to us all.

I am somewhere between the noble Lord, Lord Deben, and the noble Baroness, Lady Hayter, on care homes because, for the purposes of this discussion, I would rather not go down the care home horror story route. However, even if you accept care homes as positive places in general, there are still huge challenges in the Bill in relation to them. I will lay out some of these challenges.

Despite the horror stories, in most instances, care homes are incredibly important to society’s care of the elderly and frail. Although they are too often neglected—understatement of the year—by state support, they are fulfilling an incredibly important public service. By and large, the care workers I know and have encountered—far too many of them, for a variety of reasons—are heroic. They are poorly paid, underappreciated and overworked, and we know there is a massive turnover of staff. These things have been well covered in different discussion. I also find that many care workers are amazingly generous and creative in their care of our older citizens who are in need of residential care.

Despite all that, we must be realistic. There are difficult, challenging circumstances in care homes, and we have a social care crisis, which we talk about all the time. This is the living example of that crisis. There is not enough space in care homes, and they can be chaotic—not because of the staff. In a day-to-day sense in care homes, standard mental capacity assessments are done by overworked care workers who are not clinical professionals. I worry that these assessments used for treatments might bleed, in some way, into the future as a way of signing off a new medical treatment on the block: assisted dying. We must recognise that as a possible concern.

I am slightly contradicting myself now, but we must recognise the kind of pressure that people are under. Many elderly people in care homes have had things like do not resuscitate orders or inappropriate diagnoses. I think it was the noble Baroness, Lady O’Loan, who made a point that I too can relate to, where an elderly person was given their meal and drink, and it was ticked off by care staff as having been eaten and drunk but it was not; the elderly person did not even know what it was, but it was ticked off anyway. That was not cruelty, on behalf of the staff; it was rushing around. They did not feed that elderly person, but they were not starving them; they simply did not have time to sit down and do anything about it.

This matters because a large number of people who may fall into eligibility because they are terminally ill will be people whose capacity needs to be assessed, and they will live in care homes. The problem is that care homes are a gathering of people who have fluctuating cognition. The main thing that goes on in care homes, beyond care, is that cognition changes all the time. The idea that a firm, autonomous decision will be made in those circumstances needs to be, at the very least, queried slightly.

We are talking about UTIs, dehydration, infection or the effects of medication, but the big one, of course, is undiagnosed dementia or early dementia that no one has yet noticed. Alzheimer’s Society data shows that only two-thirds of those with dementia have received a formal diagnosis. Sadly, there are massive waiting lists, so the diagnosis rate is low—and in Wales, inevitably, it is sadly even lower. There is also hidden dementia, where no one is trying to get the people assessed but it is there none the less. Due to the heightened risks of cognitive impairment issues and the instability of cognition, we definitely need to take these amendments seriously. We need to have specialist clinical assessments to ensure that capacity means capacity and is not part of a “good days, bad days” scenario.

Anyone who has had relatives in care homes, or spent any time in one, will know all about the “good days, bad days” situation. You can go in one day and chat away to a coherent and articulate older person, but the next time you see them they are completely incoherent and confused. You then go back and they are chatting away again.