Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I have spent some years working to improve care and support for vulnerable people, specifically as chief executive of Cerebral Palsy Scotland, through my involvement in the Scottish Government’s framework for action for neurological conditions and as a previous trustee of the Neurological Alliance of Scotland. I believe that we all want to ensure that compassionate care and services are available for anyone when they need it; I also believe that everyone is entitled to be supported to make informed choices about their treatment, to access care that ensures they are able to live as pain free as possible and with dignity.

Sadly, however, as we have heard, for too many people that is not a reality. Lack of access to condition-specific support, to palliative care and to social care are all reasons why the status quo does not work for too many people. Set in the context of clinical backlogs and constrained funding in health and social care, people will not make all their choices in a context that is equal.

Here in this Chamber, we are all, in the main, healthy, competent, articulate and above all, privileged people. I have been asked whether I would not want an assisted death if I was unable to speak for myself, dress myself or eat by myself, but this is the reality every day for many disabled people. In seeking to ensure that the Bill leaves this place fit for purpose, we must consider assisted dying not through the lens of what we think we might want for ourselves, but rather through its impact on the most vulnerable in our society. We have been told that the Bill gives people choice, but which people and what choices?

As it stands, the Bill leaves me profoundly uncomfortable. The personal stories of people seeking choice and control over the manner of their death, or the heart-rending examples of poor care, seem not likely to be resolved by the provisions of the Bill. I am also concerned about the differences between this Bill and the Bill currently going through the Scottish Parliament, and the implications of those differences for service provision and regulation across the UK if both Bills pass. I gave evidence to the lead committee scrutinising the Bill on behalf of Cerebral Palsy Scotland in Holyrood, and both Bills leave too many details to be agreed later. Sweeping consequential powers, such as the process for the approval of drugs or other substances and the regulation of professions, will require co-operation and co-ordination between the two Administrations and should, I believe, require full and transparent scrutiny in both Parliaments. Where these Bills use words such as “terminal”, “progressive” or “treatment”, we need greater clarity on what exactly these terms mean, otherwise such broad terminology and the lack of detail around the process of assisted dying will result in unintended gaps that would be challenged.

I also want to seek provisions to ensure mandatory involvement of health professionals who actually know the person and are experts in the condition the person is presenting with. There is, however, a host of other issues that currently concern me, including greater clarity on how people will die, especially if they are unable to use their hands or ingest a substance; direction on what medical professionals are supposed to do or not do in case something goes wrong; stronger protections for conscientious objectors; and far greater clarity on training and reporting standards and requirements.

At the moment the Bill presents too many questions and not enough answers. I look forward to playing my part during its passage, as it is essential that these questions are not brushed aside or dismissed and that clear answers are provided.

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Harper (Con)]

I am happy to answer. I do not know how many did. My understanding is that the royal college, whatever its decision-making processes are, has publicly said that it does not think this is adequate. As I said, I did not quote it, because it had been quoted at length. I put some weight on that.

As a relatively new Member of your Lordships’ House, I am also very struck that this House is blessed with those who have enormous experience in the law, who have to make some of these decisions in practice, and experienced legislators, such as myself, who have looked carefully at the operation of the legislation, both in taking it and post-legislative scrutiny. Many Members have personal experience, either themselves or through family members, of the exercise of these laws in practice. I will listen very carefully to them.

Therefore, the view of the Royal College of Psychiatrists is clearly an important one that I will put some weight on, but I will also listen very carefully to others in the House, who I think will add enormously to this debate as we weigh up this important piece of legislation. I thank the noble Lord for his question.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank the noble Baroness, Lady Finlay, for bringing this debate to the Floor. I declare my interests as chief executive of Cerebral Palsy Scotland, and I have been involved with the Scottish Government on neurological conditions and policies for many years.

What has struck me in the debate so far is something that the noble Baroness, Lady Hayter, said about concentrating on the interests of the person. This is what I see every day when I deal with vulnerable people and they are dealing with service providers, whether in health, education, housing or whatever. I take the point your Lordships have made that this debate is about the difference between “capacity” and “ability”; capacity, as we define it in the Mental Capacity Act, is something that professionals will assess. They have lots of experience of doing that, and that is great. However, if we come back to concentrating on the interests of the person, the person is quite often in this difficult, complex situation for the very first time. Therefore, as my noble friend Lord Deben said, their ability to take on complex information, potentially when there might be multiple comorbidities and issues going on, is very different.

We see it in children in education and in people with communication difficulties—I have an amendment later on about how we support people with communication difficulties to navigate this. But we see it every day with the ability of people to take on something really profound that professionals are used to talking about—and we are professionals in here; we can talk about definitions and how we define things in legislation. I wanted to question whether people in the street that will be dealing with this have the ability to understand all the options, the prognoses and everything in front of them.

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness accept that someone can take their own life now? They are dying; it is completely legal for them to commit suicide without anyone doing any checks about whether they have capacity, ability or anything else. So the Bill is in fact adding a safeguard that is not there at the moment, because at the moment someone can take their own life.

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. Every suicide is a tragic situation, and I am sure that all of us would wish to help that person. But that is not what the Bill is about. It is about whether we find a method where they have a settled will to make a decision—to make a choice.

[Lord Deben (Con)]

Is the difference not absolutely fundamental? The Bill allows the state to enter into this discussion and allows somebody in fact to kill somebody else. That is wholly different from suicide, and the noble Baroness is wrong.

[Baroness Fraser of Craigmaddie (Con)]

I thank my noble friend for saying what I wish I could have said myself. I will end, because we have had a very long debate on this. I just want to emphasise that from my experience of dealing with people, with families, versus what professionals think, it is a very different landscape when we compare those who do it every day with those who are faced with these difficult decisions for the very first time.

[Baroness Hollins (CB)]

My Lords, I want to add a correction for the noble Lord, Lord Winston. The Royal College of Psychiatrists voted on the principle and it was a 50:50 split. The issue of this Bill is different. The college has taken the view, after a great deal of consultation, that it does not support the Bill.

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

Moved by

[Baroness Fraser of Craigmaddie]

17: Clause 1, page 1, line 11, after “England” insert “, Scotland”
Member’s explanatory statement
This is a probing amendment to establish whether it is intended to exclude from the scope of the Bill residents of border areas of England who are registered with a general medical practice in Scotland.

--- Later in debate ---

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I rise to speak to Amendments 17 and 309A in the name of the noble Lord, Lord Beith, which I have supported. The noble Lord sends his sincere apologies that he cannot be here today. I will also speak to Amendment 62 in my name. I thank the noble and learned Lord, Lord Falconer, for his discussions with both the noble Lord and me on how this Bill affects Scotland.

These are probing amendments. They seek to establish the scope of the Bill, firstly with regard to residents of England who may find themselves availing of Scottish health services. Amendments 17 and 309A remove an anomaly in the Bill under which some residents in England close to the Scottish border will be excluded from its scope because they are registered with a Scottish GP. This is relatively common in border areas, as it may be that a Scottish GP is closer than the nearest English practice, or it may reflect a desire to stay with the same practice after moving house. The BMA has identified cross-jurisdiction protection for doctors supporting their patients in shared-care arrangements across borders as a gap in this Bill that it would like to see addressed in Committee. The Scottish Ambulance Service has also requested further clarity on what paramedics should do or not do across border areas. How does the noble and learned Lord plan to address these issues?

My Amendment 62 is about whether the remit of the Bill extends, perhaps unwittingly, to Scottish doctors, as it probes whether any Scottish GP, whether or not you are registered with them, can undertake preliminary discussions. The Amendment refers to Clause 3, referred to on page 1 of the Bill, and the steps taken under Clauses 8, 10, 11 and 19. Clause 8 refers to the preliminary discussion, the initial request for assistance and the first declaration that is done by the terminally ill person who, under subsection (3)(a), must be in England and Wales, but Clauses 10 and 11 are about the role of doctors. My reading of Clause 1(3), which was inserted in the other place, is that the steps in Clauses 8, 10, 11 and 19 must be taken when the terminally ill person is in England or Wales, but the steps in Clauses 10 and 11 are to be taken only by doctors in England and Wales—not Clause 8, the initial request for assistance, or Clause 19, the confirmation of the request for assistance, or second declaration. They could be undertaken by any GP and, as such, the Bill as it stands would permit discussions to be undertaken by GPs in Scotland even though they would not be regulated under the Bill. Is this what the sponsors of the Bill intended?

I believe there would be a number of consequential issues that might need to be addressed, depending on the territorial extent of the Bill. For example, can the noble and learned Lord say whether the recording required of the preliminary discussion in Clause 7 would work for Scottish GPs? Given the very separate record keeping of NHS Scotland and NHS England, which he and I have discussed, the considerable challenges of cross-border data sharing in the context of health, particularly in primary care, and the separate Scottish legal context, where does that leave the offence of destruction of documentation in Clauses 35 and 36 if the preliminary discussion is undertaken by a Scottish GP? If the intention is that Scottish GPs can undertake these discussions, can I ask the sponsors to clarify this for the record? If this is not the intention, can the noble and learned Lord consider whether the territorial extent needs to be clarified in other areas of the Bill? If it is not the intention, does the noble and learned Lord consider that further amendments need to be tabled to ensure that this loophole is closed? Perhaps he could take us through the provisions relating to Scotland in this response and clarify.

I believe that, when parts of the Bill were extended to Scotland on Report, the sponsor did not have time to explain why they were needed or what they did. The honourable Member for Glasgow West asked whether the Bill’s sponsors had had any conversations with Scotland’s Lord Advocate and the Scottish Government, and the honourable Member for Spen Valley was only able to confirm that she had taken legal advice from government officials to ensure that devolution is respected. She stated that conversations had already started and would continue where legislation that affects other jurisdictions needs to be amended. Could the Minister confirm for us what guidance the Government have provided regarding the provisions relating to Scotland and their necessity?

As this House is well aware, the Scottish Parliament is currently going through its own stages on an assisted dying Private Member’s Bill in Holyrood, so we are facing the very real possibility of a two-tier system in Britain, which the former Prime Minister Gordon Brown has highlighted as being extremely concerning. There is currently a sharp divide between what has been proposed for Scotland and what we have before us here. The amendments in this group do not affect in any way what happens in Scotland, but, like the former Prime Minister, I am very concerned that we could find ourselves in a situation where people are moving between the two jurisdictions. At the very least, I would have expected there to be intensive consultation between the two Parliaments.

The Scottish Cabinet Secretary for Health has written a number of letters to the lead committee on assisted dying in the Scottish Parliament, in which he acknowledges that the Scottish and UK Government officials must continue to hold discussions on the legislative competence issues. Is the Minister able to say more about these discussions? Are they confined to legislative competence or do they extend to issues such as delivery timescales, the regulatory framework of medical practitioners across the UK and the intention to give Scottish Ministers the authority to determine approved substances to use, all of which Mr Gray has highlighted as concerns and are indicative of the problems of having potentially different systems north and south of the border?

In conclusion, it seems to me that matters are moving and changing at pace, both with additions to this Bill and the Scottish Bill. If things are done piecemeal or with haste, we are in danger of assisted dying becoming another deposit return scheme—although you cannot return from being dead. The deposit return scheme was an example of the two Parliaments wanting to implement something that needed careful consultation and co-operation across the UK, legislating separately, both totally within their devolved areas but, in the case of Scotland, ending up with a Bill that could not be implemented because of the cross-border issues that had not been fully acknowledged and addressed. Addressing these issues and getting clear answers from the Bill’s sponsors and the Minister are what this group of amendments is about, and I believe they are essential. I beg to move.

[Lord Shinkwin (Con)]

My Lords, I rise to speak to Amendment 17, particularly in relation to the Scottish Ambulance Service, which my noble friend Lady Fraser of Craigmaddie mentioned briefly in her speech. I do so as someone who can remember just about all my journeys in ambulances—some in agony after a fracture, some with the blue light flashing, others more sedate. What marked them all was a sense that, however much pain I was in, I was none the less safe. The ambulance crew were in control of the situation, caring, competent and consistently professional. That is my abiding memory based on first-hand experience.

I am concerned, as I understand the Scottish Ambulance Service is, that there is currently no guidance on this specific issue even though its absence has significant practical implications. Simply put, from a frequent ambulance traveller’s perspective, without this amendment ambulance crews and other healthcare professionals might well not feel fully in control of the situation. That is just not where you want to be as a potential patient needing urgent emergency care.

Surely, emergency services operating across the Scotland-England boundary not only need but deserve clear guidance. For example, what exactly is a paramedic meant to do if they are called out because an assisted death has gone badly wrong, leaving the individual seriously injured but very much alive, which of course can happen and indeed has happened on occasion in other jurisdictions where such legislation has been implemented? It does happen, yet the Bill, as far as I can see, is silent on this point, which is not much use to a paramedic desperately wanting to provide care when an emergency response is requested due to complications such as choking or vomiting.

I am not aware of this having been covered in the impact assessment, or of John Grady having received an answer when he raised this very issue on Report in the other place. So, I would be very grateful if the Minister could share with the House in her closing remarks what work has been done by the Government to evaluate and address such an important cross-border issue.

--- Later in debate ---

On the points raised by the noble Lord, Lord Shinkwin —to which one is very sympathetic—I do not think that how you deal with somebody in distress in the circumstances raised by the noble Lord is a real question in relation to the cross-border issues. I think I have answered the questions that the right reverend Prelate raised, as they are effectively the same issues raised by the noble Baroness, Lady Fraser of Craigmaddie. In the light of that, I invite the noble Baroness to withdraw her amendment.

[Baroness Fraser of Craigmaddie (Con)]

I thank all noble Lords who have taken part in this short debate, and I thank the Minister for her words. We all want to ensure that the Bill is coherent. We all appreciate that it is an evolving situation and that there might be consequential things that need to happen down the line. I just fear that the interactions with Scotland seem to have been very hastily done. We had our debate on Wales on the first day in Committee but I feel that Scotland is different, both with health and justice being devolved and with the fact that there is a Bill going through the Scottish Parliament at the moment.

I have the permission of the noble Lord, Lord Beith, to withdraw his amendment. On the assurance that we can continue to monitor this evolving situation to ensure that things are indeed coherent, I beg leave to withdraw the amendment.

Amendment 17 withdrawn.