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.

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I am grateful to the noble Lord for his intervention, but I think we need to stay focused on the amendments in this group and not get diverted. That is what I am trying to do.

In terms of palliative care provision, I am extremely worried that the amendments put down to the amendments tabled by the noble Lord, Lord Birt, had to be limited because palliative care is repeatedly being deemed out of scope of the Bill. That is a major problem. We hear about bad deaths, but we know that actually, if clinicians act with urgency and have a 24 or 48-hour limit before they call for specialist palliative care intervention—so there is rapid intervention, with highly specialised knowledge—all of the outcome measures show an improvement, using things such as the IPOS scale and so on. Family reported outcomes can also improve. To view bad deaths as something that we should just leave and tolerate, and to say the only solution is the proposal in these amendments, does not recognise the reality of the services that are available already.

In introducing his amendments, the noble Lord quoted extensively from Australia and painted it as everything being perfect. I would like to briefly counter that by quoting the honourable Robert Clark, who was Victoria’s Attorney-General from 2010 to 2014. He has written about the Australian experience of assisted suicide. He describes a change in “attitudes”, with the “ethos” of the medical profession moving away from the practitioner’s primary duty to solve the problems the patient has, and a grave risk that this will lead over time to doctors forming views that a patient ought to be opting for assisted suicide and becoming inclined to regard that patients should go down that road.

He also highlights that there are things going wrong. I will not detain the Committee because of time, but I think there are alternatives. He points out that there are some doctors who, when they have resisted going along with a request for an assisted death, have found their whole careers eventually becoming somewhat blighted. Although there is a clause in the Bill which tries to avoid that, there is concern that that clause is incomplete. So, when we quote international evidence, we also have to be quite balanced in it.

The proposal in the amendments from the noble Lord, Lord Mackinlay, do us a favour, because they demonstrate that this cannot be part of the NHS as it is at the moment. It begins to move us towards viewing some kind of proposal like this being completely outside NHS services but not planted in the NHS. Then, of course, the funding question arises. If funding erodes palliative care funding, which has happened in other places, we really have a problem, because recent evidence to the Public Accounts Committee showed that, if you have specialist palliative care in place and available, as it ought to be, the savings to the country would be about £800 million a year.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I was not intending to stand up today, so I apologise, but this group has not gone at all how I thought it would.

When I looked at Amendment 771 and the proposed assisted dying help service, I was confused. I had thought that navigators might take a similar role to that of independent advocates. We have a group about the importance of independent advocacy, which I am a huge supporter of, and about advising people on other care, health or treatments. That is coming up in 19 groups’ time. But it seems that Amendment 771 is illustrating the flaws of the entire Bill, whether that is geographical provision, training and qualifications, the right of practitioners to withdraw and the need to support vulnerable people.

We have also had a debate today about the funding of the proposed assisted dying help service. We have another group—group 30, which I hope we get to—on the provision of an assisted dying service by groups other than the NHS. I suggest that noble Lords opposite take the suggestion of the noble Baroness, Lady Royall, to press the Government to provide clarity, before we get to that group, on the funding of an assisted dying service and—following the point from the noble Baroness, Lady Finlay—the future funding and support for hospice care.

I have an amendment in that 30th group, which I tabled because I think that the proposers of this Bill have missed a bit of a trick. If you want to set up an assisted dying service, you should do so in parity with the current arrangements for the hospice service. If we understand what the funding for the hospice service will be, we can have our debate in group 30 on alternative provisions.

[Baroness Royall of Blaisdon (Lab)]

I mentioned the future of palliative care. I did not mention the costs of an assisted dying service, which I am very willing to ask for as well, but at that stage I was focusing on palliative care.

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Baroness for her intervention. I think both would help us, because there is confusion about the future of support for palliative care, and confusion as to whether the funding of an assisted dying service will take away from other services within the current NHS provision.

Finally, I just want to say that it is very different from the Scottish Bill, which very specifically does say that it will be within the NHS.

[Baroness Berger (Lab)]

It may aid the Committee to know that, before Christmas, the Minister in the other place indicated via a Statement that the Government were currently developing a palliative and end-of-life care modern service framework for England, and that it is planned publication date was the spring of this year. In that context, I hope that the Government and the Minister here will hear the calls from people—both those who support the Bill and those who do not—that it would be very helpful to us all in the deliberations on this Bill if the framework, its details and funding were provided to this House as soon as possible.

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Moylan (Con)]

My Lords, it is a pleasure to be addressing your Lordships’ Committee immediately after the lunch break.

I have a number of amendments in this group which work together to do two things. The majority of them would prevent any public money being spent on the assisted dying service. One of them, Amendment 917, seeks to create an alternative funding structure. I will say immediately that my alternative funding structure is robust and effective, but I am not saying that there are not others that could be put forward that would have a similar effect. The main point is to say that there needs to be a justification given—and so far, none has been given—as to why this service, when it is created, should be a charge on the taxpayer.

The noble and learned Lord has made much in his comments about the Bill so far of the principle of autonomy—the right to dispose of what happens with your own body, I suppose. The principle of autonomy in this respect has been in place in law since 1961, when suicide was decriminalised. In my view, the Bill goes a great deal further than establishing autonomy. What it is, in fact, is coercive on the rest of us, and one of the ways it is coercive is by envisaging we are all going to pay for it.

The Bill does not say explicitly that the service is going to be paid for by the taxpayer, nor does it say explicitly that it is going to be free. But it is certainly the case that the Bill envisages public expenditure, because the Secretary of State is going to have to pay for the maintenance of the voluntary assisted dying commissioner and its staff and activities. It is implicit and assumed—if I am wrong about this, the noble and learned Lord can certainly tell me—that the provision of the service at the individual level is going to be free, so to speak, at the point of use, by the person applying for what is called assistance.

Why should this be a charge on the taxpayer? It is not, after all, a medical treatment—that is absolutely clear. We provide free medical treatments through the NHS, and the principle of free medical treatment at the point of use has been established for many years in this country. But this is not a medical treatment, so why should it be provided free? Giving someone permission legally to do something which has previously been prohibited—in this case, giving them permission to assist a suicide, which at the moment is legally prohibited—does not imply that the Government have to pay for the person to do what they are now permitted for the first time to do. So that argument does not follow in any sense at all.

It might be said that voluntary assisted dying is an act of compassion. However, it is not the case that the state pays for every act of compassion. There are many organisations that do—mainly charities—and individuals provide and express their compassion through donations and other acts of compassion. The Government are not the only source for that. Anyway, the truth is that many of us do not consider the Bill, or assisted suicide, to be an act of compassion—in fact, we consider it to be an act of cruelty.

My amendments would prohibit the expenditure of any public funds on any activity envisaged in the Bill, with the exception of activities related to Clauses 34, 35 and 36, which will create criminal offences. Of course we would expect the Government to pay for the investigation and prosecution of criminal offences, as that is a state function, but it would be prohibited for the other functions envisaged in the Bill.

In my Amendment 917, I have attempted to show at least that an alternative is possible. The alternative would involve the assisted dying commissioner establishing a budget at the beginning of the year. The budget might not be exactly what he ends up spending. Anyone who has been involved in a local council will know that you are legally obliged to set a balanced budget at the end of the year, but it does not guarantee that at the end of the year it turns out to be a balanced outcome. However, he would be obliged to set a budget and, on the basis of that budget and on the basis of the assessment of demand—which in the first year would be difficult but in later years should be fairly predictable, I imagine—to set a fee. That fee would be payable by those applying for assistance. Provision is made for the applicant to pay the fee in stages, so that the applicant might be charged so much at the preliminary discussion stage, so much later on and so much after that.

People already pay for assisted dying. I do not know what it will cost, but I do not see that it would be any more expensive, necessarily, than going to Dignitas—and people pay to go to Dignitas. Why should we assume the expenditure they make at the moment and put it as a charge on the taxpayer? I could be rebutted if people were to say that this is an argument about nothing and that, in fact, the Treasury will save so much money from assisted dying because we will not have all these sick and elderly people whom we have to pay to look after and that we are going to be quids in. If any noble Lord wishes to make that argument, I invite them to do so.

This is not in itself an argument about whether the service should be provided by the NHS; I know it sounds as though it might be, but it is not. I have later amendments about whether the service should be provided by the NHS. This is a question about whether it should be free. The NHS can provide services and charge for them—it already does. Many hospitals, in London at least, have private wings, where the NHS provides services for which it charges. I am making the conceptual point that this is a distinct question: should it be free or should people pay for it? Should there be a charge on the taxpayer? The case that it should be free, with a charge on the taxpayer, has not been made by the proponents of the Bill. If they wish to make it—it is a little ambivalent in the Bill—now is their opportunity to do so. I beg to move.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank my noble friend for opening this after-lunch debate and outlining that an alternative is possible. I will speak to my Amendments 835 and 868, which I added to this group because they seek to ensure that an assisted dying service is clearly separated from NHS provision, and that therefore there is clear transparency around funding for the taxpayer. Such a service could be set up and funded privately or charitably, in the same way that we currently provide and fund care provision or hospice services. Such a service would be clearly separate from the NHS but could operate, potentially, in partnership. The NHS could commission services if it so chose. It would have to share data and patient records and there would need to be a system for the regulation of such services.

Proposed new subsection (3) in Amendment 835 would require regulations on the definition of “privately funded organisations”. If such a service were to work in partnership with the NHS—as many hospices and third-sector service delivery organisations currently do—then further proposed new paragraphs would require the establishment of the means through which NHS providers can commission privately funded organisations to provide services, the data sharing arrangements to ensure the necessary sharing of records, and, most importantly, a system for regulating the provision of services by privately funded organisations.

Some noble Lords have expressed concern about the use of “private organisations” in my amendment. However, I point to the kaleidoscope of entities that currently provide health and social care already—some of which my noble friend Lord Moylan just mentioned. Many people have made a profit from care homes, many charities provide health services instead of the NHS, and private hospital care coexists with NHS provision, often with the same consultant working in both. I am a Conservative, so I do not think that making a profit per se is a bad thing; I accept, however, that making excessive profit out of death and dying is not particularly morally acceptable, hence the need for robust and transparent regulation of any services.

As I have said before in Committee, this is an area where the supporters of the Bill and those who support the principle of legalising assisted dying have missed a trick. I agree with my noble friend Lord Moylan in posing the question of why assisted dying should be taxpayer funded. It is essential to ask the sponsors of the Bill at this stage how the establishment of an assisted dying model would impact our current healthcare systems and healthcare professionals.

We know that the Secretary of State for Health has stated that there is currently no budget for such a service, and Stephen Kinnock, the Minister of State for Health and Social Care, who voted for the Bill, has said that the Government will have to reprioritise spending to fund assisted dying. Therefore, it appears that funds will have to come out of the health department’s existing budget. Stephen Kinnock also stated that, as it stands, the Bill includes the potential for the provision of assisted dying services privately, as well as free on the NHS. Therefore, in this group of amendments, we are asking the sponsors to ascertain what they intend. We are also asking how the Government feel about the requirement to reprioritise NHS budgets. What services would then be deprioritised?

The Bill currently going through the Scottish Parliament makes it explicit that assisted dying would, if that Bill is passed in Scotland, be delivered by the NHS. However, this Bill is silent. The Scottish Bill is accompanied by a financial memorandum which outlines the cost to a range of public bodies of the implementation of providing assisted dying—the majority of which will fall on the NHS and cover things such as the cost of anticipated clinician hours, staff training, the costs of the substance provided to end life, both the storage and monitoring of it, data collection, support and navigation services, and many others. All are extra costs the NHS will be expected to bear.

Do the supporters of the Bill, as my noble friend Lord Moylan referred to, expect the service to be cost neutral, as referred to in the financial memorandum in Scotland? The Scottish Bill identifies “unutilised healthcare” savings due to the obvious but rather unsettling statement that every person who has an assisted death will not require further care.

I accept that saving health and care costs is not the motivation of the sponsors of this Bill. However, there are many concerns expressed by individuals and organisations that implementing the Bill will have real cost implications and necessitate clinicians diverting time and resources from their already stretched patients to support assisted dying. We need to find a balance between what the Bill sets out to provide and what is best for our current health and care services. Creating a service that is separate from the NHS, as many hospices and care homes already are, would ensure such a solution.

The NHS is not a solution to all issues. I come to this from my experience in the third sector, where the medicalised approach to care and service provision, as would be delivered by the NHS, often does not lead to optimal outcomes for the patient—whereas a demedicalised social model can often be preferable. Hospices provide holistic care, not just medical care, and include support for emotional, social, practical, psychological and spiritual needs, as well as support for the person’s family and carers. Hospice teams may include doctors, nurses and healthcare assistants, but also social workers, therapists, counsellors, chaplains and trained volunteers. Is this not what the Bill’s sponsors want for terminally ill adults?

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have two amendments in this group. We have heard a lot of comments about the real world and what is actually going on now, today, out there in healthcare. It will be very interesting to hear how the noble and learned Lord, Lord Falconer, responds to all the criticisms and to the way the inherent dangers in Clause 5 have been highlighted.

My Amendment 201 concerns children. A little boy with advanced malignancies said to me, “I'm going to die when my goldfish dies”. He went on to talk through what he wanted when he was dying and how he would play football in heaven with another boy who had died recently. Not long after, his goldfish was found floating. My strenuous attempts to resuscitate his goldfish failed, and he gently died soon after.

That was some years ago. Today, children live off the internet, not just off what they hear from other children. They know about the debate on this Bill—some raise it in “Learn with the Lord” sessions. If a child is asking questions about this, they must be able to express their fears if they are already ill. They often speak with remarkable frankness. Children’s awareness is phenomenal. They deserve gentle, honest planning of their care that also explains why they are ineligible for assisted suicide. Hence my wording, but the wording of the noble Lord, Lord Rook, provides much clearer guidelines for clinicians involved, to allow them to listen but in no way to hint that the child will be eligible.

Assisted suicide is not a medical treatment. It falls outside McCulloch and Montgomery rulings, hence my Amendment 159. As has been said, if a doctor raises assisted death unprompted, the implication is that this is something you should consider—a tacit implication that this might be your best option. Addressing the comments by the noble Baroness, Lady Hayman, it is a doctor’s duty of care to sensitively explore with open questions and careful listening, to discuss whatever the person wishes to discuss at their initiation. That is patient autonomy and control. Mencap, the Association for Palliative Medicine and the Royal College of Psychiatrists have all warned how patients’ trust gives doctors a dangerous ability to steer decisions if the suggestion comes from the doctor.

Listening with undivided attention is crucial in gentle, honest communication in the face of patients’ anguish. Patients hang on to our every word, so suggesting it as an option signposts them in that direction. It abandons suicide prevention duties under the Mental Health Act and the state’s duty under Article 2 of the European Convention on Human Rights. The amendments overall have a common theme of making the autonomy of the patient paramount in these discussions, their being able to raise assisted death in their own time, at their own pace and at their instigation. I hope these amendments will be taken heed of.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank my noble friends Lord Jackson and Lady Monckton—whose speech was quite spectacular—for raising the example of DNRs. It is very good example when we are talking about who can raise assisted dying in preliminary discussions.

I want to give a very brief illustration. When my father was in hospital, five different medical professionals came into his room and took us, his family, aside, to get him signed up to a DNR. He did not really want that. It might have philosophically been the right medical thing to do, but he was not in the right place. He did not want to be asked, and certainly not five times by five different medical professionals. It left a rather bitter taste in our mouths, because when we were able quietly, as a family, to have that discussion with him, he did have a DNR. We were fortunate to have that time, rather than him having something put at the end of his bed with the Sainsbury’s bag.

This group of amendments is really important. They are all similar, saying that we need some guidance on who can raise the discussion and under what circumstances. If we really believe that patient autonomy is important, then something should come from this group of amendments and be in the Bill.

[Baroness Coffey (Con)]

My Lords, briefly, Clause 6 standing part has been opposed by my noble friend Lord Moylan because of other aspects of amendments he has tabled. I very much support Clause 6 staying in the Bill: it was the one amendment on Report in the Commons where there was a significant majority in favour. In particular, I found it astonishing that anyone could even consider raising this with a child: it disappointed me that the sponsor of the Bill in the Commons voted against that amendment, but I am relieved it got through. It is also worth pointing out to the Committee that there is slightly different wording between Clause 6 and Clause 5(1), which my noble friend Lord Moylan’s Amendment 152 addresses by making sure “other health professional” is included, not just “medical practitioner”.

I have also seen multiple times what my noble friend Lady Fraser has just referred to. It is very irritating, especially when somebody is being taken home to die, if, against their wishes, DNR had been put in place by medical practitioners and then had to be rescinded. It is somewhat frustrating in that regard.

My noble friend Lord Goodman was succinct; I think that is partly the training of a journalist, or it might have been two years of quiet contemplation when he considered his vocation in an abbey on the Isle of Wight.

I want to briefly raise one point: the noble Baroness, Lady Blackstone, referred to the BMA. I am conscious that it is a trade union for doctors and does a lot of work on their behalf, but it is not a clinical body. However, the BMA pointed out its concerns that, without it, there would be uncertainty and legal risks for doctors. The BMA went into more detail on that in its evidence. In contrast, the Medical Defence Union’s written evidence to the Commons Select Committee—by the way, the MDU is an organisation that specialises in providing indemnity and other legal issues regarding doctors—came up with a different thing. It said:

“The MDU is concerned that the legislation, as … drafted … leaves doctors who do raise it at greater risk of a complaint”,


and then subsequent legal things.

So, as has also been pointed out, at what point would this ever be raised? I support more generally the approach and understand that, if a doctor is asked about this, of course that should be open to a response, unless they do not wish to do so, and part of Clause 5 covers that. But, overall, that initiation should not be in the hands of the medical practitioner, and we will come on later in further clauses to debate the recording of such discussions.

Terminally Ill Adults (End of Life) Bill

Baroness Fraser of Craigmaddie Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

Moved by

[Baroness Fraser of Craigmaddie]

167: Clause 5, page 3, line 12, leave out “seek assistance to”

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I want to bring your Lordships back from Wales to the speech, language and communication issues that affect everybody equally right across the United Kingdom. My amendments in this group, Amendments 167 and 546, seek to ensure that people who have serious speech, language and communication issues have an element of protection in the Bill and that they are supported in accordance with best practice. I remind noble Lords of my interest as chief executive of Cerebral Palsy Scotland. I have drawn on my organisation’s experience of supporting people with serious communication issues to inform my remarks.

Amendment 167 is a probing amendment designed to explore the specifics of what is meant by seeking assistance. This is not about the requirement to self-administer, which, if we get to it, will be explored later in Clause 25. This section is to do with the preliminary conversation. Amendment 546 would simply add those with communication and speech difficulties to the list of those who may be provided with an independent advocate in Clause 22.

The Bill currently sets out in Clause 5(4):

“If a registered medical practitioner conducts such a preliminary discussion with a person, the practitioner must first ensure the provision of adjustments for language and literacy barriers, including the use of interpreters”.


I have taken that to cover those for whom English is not their first language, but I am not convinced that it covers a situation where someone has to communicate using augmentative and alternative communication, known as AAC. I shall me explain why I have specific concerns in this area.

This population can be divided into those who have moved on to AAC because of disease progression—for example, those with neurological conditions such as MND or Parkinson’s—and those who have always required assisted communication, those with complex cerebral palsy or severe autism. This population may be deemed to understand English, but they have never been able to speak, so AAC is their de facto first language. Experience illustrates time and again how those who experience communication difficulties, especially those for whom AAC is their first language, struggle to deal with difficult conversations. At Cerebral Palsy Scotland, we work with people with very complex needs, including those with learning disabilities, who need symbols to support understanding and communication. This group will express themselves in a way that is not typical, as they will be restricted to a limited vocabulary.

There are tools—Amendment 172 from the noble Baroness, Lady Grey-Thompson, specifies Makaton—but there are others, such as Talking Mats, that are designed to support big decision-making, and these are currently used to understand a person’s desire to, say, live independently or express what type of care they wish to receive. However, these methods of communication need to be facilitated by a professional who will suggest options: option A or option B. The individual themselves does not have free choice of the words that they can select. Now put that individual in a context where they have been diagnosed with a terminal disease and they meet all the criteria of the Bill yet they might not be privy to the right vocabulary or the right specialist professional support. How can we be confident that they have fully understood the process and that it is their free and settled choice to die?

Much of our communication with people who have complex communication needs is co-constructed. Tools such as Talking Mats or Makaton rely on a professional making the initial choices and making assumptions. How many times have we seen carers or family members talk for a person because they know them best and they know what they are trying to say? Again, I ask: in these situations, how can we be confident that this is truly the settled opinion of the person who is being talked over? Amendments 322, 322A and 406 from the noble Baroness, Lady Grey-Thompson, speak about communication in accordance with a person’s needs and wishes, providing translation in a format of the person’s choice and recording, if communication needs have been identified, how they have been met. I support all these amendments.

People who do not have a learning disability and may come to use AAC because of their disease progression —or, like many adults with cerebral palsy whom we support, they may be literate and use devices that use typing and predictive text—may have the vocabulary to make their views known, but only if they are given the time, space and support to do so. I do not know if any noble Lords have ever tried to communicate through an AAC device. I have, and often you have to scan through a word at a time, picking up which row you choose, and then you go down and choose the word. It requires incredible skill and concentration, and it is exhausting. You have to really concentrate because otherwise your eyes go off and you do not say what you want to. It is essential to allow sufficient time within the appointment to retrieve longer messages, and fatigue and frustration are common.

--- Later in debate ---

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I was deeply interested by the remarks of the noble Baroness, Lady Fraser, and her amendment. I would like to confirm from personal experience that a young man very well known to me can barely speak at all. He has therefore been effectively silent all of his life. Through a system called Spelling to Communicate, it turns out that he has a vast range of knowledge and high conceptual skills, which have only been discovered very late. He is now communicating by these means, but he can only communicate, at this stage at least, through his mother. I very much support what the noble Baroness has said, but—forgive me if I have missed something—I do not quite understand how the wording of her amendment will achieve the effect she intends.

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Lord. By probing the words “seek assistance”, I am trying to explore what assistance is provided. The noble Lord is quite right in the example of his friend. There are people who cognitively can absolutely understand what is going on. Therefore, in the context of this Bill, they would understand the assisted dying process. But they would need help with the tools by which to communicate their will, and the time and space and sometimes the vocabulary to do that. I note that, in the noble Lord’s example, his friend has only recently come to it. An issue is understanding what the right thing is for some of these people. He also said he can, at the moment, communicate only through his mother. That is my other fear. Far too often with this population, people speak for them because they know them best. I hope that clarifies my intentions.

[The Lord Bishop of Southwark]

My Lords, I support the amendments in this group, particularly Amendment 171 in the names of the noble Baronesses, Lady Nicholson of Winterbourne and Lady O’Loan.

Clause 5, as we have heard, introduces a key element in the infrastructure of assisted dying in this Bill by providing what is intended to be a safe, but not mandatory, introduction to the subject of death with the assistance of another human being. For proponents of the Bill, the advantages of such an introduction are obvious. In their minds, it will remove a good deal of unnecessary distress on the part of those who wish to proceed with such an option and on the part of those who do not. However, as we have heard from those of us who have long experience of pastoral encounters, the experience is likely to be rife with pitfalls.

This amendment and the one that follows it, about which I shall say a little and leave it to others to say more, is designed to correct some very obvious impediments to mutual understanding. A good deal of communication is picked up visually. Visual impairment requires an extra dimension when communicating. My twin brother was born with a severe hearing impairment, so I speak with lifelong experience of what it is to communicate thoughts, directions, information and feelings appropriately to someone who has a hearing impairment.

Finally and briefly, for I understand that the right reverend Prelate the Bishop of Newcastle wishes to say more, I also commend Amendment 171A. My experience of more than 40 years of ordained ministry is that there are those who purport to represent a religious or cultural identity and do so for less than an individual’s best interests. That may cut both ways in this debate.

I hope that the noble and learned Lord, Lord Falconer, will look favourably on these amendments, which are designed to provide assistance to women who may face coercion. Should the Bill become law, it will make the vulnerable more vulnerable as it currently stands. That is why so very many amendments, including this one, are so vital, although I continue to fear that assisted dying itself would make the vulnerable more vulnerable.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

I am not in favour of a mandatory bar on any young person. I expect it to be dealt with in a code of practice. I agree that unless there is a mandatory provision in the Bill it will not be effective, but I am not in favour of that mandatory ban.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I thank everybody who spoke in the debate. I am very conscious that I stand between noble Lords and their lunch, so I will try to sum up quickly. I agree with the noble and learned Lord that we are all trying to ensure the same thing. I am disappointed by his response pointing to his amendments around the right to an independent advocate, because that is only one small part. My Amendment 167 was really about seeking assistance in the preliminary conversation. The reason for that is understanding that, as my noble friend Lord Shinkwin so eloquently said, it is about thinking about the process from the perspective of the person with the communication issues.

Any of us might find ourselves at any moment in our life, through illness, accident or frailty, in this position. Turning the tables and thinking about how we would feel going through this process and the preliminary conversations is really important.

I want to just quickly give examples of why words really matter and why it is not just about independent advocates. We have the next group after lunch on that. In Scotland we had the “right to speak” legislation that went through after the campaigning of Gordon Aikman, and the Scottish Government put in the right for people to access communication aids and support. The problem in practice is that many people have been able to access aids but not the support; that was the essence of my probing.

The noble Baroness, Lady Hollins, mentioned training. Yes, people are trained to support, and independent advocates might be in that camp, but it tends to be very basic. If you consult the Royal College of Speech and Language Therapists, it is extremely concerned about the number of professional people available to support this group of people. Clarity is vital all the way through the process.

I am conscious as time goes on that I cannot mention everybody. The point is that language being either mediated by someone else, culturally shaped or indirect can cause an issue at any point in the process, and therefore we must have support for people with severe communication issues and other issues. I pay tribute to my noble friend Lady Nicholson. We must surely do all we can to ensure that the decision of a person to end their own life is truly that of the individual and not simply a miscommunication.

[Baroness Nicholson of Winterbourne (Con)]

I add my thanks to the noble and learned Lord, Lord Falconer, for his comments. I look forward immensely to the meeting with him. I also point out that his colleague on the Front Bench stood up and said something about me and, of course, I could not hear it. Hearing is a very difficult thing to ignore. I sincerely hope that the amendments will cover that.

[Baroness Fraser of Craigmaddie (Con)]

I beg leave to withdraw my amendment.

Amendment 167 withdrawn.