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.