Terminally Ill Adults (End of Life) Bill

Baroness Gerada Excerpts

Friday 27th March 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My answer to that is that they jolly well should be. I do not see at all that that is a point against the argument I am making. I would say exactly what I am saying in relation to any specialism. It is a very simple point: do I want someone knowledgeable to explain what palliative care is, or is not, available to me, or do I want it explained by a generalist, who may be extremely good, such as the noble Baroness, Lady Gerada, or rather less good? I used to be a lay member of the General Medical Council, and I have disciplined very large numbers of doctors as a result of that experience. Having this specialist care is an absolutely essential requirement of what we are discussing.

[Baroness Gerada (CB)]

My Lords, I thank the noble Lord for his “any old” comment; I am “any old” general practitioner. I will pick up a few issues. One is around the register being made publicly available. I absolutely would not want my name on a publicly available register as somebody providing the services of assisted dying—not because I would be ashamed but because of the hate mail that I would get and the distress that I would already have. That does not mean that I am against some form of register. Of course there can be a register, just as there is for doctors who do Section 12 approvals under the Mental Health Act, and for doctors who do all sorts of things, but to have a publicly available register goes one step too far.

The second issue is that we are—I am—already getting confused about the opt-in/opt-out; we saw that earlier. If this becomes law, all doctors must be trained in assisted dying, whatever that training involves; the royal colleges will determine that. Just as all doctors are trained in the termination of pregnancy, even though they may not deliver a termination of pregnancy—whether they opt out of delivering any services is up to them—all doctors must be competent in this area. I have been a GP for nearly 40 years and have worked with doctors who do not want to get engaged at all in the delivery or any aspect of the termination of pregnancy. Nevertheless, they are there to counsel their patients and direct them to a doctor who is available and willing.

[Lord Harper (Con)]

The noble Baroness said that she does not want a publicly available register. Does she think that the patients of a general practitioner have the right to know whether that general practitioner is willing to provide assisted suicide services?

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[Baroness Gerada (CB)]

I have talked before about using the term “assisted suicide”. If this becomes available, it will be an unusual event: we are not talking about hundreds of patients wanting an assisted death. I suspect that, within each local area, a list will be available, held at the local health authority or wherever, of those doctors who are willing to participate. Noble Lords may have gone to the event at which the Australians said how it is done in their country: it is done by doctors of all professional groups. It is about the competence and capabilities, not the specialties, of those doctors who wish to pursue the training in order to become competent and capable of doing this. This is all feasible. We are not talking about me in my consulting room nipping off at lunchtime and administering assisted death. We are talking about a regulated system that will be properly managed with small numbers. I hope that is an answer.

My final point is about the use of drugs that are there to treat disease. I am sure that, with her expertise in palliative care, the noble Baroness, Lady Finlay, will know that, at the end of life we use drugs, sometimes at extraordinarily high doses, that we know will accelerate death.

[Baroness Finlay of Llandaff (CB)]

I intervene on the noble Baroness’s comment about training. Everybody is, indeed, trained in abortion, for example, as they go through medical school, but by the time you are practising clinically and you are on a specialist register, you are no longer keeping up to date with those skills at all, and your revalidation depends on your keeping up to date with those skills, which is the benefit of having a specialist register.

If I might comment on the noble Baroness’s opening remarks about being worried about receiving hate mail, perhaps she might have some sympathy for those of us in palliative medicine who have been receiving a great deal of hate mail because we are known to be specialists in palliative medicine and because we have been flagging up concerns over the Bill. As for the numbers—

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[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank the noble Baroness, Lady Cass—that was totally compelling. We will all have to read it and reread it, but it gave us a real sense of what it would be like. Sometimes, we are talking in the abstract.

In a more concrete sense, I think of this group of amendments as the workers’ rights group. We must take seriously what is being asked of all the workers involved. If a Bill of this kind were to be passed, all sorts of workers associated with health and social care would be expected to deliver it. What happens if that goes against their conscience? This is why I have added my name to Amendments 268 and 617 in the name of the noble Baroness, Lady Finlay of Llandaff, which seek to make opt-in for doctors explicit in the Bill. It is important to extend any conscience protections to a wider range of workers who might not want to be involved in assisting in the death of others.

I wished to add my name, but there was not room for me, to Amendment 673 in the name of the noble Baroness, Lady Fraser of Craigmaddie. It is very important that all workers be free to refuse to participate without penalty. I have also tabled my own Amendment 657 and thank the noble Baronesses, Lady Smith of Newnham and Lady Eaton, for supporting it. It concerns proposing that the provision of assisting in someone’s death is not regarded as a medical treatment. We have heard excellent explanations of why, existentially, it should not be a medical treatment, and there are a range of ethical reasons for that. However, for the purposes of this group, the amendment is relevant because, if assisted dying is a medical treatment, this could put practical and regulatory pressure on doctors in particular in terms of their duties.

The aim of this group is quite straightforward, particularly in relation to opt-in: to ensure that no medical professional or related staff are forced to participate in assisted dying or undergo training in assisted dying against their will. I know that supporters of the Bill are keen fans of autonomy, so this group of amendments is indispensable. Let us make this an autonomous, positive choice for those workers who are happy to take part in the process. The noble Baroness, Lady Andrews, has reassured us that, under the Bill, there will be no pressure to participate. However, she will know that in many workplaces, unless opt-in is made explicit, workers’ rights are not always given full satisfaction.

However, as it happens, the noble and learned Lord, Lord Falconer, thinks that this opt-in should be in the Bill. He emailed us in January to tell us that, following extensive conversations with the BMA, “I believe that explicitly including the words ‘opt-in’ on the face of the Bill would provide greater reassurance to medical practitioners”. I agree. I was a bit disappointed that those amendments were not tabled more quickly, but they have now emerged. I am glad to see that there is an explicit opt-in provision, but it is too narrow and too exclusive, being confined to a co-ordinating doctor, an independent doctor and so on, as explained so well by the noble Baroness, Lady Finlay. This leaves out significant parts of the wider medical workforce. I am worried that GPs, nurses and other front-line staff could still be mandated to participate in either assistance or training regardless of their conscientious objection.

These concerns are not only about narrowly focusing on opting only for the co-ordinating or independent doctor. We must recognise the dangers of considering opt-in only in relation to medical professionals. Amendment 673, tabled by the noble Baroness, Lady Fraser, is a reminder not to leave out the plethora of staff who might well be asked to play a secondary role in assisted dying, such as those who work in care homes or prisons. What about the member of staff, perhaps a porter, who is asked to escort a patient to a room where an assisted death will take place?

[Baroness Gerada (CB)]

For goodness’ sake.

[Baroness Fox of Buckley (Non-Afl)]

“For goodness’ sake”—well, a bit of empathy might be helpful.

Our main focus is understandably on doctors, even nurses, but we must be careful not to assume that those with medical degrees—the professionals—are entitled to a greater respect for their consciences than other relevant workers: like porters.

I have previously spoken about my qualms regarding the care sector being sidelined in discussions about the Bill. Care England has complained that it has been under-consulted, not least on “opt-out, opt-in”. This matters in terms of the unintended consequences of the Bill. In Care England’s survey of its members, 24% of providers said that staffing would be very difficult because of the likelihood of conscientious objection, speculating that if forced to comply, care staff will walk out. Imagine what a tragic unintended consequence that would be. Only 14% reported that staff would willingly participate in the procedure; 34% reported that their staff would not be willing to participate at all. On what constitutes participation, the Royal College of Nursing has reminded us in written evidence to the other place of the need to consider administrative work:

“protection should also extend to indirect involvement, such as administrative tasks or referrals, to ensure all”

professionals

“are supported in line with their personal and professional values”.

I now want to reflect briefly on the issue of training, which is so important in relation to these amendments. Practically everyone involved in providing medical or care services, particularly medical services, has to do mandatory training units. Obviously, they are studying at university, but there is, as we have heard, revalidation, CPD and so on. If a robust opt-in conscience clause does not cover all such training, might those who try to opt out get a career-limiting black mark against their name? Might those forced to do such training fail if they do not endorse assisted dying as a medical treatment of merit or receive professional sanctions if they give the wrong answers? I am looking for a guarantee from the noble and learned Lord that no workers will face legal or professional repercussions, including indirect penalties of discrimination, for declining to participate in either training or the procedure.

On my Amendment 657, despite the insistence when we discussed Wales last week that this is a change in criminal law, not a health Bill, the necessity to amend the constitution of the NHS and the huge changing expectation of medical ethics—

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If this amendment is accepted, doctors will at least be sure that they will not be failing to comply with their duty to raise treatments in discussion with patients and that no liability could arise from their not doing so. I commend these provisions to the House.

[Baroness Gerada (CB)]

On a point of clarification, we have heard it said several times that the Royal College of GPs is in favour of a publicly available register. To the best of my knowledge, and having just checked, the Royal College of GPs is not in favour of a publicly available register. It is in favour of opt-in, but not of a publicly available register.

[Baroness O'Loan (CB)]

I said that there should be a publicly available register and that the Royal College of GPs is in favour of an opt-in.

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My final point is about extending this to everyone in the process. There is a lack of clarity about what “provision of assistance” means: whether it is simply the provision of the poisons that are to end life, or every aspect of the process. I do not know who said it, but I was very disappointed when the noble Baroness, Lady Fox, referred to a porter being very uncomfortable and not wanting to participate in the process, and somebody shouted out, “For goodness’ sake!” I thought that was appalling. A porter in the health service has exactly the same right as a doctor to not participate in this process. They should have the same right to object to this as anybody else and to have to opt in to it. Expecting in particular junior members of staff to have to use the employment tribunal system, and to defend themselves if they are put under pressure to participate, is not the right way to deal with it. An explicit opt-in system for every single person in the system is the right way to go. I strongly support the amendment, which makes it clear and puts beyond doubt that this is not a medical treatment, because that then deals with the other duties that may fall on medical professionals in the National Health Service.

[Baroness Gerada (CB)]

Can I give a clarification? I have just been in contact with most of the senior officers at the Royal College of General Practitioners. To put it on the record, to the best of my and their knowledge, the RCGP has not called for a register, a public one or otherwise.

[Lord Harper (Con)]

I am grateful to the noble Baroness. I said they were in favour of an opt-in system; I did not say they had called for a register. I want a register and I support the amendments that say we should have one. As the noble Lord, Lord Moore, said, it should be a public register. In essence, if you did not have a public register, as soon as people asked their GPs and other medical professionals for their view, in the modern world that information would become public. It would be much better to have a proper, well-managed system that was published, and then everyone would be clear about where people were on this and could access the relevant medical professionals if they wished to use them.