Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, I declare an interest as a director of Living and Dying Well. While my view on this subject has been publicly expressed, today is about the contents of the Terminally Ill Adults (End of Life) Bill and the implications for wider society with all its pressures and tensions.

We should therefore learn from other jurisdictions. Just as good laws are not made from hard cases, soundbites do not make watertight Bills. We have heard that the Bill is “the safest in the world”. However, in Committee in another place, judges were replaced with a panel, in a contradictory term called “judge-plus”. This change was made after the Ministry of Justice and senior judges raised concerns about the impact on courts. The Royal College of Psychiatrists says that the suggested model is not even possible. The EHRC stated that the impact assessment in another place was published too late for it to be properly utilised to strengthen the Bill. The Bill gives the Secretary of State extensive powers. The Henry VIII clauses allow statutory instruments to be endlessly rewritten.

Specifically, Clause 5(4) requires

“the provision of adjustments for language and literacy barriers”,

but there is no requirement for modified information for those with learning disabilities or additional needs. Additionally, the doctor only has to “ascertain” that the person has been coerced. But how? It is not in the Bill. Clause 25(8) allows the co-ordinating doctor to assist the person

“to ingest or otherwise self-administer the substance.”

This blurs the line between assisted dying and euthanasia.

At a recent meeting with those who provide voluntary assisted dying in Australia, claims were made that all deaths were peaceful. But there are no requirements to report adverse events, and no impartial oversight. In Oregon, the presence or absence of complications was left unrecorded in 72% of deaths. The Bill does not sufficiently outline protocols for recording or dealing with complications.

The “approved substances” mentioned in Clauses 27 and 37 do not explain how a drug will be approved. In Oregon, patients were given experimental drugs, with one treatment turning out to be

“too harsh, burning patients’ mouths and throats, causing some to scream in pain”.

Over 27 years, half the patients in Oregon took between 53 minutes and 137 hours to die. If the Bill is to bring compassion and calm at the end of life, how can this be ensured when we do not know what lethal drugs will be given?

Having no requirement in the Bill for a coroner’s report could lead to a lack of proper oversight. There are cases where it is revealed post-mortem that the patient did not have a terminal illness. As the Bill stands, we would never find out. If there is nothing to fear from the Bill, there is nothing to fear from accurate reporting.

Claims have been made that once on the statute books, the law cannot be expanded. Just as the Bill amends the Suicide Act 1961, fundamentally, our role is to scrutinise and improve legislation. Parliament can do anything, but it cannot bind its successor. I am constantly told that there has been no expansion in jurisdictions such as Oregon. But 2020 saw the removal of the 15-day waiting period between requesting assisted dying and administering it, and in 2023 the residency requirement was removed and the definition of “terminal” expanded by interpretation. In Victoria, Australia, a five-year review in February proposed a plethora of “improvements”, which lead to substantial expansion.

Our role, and what we must endeavour to do, is to weigh up the evidence, safeguard the vulnerable and avoid wrongful death.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Mackinlay of Richborough (Con)]

My Lords, I am in favour of the amendments from my noble friend Lady Coffey. This has been a fascinating debate about the issues that we have with the devolution settlements across our United Kingdom. It is not only about the issues across the English-Welsh border, which have been so ably demonstrated and described by my noble friend Lord Harper, who has experience in this matter from the other place, but we have other strange dynamics going on in this country on the English border over into Scotland, where things are very different. There are other differences between England and Northern Ireland. We are not proposing to usurp the settlement with Scotland or to usurp the settlement with Northern Ireland.

I am quite interested to hear, at the appropriate time, whether the noble and learned Lord, Lord Falconer, will declare whether he is no longer quite so keen on the old devolution settlements that I can but assume he was part of during the Government that he served in, in that it is not quite as convenient now in this Bill to do the things required by those devolution settlements.

I was interested to hear the comments from the noble Lord, Lord Weir, because the Northern Ireland arrangement has a further dynamic, between Northern Ireland and the Republic of Ireland, where there is, again, a swapping over and a commonality of health provision, and it is quite commonplace that people come and go.

The matter of abortion was also raised. That has had a different dynamic across our United Kingdom over many years. My voting record in the House of Commons will show that I took no part in the rather heated debate on abortion that happened some years ago. I abstained because I appreciated that the devolution settlement was a matter for the Northern Ireland Assembly to come to its own conclusions on.

We have to ask ourselves what this Bill is. Is it a criminal justice Bill? We have 42 Henry VIII powers, exercisable by Ministers, so the Bill before us is not actually the Bill that will affect people’s lives; that will be written later because this Bill has so many of those Henry VIII powers in it. Many of those powers, as I described at Second Reading, should not really be there. We should not be having Henry VIII powers to create criminal matters under statutory instruments and delegated legislation; that is just not the way we do things.

So is this a criminal justice Bill? I do not think it is, because it has now morphed very much into a health Bill. It seeks to amend the NHS Act. I think it is the intent of many of the Bill’s supporters that it is the NHS that does these things: advise, provide the medical staff and do the deed. I do not know which chemical might be used. It may be barbiturates in England; it might be heaven knows what in Scotland. These are serious matters.

Is this a medical Bill? I believe that it is. Because it has morphed increasingly into a medical Bill, whether or not we agree with the devolution settlements, we have to respect them. As my noble friend Lord Harper highlighted very clearly, this is the danger of a Private Member’s Bill that is so interwoven with and entrenched in the complications of a devolution settlement. Whether you are for or against this Bill, or whatever, these are complex matters. These are matters of a different potential life or death, depending on which border you are close to in this United Kingdom. This is a matter of health in Wales.

Looking back to Covid, I know that it is a period we all rather like to forget, unpleasant as it was. At that time, I and my noble friend Lord Harper—I am sorry to keep mentioning him—were somewhat active in the space. Do noble Lords remember? These were matters of life and death; I mean, Covid was deemed to be. I was not quite so keen on the measures and voted against them all, but they were deemed to be measures of life and death; that is why they were so draconian.

I remember very clearly that I came up with what I called the Wilkinson conundrum. It is not a good conundrum now, because Wilkinson has subsequently gone into liquidation, but I made the point that because Wilkinson sold everything—fresh fruit and vegetables, tins of beans, and pots and pans—it was allowed to open. The lunacy was that the independent trader next door who sold only pots and pans was not allowed to open. We did that for whatever reason—it was deemed to be a matter of life and death—but Wales did something entirely different. In Wales, Wilkinson had to hide the pots and pans; one could buy beans and everything else, but a cover had to be put over the pots and pans. In matters of life and death, we allowed Wales to have its way.

This is most seriously a matter of life and death. We have a devolution settlement, and it has to be respected.

[Baroness Grey-Thompson (CB)]

My Lords, I declare my interests in this debate: I chair Sport Wales, which is an arm’s-length body of the Welsh Government; I am the president of the LGA; and I am a director of Living and Dying Well. I also spoke recently at a fundraiser event for a hospice in Wales.

A fundamental part of why we are here is to debate legislation, including looking at how this Bill might impact various parts of the UK—most specifically, England and Wales. I am concerned that we could end up with vastly different systems in England and Wales. Generally, there is a lack of understanding on devolution. In sport, I seem to spend quite a lot of time in meetings asking, “What about devolution?”, and we have to be careful about what we do in Westminster and what should be a matter for Wales when the health service is devolved.

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[Baroness Coffey (Con)]

I am very interested in that, because the response that I have had from the Minister is that nobody should be working on this beyond the Bill team, so nobody should be working on implementation. What the noble Baroness says is very interesting.

[Baroness Grey-Thompson (CB)]

I thank the noble Baroness. At the Lady Mayor’s parade, a member of the public introduced himself and told me that this is what he was doing. We agreed to disagree on the outcome of the Bill. Slightly patronisingly, he followed this up by saying how wonderful he thought I was and to keep going.

I did not mean to make a point that was amusing to the Chamber, as this is far from amusing, but these are the details that we need to understand. Is there far more going on behind the scenes? Is the presumption that very few amendments will be accepted, as happened in another place, or are the supporters of this Bill really open to making it better? I have tabled the second-highest number of amendments; my competitive edge fails in this example, as my noble friend Lady Finlay is about 30 amendments ahead of me. My amendments are to improve the Bill. Many are slight drafting changes, changes of words, which are to improve this Bill. That is our role. That is what we must remember. We have to improve this Bill. We have to make it workable.

Coming back to the point of this grouping, we have to make it work for England and Wales and we have to remember, as people who work in Westminster, that we have a responsibility to the people of Wales and should not step into areas that are not for us to step into.

[Lord Wolfson of Tredegar (Con)]

My Lords, this is the first debate in Committee on this important Bill so I hope that the Committee will allow me to take a minute or two to set out the approach of the Official Opposition. As my noble friend Lord Kamall and I said at Second Reading, the Official Opposition have no collective view on this Bill. Although each Member of the Opposition Front Bench will have their own view on the Bill, we will support noble Lords across the House in their scrutiny of the Bill. We will also table a small number of additional amendments where we feel that parts of the Bill need probing further. We will not seek to delay the passage of the Bill, nor will we seek to hold up progress in Committee. Instead, we will seriously engage in detailed scrutiny of the Bill so that we can collectively deliver the best possible piece of legislation.

In that regard, I respectfully pay tribute to the noble and learned Lord, Lord Falconer of Thoroton, for demonstrating his openness to improving the Bill already by tabling amendments that we hope to get to today and which reflect concerns that have been raised by noble Lords. I speak for all my colleagues on the Opposition Front Bench when I say that I look forward to working with him to ensure that we send a better Bill back to the other place.

The amendments in this group relate to the territorial extent of the Bill. My noble friend Lady Coffey is seeking to remove references to Wales in the Bill so that it would apply only to England. While I am not entirely persuaded that making this an England-only Bill is necessary per se, these amendments raise important questions about devolution. The core question for the noble and learned Lord, Lord Falconer of Thoroton, is why the Bill does not apply to the whole of the United Kingdom on the one hand or only to England on the other.

At the heart of this is, as the noble and learned Lord, Lord Thomas of Cwmgiedd, said—although various Acts of Parliament may put us to sleep, a speech by the noble and learned Lord never does; I was listening very carefully—that these amendments speak to the devolution settlement that we work with and the inconsistencies and confusions of that settlement. The noble and learned Lord used the word “complexity”. It is extremely complex. In this area, we have the problem that criminal law is not devolved to Wales whereas health is devolved. To pick up the point made by the noble and learned Lord, with which I respectfully agree, declaring the appropriate interest, Wales should not be regarded as inferior to Scotland. That is a point of general application.

The Scottish Parliament, as noble Lords know, is currently considering its own legislation on this topic. I hope that noble Lords have picked up that the Scottish Bill is significantly different in key ways—most markedly in the definition of terminal illness. In Scotland, it lacks the “six months to live” test which, whatever view we take, is at the heart of the Bill before us. The definition of terminal illness in the Scottish Bill is:

“For the purposes of this Act, a person is terminally ill if they have an advanced and progressive disease, illness or condition from which they are unable to recover and that can reasonably be expected to cause their premature death”.


I am not quite sure about “premature” in that context in all cases, but that is what the text says.

Leaving aside the point that those resident in one part of the United Kingdom will therefore have different rights to assistance under the law from those in another region of the United Kingdom should both Bills pass, I see the point that my noble friend Lady Coffey is making. If the people of Scotland may choose whether to have a law for terminally ill adults who wish to end their lives, why—I ask rhetorically, so to speak, looking forward to the response of the noble and learned Lord, Lord Falconer—should people in Wales not have the same choice? This is the key question that the noble and learned Lord has been presented with by this group of amendments.

--- Later in debate ---

[Baroness Merron (Lab)]

I will certainly look into the matter that the noble Baroness raised and would be pleased to write to her. However, the first point I wanted to make here was about engagement with the Welsh Government. Of course, Ministers themselves have not met with the Welsh Government in relation to this Bill, as again would be expected, as it is not a government Bill. I know that the sponsors have met with the Welsh Government to discuss the policy intent and to negotiate which clauses require a legislative consent Motion.

The sponsors are also leading engagement with Scotland and Northern Ireland while—on the point made earlier by the noble Lord, Lord Harper, and others—UK government officials are providing technical support to support the sponsor and are engaging with Welsh government officials to discuss technical matters in relation to clauses that require a legislative consent Motion or those to which Wales has requested that further changes are made. Officials have regular meetings; they can be as frequent as weekly, as was the case at some points over the last few months.

[Baroness Grey-Thompson (CB)]

The noble Baroness mentioned that the role of Ministers is to ensure that the Bill is legally robust, effective and workable, but surely safety has to play some part in that as well.

[Baroness Merron (Lab)]

I am sure it would be expected that safety is absolutely paramount. The point I am making—and I look forward to hearing from my noble and learned friend—is that our position in government here is not to deal with matters of policy. As I have said, we are restricted to areas to which any Government would be restricted.

We will absolutely work with the Welsh Government, NHS England and the NHS in Wales to understand the impact of any changes to the law and the provision of healthcare services in Wales, during the coming stages of the Bill.

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[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.

[Baroness Grey-Thompson (CB)]

My Lords, may I clarify that? I have just checked the information. My noble friend is correct in what she says, in that the support was 50:50, but the majority of respondents—64%—opposed expanding eligibility and 65% of them were not confident that consent could act as an adequate safeguard against unfree choices, such as those resulting from coercion or psychopathology.

[Lord Markham (Con)]

My Lords, it is clear, I think, that we all want the same thing here. Whatever one’s feelings about it generally, if this Bill is passed, we want to make sure that the person is in the right position—I do not use either “capability” or “ability”—to make a decision on whether to take part in assisted dying.

We all want the same thing, so what we have to decide is whether we believe that the existing framework, the Mental Capacity Act, can work here. I have heard a body of evidence that says it can. I respect in particular the evidence from Sir Chris Whitty, who, as Chief Medical Officer, is probably our highest adviser in the land in the medical space. He believes that it can do it. I also respect the opinions of the psychiatrists who have written in and said that, in their professional opinion, they are able to use the Mental Capacity Act to assess whether a person is in the right position to take part in assisted dying. So, as the noble Baroness, Lady Andrews, and others have made out, we have a body of evidence and 20 years of experience showing that the Mental Capacity Act can work and is already acting in very similar situations.

One can argue whether these two things are exactly the same, but they are pretty similar: both involve life-and-death situations, such as “do not resuscitate” orders, people deciding not to eat or drink any more, and people with motor neurone disease asking to come off ventilators. These are all very similar situations that, today, are decided under the Mental Capacity Act. So we have a system that is being used and which our best adviser says works, and we are setting an unknown definition against that. If we set about asking, “What do we mean by ‘ability’?”, we would probably all come up with very different answers. This would be untried and tested; it may take years, if not decades, to find something, against something that exists today. It would be very confusing: when do you use the Mental Capacity Act and when do you use this new definition?

Again, we all want the same thing: for the person to be in the right position. Our highest expert in the land says that the Mental Capacity Act can do it, and a number of psychiatrists are also saying that they can make the assessment under it. To my mind, that is what we should be considering.

--- Later in debate ---

[Lord Goodman of Wycombe (Con)]

My Lords, in debating ability and capacity, I will speak briefly as a member not only of the Delegated Powers Committee that considered the Bill but of the Select Committee that also did so. Noble Lords have heard differing views from members of the Select Committee about the various goings on that took place there, but I am sure we can all agree that we heard some very fine evidence.

All I wish to do in intervening here is to quote what Professor Alex Ruck Keene, whom my noble friend Lady Berridge referred to earlier, said about capacity and the role of psychiatrists, as it is extremely relevant to the debate on this clause. He said:

“The point I am trying to make is that, if you simply say, ‘Apply the MCA. Apply the principle of the presumption of capacity. Support the person to have capacity to decide their own life’, I anticipate, if you asked very many psychiatrists, they would go, ‘How am I supposed to think about that?’ That is for a very specific reason. For psychiatrists, most of the time, their job is to secure life. Their job is suicide prevention”.


He concluded:

“We need to know—and one of my real concerns is—how this Bill sits in the wider landscape of the law. I need to be able to tell, because I am going to be one of the people writing the books here and giving the training. I need to be able to say, with absolute crystal clarity, to a psychiatrist, ‘This is the point where you are not in the suicide prevention zone, and if you do not do all steps necessary to try to secure this person’s life, you could be prosecuted or you could be charged in various different ways or be civilly liable’. I need to be able to say, with crystal clarity, ‘You’re no longer in that zone; you’re now in the zone of the Terminally Ill Adults (End of Life) Bill’”.


I quote the professor simply to draw to the Committee’s attention once again the complexity of the issues before us. Although “ability” may be flawed and legally powerless, as the noble Lord, Lord Pannick, suggested, “capacity” is deeply problematic in the context of the Bill.

[Baroness Grey-Thompson (CB)]

My Lords, there is probably one thing we can all agree on today: everyone’s frustration with the process of evidence giving. I was hugely frustrated when the committee in another place was looking for evidence but deaf and disabled people’s organisations were not able to give evidence, despite making up 25% of the population.

I hope that I speak on behalf of the whole House when I say how sad it is that my noble friend Lady Campbell of Surbiton is not able to be in her place. She has experience in politics and in the House of Lords of extensively debating capacity, on what became the Domestic Abuse Act and in previous debates on assisted dying. I would urge anyone who has time to look at her contributions on capacity.

My noble friend is an individual who, I am afraid to say, in her 66 years, has been deemed terminal more times, probably, than most of us in the Chamber combined. She has had her capacity challenged probably an equal number of times. I remember a few years ago, when I had not long been in your Lordships’ House, when my noble friend was in hospital and several of us had phone calls to say that we needed to get to the hospital right away because they were challenging her capacity. Her husband was told that she was not able to make decisions on her care because she was delusional. Why was she delusional? Because she had told the doctors that she was a Member of the House of Lords. The response was, “She can’t be in the House of Lords—she’s disabled”. I cannot remember whether her husband got away with taking her pass in; there was talk about having to take her seal in to prove that she was in the House of Lords. But this highlights some of the issues with mental capacity assessment.

I have had personal experience of it. When my father was ill and the doctors found out I had lasting power of attorney, I was taken to one side to argue that he should have a different set of treatment. He had the capacity and ability to decide what he wanted. In this case, he had to have his leg amputated, and he was told that, as a wheelchair user, he would have no quality of life—they said that to me. If there was one thing I could do for my father, I could get him a wheelchair.

More recently, I have had an experience with my husband. At the end of 2020, he had a blood clot on the brain stem—he had a stroke, and he was blue-lighted to hospital. It was a dreadful experience. My daughter was in her first year at university and had to be called home. We did not think he was going to make it, and we were not allowed into the hospital. I was frequently told by the medics that he had no capacity to make a decision on his treatment. My husband said, “Look at the notes”; I said, “Look at the notes”. What they were arguing over in terms of his capacity was his ability to walk. Looking at the notes was really important, because his lack of ability to walk was nothing to do with the fact that he had a stroke; it was due to the fact that he had had a spinal cord injury in 1984 when he crashed his pedal bike into the back of a double-decker bus.

I understand what the Chamber is saying. I have personal experience where I think the Mental Capacity Act has been used in the wrong way. We have to find a way of making it work so we are able to take care of capacity. Like others, I am not entirely sure that “ability” is the right word. I understand what I mean by “ability”; I have amendments later on around the ability to understand decisions. I have one on British Sign Language because of the case of a deaf man who was told by a nurse who could only fingerspell that he had HIV when he did not—he thought for two days that he had HIV—and I have another amendment around people with learning disabilities. So maybe “ability” is not the right word.

My noble friend Lord Pannick talks about legal definitions, and I also have a number of very minor amendments which look at a better legal definition of disabled people. Perhaps we can take this away, work on it and do something. As the noble and learned Baroness, Lady Scotland, said, we have to make it work. We have to look at the Mental Capacity Act through the prism of the Bill, not in terms of what it was designed to do.

[Baroness Coffey (Con)]

The importance of the amendment in the name of the noble Baroness, Lady Finlay of Llandaff, is that, as has already been well described, there are genuine concerns about the appropriateness of the Mental Capacity Act 2005 as it stands. I think also that there has been more interest at this point because, so far, it has not been deemed to be in scope to put an amendment down to amend the Mental Capacity Act 2005—although I noticed that my noble friend Lord Goodman managed to get something in, so I congratulate him on that. That is why it is taking more time to consider aspects of this. I hear a noise—I thought it might have been someone shouting “Order!”, but perhaps it was excitement elsewhere.

I am just conscious that it is without doubt that, in the consideration in the Commons, Professor Sir Chris Whitty—who used to be one of my Permanent Secretaries when I was at the Department of Health and Social Care—suggested that the Mental Capacity Act had a higher test for basically a life or death decision, and then of course changed that evidence. However, I accept that he said, in evidence given orally to the Select Committee in this House, that having something that people are used to using is important. So one of the things that we need to judge is recognising the role of the Royal College of Psychiatrists—admittedly, it is not the Chief Medical Officer—and take its words seriously.

I was somewhat shocked by the words of the noble Baroness, Lady Murphy. I do not know if she ever used the Mental Capacity Act in her time as a professional. I know she is experienced in this in terms of psychiatry, but I was pretty horrified by the words she just used in this Chamber about the witness.

Terminally Ill Adults (End of Life) Bill

Baroness Grey-Thompson Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Lawlor (Con)]

I thank the noble Lord for the intervention but, if he will permit me, I would like to finish. We can imagine many different sorts of conversation. If noble Lords would like to hear more examples, I am sure they will ask for them.

None of these possibilities is ruled out by the Bill as it stands. They would not be considered an instance of coercion or pressure. Nor will it be possible when this Bill becomes law to investigate with due legal process whether someone has been instrumental in inducing a person to assisted suicide, provided they are covered by the terms of the Bill. Clause 34 outlaws dishonesty, coercion and pressure, and Clause 35 the destruction of documentation or the falsification of what purports to be a declaration, but the Bill does not address other means of inducing someone to opt for assisted dying. Under Clause 32, criminal liability for providing assistance will be removed from the Suicide Act 1961; as will civil liability under Clause 33, which stipulates that

“providing assistance to a person to end their own life in accordance with this Act”

or assisting a person to end their life while performing a function under the Act does not of itself give rise to any civil liability.

Moreover, the Coroners and Justice Act 2009—the duty to investigate certain deaths—will be amended so that the reference to unnatural deaths does not include a death caused by the self-administration by the deceased of an approved substance within the meaning of this Bill. Similar changes will be made in respect of arrangements for medical certificates under the new regulations and for Schedule 1 on suspension of investigations. These changes mean that there will be no effective way of investigating improper behaviour after an assisted death has taken place. The Bill already, in effect, recognises this problem by making absence of coercion and pressure a condition for eligibility for someone to be given assistance to die under its provisions. It opens the possibility to object to an assisted suicide going forward on the grounds that the person about to die has been coerced or pressured.

Furthermore, Clause 10(2) gives the first doctor—the co-ordinating doctor—the duty of ascertaining that the person concerned has not been coerced or pressured. We have heard from the noble Baroness, Lady Finlay, and others who have great professional experience in looking after people with terminal and other grave illnesses how difficult it is to establish coercion. It is often very difficult to establish coercion. It is true that the Bill wants to establish coercion—or so it alleges—but, as has been argued, the grounds are too narrowly defined.

A person in a poor mental state, because of their terminal diagnosis, is especially likely to be open to suggestions from other people, especially figures of authority such as their doctor, or their own family, whom they want to believe are thinking only of them. If we want to be sure that the decision to have assistance to die is genuinely their own, it is not enough just to rule out coercion or pressure. We need also to outlaw subtler, more insidious, but no less effective forms of persuasion. There is a danger that, if the Bill includes, as it does now, just a prohibition on coercion and pressure, the inference will be drawn that any form of encouragement or inducement, so long as it is not coercion or pressure, is allowed. Surely that is not what the proponents of the Bill would want.

The noble and learned Lord the sponsor and his co-sponsor are putting forward the Bill under the banner of giving dying people more choice over what happens to them, and providing greater freedom. Surely, in pure consistency with this underlying purpose, they must be intent on ensuring that the irrevocable choice a person makes to undergo assisted suicide is genuinely that person’s free choice, and therefore must support the amendment I am proposing, and indeed the amendments that others are proposing.

I hope that we can go even further. If my amendment is adopted, a further provision could be added to Clause 10(2), making it the duty of the co-ordinating doctor to ascertain not just that there was not coercion or pressure but that the idea of assisted suicide was not suggested to the person by another party.

[Baroness Grey-Thompson (CB)]

My Lords, I have three amendments in this group—Amendments 52, 58 and 181—which seek to explore coercion and ensure that people are free from undue influence, including social, economic and care-related pressures—not only active coercion, which is very difficult to prove. These amendments also seek to understand the reasons why someone would choose to end their life, so that we can look at how we might improve further NHS services or use that in important debates on reforming the welfare system.

It was raised on the first day in Committee that definition is important, and I believe that much further work needs to be done on the definition of “pressure” and how it becomes a strict liability. However, we find that it is very hard to gather data. We have been told that there is no evidence of coercion in other countries, but Ellen Wiebe et al, in a paper on the reasons why people request assisted dying, highlighted some of these very important issues.

In 2018, Dr Wiebe’s team looked at 250 deaths in Canada and noted that data was collected differently across different jurisdictions. Of the 250 deaths, six charts had no reasons; 56 gave one reason; some of the charts gave three or four reasons, but only two reasons were coded. This does not show the whole picture of why people are choosing to end their life on top of having a terminal condition. Looking to other jurisdictions, in Belgium, legal requirements were more frequently not met in unreported cases of assisted dying than in reported cases, and we still do not really know how it is practised. In Oregon, the data and the records are destroyed a year after someone has died.

Admitting coercion is highly unlikely to occur, so that is why we need a robust process of identifying it so that it can be acted upon. I look forward to debates in other groups on the role of the coroner in this. It is hard to find studies on coercion—I spent a lot of time trying—but it is possible to find a huge number of individual cases. In Canada, Lisa Feldstein was with a patient when the patient was pushed towards assisted dying. The person who suggested it did not realise that Ms Feldstein was a lawyer. Heather Hancock, a woman with cerebral palsy, was told by medical professionals while she was in hospital that she was not living but merely existing. I wonder how that made her feel.

Again in Canada, slideshows of MAID have been shown to healthy patients, which would make you think as your condition deteriorates that you do not have any other options apart from ending your life. In Australia, in November this year, three people were arrested after a man was found dead with euthanasia drugs in his system, and the police believed he was part of a suicide encouragement ring. Ruth Posner ended her life abroad with her husband; a friend spoke publicly about Ruth’s emotionally controlling husband and did not believe it was a free choice. But the difficulty is that, once you are dead, it is really hard to prove. As the noble Baroness, Lady Berridge, raised, the Bill does not take into account the impact of social media.

In New Zealand, doctors are told to do their best to detect how pressure may be placed on a patient, but this is completely unclear as to their duties and does not stand as a safeguard. This is listed in the review of the End of Life Choice Act 2019 in the report published on 19 June this year. In Washington state, physicians are rarely there when lethal drugs are ingested, which makes it nearly impossible to ensure that the patient’s decision is free from last-minute coercion, impairment or doubt. In Holland, it was found that GPs in an interview study felt pressured by emotional blackmail, family influence, time constraints or systematic pressures when processing assisted dying requests. As mentioned before, real-world data from Oregon shows that the top reported reasons for assisted death are loss of autonomy, loss of enjoyable activities, loss of dignity and being a perceived burden—not uncontrolled pain, which is missing from the Bill.

At the Select Committee evidence sessions, the honourable Stephen Kinnock, the Minister for Care, was asked about protecting vulnerable people, but the panel has no power to ensure that unmet needs are supported, such as increased care hours, adaptive technology and palliative input. We should ensure that the law does not default to death as a substitute for deficient services, which is an ethical red line repeatedly emphasised by disability advocates and UN experts reviewing permissive regimes. Best practice guidance from jurisdictions with assisted dying frameworks highlights the importance of exploring whether enhanced external support might address these factors, and it should be the case that the approval process checks them.

What is presented as a voluntary choice may in fact be a choice made under hidden pressure. The Australian Care Alliance research shows that the training for voluntariness and assessing absence of coercion was a two minute and 10 second video, with slides that take approximately two minutes and 50 seconds to read. Qualitative reporting in Canada shows disabled applicants citing inadequate housing or lack of care rather than unmanageable pain.

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[Lord Falconer of Thoroton (Lab)]

I completely appreciate what the noble Baroness is saying. She is, in effect, repeating what she said with such force and articulateness before. My answer to that is that there will be some professional people, and Clause 5 recognises this, who think the person is saying, “I just can’t bear this, I want this to end”. Would it be inappropriate in those circumstances for a professional person, in the context of all the other options, to raise it? In my view, it would not be, and in my view, it would be completely wrong to say that if you did raise it in those circumstances, that person, the patient, would be barred from ever having an assisted death.

On Amendment 58, the lead amender—not every other amender—said that coercion or pressure should include

“intentional or indirect structural disadvantage including poverty or lack of care”.

We are all agreed that coercion and pressure on an individual by another individual is not to be allowed. Where the reason that you want an assisted death is because in your mind you are influenced by your circumstances—for example, because you are poor—should you be barred from having an assisted death because of your poverty? In my view, you should not be. What the two doctors on the panel have to be satisfied about is that it is your own decision.

[Baroness Grey-Thompson (CB)]

This partly follows on from the comments of the noble Baroness, Lady Fox. The noble and learned Lord mentioned in his previous answer to one of my amendments that the doctors would be able to investigate. I think many of us still do not understand how that investigation would take place. In terms of understanding the standard of proof, Minister Sarah Sackman in another place said it would be on a civil standard. So, in terms of balance of probability, is the noble and learned Lord saying that the doctor has to be only 51% certain that there is no coercion for the panel to carry on and for an assisted death to be granted?

[Lord Falconer of Thoroton (Lab)]

They have to be satisfied that the person is not being coerced. That means that they have to do the appropriate inquiries. If, for example, as the noble Lord was saying, they do not understand the community, then they cannot be satisfied. If, for example, they do not know enough about it, they cannot be satisfied. Every case will depend upon its individual circumstances. They will have to do what is required in relation to it.

Amendment 118, in the name of the noble Lord, Lord Hunt, proposes that if you have a close relative who has been convicted of fraud or you are living with somebody who has been convicted of fraud, there has to be an independent financial assessment. That means that if your child, grown up by this time, has committed a fraud, there has to be an independent financial assessment of your circumstances before you can have an assisted death. I am strongly against the idea that if a relative of yours committed such an offence, that would mean there would have to be a yet further layer that you have to go through. There are still all those protections.

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[Lord Falconer of Thoroton (Lab)]

On my noble friend’s first question, I have not dismissed all the amendments; I have accepted that we should look at some of them, and very many of the ones I am not accepting are because they are already covered in the Bill. I am rejecting some of them on the basis that I do not think they are practical. When my noble friend talked about the donor, I think he was talking about, for example, somebody who may benefit from the will of the patient. Indeed, that was a point raised by the noble Lord, Lord Farmer. Very often, the person who most supports you in relation to this is the person you love most and who is going to benefit under your will. So, very frequently the person who has taken a loved one to Switzerland is the person who is then going to inherit under their will. That does not make them bad, and I would most certainly not exclude people who benefit from the will of the person who dies because they have helped them in this respect. It seems to me to not properly recognise the importance of human relations in relation to this.

I have dealt with the point of the noble Lord, Lord Farmer, about the will. His second point was that, if you had a friend who was convicted of a criminal offence involving financial fraud of some sort, you should not be able to have an assisted death unless there is an investigation of your financial position. Well, if I reject the point from my noble friend Lord Hunt in relation to a close relative or the person you speak with, then I think, for the reasons I have given, it also does not apply in relation to a friend.

In Amendment 181, the noble Baroness, Lady Grey-Thompson, proposes that the doctor must ask why and seek specific confirmation that a decision is not coerced. There is no specific requirement for that in the Bill: it is for the two doctors to determine what they think the right course is. If they felt that they could not reach a decision without asking why, or without asking, “Are you being coerced?”, they would have to ask that. But there is no prohibition. It is, as the noble Lord, Lord Pannick, said, a decision for the two doctors and the panel to decide, in each case, what is the best way to reach a conclusion as to whether this person is being coerced. That is the question that all these things are addressing.

[Baroness Grey-Thompson (CB)]

So, the two doctors could ask an entirely different set of questions to each person who is requesting to end their life?

[Lord Falconer of Thoroton (Lab)]

It will depend on the circumstances. If, for example, the doctor had a very severe doubt about whether somebody was being coerced, I would expect them to ask very many questions about their domestic circumstances. Suppose, however, it was somebody who was clearly not, on the face of it, at the slightest risk of coercion—a person of 60 in the full flush of his or her pomp, as it were—and who had said, right from the outset, “I can’t bear the thought of this illness”, and the idea that this person has been coerced is not really plausible, then I would expect the doctor to be asking different questions from the sorts of questions that they would be asking if the circumstances of somebody’s home life were completely different. It would obviously depend on what you knew as the doctor, or had found out as the panel, about the circumstances of the individual.