Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Friday 20th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

What I understand the noble Baroness to be saying is that a doctor who will not conduct the conversation because, for example, he or she is against it on conscience grounds, might refer somebody to what she describes as a pro-assisted dying mafia. First, that seems to me to be unlikely. Secondly, the Bill cannot prevent people talking to anybody they like about assisted dying. We have free speech in this country. Thirdly, the Bill provides that before you can have an assisted death, you have to have a Clause 5 conversation, which requires the doctor—legally—to put every option before you. What is being proposed is a network of neutral advisers to ensure that before you get to the second Clause 5 doctor, you have not talked to somebody who might be pro it, who you are not prevented from talking to anyway by the law. No, I am not in favour of it.

[Baroness Grey-Thompson (CB)]

I thank all noble Lords for the debate this afternoon and the noble and learned Lord for explaining his amendments. I think the answer to the problem that we are trying to solve is somewhere in the middle of this group of amendments. I still have a level of concern about whether an individual knows what they are saying yes or no to with the independent advocate and their understanding of the information that they are given. I would be very concerned if it turned into some sort of tick-box compliance in terms of someone’s understanding.

I thank the noble Baroness for her confirmation that, under the Equality Act, someone with cancer or leukaemia would count as being disabled. It was not my original intention for everybody who wanted to enter this process to have somebody independent alongside them.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 13th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

A whole range of issues is covered to a large extent by the Online Safety Act in relation to the promotion of suicide, particularly to young people. That, in a way, is a separate issue from this issue. I fully encourage and support all attempts to try to reduce the risks to young people, but I am afraid that the Bill cannot take that on, on its own.

[Baroness Grey-Thompson (CB)]

My Lords, I thank all those who have contributed to the debate on this group of amendments on raising AS in conversation and preliminary discussion, including training.

I thank the Minister for her response to my amendments. However, given the government response and the question about funding, it lays open the bigger question of the whole Bill that many of us are grappling with: who pays for this and what that final bill may be.

The debate has gone in a slightly different direction from what I expected. It is interesting that the noble and learned Lord, Lord Falconer, differentiated in his response between non-disabled and disabled people. Independent advocates will come up in a later group, but I think it is really important that it is understood, as part of this group, when we are talking about learning disabilities, that it may be very difficult for someone with a learning disability to understand what an independent advocate is and what their role is. They may say that they do not need it but not really understand what they are saying yes or no to. We will cover that next week.

I am slightly worried that there may or may not be guidance from the GMC and/or the Secretary of State. I will be very interested to discuss that with the noble and learned Lord away from this Chamber. This is where we probably disagree. Those who support this Bill will talk about Victoria and say that it gives greater access; I say it is a slippery slope and that it is making it easier for a wider group of people to enter this process. We have covered in previous amendments the use of language. “Person with a disability” is not used in the Equality Act. I had hoped, through my contributions to previous debates, that there was some understanding of it and why organisations of and for disabled people are worried about this Bill. It is not just about the contents of the Bill; it is about the language of the Bill. Organisations of and for disabled people use the social model. I will not go through that again, but the language they choose to use is “disabled people”.

The noble Lord, Lord Weir, has apologised for having to leave, but he raised the issue of how disabled people are treated. I am going to raise a difficult question, not to anyone in particular but to the whole Chamber. It is rhetorical. How many in your Lordships’ Chamber have ever felt sorry for me because I am a wheelchair user? My previous career as an athlete negated some of that feeling because, if you like sport, competing for Great Britain is a privilege: of course it is. In my second career, however, I consider the way that I am treated every single week. I am a long way from my sporting career now but, if I am rushing to a meeting, I luckily do not hear “It is not a race” too often these days. I know: I am not in my racing chair and I am not wearing Lycra. I am not sure sometimes, when people say this, whether they think they are being kind, sweet or funny. I did not have a traumatic or dramatic accident; I was a wheelchair user from a very young age. There were a few points in my life when I had three spinal surgeries and experienced terrible pain, but I am healthy.

The noble Lord, Lord Weir, raised the different views that doctors have of people. I have said before that my husband had a traumatic accident at 21. He broke his back and spent nine months in hospital. Many people assumed that it irreparably changed his life. It did not. He went on to complete his PhD. He changed sports; he went from cycling to wheelchair racing and he met me. But the way that he was and is treated is very different depending on whether he is walking with his crutches or is occasionally using a wheelchair. If he is walking, people like to think that he has had a skiing accident or something quite cool but, when he is in his wheelchair, people talk down to him. His colleagues have completely forgotten that he has a PhD and have talked to him differently.

He had a stroke in 2020 and I was really worried about him going into hospital because I was not sure of the outcome. I had calls with doctors telling me about the impact of the stroke. The noble and learned Lord talks about doctors needing to know all the information. It was really clear in his patient notes that he had a spinal cord injury, but the doctors rang to tell me that both of his legs were really badly affected, and I was saying, “Well, that would be the spinal cord injury”. They then told me that his grip strength was really good. Well, 30 years of doing wheelchair racing and cycling and walking with crutches would make that happen; they had no idea what his grip strength was like before he had the stroke. So the information they were giving both of us was not very helpful at all.

All our experience of healthcare is very different. I had a doctor in a spinal unit ask me, “How did you catch spina bifida?” I laughed. I have been asked it several times. I think the first time was when I was in my early 20s, and I said I had caught it with a butterfly net—humour does not always go down very well, either in the Chamber or outside. I was really shocked that a doctor in a spinal unit was asking me how I caught a congenital disability. Because of my scoliosis, my internal organs are all in rather strange places in my body. Every time I go to the hospital for a kidney scan, I am asked, “Do you have one kidney?” I say, “I have two kidneys; look at the notes”. “Are you sure?” “Yes. I haven’t had an operation to remove one of my kidneys”. Every time you are measuring what you say because you do not want to offend doctors and you do not want to be rude or flippant. I sit there and say, “I have two kidneys. My right kidney is somewhere up under my arm”. “It can’t be there”. “Look at my notes”. Eventually, they find my kidney somewhere up underneath my right arm.

This is the frustration that disabled people feel. It is lovely to say that doctors will read all the notes and understand them, but actually something as basic as “I have two kidneys” is often misunderstood. So I challenge your Lordships’ Chamber. Have you ever pitied me? Do you think I am brave? Do you ever think, “Well, at least it’s not me?” Am I brave as a wheelchair user or brave because I was an athlete? How many people consider that, because of my impairment, I suffer? I apologise for sighing when the noble and learned Lord talked about the suffering of disabled people. My phone started pinging. I cannot read out any of the responses or the messages I have had on that, as all the language is unparliamentary. This is why disabled people are scared. The assumption is that we suffer. I do not suffer.

Disabled people are worried. That is why they are fighting this Bill. It is not kind, it is not sweet, it is not being understanding, it is not being compassionate. We are constantly having to try to fit into a version, an idea, of what non-disabled people think of us. If we dare challenge that, we have a chip on our shoulder, and we are one of those funny disabled people who just do not understand that we are meant to deal with people being kind to us. We have to deal with being patted on the head, literally and figuratively. It once happened to me in this building. It was a Peer who did it to me. I was with colleague who was a wheelchair user and we were chatting about a Bill that we were working on. The Peer came up to us and said, “Are you having a nice time?”—in that tone. We said, “Yes, actually, we’re debating the Bill that we’re working on at the moment”. The Peer ruffled my hair. This is patronising. This is ableist. It is not kind. How does the noble and learned Lord assume that people like me “suffer”? I am really squeamish about the word. So many people are frightened because of the assumptions that are constantly made. I want to take my challenge further. How do you see disabled people who might be on the streets? Are we deserving and undeserving disabled people? That happens between Paralympians and non-Paralympians.

My noble friend Lady Campbell of Surbiton talked about DNRs being put on healthy disabled people. By virtue of how people who speak remotely are able to contribute, my noble friend and the noble Lord, Lord Shinkwin, were not able to come back into the debate. My noble friend wanted to make it clear that she has to rely on doctors for everything in terms of her well-being. We put huge trust in those people. My noble friend has been in hospital many times, and it is important to listen to her experience of what it is like. I will keep raising this in terms of how I am able to contribute in debates. I can sit in one place—well, three places—in the Chamber. I cannot sit with my colleagues. Those speaking remotely cannot come back and ask questions. There was one time in the time that I have been here when five wheelchair users wanted to speak in a debate. We had to tag-team in and out of the Chamber. How many other noble colleagues have had to do that?

My noble friend Lady Campbell wanted to reiterate the unequal nature of the system. She also wanted to draw attention to a BMA survey looking at doctors and medical students who are disabled or have long-term health conditions. It was published on 3 December 2025. The author, Natasha Wilcock, is deaf. It raised the ableism that exists in that profession. The assumption is that the barriers are from patients, but actually there are deep-rooted issues in the experience of doctors who are disabled. A huge amount of prejudice comes from other doctors.

The noble Lord, Lord Shinkwin, again, was not able to come back in, but he wanted to raise a couple of points. He asked me to say that the noble and learned Lord did not answer any of his questions and that he would be happy if he could write to him.

If you treat your disabled colleagues with prejudice and contempt—sorry, I am again referring to the BMA survey—how do doctors treat disabled patients? The equity of treatment of staff and of patients is inextricably linked.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 6th February 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords—

[Lord Falconer of Thoroton (Lab)]

May I just finish this?

For example, the noble Baroness, Lady Lawlor, proposed 80% and two people expert in the area. The requirement of the Bill is that there should be a reasonable expectation that the person’s death will come within six months. That has to be approved by two separate doctors and a panel. Where there is any doubt about the prognosis, each or both of the doctors have to seek the advice of somebody specialist in the area. That seems an appropriate degree of safeguard.

I apologise to the noble Baroness.

[Baroness Grey-Thompson (CB)]

I just wanted to clarify what the noble and learned Lord said. He said, as I understand it, that he did not support these amendments because they would mean that a dying person would have to make difficult decisions. Is requesting assisted suicide not a difficult decision, which they would already be taking?

[Lord Falconer of Thoroton (Lab)]

Of course it is a difficult decision, but that is the decision the person has to be clear, firm and settled about. I do not see parity between the decision the individual has to make and making sure there are appropriately qualified people ensuring that the person has the disease. They seem to be two important but different requirements.

The next group of amendments, primarily advanced by the noble Lord, Lord Frost, is on the question of whether suffering should be an element in the eligibility—that terminal illness itself is not sufficient. We have had this debate a number of times, particularly at Second Reading, on some the circumstances where a terminal illness should be excluded. For all the reasons I have given in the past, I am not in favour of suffering being the requirement. What suffering is will vary from person to person. In some cases, it will be the indignity. In some cases, it will be the appalling thought of the change in relationship with those they love. For others, it will be the pain they are going through. It is not, in my respectful view, an appropriate or easily applied condition. So, for all the reasons I have given on a number of occasions before, I am against putting in the question of suffering.

The next group of amendments is that advanced this morning by the noble Baroness, Lady O’Loan. They say that if you are the victim of medical negligence, you should not be entitled to an assisted death. If, for example, your doctor failed to diagnose your condition early enough for you to get treatment and, as a result, you are likely to die earlier, even though you have the condition—for example, prostate cancer—is the position that, because of the negligence of your doctor, you are truly to be denied the right to an assisted death? Unfortunately, I cannot see the logic of that.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 30th January 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

I realise that your Lordships wish to get on to the substance of the Bill, and the points I am about to raise are specifically on the Bill and will have an impact on the groupings we are about to debate. I notified the Chief Whip, the clerks and the noble and learned Lord, Lord Falconer, of my intention to raise them.

The noble and learned Lord, Lord Falconer, explained in his letter this week that he recognises the concerns raised about independent advocates and that following discussions with the sponsor in the other place and their amendments, he has tabled changes. I am raising this now because of the sense of frustration that we are not getting answers to the amendments we are tabling in good faith. I hope that the noble and learned Lord will be able to answer these questions, so that we can move with a bit more pace.

I would like to probe how the changes the noble and learned Lord has suggested relate to what was agreed in the other place. The amendments in the Commons were understood to introduce independent advocates as a mandatory safeguard. This is an area that many of us are concerned about, reflecting the fact that the individuals in scope may have substantial difficulty understanding the process or communicating their wishes. Under the noble and learned Lord’s amendments, a person is treated as having an independent advocate, even if the advocate is not present or involved in the decision-making process. The amendments do not require an advocate to be present when the co-ordinating or independent doctor meets with the patient, nor when the panel considers the case. Advocacy is therefore satisfied by instruction alone rather than active participation. In addition, advocacy is made conditional on request. The preliminary discussion may proceed without an advocate, and a qualifying person may refuse one.

Could the noble and learned Lord please explain whether he considers that this framework preserves the substance of the Commons concession, or whether he accepts that it represents a shift away from a mandatory safeguard towards a more discretionary model? In particular, how does he address the concern that people who qualify precisely because they struggle to understand are required, unaided, to decide whether to waive one of the Bill’s central protections at the very outset of the process?

[Lord Falconer of Thoroton (Lab)]

These questions relate to a detailed amendment to Clause 22 that I tabled yesterday, which provides for an independent advocate to help people who need assistance. I will read the questions the noble Baroness has given me—she did not give me notice of them, and I make no complaint about that at all—but the appropriate place to deal with them is when we get to the amendments relating to Clause 22.

Clause 1: Assisted dying

Amendment 60

--- Later in debate ---

[Baroness Grey-Thompson (CB)]

I understand the noble and learned Lord’s comments about “reasonably practicable” in relation to this group of amendments. But the Bill actually has “reasonably practicable” written many times—in Clauses 10, 11, 16, 18, 47 and 50—in relation to the length of time a doctor should take to write a written report. I have amendments to shorten that length of time. I am interested in why the noble and learned Lord does not think—I am sure he is going to say that we will discuss this when we get on to those groupings—that “reasonably practicable” is not suitable in this situation, but is suitable in situations such as the length of time it takes doctors to write a report?

[Lord Falconer of Thoroton (Lab)]

That is a very valid point in relation to this particular amendment. The reason I think some sort of regulatory process from the Secretary of State—a code of practice or something similar—is better is that you can give much more detail and many more examples. You should not be relying on just a particular two-word legal test.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I hope I have been clear about not liking the amendments as they are and that I am keen to see whether what the noble Baronesses, Lady Smith of Newnham and Lady Fox, said can be incorporated somewhere in the Bill. It may well connect with things we have said already. I hope I have made my position clear.

[Baroness Grey-Thompson (CB)]

My Lords, I feel a sense of disquiet listening to the noble and learned Lord’s response, especially when he talked about privilege. I have a huge amount of privilege in my life. If I need a new wheelchair, I can buy one. I can put a lift in my house. I can buy a car and pay for the hand controls. When I need a van with a tail lift, I can pay for that. Is he really saying that lack of privilege plays no part in somebody choosing to end their life?

[Lord Falconer of Thoroton (Lab)]

I am saying that everybody should have the choice. The way that one makes the choice is inevitably determined by how one got to the point where one had to make it. It is an impossible question. Why do we all make choices? They are all affected. Some people make them because they are richer or poorer than others, but I am not in favour of drawing financial distinctions. I hope that, in the light of my remarks, the noble Baroness— I cannot remember who started this—will withdraw her amendment.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I do not understand that proposition. It seems to me that the panel is able to take that into account just as well as the court—and, indeed, I think the panel would probably be better able to assess it. I am not sure I accept that proposition.

[Baroness Grey-Thompson (CB)]

My Lords, when this was debated in another place, that argument was made, and the Association for Palliative Medicine wrote formally to correct the record. In the statement, the APM clarified that the Bill does not align with the standard multiprofessional team decision-making process. The noble and learned Lord mentioned Dr Cox, who argued that the Bill’s model of two independent doctors working alone was inadequate, and that assessments should be carried out within the multiprofessional team model to strengthen the Bill. On that discrepancy, the APM and MPs noted that although the Bill introduces a panel of psychiatrists and social workers at the end of the process, that does not equate to multiprofessional assessment at the beginning—the assessment stage that Dr Cox was advocating for. That is really important. The Association for Palliative Medicine wrote formally to correct the record following the debate in the other place. If the noble and learned Lord does not want to respond to that point right now, I am very happy for him to write to me, but I think it is important for that to be on the record in this Chamber, as a by-product of what happened in another place.

[Lord Falconer of Thoroton (Lab)]

The reason why I quoted Dr Cox of the Association for Palliative Medicine was that she specifically said that it is better to approach this issue through a multidisciplinary process rather than by placing it on the shoulders of the two doctors and the High Court judge. The panel approach reflects that approach. That is why I quoted it. I do not think I need to write to say that. It was part of the evidence that was saying, “Have not one pair of eyes to judge, but three pairs of eyes”.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

I do not need to withdraw the amendment, because if the noble Lord objects to it, I will not press it in Committee. It depends on what we get to when we get to Report. What I am saying is that, at the moment, I cannot see the difference. I am more than happy to talk to him before Report. If there are valid points, let us put them in. However, at the moment, it looks to me to offer just as good, if not better, protection.

[Baroness Grey-Thompson (CB)]

I would not be able to accept the amendment as tabled because I have numerous other amendments on disability, language, BSL, different levels of interpretation and Makaton that are all important when having these conversations. Following the offer that the noble and learned Lord made to the noble Lord, Lord Shinkwin, I would be delighted to join the meeting as well, to see how the noble and learned Lord’s amendments can be improved to move further down the road. What we are trying to do is to make sure that people go into this decision-making process clearly understanding the decision they are taking.

Terminally Ill Adults (End of Life) Bill

Debate between Baroness Grey-Thompson and Lord Falconer of Thoroton

Committee stage
Friday 21st November 2025 Lords Chamber

[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.

--- Later in debate ---

[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.