Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

My Lords, we have heard three arguments against the Bill: from those who oppose assisted dying in principle, those who say it will undermine pressure for palliative care, and others who think that the Bill is faulty.

There is not much I can say to those whose objections are deeply religious, but I disagree with the right reverend Prelate the Bishop of London that enabling a dying person to end their own life means that we, as a society, believe that

“some lives are not worth living”.—[Official Report, 12/9/25; col. 1785.]

I say no; it means that we value our fellow human beings and their choice to hasten the inevitable, at a time of their choosing.

I acknowledge the views of the noble Baroness, Lady May, although I do not think she should prevent others from exercising a different view. I disagree with her that:

“As a society, we believe that suicide is wrong”.—[Official Report, 12/9/25; col. 1784.]


As the noble Lord, Lord Pannick, says: it is legal, but there are no safeguards—particularly when people go to Switzerland. As we have heard from a former DPP and a former chief constable, the current need to interrogate the loved ones of those who have legally taken their own life is a situation none of us would want to face.

As the noble Lord, Lord Purvis, and others have said, the Bill is not about people choosing to die. They are dying. The Bill is about helping to make those final days easier for those who so choose. It is about dying people who want a loved one with them; the Bill allows that. It is not just about a medical intervention. It is for those who want a loved one with them, if they choose to end their own life, when the pain, discomfort, indignity or scale of intervention become unbearable.

Some noble Lords claim that the Bill would undermine pressure for palliative care. But there is no evidence for that. Indeed, the Bill has already led to more discussions about dying; the need for dignity, support and help; and it may even have increased the likelihood of improved provision. I say to those noble Lords: campaign away for palliative care, but do not do so at the expense of those who have had palliative care and then, in their final hours, want help to die.

Palliative care is about improving the quality of the last part of life for those approaching death, by managing pain and other symptoms—often in their own home. Why, when those symptoms are no longer manageable, should professional help be unavailable at a time and manner of their choosing and in their own surroundings, alongside those they love?

I address the argument from those—who would otherwise support assisted dying, rather than those who never would—who say that this Bill is not right. Our task is not to undermine the clear public desire, and the Commons’ support, for this measure. Our task here is to ensure that it achieves its ends but with proper safeguards, albeit not with so much bureaucracy that its purpose is defeated. We should look for genuine improvements, helped by a timely Select Committee and then by the whole House, without derailing its timetable. Let the Commons then have the final word.

There is a right to die; it is already in law. This is about helping those who, in their final days, when the inevitable is coming, can have the comfort of professional help as well as having their families around them if they choose to end their life.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, the noble Baroness has told us a very sad story about her brother, but it really is not on the issue that I am speaking of today. It is, of course, the case that decisions about life and death are made. What I am saying is that, in this case, the decision is to ask the state to enable the person to administer that, and for the state to bring all the forces and resources available to do it. That is what we are debating today: does the Bill provide a situation in which “capacity” is the correct term to use in this clause?

I support Amendment 2. The use of the word “capacity” is undoubtedly provided for in the Mental Capacity Act. This Bill says that

“references to a person having capacity are to be read in accordance with the Mental Capacity Act”,

which is very helpful. The Mental Capacity Act was not passed to deal with the decision to end one’s own life, but rather it was formulated with the basic assumption that a person has capacity. In November 2021, the Supreme Court said in A Local Authority v JB:

“‘A person must be assumed to have capacity unless it is established that he lacks capacity’”.


It continued:

“This principle requires all dealings with persons who have an impairment of, or a disturbance in the functioning of, the mind or brain to be based on the premise that every individual is competent until the contrary is proved. … Competence is decision-specific so that capacity is judged in relation to the particular decision, transaction or activity involved. P may be capable of making some decisions, but not others”.


Therefore, there are circumstances in which capacity cannot be assumed and a person may not be capable of understanding, to the necessary extent, the information that should underpin any decision-making, or of analysing the consequences of that information or of making a decision in their own best interests. When these conditions are not fulfilled, the Mental Capacity Act requires, in particular circumstances, that a decision be made by a third party, but always in the best interests of the person. As the Royal College of Psychiatrists told us in evidence,

“an assessment of a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding”

than assessing capacity for treatment decisions.

We have received very helpful evidence from Professor Gareth Owen, Professor Alex Ruck Keene, and Professor Katherine Sleeman of the Complex Life and Death Decisions group at King’s College London. They have stated quite clearly that

“the MCA 2005 was not designed to be a universal framework for determining capacity.  It is primarily a workaround for the inability of a person to give consent to actions required to secure their health and social care needs. In the MCA 2005, the principles applying to and the test for capacity apply in a context where a decision can be taken on a ‘best interests’ basis for the person if they lack capacity”.

In the context of the Terminally Ill Adults (End of Life) Bill, they state that,

“no such best interests decision could ever be made”.

Capacity is not a constant state. It may fluctuate depending on a variety of circumstances, including some illnesses, disabilities and the side-effects of medication. A person can have capacity in relation to one decision and not another. A person may have capacity at one time, but not another. It is an enormously complex issue. When the decision in question is the decision to end one’s own life, capacity to make that decision requires very significant analysis in each case at the time in question.

That is the reason why “capacity” is not an adequate word to deal with the situation in which a person is coming to make a clear, settled, and informed decision. “Capacity” cannot be the test. “Ability” is a wider test, and there will be opportunity for the Committee to consider what that might look like as we go through future groups.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this issue was well discussed in the Select Committee, and I want to refer to Professor Sir Chris Whitty, who I think knows a little bit about this. I want also to respond to and endorse the words of the noble Baroness, Lady O’Loan, because she talked about concentrating on the interests of the person concerned. They were not exactly her words, but she was saying how important that was. We are talking here about someone who is dying. They are in the last months of their lives and, under the Bill, they must have capacity throughout the stage for which this legislation will provide. In other words, at each stage, they must have capacity. Professor Sir Chris Whitty, who knows a lot about this, spoke on it—it is on page 153 of the committee’s report, if anyone would like to look. He said:

“There is plenty of evidence, and it goes with common sense, that, when people use an existing system that they have used for many years, that they are used to and that has been tested in the courts, they are far more likely to be able to follow a reproducible and sensible pattern of making decisions than if they are faced with a completely new approach which they have not used previously and in which there may well be legal ambiguities the courts have not yet adjudicated on”.


If we want this Bill to work, as I assume the House of Commons did when it sent it to us, and as I think a majority of this House does, we must give to doctors and everyone else a form of words that they already understand, they can use and, above all, what is in the best interests of the patient in front of them.

[Baroness Noakes (Con)]

My Lords, I am a little confused about this debate. The debate is on Amendment 2, which would replace “capacity” with “ability”, but we have heard hardly anything about ability. We have heard from the noble Lord, Lord Pannick, who said that it would replace a defined term with an undefined term, which is an issue we should take seriously, but most of the debate has been about whether the definition of “capacity” in this Bill—that in the Mental Capacity Act—is the right one to use. We are not debating whether “ability” is a better term; I hope that we can do that and move on to some other important areas in this Bill.

--- Later in debate ---

[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.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

I think it might be appropriate to hear from somebody who is not against the Bill. We have heard endless interventions.

[Lord Polak (Con)]

My Lords, I want to respond to the noble Lord, Lord Griffiths, who is a member of the Labour Party. With respect, I would like the Committee to listen.

[Lord in Waiting/Government Whip (Lord Lemos) (Lab)]

Does my noble friend Lady Hayter want to make one point? Then we can hear from the noble Lord, Lord Polak.

[Baroness Hayter of Kentish Town (Lab)]

My one point is that it would very nice if somebody who supports the Bill could also have a hearing.

[Lord Polak (Con)]

It is a shame, because I have a particular and important point to raise in response to the noble Lord, Lord Griffiths.

[Lord Polak (Con)]

I will. I was given six months to live 37 years ago. I do not often share this personal issue. I stand here today as living proof that prognosis is not certainty. Estimates are sometimes wrong and sometimes wildly wrong. That experience shapes my approach to this legislation and underlines why safeguards matter so profoundly.

When I spoke at Second Reading, I made it clear that I was against the premise of the Bill, and that remains my conviction. However, if the House decides that the Bill should proceed, it must do so with the strongest possible protections, and I support many of the amendments that were mentioned, particularly Amendment 46 in the name of the noble Baroness, Lady Finlay.

In listening to the debate, I was particularly moved by the noble Lords, Lord Evans, Lord Carlile and Lord Deben, and by the noble Baroness, Lady Fox, on the issue of coercion and encouraging. I actually pay tribute to the noble and learned Lord, Lord Falconer, on this whole issue, which is so difficult. I understand. I think that he is plastering over gaping wounds in the Bill. In fact, I think he must have more plasters than my local pharmacy. I will return to this properly when I speak to my own amendments, but I want to say that this vital piece of legislation is not fit for purpose, no matter how many amendments or how many plasters. I think we need to look.

I shall end with just these words: when we debate matters of life and death, we do so with the utmost seriousness. I believe that those who brought forward the Bill are acting from the highest motives, and I respect that, but in moments such as these, I know the whole House feels the absence of the wise counsel of the late Lord Sacks. He reminded us that purity of motive does not guarantee rightness of outcome. Our responsibility here is clear: to ensure that the law we craft is robust, precise and overridingly safe.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, this has been something of an unbalanced debate, so I hope it might be possible to hear from someone who supports the Bill. I was particularly anxious to come before the noble Lord, Lord Polak—for whom I have a lot of respect; we agree on many other issues—to respond very soon after the right reverend Prelate the Bishop of London. She was very honest when she said that she did not support the Bill, and I think she said that it was unamendable. Here we are, however, discussing amendments.

The noble Lord, Lord Carlile, spoke earlier about whether we should discuss a form of wording on which we could all agree. The question then would be: if we can agree a form of wording, would he then support the Bill? My feeling is that these amendments are not about making the Bill acceptable so that those putting them forward could then support it but are a way of trying to stop our discussion and proper scrutiny, because they do not want the Bill to go ahead.

[Lord Deben (Con)]

My Lords—

[Baroness Hayter of Kentish Town (Lab)]

If I could just finish. It has been a long time in this debate without hearing from my side—I want to come on to something that the noble Lord, Lord Deben, said anyway.

The amendments to this Bill are about coercion or pressure. As stated by the noble Lord, Lord Pannick, the situation at the moment is that people can go to Dignitas without even proving to a doctor that they are dying, and without any check as to whether there is coercion or pressure, or whether someone is going to inherit their house. They can go, and that is the way they end their life, and they feel it is not worth living any longer. On the definition of coercion, are we really content with continuing the status quo where there is absolutely no check—from a psychiatrist, a social worker, a lawyer, or anyone else—on whether they have been coerced? That is the alternative: allowing the status quo to continue with no checks whatever.

We have to ask, therefore, whether these discussions about definition are really about that, or whether they are about trying to stop the Bill. Perhaps we could discuss whether those who want the wording changed would then support the Bill. If they would, let us get down to discussing that, but if they are never going to, they are wasting the time of those who want it to go through.

[Lord Carlile of Berriew (CB)]

My Lords—

[Noble Lords]

Order!

[Baroness Hayter of Kentish Town (Lab)]

I do not have to give way. I have been speaking for three minutes, and I have listened for some hours. I am sure the noble Lord can come back; it is Committee stage, so he can speak again.

People have talked personally. Both my parents died when I was a child. People know that one of them died tragically and very suddenly; the other did so in enormous pain at the end. As a child, I went through that, so I understand about bereavement and grief, and seeing someone die in great pain. We have all been through that, and some of us come to a different conclusion. We come to a conclusion that no matter how we define pressure or coercion—the discussions we are having—what we want is the ability to move forward and help those who want help to bring things forward a few days earlier. I do not know whether the noble Lord, Lord Deben, has been through probate when trying to sell a house, but for someone who is already dying and may be a month off, bringing it forward a month or a couple of weeks would not make that much difference. We are finding excuses.

I am sorry not to have given way, but I have listened for some hours, and it is only appropriate that someone who supports the Bill also gets the chance to speak today.

[Baroness Hollins (CB)]

Before the noble Baroness sits down, can I just ask which amendments she was speaking to, because this is Committee and not Second Reading? Every amendment that I have tabled is designed to make the Bill better and I feel quite concerned to be accused of time-wasting.

[Baroness Hayter of Kentish Town (Lab)]

I was talking to the debate on coercion, because there is no check on it for the existing way of ending one’s life early, which is to go to Dignitas. I was asking whether, if the Bill is changed in the way that, for example, the noble Lady, Lady Hollins, would like, she would then support it.

[Baroness Butler-Sloss (CB)]

My Lords, before the noble Baroness sits down, there are two separate situations here, and I wonder whether she agrees. One is that there are many of us who do not like the Bill, but there is a real probability that the Bill will pass, and if it passes, we want it better than it is at the moment. Consequently, we are not wasting time.

[Baroness Hayter of Kentish Town (Lab)]

I was not suggesting wasting time. I was asking whether, if these changes were agreed, people would then allow the Bill to proceed.

[Lord Carlile of Berriew (CB)]

Before the noble Baroness sits down, I have great admiration for her, but I and many others resent her waving her hands at us. The reason we wish to have the sorts of discussions that I was mentioning was so that, believe it or not, we can make a judgment as to whether we are prepared to support the Bill, or to be silent on whether we support the Bill, or to oppose it at Third Reading. It is unworthy of the noble Baroness to allege that all of us here who are expressing concerns are wasting time. It is not true, and it is what she said.

[Baroness Hayter of Kentish Town (Lab)]

I never said that about wasting time. The words did not come; I did not say them. I was asking whether the people who want a better definition will then be able to support the Bill.

[A noble Lord]

They can decide at the end.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

I hope that the right reverend Prelate is not going to push for a vote at Third Reading. The task for this House is scrutiny of the Bill both at this stage and on Report, and I hope that that is what we will do.

[Lord Sandhurst (Con)]

My Lords, I will not be long. I speak to Amendment 726, which, as those of you who get that far in the list of amendments will see from the explanatory statement, is one of a number of amendments that I have been prompted to put down by the Law Society. They are intended to make the Bill safer in operation.

I would also like the House to know that I speak free from religious belief, but I do speak as a world-weary lawyer with many years’ practice at the sharp end in both medical negligence matters and legal professional negligence matters. I am all too conscious of my own experience of having seen things go wrong even where the people concerned were decent, honest professionals. Some of them, of course, although professionals, were neither decent nor honest. I have also sat as a legal assessor for five years at the General Medical Council, and I appeared as counsel for a north-eastern NHS trust in a very messy inquiry about 20 years ago about the misdoings of a Doctor Neale, who had featured in a “Panorama” programme—some of you may know about that. I have seen things go wrong on the ground for the past 30 or 40 years of my life.

It is with that in mind that I put down, among others, Amendment 726 with the support of the Law Society. I stress that the Law Society is neutral in principle but has looked at this Bill with what can be described as lawyers’ eyes. Its amendment is designed to make the Bill safer and better in practice. This amendment would “require” and not just permit—that is the difference—the Secretary of State to issue a code of practice in connection with what we are concerned with today; that is, capacity and so on, and the absence of coercion. A code is necessary. In Clause 39 of the Bill, there is provision for other codes of practice to be made; this is simply to add an additional code.

I suggest that this is a perfectly safe, non-destructive amendment that would improve the Bill in respect of a very important practice. As we have heard, coercion—I use the word loosely to cover a wide range of subtle pressures—must be addressed, and it should come from the Secretary of State. The panels that will oversee all this will not be enough. This must come from the Government, looking at things carefully and putting down a code of practice which says: “This is how the panels must address this”. We cannot have a postcode lottery with a panel in one part of England adopting one approach and another adopting a much tougher approach. We need uniformity.

--- Later in debate ---

[Lord Empey (UUP)]

My Lords, there is one aspect of coercion that we have not so far discussed. It was mentioned tangentially by the noble Baroness, Lady Hollins. It is institutional coercion. As somebody who has unfortunately had to bring a loved one into hospital to be treated and discharged on a large number of occasions in recent years, I have become familiar with the process called “clerking”, where an individual is brought into the hospital, the paperwork obviously has to be brought to bear, the healthcare staff have to fill it in and so on.

If this legislation gets on to the statute book, in whatever form, it has to be translated into paper that the health service will have to deliver when a patient is brought into a hospital. We already have the “Do not resuscitate” aspect of an induction, and we will now have to have another set of paperwork. I have seen how it works frequently: the pressure that the staff are under from time to time, and the fact that the people coming and going and dealing with a patient are frequently different and they change at 8 am in the morning and 8 pm in the evening. That paperwork has to be done by an individual, sometimes a relatively junior member of staff, and all these things have to be translated into a box that has to be ticked.

How is that to be done? The actual process that one has to go through, particularly dealing with somebody who is seriously ill, is challenging in itself, and when you have to ask the person, “Do you want me to tick the box that says, ‘Do not resuscitate’?”, that is a big thing to do, and the person needs to be coherent, informed et cetera. We are moving things to a stage well beyond that.

I had the experience of being in a hospice and, while it was not an issue with pain that was the problem, when the consultant comes along and says to your loved one, “Have you considered the D-word?”, that sobers you up. Somebody who was perfect intellectually, who had the ability and the capability, shut down completely and could not cope with, “Have you considered the D-word?”. So, I say to noble Lords, these are emotional things, coercion is a very hard thing to define, but I have to say to the noble Lord, Lord Pannick, that the difference between his scenario and what we are facing is that the state is co-operating, providing the mechanism and delivering the mechanism for a person to end their life. That is the antithesis of what the medical profession and the National Health Service have stood for since its inception.

With regard to how we treat things in this House, when Bills come to us, of course we have a view on whether we are for them or against them. I remember when the Brexit legislation came before this House and I gently remind the noble Baroness, Lady Hayter, that she was not running to try to improve it so that she could get into the Content Lobby. It is the way things are. On an issue such as this, we have to be driven by our conscience, not by our parties or anything else, but let us remember that this will have to be translated into the room where the patient is sitting. What box is a junior nurse or a junior auxiliary going to be asked to tick? What is the question? Who is going to fill it out?

As the noble Lord, Lord Hunt of Kings Heath, said, if we had had a royal commission and a proper government Bill, we could have answered these questions, instead of having to sit here and go through the whole process again. I just ask the noble and learned Lord, Lord Falconer, to bear these things in mind. These are gaps in the system which the staff are going to have to face. There will be shifts coming on and there will be some members of those shifts who will refuse to participate. What kind of chaos is that going to create? These things need to be thought through and they are not thought through.

[Baroness Hayter of Kentish Town (Lab)]

I just remind the noble Lord, Lord Empey, that of course I did vote for the Brexit legislation and in fact led the Labour Party into the Lobby to support the final agreement on Brexit.

[Lord Harper (Con)]

My Lords, I support the thrust of the amendments in this group, but first, I want to say a word or two on one of the issues that has come up in this morning’s debate. I hope the Committee will indulge me if I just quote a few lines from yesterday’s maiden speech by the right reverend Prelate the Bishop of Chester. The House was a little less well-attended for the debate on the Sustainable Aviation Fuel Bill in which he spoke, but I thought his words yesterday, the ones I am going to read, are very relevant to the debate and the tone of it, so I hope the Committee will forgive me. He said that

“communication is a vital gift for those of us who nurture and curate community. In communication, we need to learn to speak and to listen. This is almost always done in person and directly. Indeed, I argue that one of our primary vocations in this noble House is to be with and to listen, for few disciplines are more vital in the search for wisdom—the search I so often witness in your Lordships’ House. The question for me is not so much how we can be great again, but how we can be kindly present. Greatness is great, but grace is greater”.—[Official Report, 20/11/25; col. 965.]

I think those were wise words. They moved me and I think they are relevant to how we conduct ourselves in this debate on these vital issues.

The noble Lord, Lord Carlile, referred to how useful this debate was, and I believe that it is vital. That is why I quoted those words from the right reverend Prelate. We have raised a range of issues, all connected to people’s capacity to make an informed choice. The point of the debate is for us all—but especially the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton—to listen to the concerns that have been expressed. I agree with the noble Lord, Lord Carlile, that the noble and learned Lord will then have the opportunity to talk to noble Lords and to bring forward on Report amendments that deal with these issues.

Part of the problem here, and the reason there are many amendments on the Marshalled List and the debate will be lengthy—the noble Lord, Lord Watts, referred to that—is that the House of Commons spent, I think, 17 hours in Committee, focusing on just the first three clauses of this legislation because they are very important. That involved just 23 Members of Parliament. Almost all the proposals that we are discussing were brought up in the House of Commons, but almost all were rejected or disposed of. If some had been accepted and dealt with in the House of Commons, all we may have been doing here is tidying up some of the wording or improving the amendments. However, we have to address them from scratch because they were not dealt with in the House of Commons.

It is our job in the House of Lords to scrutinise legislation and to deal with the things that have not been dealt with. We do that on behalf of people— a number of today’s amendments deal with vulnerable people who do not have the same opportunities that we have. The one thing that we all have in common in this House is that we are all privileged. I am referring not to our material circumstances but to the fact that we have a voice. Many people in this country do not have a voice. Many of the people who have been touched on in these amendments—people of poor material circumstances; people undergoing coercive control, as my noble friend Lord Gove suggested; and people who have severe disabilities—have no one to speak for them. It is our responsibility and duty to make sure that we test these issues and make sure the Bill is as good as it can be.

The noble Baroness, Lady Hayter of Kentish Town, asked whether the noble Lord, Lord Carlile, would support the Bill if some of these things were dealt with. That is not really the question. I have been very clear that I do not support the change, and I will set out why in a moment in relation to one of the amendments. However, I have to confront the possibility that the Bill may become law; I will not find that welcome, but the noble Baroness will. If it becomes law, it is absolutely my responsibility—and the responsibility of everyone in this House—to make sure that the Bill has in it all the protections for vulnerable people. If we were to fail to do that, we would have failed the people of this country, whom we are supposed to support—that is our duty. There will be some people in this House who will, if the Bill is improved, support it; there are some who will not, but that is not the point. The point is to get the Bill in as good a shape as possible.

Let me now turn to the amendments. I will deal first with Amendment 45 on encouragement, so powerfully spoken to by the noble Baroness, Lady Fox of Buckley. The reason that word is important was demonstrated in the short debate between the noble Lords, Lord Pannick and Lord Carlile, on the present position. I hesitate, as a humble accountant, to trespass in the debate between those learned noble Lords, but I will make two points. First, there is a fundamental difference between someone refusing treatment or not having treatment and someone taking deliberate steps to kill themselves. Those are fundamentally different things, and trying to elide them is not helpful to the debate.

The noble Lord, Lord Pannick, talked about the status quo. As I understand it, the current position if you assist somebody to take their own life and the DPP investigates is that the guidance contains the concept of encouragement. There is a specific point, when the DPP is considering whether to prosecute you, about whether you have encouraged somebody to take their own life or tried to talk them out of it. If you have encouraged them not to take their own life but you have, none the less, assisted them, the current position is that that is treated much more favourably than if you had not tried to discourage them. That subtle position in the status quo is something we should maintain, because something very important will happen if this legislation passes, which is why I do not support it: it will, effectively, change society’s view of suicide. In some circumstances it will, effectively, support suicide where currently we do not. In those circumstances, the use of “encouraged” is vital. That is why I support the amendment.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Lord Moore of Etchingham (Non-Afl)]

My Lords, I support the amendment from the noble Baroness, Lady Berger. It is reasonable to have these considerations about the different ways people think and feel at different times in their life. One of the big discussions we have more broadly about the Bill is about the cognitive capacities of old people, which are very important in their freedom of decision.

In a similar way, it is reasonable to talk about the cognitive capacities of very young people. In particular, one of the things that makes very young people different from older people is that they naturally have very little encounter with death; they are much less likely to have come across situations in which people die and people they know have died. They simply do not know what it involves. If it were banned throughout the world that anybody under the age of 25 would fight in a war, we would hardly have any wars. One reason why soldiers are prepared to fight in wars is that they do not understand death when they are very young. They are ready for anything.

There is often a very strong culture of suicide in young people, because it is a romantic idea. The poet Keats expressed it absolutely beautifully in his “Ode to a Nightingale” when he speaks about being

“half in love with easeful Death”,

and the joy of ceasing on the midnight with no pain. He knew of what he spoke, in a sense, because he was suffering from a terminal illness, and he died before he was 25.

As the noble Baroness, Lady Berger, and others have brought out, we need to think about the influences on young people who may go in that direction. If they suffer from a terminal illness, that becomes even more acute. Because of their lack of experience in these matters, they will be under greater pressure, quite possibly, to feel that suicide is the way out and is somehow a noble thing to do.

I remember, at school, there was a very brilliant boy who was 18 and wrote a very short poem that just said, “If I should die, think only this of me: ennui”. It was a very clever thing to write, and he subsequently committed suicide aged 19. I ask noble Lords to think about what it might be like in such a situation at such an age.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, the people we are talking about are dying, in suffering and in pain. They are not being offered; they are going to be asking. I think of a 23 or 24 year-old in pain and about to die, possibly within weeks or months, and we turn around and say, “I am really sorry. You have had children, taken big decisions in your life, taken career decisions and seen whatever has happened to your parents, but you cannot be helped in your last few days, weeks or months because you are only 24”. I find that extraordinary. The age of 18 is probably the right one. Can we remember that these people are dying, and they are suffering? Those are the people who will be applying for this.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I tabled Amendment 20 and I have put my name to Amendment 220, in the name of the noble Baroness, Lady Foster, who is not able to be here today. I am sympathetic to Amendments 21 and 29 and to the process devised by the noble Baroness, Lady Lawlor, in her Amendments 30B, 265A and 443A.

A huge range of clauses—Clauses 7, 8, 10, 12, 15, 19, 20, 23, 24, 28, 29 and 30—refer to the applicant’s GP practice and the importance of keeping a GP informed. Clause 12(2)(f) includes a provision for the assessing doctor to recommend that the applicant informs their GP practice. These amendments also refer to the very relevant information that may be available from those who are close to the person seeking assisted death.

There is an assumption that the GP knows the patient and that the patient has an ongoing supportive relationship with the UK GP practice. Notwithstanding what the noble Baroness, Lady Gerada, has just said, that is no longer the case for many people. Many patients now see different clinicians on each visit. Locum and temporary staffing arrangements reduce the possibility of a GP being familiar with the patient’s condition or with the context in which they live. Home visits have almost disappeared. People in need of care often have to go to A&E, since doctors no longer visit as they once did. A major theme in UK and international data on GPs is declining continuity of care, particularly where people live in poverty or deprived areas. The Government’s equality impact assessment notes that such people experience “poorer quality healthcare”. They

“have a higher patient to GP ratio … have worse continuity of care”

and

“are more likely to struggle with navigating the healthcare system”.

Amendment 20 in my name would provide that it is not enough to be registered with the GP, but that there must be an established relationship between the GP and the patient. The GP must be able to certify that they have good knowledge of their personal circumstances, having seen the patient at least four times in the year and made at least one home visit in the last 12 months. As I said, the reality today is that many sick and elderly people do not have the relationship they might like with their GP; it is a thing of the past. Moreover, when a person moves into a residential or nursing home, they are often required to change to the GP who attends that facility and who may only have seen them on a few occasions, if at all. A GP who does not know a patient may not have the ability to make the necessary assessment.

The Select Committee heard evidence highlighting the very real inherent difficulties in detecting coercion, pressure and complex capacity issues. Making someone feel that they are a burden does not normally happen by direct coercion but is more likely to occur over a period of time. The National Care Forum stated:

“Our members are concerned that some of the people they support may sadly already see themselves as a burden. This can be financial, or just because they are now reliant on those who once relied on them. The concern is that this makes them vulnerable to deciding for this reason alone, or as a result of exploitation”.


Dr Annabel Price of the Royal College of Psychiatrists said in her evidence that coercion

“is everybody’s business. It is an area that is difficult to rule out confidently”.

It needs to be thought about throughout the process, not just at the scrutiny at the end of the panel. Professor Patel, president of the Royal College of Physicians, said in his evidence:

“Involvement of family within decision-making is important … I feel that the complex decision-making is hard. It has to be shared”.


Amendment 220 would provide a mechanism to allow GPs to consult with those who have a close interest in the applicant’s welfare when there are concerns about safeguarding capacity and undue influence. Such concerns, regrettably, often arise. Family members and close contacts may possess information which could be vital for a robust assessment and which is otherwise unavailable to the assessing medical practitioner.

Professor Katherine Sleeman said that

“complex capacity assessments do conventionally require triangulation, with input and information from the family”.

This amendment would allow access to professional records, including police and local authority records. Medical practitioners may be unaware, for example, of existing domestic abuse situations which have been reported to the police but have not made their way back to the doctor, where you have got a patient or an elderly person.

It should never be the case that the first time that somebody finds out that a family member has been granted a request for assisted dying is when they are asked to go to the mortuary to view the body. Anybody with any experience of the situation in which a person dies by suicide will know the terrible shock and trauma which ensue for surviving family and members. The reality is that, by extending the concept of autonomy to this extent, there can be a terrible impact on the ability to function of those who love the person who has died. Autonomy in this context can cause serious medical problems for those who are left behind. Autonomy, to the extent provided for in the Bill, does not ensure sufficient protection for a vulnerable—

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness accept—because she has been quoting some of the evidence given to the Select Committee of which I was a member—that the committee was not able to hear either from people who were dying or indeed from the families who had been through what she is talking about? That was absent; we lost that. On the particular point she raises about the first time a family may know about it, might she also reflect that the evidence was that most families try to discourage somebody from taking their own life rather than the other way round?

[Baroness O’Loan (CB)]

My Lords, I thank the noble Baroness for her intervention. It is of course the case that the Select Committee was very truncated in its ability to hear evidence. That was a decision of the House and, although we would have preferred to hear evidence from others, it was not possible.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Markham (Con)]

My Lords, I have found this debate to be very helpful, because we all of course want the safest processes possible in all of this. It is clear that we are all reaching to try and find a way that we think will work. To a certain degree, it is all down to whether the best way to do this is through a multidisciplinary panel or a judge-led court process.

The example that the noble Lord, Lord Carlile, gave in terms of life support is quite illustrative, because life support decisions are made by medical professionals. In the vast majority of those cases, they then go through on the basis of that professional advice. It is only in the edge cases or serious cases where there is an appeal process that the family can take to court.

On this proposed process, there is a multidisciplinary panel, very well described by the noble Lord, Lord Pannick, which includes a psychiatrist, social worker and judge—the professionals in this particular area—who will be very well placed to reach a decision in a similar way to life support decisions for which, in the vast majority of cases, everyone is happy that it is the safest and right decision. There is also the oversight role of the commissioner, who is of course a judge in this process and, rather like the example of the life support case, has the ability to oversee and review that case where there are serious concerns. The life support example is a very good one here, given that we are trying to adopt a similar process in the multidisciplinary panel with the oversight of the commissioner.

On a way forward, it may be for the noble and learned Lord, Lord Falconer, and the noble Lord, Lord Carlile, to discuss how those cases can interact. Where the multidisciplinary panel might need oversight, the concern is how that can be triggered and how that can be worked out in terms of the commissioners. We have a framework there that, like the life support example, can get the best of both worlds. That could prove a constructive way forward.

[Baroness Hayter of Kentish Town (Lab)]

I will take the advice of the noble and learned Baroness, Lady Butler-Sloss, and now get rid of what I was going to say, because the noble Lord, Lord Markham, has said most of it. I now have only three points to add, so I thank the noble Lord for that.

First, the big discussion is on whether it should be a court or panel. The reasons for the panel have been put, so I do not need to repeat that. The only thing I would say is that when this was discussed in the Commons, it was not about the capacity of the courts that made them make the change to a panel but about the advice they got that this would be a much better, holistic and patient-focused way of doing it. In fact, making sure that that bit was added was very much welcomed by the British Association of Social Workers and the Association of Palliative Care Social Workers.

Secondly, the mention just now of legal aid says it all. Surely, we do not want this to be an adversarial process. It should not be argued in front of a court that way. I want to be very brief, because I am taking the advice of the noble and learned Baroness to be very brief, but we want this to be a conscientious decision and not one that is adversarial, which is why I think the panel would be so much better.

Lastly, this is not a life-or-death issue, because these people are dying. We are discussing only when they die, not whether. That is different from deciding that a baby will die who was not going to die anyway, or even someone in a permanent vegetative state. That is why I really do not agree that it is right to use the word “suicide”, rather than “assisted dying”. People are dying, and this is the issue of when they die and not whether.

[Baroness O'Loan (CB)]

Is the noble Baroness aware that we are discussing the possibility of having either a panel or a court process? The research and reports show that families and individuals have great difficulty negotiating the Family Division of the High Court and the family-designated judges processes. Legal aid may well be necessary to assist in some of these matters.

--- Later in debate ---

[Baroness Finlay of Llandaff (CB)]

My Lords, the noble Lord, Lord Carlile, has done us all a great service. Last night, it was clear that there is a view that some really major parts of this legislation need to be addressed and debated. This is absolutely one of those major parts. It is about where decision-making finally sits. The noble Lord has provided a clarity that could improve safety in relation to the Bill—I will not say to make it safer but to make it less unsafe—and that becomes important.

The scheme that the noble Lord has proposed would reinstate a court-based model that was previously welcomed when the Bill was introduced because of the clarity of decision-making that it provided. On the process of assistance with suicide or having an assisted death, we are not going to argue about the wording here now. That is not appropriate. The clauses relating to the specifics of the lethal dosage of drugs both make the death part of the process clearer and provide better governance oversight. The process also seems to provide some protection for NHS services by putting the decision-making outside healthcare, with clarity of the roles between the two.

I added my name to the amendment to strengthen the conscience clause, Clause 31, so that no registered medical practitioner is under any duty to perform a function in relation to this Bill other than those of notification and recording matters. This avoids eroding NHS clinical services and maintains the core duties and responsibilities of the NHS. It will be particularly important if legislation is passed in Scotland, because we need compatibility of the conscience clause between England and Wales and Scotland. The legislation currently going through in Scotland will have its draft conscience clause removed at the time that the Scottish Parliament goes to vote on it, because the provision of such a conscience clause is not a devolved matter. The exercise of conscience not being a devolved matter will require a statutory instrument passed from this House, or possibly even primary legislation, for it to be then included later in the Scottish legislation.

The noble Baroness, Lady Berridge, raised concerns about the wording of proposed new subsection (1) in Amendment 116. I wonder whether the noble Lord, Lord Carlile, would consider changing that to incorporate the amendment that I have tabled—the proposed new clause would replace Clause 3—over the assessment of capacity. This amendment was developed by the Complex Life and Death Decisions group at King’s; the national expert on mental capacity assessments sits as a key member of that group and as a professor at King’s College.

I hope the proposers of the Bill will recognise that proposed new subsection (2) in Amendment 116 provides very important minimum criteria that must be provided: questions that must be asked when such a decision is to be made. The court can certainly ask for them to be provided to it. It seems as if a panel would be discretionary over whether these criteria were looked at, and it would strengthen confidence in the decision-making to know that they were there, because it would provide transparency and consistency, and a process of appeal would be available. We know that no appeal system exists in the Bill as currently written in relation to panels agreeing to an assisted death being provided, and the real concern there is that these panels could eventually become something of a tick-box exercise under quite a lot of process. As has said been said before, those with a judicial background are not acting in a judicial capacity on the panels, whereas the proposal by the noble Lord, Lord Carlile, provides judicial capacity and processes.

The amendment that seems to be key is Amendment 120: its proposed new subsection (4)(b) would require a statement of medical fact, with the decision-making being taken by the court. Again, it will be much easier for people to provide a statement of medical fact than to feel that they are taking a decision over the provision or non-provision of lethal drugs. In proposed new subsection (5)(a), I hope that the doctor has to be on the specialist register for the specific condition of the patient—I seek clarification on that—or to have been a GP principal for longer than three years. It is important to be clear that this should not be a doctor who is at a training level, even if they have been a trainee for more than three years, because the ultimate responsibility sits with the consultant or the GP under whom they are training. There could be confusion over responsibility if this is not clarified.

On Amendment 120’s proposed new subsection (6)(a), can the noble Lord, Lord Carlile, confirm that it may be not the GP at all who is involved but a hospital consultant or long-term associate specialist who has been providing medical care? These might seem like minutiae, but we are in Committee and discussing amendments that can be changed, and I think it will be important to have that clarity.

It seems that proposed new subsection (5) in Amendment 426 seeks to provide additional security with a court-appointed medical expert. This proposal seems to protect us against going down the route that Canada has gone down. It seems to really attempt seriously to detect undue influence. Allowing interveners is very important; it is all part of the desire for there also to be an appeals process and of getting all the information.

I stress that there is a clarity between decisions about whether somebody is given lethal drugs to significantly shorten their life, accepting that a prognosis of six months is not much more than a guesstimate—in fact, it is a guesstimate—and the position that has been discussed over life support decisions. When a patient is on life support, the decision to cease that intervention is based on two potential factors: one is the futility of continuing with an intervention that is not achieving a therapeutic goal, and the other may be because the patient withdraws their consent for continuing that intervention in an informed way and has capacity to do that. That is fundamentally different from somebody providing lethal doses of drugs with the deliberate intention to shorten a person’s life—which may be by days, weeks or months, but may be by years. As has already been said, we all have experience of people given a very short prognosis that turned out to be completely wrong.

I have some questions for the noble and learned Lord, Lord Falconer. I know that he has already been given a large number of questions to answer, but I think it is really important. First, in 2024 he stated that

“family judges are … completely unsupported”

and that the family justice system is—I think I can quote correctly—“literally crumbling”. Were these the reasons behind the removal of the court oversight when the Bill was considered in the other place?

Secondly, in discussing these proposals with officials, what assessment has been made of the volume of cases outlined in the impact assessment being handled by this system, and what provision has been made for recognising that the numbers in the impact assessment are almost certainly inappropriately low? The data from Australia, New Zealand and other places has shown that, by year three, the uptake will probably be about 10 times higher than written in the impact assessment, because the impact assessment was based on data from quite a long time ago, when the Oregon system was instigated.

Thirdly, what costing has been undertaken for each of the models—the model of the panels as put in with the different numbers that might be involved—and what consideration has been made for a costing over this model?

I ask the Minister: what budget has been put aside to fund the system, whichever model is adopted, and what option appraisal has been undertaken over the safety of individuals and the ability to identify coercion with a higher degree of probability than currently exists and to identify abusive relationships?

As I have said, the financial costs for each model, tested against the impact assessment numbers, appear unrealistically low. I think we all look forward to the questions being answered.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, given the number of questions that have been put to the Minister—and, indeed, to my noble and learned friend and to the mover of this amendment—I wonder whether it might be useful if we now move to the Minister and the others to answer some of these questions. There are so many that it would really help the Committee if we could hear some of the answers.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, thank you. If there is one place where language matters, it is in the Bill before us. As a young disabled person, I used to interchangeably use “person with a disability” and “disabled person” and did not understand the importance of that. In later amendments, I will argue that “disabled person” is much better phraseology to use.

Language is the dress of thought. We are all spending many hours working on this Bill, but, if the outside world does not understand what is meant by “assisted dying”, we could be in a situation where somebody with learning disabilities or who uses British Sign Language, who has not spent as much time as we have interrogating the Bill in every single session, might not understand what they are signing up to. Personally, I would prefer something around “died by suicide”—that is something else that can be finessed as we go through the Bill.

The BMJ published an article that showed how poorly understood the phrase “assisted dying” was. This highlights the problem that we are facing: the phrase is poorly understood and creates confusion. Just 43% of respondents thought that “assisted dying” involved

“the provision of lethal drugs to end somebody’s life. The majority believed the term meant withdrawing life-prolonging treatment or providing hospice-type care”.

That is something we must consider. The noble Lord, Lord Winston, talked about how the Bill should be largely workable. It should be workable, but it should also be safe. Part of that safety is about the public understanding what they might be signing up to.

In other groups, we have talked about doctors and medics, and I have many in my family. There is nothing more medic-like than using very long words and things that the public do not necessarily understand. Not everybody is an expert patient. We must be clear about what we mean in the Bill. We should stop hiding behind phrases that people may choose to use. To be clear, I have used the term “assisted dying”, because I try to be very thoughtful of the people who do not like “assisted suicide”. However, I have used “assisted suicide” today, and I will from now on, because that is what the Bill is going to do to the people who sign up to it.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I will speak, given that we are going to continue until 5.30 pm and the noble Baroness, Lady Fox, has mentioned me. The problem with removing the word “dying” is that it does not give to the public the absolutely key bit of information, which is that these people are dying anyway. We are talking only about people who are dying. That is what the Bill is about: people who have less than six months to live. They are dying. We may have a theological belief that we are all dying, and that each day we get nearer to that, but let us put that to one side.

The removal of the word “dying” would be the worst way to tell people what this Bill is about. The Bill is not about assisted suicide for someone who just decides that they want to commit suicide or have a suicide death—I do not like the word “commit”. It is not about people who suddenly say that they want to commit suicide because of this, that or the other. We are talking only about a cohort of people who are dying; remove that from the Bill and it is less likely to be understood.

[Lord Hamilton of Epsom (Con)]

Does the noble Baroness not share my concerns about the misdiagnosis of six months, when you think of all the people who live for much longer afterwards?

[Baroness Hayter of Kentish Town (Lab)]

While that is absolutely a legitimate thing to discuss, and I would always defer to doctors on that, it makes no difference to this part of the argument of whether we call it dying. The noble Lord may well want to raise the question of whether we can ever be sure that someone is dying, although I have to say that I cannot be the only one who has been with someone where it is jolly clear that they are not going to live till the end of the week. There are times when you absolutely know that someone is going to die. While he may well be right that there are other cases, that is not the issue of this word. This word in the Bill is to give to the public the understanding that we are talking about whether there is a way of helping either the final timing or the way of those final days. We are not talking about someone who just decides to commit suicide for some other reason; we are talking about people who are dying from some sort of terminal illness.

[Lord Kamall (Con)]

My Lords, I remind the Committee that I am one of those who are still balancing the arguments on the overall Bill, and where I get put off some arguments is when people heckle those who are trying to make a point. I do not think it helps their cause. On the other side of the argument—I am trying not to sound as if I spend my life sitting on the fence—those who speak much longer than they need to in making a point also make it difficult to support some of the points that are being made. On future Committee days, I would like to see a bit more mutual respect between the different sides of the debate, with shorter points made but also less heckling of those who want to make a point. It is important, if we are going to say that we are doing our job in scrutinising the Bill, that everyone who wants to make a valid point, relevant to the amendments, is allowed to make it.

I thank my noble friend Lord Frost for tabling the amendments in this group. I recall that at Second Reading my noble friend Lord Moylan spoke about the importance of language. Language is important, especially clarity of language, so I understand my noble friend’s intentions in tabling these amendments. One could argue that there is a distinction to be made between the terms “assisted dying” and “assisted suicide”. “Assisted dying” on its own, before you even consider the Bill, does not necessarily mean consent on the part of the person whose life is being ended. The Bill introduces that element of consent, but “assisted dying” on its own does not mean consent, whereas it could be argued that the term “assisted suicide” conveys some form of intent—that it is a person seeking to end their own life, they want to do so and are not being assisted to die, regardless of whether or not they want to die. That may seem to be a philosophical point, but it is important that there is a distinction between assisted dying and assisted suicide. As the Official Opposition, we have no collective view, but it is a legitimate challenge by my noble friend to the language of the Bill, seeking clarity or, as the noble Baroness, Lady Fox, said, transparency.

Noble Lords have argued that people in this country should be able to access the services that people can access from Dignitas in Switzerland. However, Dignitas is described as offering physician-assisted suicide. Looking at the Dignitas website—not because I have lost the will to live after trying to get through a day of debates, but to look at the language—I see that it uses the phrase:

“Legal assistance for suicide with DIGNITAS”.


So we have to ask ourselves: if we are trying to be consistent with Dignitas, why is it okay for Dignitas to use the language of “suicide” but, when people want that same service in this country, we cannot use that language?

[Baroness Hayter of Kentish Town (Lab)]

That is exactly because it will take people who are not dying. This is not what this Bill does.

[Lord Kamall (Con)]

That is a fair point to be made. It is why the question was asked, and I thank the noble Baroness for answering it.

I thank my noble friend Lord Frost for provoking this debate, because there are still other arguments for using the phrase “assisted suicide”, particularly in terms of clarity. I look forward to the consideration of the arguments made by my noble friend Lord Frost from the noble and learned Lord, Lord Falconer, and the Minister.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

If we are talking about informed consent and approval of lethal drugs, we need to know: will there be a commitment to undertake proper research to ensure that patients have accurate information about how the lethal drugs that they want will work, what side effects may occur and what they must do to self-administer? If they opt not for oral ingestion but to use some device, as has been suggested, we also need to know that the work has been done to make sure that the device will maintain deep sedation while they die, rather than risk them reawakening. Will the noble and learned Lord, Lord Falconer, state the drugs processes in more detail in the Bill? I am sure that he will say that the types of drugs used are bound to change over time, as they will, but that does mean that we should not state in the Bill what may happen.

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness agree that, if we do not pass the Bill, people will continue to self-administer drugs that they obtain from who knows where or, as some of us know, hang themselves or take themselves into a car and use the exhaust pipe? Am I right that the noble Baroness seems to want to add something that is not there now for people who take their lives in the same position?

[Baroness Finlay of Llandaff (CB)]

That is a very helpful intervention because the evidence from the places that have gone down this road and changed their legislation is that the unassisted suicide rate does not fall. This does not seem to prevent suicides from happening and these amendments are about people having information. With these amendments, we are not debating whether the Bill passes; we are debating the contents of the Bill and whether it is safe for patients.

Given the problems, I ask the noble and learned Lord, Lord Falconer: is there a plan to relicense drugs that in this country are available only for veterinary use, for the purpose of ending the life of patients here?

--- Later in debate ---

[Baroness Berridge (Con)]

Sadly, for the noble and learned Lord, I think that there are more amendments that need to be discussed, including one that I have laid. We have all discussed this on the basis that there is no one else in the room. There could be relatives there expressing a wish. We have discussed this on the basis that the patient rises and has capacity. They may not have capacity and there may be relatives in the room with enduring powers of attorney. The noble Baroness, Lady Hayter, shakes her head, but there are many scenarios in which there is not clarity in the Bill between the moment the drug is administered and the moment of death or it fails. I am afraid that I give the noble and learned Lord notice that I think we will have to come back to this, because the medical profession is asking for clarity.

[Baroness Hayter of Kentish Town (Lab)]

Can I put it on record that I am not shaking my head? I think it was made clear that the power of attorney could not be used for this purpose.

[Lord Blencathra (Con)]

This has been another interesting debate. Possibly more important than the speeches that we all made at the beginning has been the last 40 minutes of real debate and interchange with the noble and learned Lord. I am left with the feeling that many colleagues in the Committee feel that there are a lot of unanswered questions and some uncertainties that we may need to return to.

However, I will follow the instructions of the Companion and the Government Whips, and I will not seek to respond in any detail to the many good points raised by noble Lords. I merely wish to remind the Committee that in the debate we heard from the noble Baronesses, Lady Coffey, Lady Lawlor, Lady Hollins, Lady Berridge, Lady Finlay of Llandaff and Lady O’Loan. We also heard from the noble Lords, Lord Empey, Lord Harper, Lord McCrea, Lord Carlile of Berriew, Lord Wilson of Tredegar and Lord Mawson. What they all had in common was that they were deeply concerned that the definition of informed consent is not strong enough in the Bill and something more needs to be added.

I think that the noble and learned Lord relied on Clause 12(2)(c)(iv). The doctors have to discuss

“the nature of the substance that is to be provided”

and, in Clause 12(2)(d),

“discuss with the person their wishes in the event of complications”.

However, there is nothing in there to say that they have to discuss the complications with them or the possible side effects. The noble and learned Lord may pick me up on this if I put the wrong words into his mouth, but I think that he said that explaining the nature of the substance could possibly—I think that he used that word—include discussing the possibility of complications and side effects.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Lord Harper (Con)]

My Lords, I had not intended to say anything, but I was provoked—in a nice way—by the noble Lord, Lord Rooker, and his advice, which was well meant, to the sponsor of the Bill, the noble and learned Lord, Lord Falconer. I agree with him, but I think a bit more work is required.

I referred earlier to the letter that the noble and learned Lord sent to Members of the House. I urge him to test his mailing list, because it did not go to all Members; I received a copy of it only from another Member, and it would be helpful if we all received a copy. I now hear from my noble friend Lord Deben that he has not received it at all.

I have two things to say. First, I absolutely agree with the noble Lord, Lord Rooker, about the Delegated Powers Committee’s recommendations. It was pretty scathing about the number of powers the Bill gives to Ministers with very little oversight. If I am being fair, the noble and learned Lord, Lord Falconer, has engaged extensively with the recommendations of the committee in what he has set out. That is the good bit.

But I do not think the noble and learned Lord has really taken on board the point the committee made because he has largely, as I see in his amendments, preserved the Bill’s delegated skeletal architecture. Rather than limiting executive power and putting safeguards and limits in the Bill, he has added in all sorts of things, such as scrutiny and consultation, at the back end. He has not actually got the point, which is that the Bill should not have those delegated powers in the first place. Exactly as the noble Lord, Lord Rooker, said, I humbly suggest accepting what the committee said and following its recommendations. That would be helpful.

The second point is about pace. The Delegated Powers Committee reported in September last year, and only half way through Committee we got a letter from the noble and learned Lord, Lord Falconer, setting out his response to it. My experience as a Minister was that if we had received the report from the Delegated Powers Committee, as the Minister I would have been expected to have my response ready at the start of Committee—or, frankly, Members of your Lordships’ House would have stood up and said some very disobliging things.

[Baroness Hayter of Kentish Town (Lab)]

The noble Lord would have had a whole department and civil servants behind him at that time.

[Lord Harper (Con)]

I have two points to make on that intervention from the noble Baroness. First, on several occasions the noble and learned Lord has made reference to quite a significant number of officials that he has had working with him, helping him draft clauses and so forth. If the argument is that that is still not enough resource, that rather supports my contention—which I have made from the beginning—that the extent and nature of this legislation makes it absolutely not suitable for a Private Member’s Bill, and it should have been a government Bill. As I said, the noble and learned Lord has had extensive support from not just one but a number of government departments in helping him draft it.

My second and final point is on the issues that have arisen so far in Committee, particularly the issues that have arisen on Clause 1, which I think is why it is relevant to bring it up on the Clause 1 stand part debate. The noble and learned Lord referenced them in his letter, but he has not yet been in a position to set out what his amendments are going to be. He said that he will make them available as soon as he possibly can. That is good, and I welcome that, but, until we see them, we are not in a position to know whether further amendments need to be tabled for later in Committee or on Report. I finish by saying that I agree with the noble Lord, Lord Rooker. The extent to which we can now make progress is going to be largely governed by the extent to which the noble and learned Lord the sponsor of the Bill engages with the very fair criticisms that have been made across the Committee. We will listen carefully to what he says in response to this debate and in subsequent groups.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

Finally, when the Minister replies, can we please not have the bogus excuse we have heard in almost every single group that the proposed amendments are probably contrary to the ECHR? The Government keep pulling that poor rabbit out of the hat and its ears are getting a bit battered by now. I beg to move.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I was not able to be here this morning; many noble Lords will know that I spend much of the mornings, most days, in a care home—very often two or three times a day. My husband is being brilliantly looked after in one of the most brilliant care homes. I should have got their names this morning and I could have given them all a shout-out, but I will simply say that Bridgeside Lodge is one of the most amazing places for looking after people.

I must say to the noble Lord who moved this: I do not know whether he spends as much time in care homes as I do, but they do everything possible to keep their residents alive, well, well fed, replenished and amused, and to give them a quality of life that I think would be appreciated by everyone. But, of course, a lot of people in care homes are very ill, and some of them will be exactly the sort of people who may well need this.

It is a bit condescending to think that all those people are vulnerable. Most people in the care home do not know what I do. They think that I am a doctor sometimes, because I am known as Dr Hayter—I have a PhD, but I am not a doctor. But one of them discovered the other day and grabbed hold of me and said, “You won’t let them stop it, will you?” This was a very senior medical physicist, a professor of physics at UCL. I will give a shout-out to him by name: Andrew Todd-Pokropek. These are people in care homes with capacity who know exactly what they are doing and are urging me and others in your Lordships’ House to get this Bill through. Some of them will know that they are exactly the sort of people who may well want to make use of it, although not now.

The idea that the doctors looking after them, who are specialists in geriatric care, are somehow incompetent and that we should somehow need an extra layer of safeguards, is not living in the real world. So many people at the end of their lives will be in care homes, hospitals or hospices, and the idea that we would almost exclude them from the normal way of this Bill seems to me extraordinary. I hope that the noble Lord and others will think very carefully before saying that the exact cohort who are already ill should somehow be excluded from the normal trail of this Bill, because that would really be inappropriate. I urge him to withdraw his amendment and think very carefully before he pushes it again.

[Lord Deben (Con)]

I have some sympathy with the noble Baroness. She is very fortunate with the care home her husband is in, as is he. For many years, I represented the constituency that had perhaps the largest number of care homes in the country. Suffolk Coastal is an elegant area, and with towns such as Southwold, Aldeburgh and Felixstowe, it is a natural place for them. I would, of course, visit them on a regular basis, as indeed did my wife.

I have to say to the noble Baroness that the difference between the best and the worst is very considerable indeed. In grave humour, if I displeased my children, they would mention the worst one as the one where I might be placed. I put it like that because they recognised it, too: the very considerable difference. The reason why I think the amendment from the noble Lord, Lord Blencathra, so important is precisely because it does not exclude people. It says that the conditions of care homes are such that it is important to protect people rather differently, because of our experience. Some of the care homes in my former constituency are absolutely wonderful, with really good care by really good clinicians. However, I cannot say that that is universal, so I think we should have some protection—and this seems to me to be very sensible and it does not exclude anybody.

The noble Baroness suggested that this would exclude people, but this is a proposal that would protect those who are less happily off than the noble Baroness and her husband. It is very generous of her to share her current concerns: mine are not as current, but they are very much wider and from a much longer period. I looked again at the devastating effect of Covid, which came after my membership of the House of Commons, because of connections that one had—and that has made me even stronger in my belief that we should be especially concerned for those in care homes, not because of the best or even the average, but because there are many where people would otherwise be vulnerable.

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[Baroness Smith of Newnham (LD)]

My Lords, like the noble Baroness, Lady Hayter, I have recent experience of visiting care homes. My late father was in a care home from November 2024 until December 2025. Unlike in the noble Baroness’s case, although he was well cared for, there were a range of issues that I was aware of while he was in the nursing home, and in the period before he entered the nursing home, that might be relevant for noble Lords to reflect upon, not least because they also provide a lesson for those the noble Baroness has talked about who are in nursing homes but still have capacity, are able to form a view and would be able to say, “I still want an assisted death”.

The reason why I say that is precisely because of issues of fluctuating capacity, infection, delirium and medication. Before my father went into a nursing home, there was a period when I assumed he had dementia. He was becoming more and more vague. He was on a new medication, and over time the doctors had said, “Double the medication”, then, “Quadruple the medication”, and he became more and more vague and did not seem to know who I was.

Then, for whatever reason, the medication was changed. This was nothing to do with dementia or mental capacity; it was to do with blood pressure. The medicine was taken away and something else was put in its place, and my father returned. It happened to be around Easter, and it was like some Easter resurrection. He was able to function normally, as he had before.

Then my father got pneumonia, went into hospital and was let out into a care home. In the home, they said, “We’re slightly worried about cognitive decline and impairment”. At a review meeting they went through his medications, and I said, “Can you tell me everything he’s on?” They listed the medicines again, including doxazosin. I said, “Why’s he on that? That caused problems before”, and they said, “We don’t know, really. The hospital put him on it”. There had been nothing in his medical notes to say, “Don’t use this medication”.

The new GP, to whom my father had been referred, spoke to me on the phone and was entirely happy to accept my wholly non-medical suggestion that this medication was not appropriate. He was taken off it again, and a mental health practitioner was asked to call me. The suggestion had been that my father should have a capacity test while in the nursing home, but this practitioner said, “To be honest, there is not much point, because if somebody’s been in a care home for more than a few weeks they’re not even going to know what day of the week it is”. So the view was they would not bother testing my father for capacity. He subsequently had on his death certificate that he had vascular dementia. If a full capacity test had been done, maybe that would have been diagnosed at a point before he died rather than after. It was never fully diagnosed while he was alive: there was merely a suggestion that there might be an issue.

The point is that if medication can affect somebody who would otherwise have capacity, it might affect the resident that the noble Baroness, Lady Hayter, referred to. In a nursing home, that person could equally get an infection or be prescribed something for which there were contraindications, but would there be sufficient recognition of that? Although some nursing homes will have brilliant care, not all of them will, and my father was—

[Baroness Hayter of Kentish Town (Lab)]

Would the noble Baroness accept that could have been even more so than if her father, or my husband, were at home all day without any medical or nursing staff around them? These people are more likely to pick up those infections than equivalent people who are living at home.

[Baroness Smith of Newnham (LD)]

I can see a point to that, but the message I was given by the mental health practitioner who rang me from the mental health team—I think he was a psychiatrist—was basically that once somebody is in a home, these tests become much more difficult because of the nature of the environment. That may differ from home to home—and yes, when my father had pneumonia and was clearly delirious, he was at home. If there are concerns, we should surely make sure, if people have a cognitive impairment, that we know that is the case, but if somebody does not—if there are the short-term issues that are being discussed in the amendments, in particular Amendments 111 and 112—then surely those people who want an assisted death would want it ruled out that they had some sort of cognitive impairment if it were temporary and reversible. That is the sort of thing we really need to get right, not only for those people who have an impairment but for those who actually do not have one but would not then be able to have the assisted death that the noble Baroness, Lady Hayter, and others might wish them to be able to avail themselves of.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I am quite shocked at what I have just heard. However, before I respond to that—I am sorry, I really am quite shocked— the noble Lord, Lord Murray, has said again, and it was objected to last time I raised this, that this is a life-or-death matter. These people are dying anyway and, therefore, a refusal of assisted death does not mean that the person will continue to live. They are going to die anyway and, indeed, may still commit suicide. We seem to forget that. If they do not get the assisted dying, they may still go abroad or commit suicide themselves, in ways that we know are not always reliable.

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[Baroness Coffey (Con)]

My Lords—

[Baroness Hayter of Kentish Town (Lab)]

It is Committee; the noble Baroness can come in later.

As I say, the noble Baroness, Lady Finlay, will be able to speak to Amendment 459 afterwards. One consideration has to be that the person has informed their children of their decision for an assisted death. I cannot be the only person who knows people for whom there is completely no relationship between parent and child. The child could be aged 60 and have been living abroad for years. They might not know their parent is ill and may not have been in touch with them for 40 years. But somehow we are going to have to try to track down children. Also, the ill person may not want their child to know that they are ill. We are all old enough now; we have had lots of friends go through this. I had a friend who did not want his daughter to know he was terminally ill because she was facing her own health issues at that time. But this would somehow lay down that despite the desire of a father, in that case, nevertheless that child has to be found and told that their parent not only wants an assisted death but that their parent is dying and wants an assisted death.

I really wonder about this denial of agency. If that person does not want to tell their child, according to Amendment 459, they have to make

“adequate arrangements for another person to inform the children”—

who might live abroad, or whatever—

“of the assisted death and provide bereavement support”.

I just wonder what world we are living in where, when someone is reaching the end of their life, some agency of the state demands that they tell them whether they have any children, whether they know that those children are still alive and where they are, and has to tell that child that their parent is ill and that—in a way, a smaller matter—they want to bring forward that death a little bit so that it is not too bad at the end.

Some of these ideas seem to me to exclude from our consideration the patient concerned. They seem to put everyone else in a position of taking decisions. The noble Baroness, Lady Cass, spoke earlier about the amendment that wants more and more specialist advisers brought in. Can we just sometimes revert to remembering that we are talking about seriously, terminally ill people who surely have some agency over their life? If they are refused this, they can still commit suicide but they will probably do it, as a friend’s father did, by going into the garage, blocking the bottom of the door so that no air can get through, turning the engine on and killing themselves that way. I wonder sometimes whether we are remembering that people are facing a terrible end and we just ought to have a little respect for them.

[Baroness Finlay of Llandaff (CB)]

May I intervene on that, given that my amendment is being questioned? Let me explain. When looking after people who are parents, a conversation is often about what the children know. Telling the children about someone’s impending death is extremely difficult for most parents. Usually, it is because the person who is ill wishes to protect those children; they think that, by not telling them and preparing them, they are somehow protecting them. The way children are informed needs to be age appropriate and appropriate to where that child is.

I do not suggest in this amendment that it should be an agent of the state. The amendment refers to making

“adequate arrangements for another person”.

That could be anybody. It is about asking whether they have somebody who will inform those children—or not—about the death. As for bereavement support, it might simply be about telling them in person and letting them talk about it for an hour over a cup of tea, or it might be much longer, depending on the needs of the individual—because bereavement is a very individual thing as well.

I am concerned that we could legislate and somehow believe that, by someone having an assisted death, rather than a death for which there has been preparation, the impact on any children in a family will be less, because the evidence is that it will not.

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[Baroness Berridge (Con)]

When I mention drafting changes, I mean in relation to the timing of this. As drafted, it would need to be done before the application is granted, and it may be that the requirement to go to the local authority could be at the same time as having approved it, not before. But, yes, this would be an additional requirement on the panel.

I hope the noble and learned Lord the sponsor or the noble Baroness, Lady Finlay, can help with my second point on the principle of the Bill. The noble Baroness, Lady Hayter, referred to the situation based on autonomy: the individual wants to do this and does not want to tell relatives. If we are strict purists about that—we had evidence on this at the Select Committee—then with this Bill there could be a situation where the first time anyone hears about the death is when the medical examiner telephones a relative.

I have tabled amendments in a different group on a requirement to nominate next of kin who are over the age of 18. I think it would be useful for the Committee to know what the situation is if someone acts completely autonomously like this and the body is there. Does the noble and learned Lord the sponsor need to bolt on a provision so that there is a public health burial? That is the continuation of the logic of this that you can do this alone, with no one in your life knowing about it. Therefore, to exercise that autonomy fully, there would need to be a public health burial, with everything done before anyone in the family knows. That is a conceptual difference. The noble and learned Lord and I spoke about this in a meeting in relation to what the law is, and it would be good for him to clarify the situation. Can the medical examiner not call anybody and go forward with a public health burial?

[Baroness Hayter of Kentish Town (Lab)]

Does the noble Baroness understand that, quite often, people die and their family does not know about it?

[Baroness Berridge (Con)]

Absolutely, and therefore the medical examiner’s evidence is that, when they have the body in that circumstance, they are under an obligation, we think, to locate and find a relative. Sadly, this happens more frequently than we would like to think, and the local authority powers to perform a public health burial then become apparent. So, yes, there are these situations.

It is important to clarify this in relation to this Bill, because we have this evidence from the medical examiner that the first the family might know is when they are called by the medical examiner. We need to be clear about that and about the position of families. Is this personal autonomy—that is the conceptual point—so fully and properly enacted that there would be a public health burial, without any obligation to inform anybody that this is happening?

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[Lord Harper (Con)]

I shall speak briefly to the three amendments that I have tabled in this group, to start off with. First, Amendment 472A would slightly tighten up the requirement for the panel to speak to the person’s proxy, when they have a proxy. Currently, as the Bill is drafted, they may speak to the person’s proxy, but I think that they should speak to the person’s proxy. There are no criteria set out about how they make that distinction. Given that the person’s proxy will have signed the declarations that kick off this process, they should speak to them. I do not anticipate it being a very long conversation, but it is essential that they do so.

Amendments 495D and 496D reference the appeal mechanism in Clause 18 and set out a time limit in line with normal tribunal and administrative appeals—so somebody has to appeal against the panel’s notification of the refusal of the grant of certificate within 10 calendar days. I shall not labour the point, but it is just sensible to have a time limit to make sure that there is a clear process.

I had intended to limit my remarks to that, but I have done the dangerous thing of actually listening to the debate, and I wanted to reference my noble friend Lord Jackson of Peterborough’s amendment. It came out in the contributions of the noble Baronesses, Lady Fox and Lady Hayter—a perfectly reasonable difference about exactly where we need to have transparency and balances against privacy. The noble Baroness, Lady Hayter, is perfectly at liberty to disagree with the noble Lord, Lord Jackson, and she obviously does, but I was surprised that she appeared to take against him for the temerity of even tabling his amendment. She said she was shocked. The presumption in the Bill as drafted, as far as I read it, is that in Schedule 2 the panels are to determine referrals in public; that is their default procedure. I give way to the noble Baroness.

[Baroness Hayter of Kentish Town (Lab)]

That is very helpful, because I can say what I said to my noble friend in private. Had we been doing this Bill at the sort of speed I hoped we would, I would have tabled an amendment that it should be in private. My personal view is that it should be. Because of the way things are happening—I will say no more—I have not tabled those sorts of amendments.

[Lord Harper (Con)]

That is very helpful. It enables me to make this point, because this is where we have a disagreement. It gives the sponsor of the Bill the opportunity to set out why the Bill is drafted as it is. I will set out why I think my noble friend’s amendment is broadly right, but perhaps there is a comparison with what we already do in similar cases. That may give the noble Lord, Lord Carlile, the opportunity—he may not wish to say so—for another “told you so” moment, as it is a judicial comparison.

The presumption in the Bill is that panels will do the referrals in public. There is a “subject to” on that: the chair of the panel can decide to do it in private if they feel that is appropriate. I accept that there is a balance to strike because, for obvious reasons, these panels are making decisions about personal, private matters. It is also right that there is some transparency. My noble friend Lord Jackson’s amendment would give quite a big window, 28 days, to publish the notice of the panel meeting. It would also include the name of the person.

The comparison I looked at, which I thought was a reasonable one, was what the Court of Protection does. It makes decision about sensitive financial and welfare matters. It used to be the case that the Court of Protection’s presumption was to sit in private and not hear cases in public. That has changed over time. The presumption now is that cases are heard in public. Again, my understanding is that there is the ability for the judge presiding on those cases to decide for them to be in private if that is felt necessary. Even when they are in private, I understand, members of the public can make applications to go and listen to those cases. I think that is all right and proper. That appears, I presume, to be where—the noble and learned Lord, Lord Falconer, is nodding.

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[Lord Harper (Con)]

I do. The reason why I partly agree with my noble friend Lord Jackson is that I had a look at what the Court of Protection does in terms of publicity—the bit that the noble Baroness, Lady Hayter, objected to. It publishes hearings in advance—not 28 days—but it does not publish the full name of the individual. It publishes initials and what the case is about: the broad category of the decision. That strikes me as quite a good balance, which provides transparency but maybe avoids people coming to “watch a spectacle”, to quote the concern of the noble Baroness, Lady Hayter.

However, there is some necessity for it to be in public. The reason for that is also set out in the Bill, which says the panels

“must hear from, and may question, the co-ordinating doctor … must (subject to subsection (6)) hear from … the person to whom the referral relates”.

At this point, I agree with the noble Baroness, Lady Berger. That should absolutely be a must; there should not be an exception. If it is the case, as I understand from the appearance of the noble Lord with me on a media programme, that the exception is designed for cases where the person’s medical situation is very severe, they should not necessarily have to come to the panel, but at least one member of the panel should absolutely still have to go and talk to them. It really should not be okay for the panel to authorise somebody to have an assisted suicide without ever having spoken to the person concerned.

[Baroness Hayter of Kentish Town (Lab)]

I am sorry that we are doing this, but the person will be at home, very often, and bedridden. Are we actually expecting a panel to go to their home, into their bedroom, and do this there? Again, this is not the sort of world that I know from some of the people who I see living in surroundings where it would be quite difficult even to put a spare chair in their bedroom—they could be on oxygen, or whatever—for someone to see them there.

[Lord Harper (Con)]

These are difficult issues, but the panel is being asked to authorise their death, so this is a serious issue. I accept that this is uncomfortable, and I am not suggesting the entire panel would rock up at their home, but at least one member of the panel ought to have to talk to them. The idea that the panel would authorise somebody to have an assisted death, never having spoken to them, is frankly appalling.

I shall just finish, because I want to stick to time—although I am conscious that the noble and learned Lord nicked a bit of it to explain to the Committee. I shall finish by saying that the amendments that have been put down are very helpful, because we have fleshed out this very sensible issue of how much of this should take place in public.

The other reason for it being in public is because, otherwise, there are two groups of people the panel is asked to talk to. It may hear from and question any other person and may ask any person appearing to have relevant knowledge. The problem is that, if these hearings are done in private and no one knows they are happening, I do not know how the panel is supposed to know who any of these people are; these people are not going to be able to make themselves known to the panel. So there is a clear argument about where you draw the line and there is clearly a balance to strike between openness, transparency and privacy, but it seems to me that this is a good debate for the Committee, and I want to hear where the Bill’s proposer thinks that balance should be struck. We have heard a little bit about that, and we can hear a little more later.

Terminally Ill Adults (End of Life) Bill

Baroness Hayter of Kentish Town Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Falconer of Thoroton (Lab)]

My Lords, I will respond to the sensible invitation of the noble Baroness, Lady Coffey, to give a brief indication as to what my amendments here do. The noble Baroness, Lady Finlay of Llandaff, earlier referred to the Delegated Powers Committee, which made a number of criticisms of the previous Clause 22, in particular that it did not specify the circumstances in which it was mandatory to have an independent advocate and that it left too much to regulations. We introduced two new clauses to deal with that.

The first proposed new clause is found in Amendment 548A. It first requires that anybody carrying out a relevant activity under the Act has to consider whether the person seeking an assisted death requires an independent advocate. The person carrying out the relevant activity is broadly either the first doctor, the second doctor, the provider of assistance to the patient or a member of the panel. If the relevant person decides that the person does need an independent advocate, the person performing the activity under the Act must give the person seeking the assistance

“information about representation and support provided by independent advocates, and … an explanation of the effect of subsection (3)”,

which is that if you need support you are entitled to have an independent advocate, but if you do not want the support you can say no to it. Where the person performing the relevant activity is a doctor, as opposed to the panel, they have to tell the commissioner for assisted dying that this person has been given the information about an independent advocate.

The people who qualify for an independent advocate are not everybody applying for an assisted death, only either

“a person with a mental disorder”

or

“a person who (in the absence of support) would experience substantial difficulty in doing one or more of the following … understanding relevant information … retaining that information … using or weighing that information as part of the process of making relevant decisions, or … communicating their views, wishes or feelings (whether by talking, using sign language or any other means)”,

as we discussed previously.

If an independent advocate is engaged, their job is to “represent and support” somebody seeking assistance in

“understanding the options available … as regards end of life care, or … anything done under this Act, by or in relation to”

the patient. The job is to help to understand, not to be an advocate for any particular cause.

In Amendment 549A there is an additional proposed new clause, which is collateral to the new clause, saying:

“The Secretary of State must by regulations make provision about independent advocates”.


Those regulations basically have to specify the training required for independent advocates, identify who gives them instructions in individual cases and make arrangements for who appoints them. So one now has —this is the point that the Delegated Powers Committee was making—clear circumstances for identifying when an independent advocate should be appointed and on whom the duty arises to make sure it happens.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, following that, I am concerned about whether I have read Amendment 553 in the name of the noble Baroness, Lady Grey-Thompson, correctly. She did say at the end that maybe not all her amendments were perfectly drafted, so I may have misunderstood it.

As I read the amendment—following after the new Clause 22, as my noble and learned friend has just said —it says that any person, not just a qualifying person,

“between age 18 and 25 wishing to receive assistance under the provisions of this Act must receive consent from a parent or guardian and must be accompanied by an independent advocate in addition to parent or guardian”.

I think I am correct in reading that as everybody, not just a qualifying person.

The idea is that someone at the age of 25 still needs a parent or guardian—if they even know where their parents are. Maybe it is partly because I was brought up in the forces, but I know of people who have taken major life and death decisions by the age of 25 while in charge of military units at war. I have known people—in fact, I see some around the Committee—who by the age of 25 have given birth to children, which seems to me an enormous decision that one takes. I, well below that age, took a decision that meant I would never have children. I know of surgeons who before the age of 25 have taken decisions of a life and death magnitude in surgery. There will be people now sitting on the Bishops’ Benches who will know of circumstances in which big decisions are taken by people well below that age.

I am really surprised that we would be writing this into the Bill for those people. Suddenly, at the point when they are terminally ill and dying, we say that, up to the age of 25, they have to locate a parent—whom they may not have seen for years—and, in addition to the parent, have to have an advocate with them. I find that extraordinarily devaluing of ordinary human life and the ability to take decisions.

As I say, I could have misunderstood the amendment. The noble Baroness, Lady Grey-Thompson, said that she may not have drafted it correctly, so it may be that this should apply only to a qualifying person and not all people. I still have my doubts that we really need to treat adults as if they are really young children.

[Baroness Cass (CB)]

My Lords, I will speak to a number of amendments in this group. I can be briefer on some because the noble and learned Lord, Lord Falconer, has copied some of my homework and taken it as his own—which I take to be a good thing.

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I thank the noble Baroness, Lady Hayter, for her question on my Amendment 533. As I said, I tabled all my amendments before the start of Committee. We debated this area in another group, but I chose to keep Amendment 533 in this group because I felt it sat better here. My Amendment 547 relates to people with Down syndrome, and Amendment 300 relates to disabled people with support needs. I very much saw Amendment 533 as sitting alongside those. I agree that I could have worded it better and been more explicit, but that is why I did not move it to a different group.

[Baroness Hayter of Kentish Town (Lab)]

I therefore understand that the noble Baroness does not mean this for everybody, but only for people in a restricted category.

[Baroness Grey-Thompson (CB)]

In the context of this amendment, I meant it in a restricted category. I did not want to start withdrawing amendments and retabling them, because, in Committee, I think it is useful to explore such issues. I am not sure for anyone reading the Marshalled List on the outside—for any who do—that it is terribly helpful to see that amendments have been withdrawn. It has been a really useful discussion to have in Committee.

I thank my noble friend Lady Cass for raising the issue of remembering information, and I thank my noble friend Lady Finlay of Llandaff for bringing in a sporting analogy. I was thinking about the work that I do outside this Bill, and over the years I have done a lot of work on concussion protocols. In the early years, when concussion protocols in sport were brought in to help make sure that people did not carry on playing rugby or other sports while concussed, there was a lot of coaching going on because the same questions were asked through the concussion protocols: do you know what day it is?; do you know who the monarch is? The answers were learned. In that moment, people might not have been able to answer the question but they had learned the answers. The point raised by my noble friend Lady Cass is something else that we need to think clearly about.

Another area I work in is anti-doping in sports. We now have a new system. It used to be that the governing body of the sport would take tests from the athletes and then, if there was an adverse finding, do the policing on that. An independent system, UK Anti-Doping, was purposely developed so that the governing body could, if there was an adverse finding at the first or second stage, guide an athlete through really complex processes. This is just anti-doping in sport, and the athletes are educated about it at least every year, but if even something such as anti-doping in sport is hard to understand—between what is written in a document and what happens when you are in the process—assisted suicide probably deserves a bit more.

I am not convinced by the amendment tabled by the noble and learned Lord. I still do not think it provides enough of a safeguard. I would be interested in being able to tie up what the noble and learned Lord said in the Chamber and then coming back with some stronger amendments.

This is in the context that statutory advocacy is generally of quite poor quality. Less than 15% of people get advocates in other areas when they need them. If you look at advocacy in general, it is worrying that there is no central data collection for advocacy under the Mental Capacity Act. In 2019, a freedom of information request which looked at this area found that 51 out of 139 local authorities did not collect data on IMCA support. There is still limited data on Care Act advocacy. The CQC said that, for Care Act safeguarding, where there is a duty to appoint an independent advocate, in England in 2025 some 83.38% of those lacking capacity had an advocate appointed. To pick some random counties, in Derbyshire, the figure was 14.38%; in County Durham, it was 32.64%; and in Liverpool, it was 53%. Where there is a duty to appoint one and the figures are so low, I wonder whether the take-up in this space would be very limited.

I still do not think that we have the right balance between accessing the process and safeguarding, but at this stage I beg leave to withdraw my amendment.

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[Lord Carlile of Berriew (CB)]

My Lords, “All’s Well That Ends Well”, and it is always a pleasure to follow such a story, particularly as it is the story of someone who told it to your Lordships himself.

I put my name to the noble Lord’s amendment and intend to address it not from the viewpoint of positivity and negativity—I tend to view that as mostly potluck— but from the viewpoint of facts. The fact I start with is an assumption: that everybody who is given a prognosis by his or her doctor desires to make an informed decision and, if they wish to make such an informed decision, that it should be based on some factual and scientific basis. All that these amendments would do —I speak not particularly to their very words but to their meaning—is require that a doctor or any other clinician who is giving a prognosis should do so on a solid medical and scientific basis: a prognosis that is founded in medicine, not stories and the last three patients they happen to have seen who had a serious illness.

I have spent a lot of time in recent weeks reading articles. There are some amazing American articles in which huge statistical samples are taken, but on this subject they all come to a similar position. For example, in one major study, only about 20% of predictions of six-month deaths were within a close range at all of ultimate survival. This is a very unscientific part of what clinicians tell their patients.

Judging the moment of death becomes very difficult the further you are away from the actual death, but it is very difficult to know how far away you are from the actual death. When my father—who was the most reasonable person I have ever known, by the way—was dying, the night before he died, the last thing he said to me was that I was to wear his black suit for the funeral because he thought mine was scruffy. He and I had been the same size at a certain point in our lives, and of course I did. We knew the moment he said that—because I knew how ill he was, the family were there, the doctor was there, we were going through his last moments and it was a very happy death, a great family deathbed scene—that he would be dead by the following day. He died the following morning.

However, when someone walks into the consulting room like the noble Lord, Lord Moylan, and is told that he is seriously ill, it is just an opinion at that stage on the part of the doctor, who may have varied experience and may actually have no scientific basis for what he or she is saying. Even what is now called GEST, the geriatric end-of-life screening tool, which uses algorithms and has tens of thousands of examples in it, still offers only varying levels of probability. I have also looked at actuarial tables because a surprising number of elderly and very ill people try to insure their lives for a relatively short period. A lot of companies insure senior directors for one year; I think it is called key person insurance. It is all based on mathematics, but it is not actually science.

So I do not think it is asking much of the noble and learned Lord that there should be a provision in the Bill that means that, in every single case when the patient asks for an informed decision, he or she is given the basis upon which that information is founded.

[Baroness Hayter of Kentish Town (Lab)]

My Lords, I am pleased that the noble Lord who moved the amendment is in remission from his cancer. On other Bills we wish he was in remission from his political views, but on this one we celebrate with him.

I used to run a cancer charity, and the truth is that on this issue not everyone is using statistics. Doctors are often using their eyes; when we are talking about the last weeks it is their eyes, rather than going to any statistical table, that will tell them. There is an assumption that all this is going to be based statistically on the six-month period, but it is not like that. My own guess is that most people who are dying will probably start thinking about this only at three months. Tonight I am going to be dining with a recent widower. His wife—a very well-known author but it does not matter who she was—had cancer. She fought it, but fighting it is not enough. It was only really in the last weeks that she realised that what she wanted was help in those weeks. It was at that point that she tried to get to Switzerland, but by then it was too late.

My judgment is that much of this, for many of the patients who will be asking for this, will be very much towards the end. I will be surprised if at that point the doctor is going to their statistical tables, because at that stage the patient’s age and underlying health and other factors will contribute as much to assessing whether it is going to be days, weeks or maybe a month as the particular type of cancer that they have. This attempt to make that process overscientific is probably not right, and we should have faith, which some people in this House do not seem to have, in doctors.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, it is hard to follow the noble Lords, Lord Moylan and Lord Carlile, whose contributions were made with such panache, wit and insight. What really intimidated me was the noble Lord, Lord Moylan, saying, “This amendment is all about understanding the mathematics”. I thought, “Oh God, I’ve put my name to it. There’s been a terrible error”. I bring absolutely no mathematical understanding to the question.

I put my name to the amendment on the requirement that medical practitioners should discuss underlying data on survival—in terms of the median prognosis of six months and how it is calculated and so on—because I am interested in ensuring that there is maximum transparency for patients under the Bill, so that any choice that they make is well informed. The Bill rightly requires that an applicant for assisted dying is informed, so it seems obvious that being informed should include an understanding of the context of the data and the reliability of a prognosis, which would help them to inform themselves.

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[Baroness Hayter of Kentish Town (Lab)]

I think the noble Lord meant to say that they could apply, not that they should apply.

[Lord Hamilton of Epsom (Con)]

All right—they could apply, if that helps the noble Baroness, Lady Hayter.

We have to think closely about this, because this is the essence of the Bill. I do not understand how we can be comfortable with the whole idea that some of these diagnoses will be completely wrong and, as a result, there will be people who will apply for assisted dying who might have lived for years. This strikes me as being a disturbing element of the whole Bill. We should be seriously considering whether something should be done to address this problem. I am glad it is not my difficulty.