Terminally Ill Adults (End of Life) Bill

Baroness Hollins Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Butler-Sloss (CB)]

My Lords, I remind the House of the extraordinary common sense of the noble Baroness, Lady Cass, who pointed out that there may well be a lack of suitable doctors of one sort or another, and they may have to put up with what actually is the reality.

[Baroness Hollins (CB)]

My Lords, I fully endorse the amendments from my noble friend Lady Finlay, and I think they deserve rereading. There has been a huge misunderstanding of what she actually described. This was not something drafted on the back of an envelope: it is based on years of work spent thinking about how it could work. Her amendments simplify and strengthen the Bill, making the whole process more transparent and more likely to be subject to evidence-based improvement in future, if an assisted death service is approved. My noble friend’s amendments may go some way to addressing the continuing concerns of the medical royal colleges.

However, my main amendments in this group concern the regulation of substances proposed for use in assisted dying. I recently co-authored an editorial in BMJ Supportive and Palliative Care called Untested, Unlicensed, Unregulated: Prescribing and Oversight Issues in Physician-assisted Dying/Suicide. I thank the noble and learned Lord, Lord Falconer, for tabling amendments that attempt to address these matters. My amendments would amend his Amendments 624A and 708A.

In this country, drugs intended for clinical use are subject to evaluation and oversight by the Medicines and Healthcare Products Regulatory Agency, the MHRA, which assesses their efficacy, quality and safety before they can be licensed for human use. These frameworks were specifically designed to ensure that drugs used in healthcare meet appropriate evidence and safety standards before they reach patients. I ask the noble and learned Lord why he is reluctant to rely on the established regulatory framework, and instead proposes the development of a separate framework specifically for substances used in assisted dying. My amendments to his amendments, as well as my Amendments 699 and 709, propose that the Secretary of State, when specifying a substance in regulations, must have regard to recommendations of the MHRA and that the established committee is required to report to the MHRA.

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[Baroness O'Loan (CB)]

It has not changed on the Government’s contemporaneous website. If I go to New Zealand, it says that the doctor cannot advise or discuss assisted dying with you unless you ask for it first. Those are both government websites today. I accept that there may be changes due and that they may come, but they are not there, as far as I can see.

[Baroness Hollins (CB)]

My Lords, when a doctor, the very person entrusted to preserve life and relieve suffering, raises the possibility of assisted dying, it is no longer a neutral act. For some people, particularly those who are depressed, isolated or overwhelmed, the mere introduction of the possibility of an assisted death risks planting the idea that this course is rational or even expected. In an inherently unequal doctor-patient relationship, suggestion is easily perceived as a recommendation.

There is no requirement for an independent advocate—somebody to sit beside the patient and help them process and grasp what is being said. We are leaving some of the most consequential conversations a person can ever have to take place in isolation, within an asymmetrical, authoritarian relationship. There is no requirement for the discussion to take place with someone with specialist expertise. A “registered medical practitioner” could be a locum doctor who the patient has never met before, a foundation-year doctor in their early years of practice, or someone with no training in palliative care or experience of autism or learning disabilities, and yet they are the people who may introduce a conversation that could seriously alter the trajectory of a life.

No clinician should be allowed to initiate such a conversation; it should arise only if a patient independently raises it themselves, and even then the doctor’s role should be limited to acknowledging the request and directing the patient to an independent body while remaining firmly focused on diagnosis, treatment and the provision of appropriate and timely palliative care, as needed. Assisted dying must not be presented as an equivalent option alongside treatment, support and comfort. To do so risks the medical service being seen as one that no longer values preserving and improving life but rather one that enables the end of life.

The Royal College of GPs has stated that the role of a GP should be limited to signposting patients to a designated specialist service if, and only if, the patient raises the subject. This week, the Royal College of Psychiatrists wrote to me expressing its continuing concern. Its view is that

“all applicants should receive a holistic, multidisciplinary assessment at the preliminary discussion stage, including for mental health needs”;

in other words, something much more like the multidisciplinary panel proposed by my noble friend Lady Finlay in the previous group. I therefore suggest that Clause 5, and, in consequence, Clause 6, should not stand part of the Bill.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, Amendment 205 is in my name, as well as those of the noble Lord, Lord Carlile, and the noble Baroness, Lady O’Loan. I declare an interest as founder of Team Domenica, and as the mother of a young woman with Down syndrome. As several of my points have already been covered by other noble Lords, I will be brief.

My amendment is simple and proportionate. It reflects the concern I raised at Second Reading: it is incomprehensible that people with learning disabilities will not be allowed a family member or, in the absence of a family member, a learning disability nurse or qualified practitioner to be with them when a doctor initiates the conversation about assisted suicide. People with learning disabilities may chronologically be adults, but many are still children who lack understanding of abstract principles. It is true that Clause 5(2) specifies that a doctor must exercise

“their professional judgement to decide if, and when, it is appropriate to discuss”

assisted suicide, but I am not satisfied that that provision is sufficiently strong. My amendment would provide an additional layer of protection for this vulnerable group, many of whom have a limited understanding of the concept of death and dying and would therefore be panicked and frightened. This combination of fear and lack of understanding would be, emotionally, absolutely devastating.

As we have heard, there is also—I see this in my own daughter—a desire to please, which is a way of seeking to belong. My daughter is also terrified of doctors, hospitals, dentists and anything medical. I dare not imagine what it would be like for anyone with a learning disability to be in a situation of having a conversation about killing themselves, probably in front of a doctor who they may never have even met, without a family member present. Yes, the Bill requires that there is mental capacity and a clear, settled and informed wish to die, but assessing capacity for people with learning difficulties is complicated on so many levels. I cannot begin to imagine how it would be done. Would it be through an easy-read leaflet with diagrams? It does not even bear thinking about.

I acknowledge—I know that this will come up—that not all families are perfect and that malign family dynamics are a reality, but I suggest that the greater threat would come from a process that fails to accommodate the specific vulnerabilities of people with learning disabilities. I find this lack of understanding extraordinary, but then, people with learning disabilities are so often ignored and forgotten. As my noble friend Lord Harper has already pointed out, during Covid, people with learning disabilities had “do not resuscitate” notices put at the end of their beds. Then came the clinical frailty scale, with nine categories going from category 1, meaning “fit”, to category 9, meaning “terminally ill”. The guidance was to deny those in categories 7 to 9 life-saving treatment. My daughter fell into category 7; thank God we did not have to send her to hospital when she got Covid.

In the Bill, this discrimination may be about saving money. The Government’s own impact assessment has revealed a saving of £2,323 if an independent advocate is not used. It is easy to work out cost, but it is much harder to measure the value of a human life.

Before I end, I thank all the parents who have written to me about the Bill. Some of them have said that they are too scared to die themselves because they do not know what on earth would happen to their adult children. These are parents who have spent a lifetime fighting. One mother wrote to me, as she digested the implications of the Bill for her own child, saying, “Sometimes, it’s easier to cry about the small things”.

My daughter has taught me a different way of looking at the world. She has taught me to live more fully and to be courageous. She has given me the strength to fight for people with learning disabilities so that they are not defined by being different. Their story is our story. We have a shared humanity and an absolute duty of care for this most vulnerable group, from the beginning of their lives to the end. It is on their behalf that I stand in your Lordships’ House and ask noble Lords to support my amendment.