Terminally Ill Adults (End of Life) Bill

Baroness Lawlor Excerpts

Friday 12th December 2025 Lords Chamber

[Baroness O'Loan (CB)]

I remind the noble Baroness that we are talking about people who are terminally ill, not the general population.

[Baroness Lawlor (Con)]

My Lords—

[Baroness Fox of Buckley (Non-Afl)]

I will just finish, because it relates to this. I appreciate that, once given a terminal diagnosis, that might be true, but not necessarily. That is the honest reality of the situation.

We have a moral dilemma here. GPs are being called on as though they are important to this Bill, but if they are just passing and you do not have continuity of care, they are actually being treated with contempt. On the other hand, in truth, the demand that you have to have continuity of care before you can ever be offered assisted dying seems unrealistic in today’s modern health service.

[Baroness Lawlor (Con)]

My Lords, I will speak to Amendments 30B, 220 and 265A in my name. They share the aim of other amendments in this group to ensure that the GP knows and has looked after the person who wants to end his or her life, but go beyond them in proposing the extent and length of the relationship needed and in requiring a letter from the GP to provide important additional safeguards. I will explain the amendments.

First, I propose that the patient be known personally to a doctor for two years through having been seen for at least six appointments. Secondly, I propose that the doctor submits a letter to the assessment panel on the patient’s physical and mental health during that period, and a prognosis. Thirdly, I stress that the doctor, as we see their involvement in this Bill, may be the patient’s GP, but that is not required; the doctor may be the first doctor, but, given Clause 11(8), this is unlikely, and it will probably not be the second doctor. The important point is that a medically qualified practitioner knows the patient over time and can write an assessment for them.

Why does this matter? Advocates of and those concerned about the current arrangements in the Bill want adequate safeguards. We all do. We want to protect the weak, the elderly and people with physical or mental health conditions from being influenced, pressured or coerced into wanting to end their own life. But if the request for assisted suicide can be accepted without a doctor who knows the patient personally over time, there will be no such safeguards. “Knows” does not mean a fleeting acquaintance but a professional knowledge of the patient built up over years. That is the aim of my amendments. By contrast—

[Lord Pannick (CB)]

What happens if my doctor retires and I therefore have not had a doctor who knows me for two years? Am I to be denied access to the provisions under this Bill?

[Baroness Lawlor (Con)]

I thank the noble Lord. I hope to come to deal with that question.

By contrast, all the Bill requires is the involvement of two doctors, neither of whom needs to be at the practice where the patient is registered or even has to have had prior knowledge of them before the process begins. Under the Bill as it stands, there is no connection between a doctor who knows the patient well and the process that leads to the assisted suicide. The other amendments in this group go some way to mitigating this, but it matters that there is a guaranteed role in the process for the doctor who may have known the patient.

The Bill recognises that the patient’s GP may not wish, as a matter of conscience, to be involved in the process, but that does not mean that they or another doctor who knows the patient should not submit a letter to the process of the assessment panel as one of a number of documents seen by the multidisciplinary panel, which would be part of the public record of the assisted suicide. It will be in a different format—neither a checklist nor compiled from the hasty notes that GPs are obliged to write that they squeeze in between their 10-minute appointments.

I turn to possible objections to these two-pronged amendments. First, the requirement that the same doctor has seen the patient six times over two years to allow adequate safeguards may be thought too much. Anything less would hardly amount to knowing the patient, the condition and their state of physical and mental health. It is feasible. Some evidence suggests that, on average, in 2018-19 patients had 3.3 face-to-face consultations per year with their GP, and 8.7 when every sort of consultation was taken into account. This data has not necessarily changed over the 20-year period of the study. Other data puts the face-to-face consultations lower, at 2.6, but these are averages. Very seriously ill people will have had far more consultations.

Moreover, only face-to-face consultations, when the patient is physically with the doctor, give a good idea of physical and mental conditions as they develop. If the Bill is so amended, in answer to some problems that have been raised, it might encourage more face-to-face GP consultations with seriously ill patients. If there is a seriously ill patient and the GP retires, they might like to leave a letter providing the evidence over the period they saw them before they retire. But there will always be objections—

[Lord Pannick (CB)]

The GP might have died 18 months ago; what happens then?

[Baroness Lawlor (Con)]

These things can happen, but we should have a process or an alternative mechanism. I am not going to deal with exceptional cases. My GP is still in situ, and I can see my GP when I want to; other practices could aim to do the same thing. We have very great demands on the practice in Cambridge, with many students registering.

[Baroness Wheatcroft (CB)]

Can the noble Baroness tell the Committee whether she actually listened to what the GP in our midst said about how practices work?

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, but I would like to press on. There are other GPs who want to see the same patients; they want to build up the patient relationship over time because they say it makes for better diagnosis, care and treatment for their patients. We should not put up with the worst-case scenarios simply because it does not happen or because we think a multi-doctor practice works well. It may work well in some cases, but there is no replacement for knowledge of a patient over time.

The letter gives the multidisciplinary panel an assessment of the patient’s illness and state of mind by someone who knows them. If anything raises suspicion that there has been pressure or that the patient is not in a state of mind to make the decision, the panel can investigate further. Moreover, unlike the other matters and activities in the process, the letter is not a matter of ticking boxes. The demand is for something that doctors are used to doing; to write a coherent letter about one of their patients is something that requires thought and careful concern for the individual case. It is standard practice in referring a patient to a consultant for specialist care where there are letters passed to and from. Doctors and consultants write letters.

If the Bill is to have real safeguards in the form of coherent and analytical evidence from a doctor who has known a patient over time, such amendments are needed. I ask the sponsor of the Bill to require it.

[Lord Deben (Con)]

My Lords, we are supposed to be making the Bill more practical; it does not make it more practical to ask for something that is manifestly impossible. I could not demand assisted dying, because I have not seen my registered practitioner in Suffolk for many years. I do not have a particular practitioner because that is not how the local system works. We are not in a sensible position if that is what we are going to ask for.

But the noble Lord, Lord Rook, has an important point that I do not want us to lose because of the suggestion that all people have the kind of National Health Service that we would all wish to be the case. We have to take his point rather differently. I was surprised that the noble Lord, Lord Winston, suggested that the proposition is that the general practitioner or the team—in normal circumstances it is the team—could in some way stop the application.

The point is—and I ask the Committee to think about this seriously—that if someone has a general practitioner, it is important that the GP and his or her team are informed of the request in case they are able to contribute to a sensible decision. The fact that this is assumed in the Bill, as was put forward by the noble Baroness, Lady Fox, does not prevent us insisting that they should at least have the opportunity. If we do that, we will be doing a very valuable thing.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

Yes, we should get the information from those responsible for the care of the individual in a health sense. However, I am not willing to commit myself to that in relation to the family. The person making the decision should think, “What should we do about the family?”—but what if the patient has not seen their family for a long time or are at odds with particular family members? I believe that it should be done very much on a case-by-case basis.

[Baroness Lawlor (Con)]

My Lords, the noble and learned Lord thought that it was ludicrous that a patient would see the same doctor. Is it ludicrous, in his view, that, on average, 3.5% of consultations between a patient and a doctor are face to face? Is it ludicrous that we should expect those consultations to be with the same doctor?

[Baroness in Waiting/Government Whip (Baroness Anderson of Stoke-on-Trent) (Lab)]

I am sure that my noble and learned friend will respond to that in the debate, but the noble Baroness has just intervened on an intervention. The Chief Whip made clear reference to that earlier.

--- Later in debate ---

I turn now to Amendments 30B, 265A and 443A, tabled by the noble Baroness, Lady Hollins. The effect of these amendments is to require a person seeking an assisted death to have a letter from a GP who has known them in a professional medical capacity for at least two years—

[Baroness Lawlor (Con)]

I beg the Minister’s pardon but she is referring to my Amendments 30B, 265A and 443A, not those of the noble Baroness, Lady Hollins.

[Baroness Merron (Lab)]

I am most apologetic and grateful for the clarification. I hope that the noble Baroness, Lady Hollins, will forgive me, too.

I will continue. The GP must also have seen them at least six times in face-to-face appointments during those two years. Noble Lords may wish to note that these amendments introduce requirements that may result in people seeking GP appointments that are not clinically necessary. This may have an impact on wider access to GP services. Noble Lords may also wish to note that, even if a person has seen their GP the required number of times over the two-year period, their GP could still refuse to provide the explanatory letter, as they are not under any duty to participate in the provision of assistance, as per Clause 31. This would result in the person being unable to access an assisted death.

Lastly, Amendment 220, tabled by the noble Baroness, Lady Foster, seeks to add an additional step in the assisted dying process. It would not be a compulsory step; therefore, it would not have a major impact or be unworkable. However, this amendment has not had technical drafting support from officials and, although the issues raised are rightly a matter for noble Lords to consider and decide, would likely require further consideration in order to be made fully workable, effective or enforceable.

[Baroness Lawlor (Con)]

If there are on average 3.5 consultations a year face to face, with calls and so on bringing it up to 8.7, it would not necessarily make for additional unnecessary appointments for a person with such a condition. That is my first clarification. My second is about a letter being required and the doctor concerned not wanting to assist in the process. The letter is not about the process. The letter would go into the person’s history over the two years they have been consulting the doctor. It has nothing to do with the process of seeking an assisted death.

[Baroness Merron (Lab)]

Acknowledging that the amendments that I was referring to were tabled by the noble Baroness, Lady Lawlor, I have nothing to add to the points that I have already made, other than to say that the noble Baroness used the word “average” and therefore there is a question about workability. Therefore, our interpretations on the noble Baroness’s second point do differ.