Terminally Ill Adults (End of Life) Bill

Baroness Levitt Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, as sizeable as this group of amendments is, the key proposals embodied within it can be described in relatively brief terms. The Committee therefore owes its gratitude to the noble Lord, Lord Carlile, for having given exactly that kind of helpful summary in his opening speech, which set our debate going on a good track. In thanking him for that, what has emerged most clearly to me in this debate is the far-reaching nature of the change to the architecture of the Bill represented by his proposals. In addition, were his proposals to be adopted in their totality, they would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death.

In combination, those two consequences inevitably open up a range of questions, as we have heard, about how these proposals would work, not just in theory but most particularly in practice. We have, for example, heard questions about the capacity of the family court, about its funding and about the extent of the opportunity costs which the family court would need to sustain. The noble and learned Baroness, Lady Butler-Sloss, and my noble and learned friend Lord Garnier gave us considerable reassurance on some of those issues, as did the noble Lord, Lord Carlile, himself. However, the questions that have been asked are of fundamental significance and I think the Committee should hear from the Minister how the Government view the practical effect of the proposals and their workability.

On the principle of the proposals of the noble Lord, Lord Carlile, we have heard some powerful points in their favour: for example, the established powers vested in the court; the analogous decisions which courts already have to make; the ability of the court to arrive at a reasoned judgment and to be a court of record; the fact that the court-based appeal system is well understood; and indeed the level of public confidence which the court already enjoys.

I would venture to add another, which is that the role for the court envisaged by the noble Lord, Lord Carlile, would be a substantive judicial role, in contrast to the role originally envisaged in the first iteration of the Bill. That came over to me, at least, as more of a tick-box exercise than an exercise of judicial judgment.

However, what I look forward to hearing from the noble and learned Lord, Lord Falconer, are his views on the strand of this debate brought out most ably by the noble Lord, Lord Pannick, my noble friend Lady Berridge and my noble and learned friend Lord Garnier: how he has assessed the merits of the proposals of the noble Lord, Lord Carlile, in comparison to the proposals set out in the Bill. He is on record, some years ago, as having favoured a court-based approach in this area of the law. If his view is that, on balance, he now favours the panel process, as set out in the Bill, what considerations have led him to that conclusion?

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, I shall respond to the amendments in the names of the noble Lord, Lord Carlile of Berriew, and the noble Baronesses, Lady Grey-Thompson and Lady Coffey. Some of your Lordships may be aware that I know the noble Lord, Lord Carlile, very well. Indeed, the convention of this House is that I refer to him as “my noble kinsman”. This has given rise to a number of jokes outside this Chamber, but there is a serious point to be made here. I reassure your Lordships that this has no effect on the Government’s neutral analysis of the workability of the amendments in question, and although I have the advantage of having advance notice of my noble kinsman’s position, I have engaged with him as to the Government’s response in no different a way from the way I would with any of your Lordships.

As this is the first time a Minister from the Ministry of Justice has spoken in this debate, I reiterate what has been said on many occasions by my noble friend Lady Merron: the Government’s position is that it is a matter for Parliament to decide the policy which underpins this Bill. It follows that I will not be providing a government view on the merits of any of the amendments, nor will I make any observations in a personal capacity.

I will, however, deal with the question asked by a number of your Lordships as to whether the Government would deliver this, were the will of Parliament to be that the general principle contained in the amendments of the noble Lord, Lord Carlile, were to be adopted. The answer is that, given our current workload, it would of course be challenging; I say this because I am in fact the Family Justice Minister, as well as the Lords Minister. But if it is the will of Parliament, then we will work with the judiciary to make sure that we have the resources in place to deliver what Parliament has decided.

This is a large group of amendments, and it is the Government’s view that—

[Lord Harper (Con)]

On that point, briefly, the Minister made the point about making available the resources to deliver what would be in the Bill. The question I asked her, which the Whip on the Front Bench confirmed she would answer, is: would that have an impact on other users of the court system, or would the Government make available extra resources to deliver what is in the Bill, but without disadvantaging other users of the court system? He did say she would answer.

[Baroness Levitt (Lab)]

He did not intend to say that he would go further than I have just gone. That is confirmed. I would be surprised if he had intended to go further than I intended to go.

With respect to the noble Lord, we are not here to debate what is going on in the family justice system. We are here to debate these amendments, and I am going to stick to that. I am also anxious not to take too many interventions because this is a large group, and there are things the Government want to say about workability. I need to get through them in the time allotted to me.

[Lord Deben (Con)]

It is of crucial importance for us to know whether, if we pass the Bill in these terms, other people who are in desperate need would find that they had to wait longer for that need to be met. It is not good enough for the Government to say, “We’ll provide resources to meet the Bill”. They must tell us whether those are additional resources or whether very sad and poor people are going to lose out because the Government take the money away.

[Baroness Levitt (Lab)]

I am sorry to disappoint the noble Lord, but I am not going further than I have gone.

It is the Government’s view that, to a great extent, the amendments in the name of the noble Lord, Lord Carlile, should stand or fall together. As we understand matters, the overall intention of the noble Lord’s amendments is to replace the assisted dying model set out in the Bill with a court-based system. That is a policy choice and a matter for Parliament, but the Government’s view is that, were Parliament to allow some of the noble Lord’s amendments but not others, this might cause problems with the drafting of other provisions, both in the Bill and elsewhere.

I give one further note of caution: if your Lordships support these amendments, the Government may need to revisit the drafting in order to ensure coherence with the statute book, and the noble Lord has readily acknowledged as much in his speech. Although our view is that the amendments from the noble Lord, Lord Carlile, stand or fall together, the Government believe that your Lordships should be aware of our observations and any concerns we need to raise about the workability of proposed clauses as currently drafted.

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[Baroness Nicholson of Winterbourne (Con)]

My Lords—

[Baroness Levitt (Lab)]

I really need to get through this. Can all interventions be saved until the end? If I can get through the things I really need to tell the Committee about, I will take interventions.

[Baroness Nicholson of Winterbourne (Con)]

My Lords—

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[Noble Lords]

Order!

[Baroness Levitt (Lab)]

I am so sorry. I mean no discourtesy to the noble Baroness, for whom I have a great deal of respect, but I must get through the matters that the Government need to tell the Committee about, so it can make decisions about this particular group.

Amendment 120A, in the name of the noble Baroness, Lady Coffey, is plainly contingent upon Parliament agreeing to a court-based application system. In that event, the noble Baroness’s amendment would then exclude those making applications to the court from obtaining legal aid or legal help otherwise sourced from taxes, except indirectly through benefits. The framework for legal aid funding is set out in the Legal Aid, Sentencing and Punishment of Offenders Act, known colloquially as LASPO—an old friend of mine. The Committee should note that there are no primary provisions permitting the grant of legal aid outwith LASPO, so the noble Baroness’s amendment would present a novel approach to extending those provisions. The Government’s view is that, if the principle contained within this amendment is the will of Parliament, the mechanism for achieving this may need to be considered within LASPO in order for there to be legislative coherence.

There is a further point your Lordships should note in relation to the noble Baroness’s amendment. Hearings related to assisted dying, as proposed by this Bill, are not currently in scope for legal aid funding within LASPO. But LASPO does contain provision for exceptional case funding, which provides for legal aid in circumstances in which the ECHR requires an individual to be able to be legally represented. The Government’s view is that excluding assisted dying hearings from legal aid funding, including the exceptional case funding mechanism, as a matter of principle and without exception could lead to a breach of convention rights.

I return to the amendments in the name of the noble Lord, Lord Carlile. Amendment 426 requires the court to be satisfied beyond reasonable doubt, first, that the applicant has sufficient capacity and, secondly, that to refuse to make the order would amount to a

“breach of the relevant human rights law”.

The Government have one concern and one observation. The concern is that it is not clear what the relevant human rights law means in this context. Given that there is currently no right to an assisted death under the convention, as drafted this would mean that the test could never be met. If the amendment refers to other rights, for clarity the Government feel that they should be specified.

The observation is that, as your Lordships will be aware, the expression “beyond reasonable doubt” means that it is the criminal standard of proof that applies. Thus, unsurprisingly, it is in criminal proceedings that the highest standard is generally required. In civil law, the criminal standard is usually reserved for cases where the courts are imposing a punitive measure and the issue to be determined is a question of fact, including findings as to states of mind, such as intentional recklessness. It would be unusual for there to be a requirement that a judge be satisfied to the higher standard on questions of clinical opinion and breaches of legal rights. That said, it would be a policy decision for Parliament whether cases of this kind required the application of a higher standard.

Amendment 426B, in the name of the noble Baroness, Lady Coffey, would require the physical attendance of the applicant in court. It seems that this would exclude any person who is unable to attend the hearing from accessing an assisted death. For this reason, this amendment would, in the Government’s view, engage with Article 8, on the right to private life, and Article 14, on the prohibition of discrimination, and that restriction would have to be objectively and reasonably justified in order to comply with ECHR obligations.

I turn to eligibility, and Amendments 69 and 95 in the name of the noble Lord, Lord Carlile. The Government have a concern that Amendments 69 and 95 would create uncertainty in relation to eligibility for assistance. It might be difficult to prove that a disease could not be halted for a short time, even in cases in which the clinical opinion is that its return and progression is inevitable. There may be a risk that this could be seen as creating unprincipled distinctions in eligibility and could therefore give rise to legal challenge, for example on the basis that excluding certain people is not justified under Articles 2 or 8 of the European Convention on Human Rights, and/or amounts to unjustified discrimination under Article 14.

On court-based mental capacity assessments, Amendment 116 would remove the use of the Mental Capacity Act and propose a different and untested approach to capacity. As part of this, the court would be required to play a more direct, investigative role than is standard practice in capacity assessments. The Government are concerned that this could create confusion for practitioners who have experience in applying, and are trained to apply, the test under the Mental Capacity Act. Switching to this new approach might risk undermining the quality of capacity assessments. There might also be a risk that it would create unprincipled distinctions in capacity by excluding anyone with any impairment of the brain or mind, even if that would not affect their capacity under the Mental Capacity Act. It would be important to be able to justify the different approach to prevent discrimination under the convention.

Amendments 427, 428, 613 and 781 would introduce the concept of independent persons who would be required to carry out various functions. It is not clear from the proposed new clauses how these independent persons would work together to carry out these functions or resolve any disagreements between them, or how the skills and experience of each profession would align with their duties. For example, under the new clause as currently drafted, a solicitor might be responsible for the collection and transportation of the approved substance. It seems that the solicitor would then be required to report on medical matters, such as pronouncing the death of the person, without any requirement that they complete medical training. The Government also have a concern that, should medical help be needed as an unforeseen consequence of the self-administration procedure, Amendment 613 might create a risk, if that independent person had no medical qualifications.

Amendment 427 would require the lethal dosage of the approved substance to be ingested by the person accessing an assisted death. Giving the word its ordinary meaning, “ingested” would not include intravenous or injectable administration. Ingestion is generally understood to mean taking a substance into the body via the gastrointestinal tract: that is to say, via oral, nasogastric or gastronomy routes. The Government believe that this is how most doctors would understand the word “ingest”. The Committee may wish to note that this amendment as drafted might prevent clinicians proposing a more clinically appropriate mechanism for a particular person, such as intravenous or injectable self-administration, or might have the effect of excluding some patients from having an assisted death even though they might be capable of self-administration by other means.

There are additional drafting issues. At the beginning of my speech, I observed that if Parliament were to allow some of these amendments, they might require some redrafting to make them workable. I give Amendment 626 as an example. First, the word “form” and the expression “lethal dosage of drugs” would, in the Government’s view, need more clarity in order not to give rise to uncertainty when regulations are drafted. Secondly, the requirement to specify the exact composition of each dosage might also raise issues of liability, intellectual property and safety. Thirdly, it should also be noted that what constitutes a lethal dose may be patient specific, depending on factors such as weight, tolerance, the patient’s health status and other medication, so the drafting may need to make provision for this. The noble Lord, Lord Carlile, readily acknowledged that there are likely to be some drafting issues. I can confirm the Government’s position is that, while we are neutral on all the policy choices reflected in these amendments, as on the Bill as a whole, the Government would provide drafting support to ensure that any amendments passed by either House are legally workable and consistent and coherent with the statute book.

Finally, Amendment 67, in the name of the noble Baroness, Lady Grey-Thompson, would require the Family Division of the High Court to make an order confirming compliance with the Act before a person could be provided with assistance. This would be in addition to consideration given by an assisted dying review panel. The Government have one observation: the amendment does not set out how and when a person’s case would be referred to the High Court. The Government feel that further detail would be needed in the primary legislation to ensure that supporting procedure rules and practice directions would be adequate.

That brings to an end my observations on behalf of the Government in relation to the workability of the Bill. I have not addressed all clauses, but I have a few moments left. As I said I would, if the noble Baroness, Lady Nicholson, wishes to make her intervention, I will take it.

[Baroness Nicholson of Winterbourne (Con)]

I thank the Minister. I would appreciate if it would be considered at some moment that the two medical professionals on the panel may not have any knowledge of hearing issues. There is about one week of a medical professionals’ training on hearing, and that of course is almost nothing. Unfortunately, in the United Kingdom, about 20 million people have hearing defects, some large and some lesser. None the less, when people are dying or are very poorly, they find understanding considerably more difficult. I want that point to be brought in, and I will raise it in considerable detail at the right moment. I merely ask the Minister to take account of it at this time.

[Baroness Levitt (Lab)]

I am sure the Committee entirely endorses what the noble Baroness said in relation to the importance of those who are hearing impaired. I think that, in these circumstances, this is not a matter for the Government; it is a matter for the proposer of the amendment and for the sponsor of the Bill should it be passed. However, the point remains an important one.

[Lord Harper (Con)]

Before the Minister concludes, she has obviously inadvertently omitted to answer the important question that both my noble friend Lord Gove and I asked. This is a resources question and the Whip, of course, confirmed that she would answer it. The Bill, as introduced, had a court system in it. It was reported that the sponsor of the Bill was advised by the Government and the judiciary that it was not possible to deliver that for capacity reasons. Did the Government provide that advice, and if they did, will the Minister publish it?

[Baroness Levitt (Lab)]

I am going to repeat the words that were used by my honourable friend the Minister for Courts in the other place. The decision as to the introduction of the panel was made by the sponsor.

[Baroness Berridge (Con)]

Can I outline that it is a matter for a Minister? There is correspondence between the Minister in the other place and Rebecca Paul MP that specifically relates to the issue of “undue influence”, which the noble Lord, Lord Carlile, has now proposed to be added for the first time into the Bill. I would be really grateful if the Minister would look at that correspondence and write and put a letter in the Library, because the Government expressed—if I am remembering correctly—a view on why “undue influence” was not appropriate to add to the Bill.

[Baroness Levitt (Lab)]

It sounds like an important point. I am sure that the noble Baroness will understand that I do not have the answer to that at my fingertips right now, but I will write to her.

[Lord Falconer of Thoroton (Lab)]

My Lords, I declare that my wife is a recently retired designated family judge—one of the people whom the noble Lord, Lord Carlile, wishes to include in his court-based process. It makes me warmly in favour of them; I admire greatly the Family Division. I also completely endorse what the noble and learned Baroness, Lady Butler-Sloss, said: if this was put in the Bill, I have no doubt that the Family Division would deal with it well and in accordance with the directions of Parliament. However, I am not in favour of the change proposed by the noble Lord, Lord Carlile, in Amendment 120. I will deal with that in detail in a moment.

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[Lord Kamall (Con)]

My Lords, one reason I was reluctant to get up is that I believe very strongly that all who want to speak in these debates should be allowed to do so, but I ask noble Lords to please bear in mind that there are many others who may want to speak to the group, and we should not make Second Reading speeches. We should repeat what the Chief Whip reminded us of a number of times: please can we speak to the amendments and keep to the point? I will try to do so in summing up very quickly.

It is quite clear that these amendments relate to palliative care and whether people who seek assisted dying services are offered a meaningful choice—not just a choice in theory or on paper because it says it somewhere in the current version of the Bill but a very real choice. I pay tribute to the noble Baroness, Lady Finlay. When I was the Minister taking the Health and Care Act 2022 through the House, she came to speak to our officials in the Department of Health and Social Care who did not know as much as her. She held a teach-in. She did not have to do that, but many officials in the department said that they welcomed the opportunity to learn from such expertise. That is why I think it is important that we learn from all noble Lords, whatever their expertise. We should also thank everyone, especially specialists, currently working in the palliative care sector, which is under pressure.

This refers to a point made early on at Second Reading, when the noble Lords, Lord Hunt and Lord Stevens, said that we know how government works and how money is shifted around government. I do not want to argue about the merits of the Bill—personally, I am torn on it at the moment and am listening to the debates to make up my mind—but the noble Lords said that, if it goes through, the money has to come from somewhere. They feel, having been in government—one having run NHS and one having been a Health Minister—that that money will come at the expense of palliative care. I think that that concern is behind many of the amendments in this group.

It seems that the principle is that anyone who is making that decision, or who seeks that help, should make a meaningful choice, so I welcome the intent of all those who laid amendments in this group—I will not waste time by naming them all; they know who they are, and I thank them. But I point out to them that, as some noble Lords have said, palliative care is mentioned in the current version of the Bill. We see it in Clause 5, on preliminary discussions with registered medical practitioners; in Clause 12, on doctors’ assessments; in Clause 39, on codes of practice; in Clause 40, on guidance about the operation of the Act; in Clause 47, on reporting on the implementation of the Act; and in Clause 50, on review of the Act.

Surely, the crucial question at this stage to both the sponsor of the Bill—the noble and learned Lord, Lord Falconer—and the Minister, are whether they believe that these clauses in the current version of the Bill, as entered this House, address the concerns raised by the many probing amendments discussed in this group. That is the crucial question to the sponsor of the Bill and the Minister.

I have a further question for the Minister, and I know that it is a little unfair because it is probably more a question for the Department of Health and Social Care and perhaps the Treasury, so if the Minister does not have the answer to hand, we understand that she will write to us and place a copy in the Library. Are the Government confident that palliative care will be sufficiently funded so that those who seek assisted dying services are offered a real as opposed to theoretical choice on palliative care, so they can make a more informed decision, understanding what is available to them? I recognise that that may be a difficult question and may put the Minister on the spot, but I hope that she can go back to the Government and ask for an answer that can be shared with your Lordships.

I look forward to the answers from the Bill’s sponsor and the Minister.

[Baroness Levitt (Lab)]

I shall be as quick as I can on this group. My comments are restricted to those amendments on which the Government have major legal, technical or operational workability concerns.

I make one preliminary point very quickly at the beginning. Pursuant to Section 3 of the National Health Service Act 2006, the provision of palliative care is a statutory requirement. Integrated care boards must arrange for palliative care to meet the reasonable needs of their populations. This can be delivered through universal services, such as GPs and community nursing, or through specialist services where appropriate. Importantly, not all patients will require specialist palliative care.

With that in mind, I turn first to Amendments 53, 54, 64 and 221, in the name of the noble Baroness, Lady Hollins. While many people at the end of life may benefit from specialist input, this would normally be based on clinical judgment and patient need, rather than being a blanket requirement. The Committee should note a workability concern in relation to these amendments, in that they diverge from this person-centred and needs-based approach. It should also be noted that these amendments conflict with current NHS statutory requirements on the provision of palliative care.

Whatever the intention, the Government’s view is that the effect of these amendments as drafted is to exclude someone from eligibility for assisted dying if they refuse the additional assessments. Consenting to, or refusing, medical treatment engages Article 8 of the convention. The Committee may wish to note that these amendments could give rise to legal challenge on the basis that excluding that group of people from eligibility might not be justified under Article 2, or might amount to unjustified discrimination under Article 14. Any differential treatment would need to be objectively and reasonably justified.

Amendment 178A in the name of the noble Baroness, Lady Lawlor, would introduce an additional requirement on the preliminary discussion stage. Every person who wants to have a preliminary discussion with their doctor about an assisted death, irrespective of whether they are eligible for an assisted death, would have to be referred to a consultant physician in palliative medicine for a full assessment and care plan. However, preliminary discussion could take place before a person met all the eligibility criteria, and it could happen more than once. Therefore, including an obligation to refer anyone who has a preliminary discussion to a consultant physician in palliative care would create a significant resourcing burden. This appears contrary to usual clinical practice, whereby the involvement of such specialist services depends on an assessment of need and on the wishes and preferences of the person, rather than via a mandatory requirement. This amendment removes the patient choice in this decision. Finally on this amendment, the phrase

“for the purpose of a full assessment and care plan”

is broad and undefined.

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[Baroness Cash (Con)]

My Lords—

[Baroness Levitt (Lab)]

I am not going to take any interventions, I am sorry. I am simply giving the Government’s view. We are very short of time. I apologise to the noble Baroness.

[Baroness Berger (Lab)]

Would my noble friend—

[Baroness Levitt (Lab)]

I am not taking any interventions.

These amendments create a further risk of incentivising the use of palliative care when it is not in line with the wishes of the individual. If a patient has relevant and available palliative care options, as with all treatment options, it remains their decision whether to pursue them.

Lastly, I turn to Amendment 832 in the name of the noble Baroness, Lady Hollins. The Government have workability concerns in relation to the amendment, which states that no person may access an assisted death unless a consultant from palliative medicine has

“confirmed in writing that all appropriate specialist palliative and end-of-life care options … have been discussed and, so far as reasonably practicable, tried or considered”.

This appears contrary to usual clinical practice, whereby the involvement of specialist services depends upon an assessment of need and on the wishes and preferences of the patient. As Amendment 832 excludes people from eligibility unless they have tried or considered particular options for care, this could give rise to legal challenge on the basis that it is not justified under Article 2 or 8 or may amount to unjustified discrimination under Article 14.

[Baroness Cash (Con)]

My Lords—

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[Baroness Levitt (Lab)]

I am not taking any interventions. I would invite the noble Baroness, with the greatest of respect, to write to me, and we will deal with the matter then.

In answer to the noble Baroness, Lady Smith, who raised the issue, along with others, including the noble Lord, Lord Harper, I can confirm that the Minister for Care said this week that we will publish an interim report in the spring and a final modern service framework by the autumn. We want to get this right, so we are not going to rush it. I remind all noble Lords that this is not a government Bill; it is a Private Member’s Bill.

For completeness, as the Committee will be aware, none of the amendments in this group has had technical drafting support, so the way they are currently drafted means that they may not be fully workable, effective or enforceable, but the issues raised are a matter for Parliament to consider and decide.

Finally, I had almost forgotten—how could I forget?—the noble Lord, Lord Kamall. I am going to commit the noble Baroness, Lady Merron, to writing to him.

[Lord Falconer of Thoroton (Lab)]

My Lords, the relationship of palliative care to the Bill is very important and concerns both everybody in this House and people generally, so this is an important group of amendments. The amendments approach the issue in a number of ways. First, they approach it on the basis that, as the noble Baroness, Lady Finlay of Llandaff, said, in order to make a decision, you have to be properly informed. So there is an information aspect, which I will address in a moment. Secondly, there is an issue about whether, if you want to make an application for assisted death, you have to subject yourself to a compulsory assessment of some sort. Thirdly, there is the issue of whether you should be entitled to an assisted death only if you can access better and therefore more appropriate palliative care than might actually be available to you in the place in which you live. I will deal with each of those three issues, which are right at the heart of this group of amendments.

First of all, should you be properly informed? Yes, you most certainly should be properly informed of what palliative care is available to you, and the Bill should make that clear. I submit that the Bill makes that clear and does so in a reasonable way. I draw your Lordships’ attention to Clause 5, which says, on the preliminary discussion:

“If a registered medical practitioner conducts such a preliminary discussion with a person, the practitioner must explain to and discuss with that person … all appropriate palliative, hospice or other care, including symptom management and psychological support, and offer to refer them to a registered medical practitioner who specialises in such care for the purpose of further discussion”.


All the palliative care options that are available to you have to be discussed with you by the doctor in the preliminary discussion and, if you want, you can be referred to a specialist in palliative care as well. In addition to that, I refer your Lordships to Clause 12(2)(c)—I am grateful to the noble Lord, Lord Kamall, who took us through the provisions very helpfully—which says that each of the two doctors has to explain to the patient

“any available palliative, hospice or other care, including symptom management and psychological support”.

Therefore, there are three occasions on which the detail of the palliative care available to you is explained to you.

The noble Baroness, Lady Finlay of Llandaff, says that maybe they would not know the full detail. I recognise that that might be possible, but is it dealt with adequately in the Bill in terms of the information being provided? My own view is that it is. I do not think you need to make further provision as far as information is concerned. I am very happy to talk to any noble Lord in relation to that, but I think that this question has been addressed head-on and that a proportionate and sensible solution has been reached—proportionate even having regard to the fact that this is the most serious decision that somebody could take.

The second issue is whether, nevertheless, should you make a referral mandatory, it has to be done, you have to be examined and you have to have a meeting with a multidisciplinary palliative care team. I say no. I say that that is a choice, because the obligations of giving information are sufficient in relation to that.

The third issue raised by this group is that palliative care is patchy throughout the country; it is better in some places than others. I completely accept that. Everything that we do in relation to assisted dying should not lead to any reduction in finance for palliative care. I am sure that it will not. As those who have read the impact assessment provided by the Health Department will know, it makes it clear that the amounts of money we are talking about to fund assisted dying are in the tens of millions, which is not going to make a difference to the provision of palliative care in this country. I am not in favour of additional provision being made to provide palliative care for those who want an assisted death, nor am I in favour of saying that, unless the standard is the highest or a reasonable standard, you are not entitled to it.

As to the first of those two points—namely, that you are entitled to a higher standard if you apply for assisted death—the Minister said that that might well be contrary to the law, but put that to one side: we should do our best for everybody in relation to palliative care, and you should not get a special advantage if you apply for an assisted death. Secondly and separately, of course, nobody wants the absence of palliative care to be the reason you apply for an assisted death, but we have to give everybody this choice on the basis of the way the world is for them. It should not, for example, be available only in the areas where the best medical attention is available. As long as you know what you are entitled to, it should be available to everybody, not just those who live in Oxford or Cambridge or those who live close to St Thomas’ Hospital and other palliative care places.

The various amendments are all twists on those themes. My view is that we should make sure that they have the right information, and they should have access to a specialist who will tell them it if they want it, but I think the Bill does that. Although I am open to any discussion people want, I think we have done enough and addressed head-on these issues, so I invite the noble Baroness to withdraw her amendment.

Terminally Ill Adults (End of Life) Bill

Baroness Levitt Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Earl Howe (Con)]

My Lords, I shall speak very briefly to the amendment in this group in the name of my noble friend Lord Wolfson of Tredegar. His Amendment 913A seeks to probe an issue raised by a number of noble Lords in this debate: namely, the means by which the assisted dying commissioner may be held accountable. As the Bill is drafted, and as we have heard, the commissioner is appointed by the Prime Minister. In his amendment 124, my noble and learned friend Lord Garnier would have them appointed by the Crown on the advice of the Lord Chancellor. The point that the amendment addresses is that, whoever appoints the commissioner, there ought to be a clear accountability mechanism and a process whereby concerns about the conduct of the commissioner can be investigated in response to formal representations. My noble friend suggests that representations might be made to the Prime Minister, but I would be very interested to hear from the noble and learned Lord what thought he and his co-sponsor have given to the way in which the commissioner will be held to account.

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, given the size of this group and the need to keep my remarks within the speaking limit, I have taken a rather different approach to the structure of my speech, which I hope your Lordships will find helpful. Rather than going through the amendments thematically or in chronological order, I will structure my speech by first setting out some observations about the legal implications of some of the amendments. Then, I will outline what the Government see as operational workability issues presented by some amendments and, finally, I will turn briefly to drafting considerations. Essentially, I will be flagging issues by theme, but if your Lordships have any further questions relating to the workability of any amendments, I will be very happy to write to set out the Government’s views in more detail and place a copy in the House Library. I will not comment on all the amendments. If I say nothing about a particular amendment, it is because the Government have no concerns.

As my noble friend Lady Merron, the Health Minister, and I have set out many times, the Government’s position remains that it is for Parliament to consider the policy, so I will not be providing a government view on the merits of any proposed changes or make any observations in a personal capacity.

In other debates on the Bill, your Lordships have asked how the Government plan to implement it. I will set this out at the outset. The Government have not undertaken any detailed implementation work that would precede the parliamentary process. Should Parliament pass the Bill, the Government will then undertake detailed work to develop a delivery model, which would involve engaging with stakeholders and delivery partners, including the judiciary. To answer the point made by the noble Baroness, Lady O’Loan, this relates also to NHS England and providers, although your Lordships may wish to note that the Bill does not specify where the provision of assistance may or may not take place.

A number of your Lordships, including the noble Lords, Lord Harper and Lord McCrea, the noble Baroness, Lady Finlay, and the noble Earl, Lord Howe, asked about the role of the Prime Minister. I remind the Committee that this is a Private Member’s Bill, so the proposal to designate the Prime Minister as the person who is to appoint the voluntary assisted dying commissioner was made by the sponsor, not the Government. It has nothing to do with the Government. It is up to noble Lords whether they wish to retain that provision.

The noble Baroness, Lady Finlay, asked me to confirm whether the standards in the Cabinet Office governance code would be adhered to. If it is the will of Parliament that the Prime Minister is the person who is to appoint the commissioner, the standard recruitment arrangements for prime ministerial appointments will be followed. These are made through an open, regulated appointments process, which includes selection by an assessment panel containing an independent member. Whether or not the Select Committees are involved will be a matter for the sponsor. The reason I shook my head at the noble Lord, Lord Harper—I meant no discourtesy to him as I did so—was that I thought, and continue to think, that it is a shame that he did not pass by the opportunity to make a party-political point, when, for example, his noble friend, the noble Lord, Lord Deben, was assiduous in ensuring that he did not. I felt it did not help and was not constructive, but I did not mean it discourteously.

I turn to the first of the three groups in my speech, on legal considerations and, specifically, the compatibility of some proposed amendments with the European Convention on Human Rights. The articles in question are Article 14, on protection from discrimination, and Article 6, on the right to a fair trial. On Article 14, Amendment 913 in the name of the noble Baroness, Lady Finlay, would prevent the employment of a person as commissioner, or a member of their staff, should they have links with any agency promoting assisted deaths. The Government wish to highlight that the amendment as drafted is unbalanced, creating a risk of breach of Article 14 of the convention. This would be avoided if it also prevented the employment of individuals who campaigned against assisted dying. In addition, the amendment as drafted would prevent the employment of a person in the commissioner role, or a member of their staff, should they have links with any agency that provides assisted deaths. But, if assisted dying were to be provided through the NHS, that would prevent the commissioner employing staff with relevant NHS experience.

Amendment 496C in the name of the noble Lord, Lord Weir, would involve differential treatment as between how reconsiderations of panel decisions would be made in the cases of, on the one hand, identified groups of people in the amendment and, on the other, those not belonging to those groups. If that is the intention behind the amendment, consideration would need to be given to whether the approach is proportionate and justified to avoid a risk of breach of Article 14. But if the intention behind the amendment is to afford everyone a right to hearings with the commissioner, but for only remote hearings to be permissible in the circumstances specified, then drafting changes would be needed.

--- Later in debate ---

[Baroness O'Loan (CB)]

My Lords, I thank the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, for these amendments. There is a very serious issue here, evidenced by the nature of the conversation we are having, because it is a conversation about realities. The noble Lord, Lord Empey, said that it was time we started using the language that described exactly what we are doing. I think that is what we are doing now. We are talking about how this is going to be paid for and who should pay for it. How should it be managed?

We have seen the Canadian experience. The noble Baroness, Lady Grey-Thompson, spoke about wheelchair access. In Canada, it is regularly reported that people who cannot get wheelchairs are offered assisted dying instead. I grant you that that would not necessarily apply in this particular Bill, but you can see how, with mission creep and with changes, this could happen. We could end up in a situation in which we are making the kind of decisions that the noble Lord just referred to in this matter.

I must declare that I have an interest, because I am a trustee of a hospice—an unpaid trustee, I would add, and it is not in my register of interests for that reason, but it is relevant to this debate.

The noble Baroness, Lady Finlay, defined the variety of costs attached to the proposals quite clearly. I have to ask, following the noble Lord, Lord Deben, if the estimate of £2,000 is in any way realistic for providing a service which requires for each individual the cost of clinicians, the commissioner, panels, admin staff, communications, monitoring and audit, et cetera. That is to say nothing of maybe a national help service, independent advocates and all sorts of other things. We know that to die at Dignitas and places like that costs an average of £10,000, not £2,000. I would like the noble and learned Lord to ask the Minister if we can have a proper assessment of what is currently planned might cost and where it is to come from.

I have another question for the noble and learned Lord, because it is not the Government who pay; it is us. It is taxpayers who pay. If the noble and learned Lord, Lord Falconer, rejects these proposals or something which approximates to taking the cost away from the National Health Service—as the noble Lord, Lord Deben, says, it is in such a parlous state that palliative care services are being extinguished or diminished very significantly—does he think that the public and the voters will think well of a Government who fund suicide while not funding hospices properly? Does he think it will enhance trust and confidence in the Government?

[Baroness Levitt (Lab)]

My Lords, I will speak only to the amendments about which the Government have significant operational workability concerns. Before I do so, I want to say a few words on the general points about funding raised by a number of noble Lords, including the noble Lord, Lord Harper, the noble Baronesses, Lady Fox and Lady Grey Thompson, and others.

I make it absolutely clear that I entirely understand the point that the noble Lord, Lord Deben, is making and why it might seem as though the choice is being restricted if you do not actually know the amounts involved, but I reiterate that it is for Parliament to decide whether this service should be provided and, if so, whether it should be publicly funded. If that decision is made, the Government will fund it. I am not evading the issue when I say that I simply cannot explain how that will be done, because that would be to put that ahead of Parliament’s own decision. We cannot possibly start, for example, putting aside a war chest for something that Parliament may decide that it does not want. As far as priorities are concerned, as I say, it is not a matter of evasion; it is a matter of principle.

It is also not right to assume that funding this, if that is the will of Parliament, will involve taking money away from other parts of the health service. That is not what the Government are saying; we are simply saying that the funding will be made available if that is what Parliament wants. My noble friend Lady Merron, the Health Minister, has written twice on this subject, and those letters are available in the Library for anybody who is interested. As for palliative care, there is an absolute commitment by the Government to increase funding for palliative care and make sure that palliative care is offered properly, irrespective of what happens in relation to this.

As for the noble Lord, Lord Deben, of course I am not upset by what he says about the impact assessment—as if I would ever be upset by anything that he says—but we are doing what is usual, which is to deliver the impact assessment at the outset and, as with other Bills, a further updated impact assessment will be provided following Royal Assent, if we get to that stage. There is a logic to this, because there are so many different elements to what has been debated in Committee that to provide a costing for each and every one would probably keep us here for as long as we are here debating all these amendments anyway. It simply cannot be done. It is not practical. I am not upset, but I am simply saying that we cannot do it and we will not do it until Royal Assent.

Turning to the amendments in the name of the noble Lord, Lord Moylan, these are collectively intended, as we have heard, to prevent the establishment and running of this service being publicly funded. Your Lordships may wish to note that, if passed, these amendments would create an internal inconsistency with Clause 41(5), which requires that the provision of voluntary assisted dying services must be provided free of charge.

Amendments 835 and 868, in the name of the noble Baroness, Lady Fraser, propose a delivery model whereby the Secretary of State must make regulations for the assisted dying service, which would be delivered only by private providers. The key workability risk here is that the new clause created by Amendment 835 would duplicate Clause 41, but with additional constraints, and that would create legal uncertainty, when the Act is looked at in the round, about the limits on the Government’s powers when commissioning a service. The Committee may also wish to note that this amendment may have implications for the devolution settlement, as Wales and the Welsh NHS trusts are implicitly included, which potentially constrains the powers for Wales in Clause 42.

[Lord Falconer of Thoroton (Lab)]

This group concerns the question of funding. First, the noble Lord, Lord Moylan, raised the question: should the people who benefit from this have to pay for it? Secondly, the amendments from the noble Baroness, Lady Fraser, raised the question of whether it should be free to the patient. Could it be provided by private providers? Separately, there were questions along the lines of: will this change the nature of the relationship between the doctor and the patient? Finally, there were questions over whether this might lead somebody to urge people to take an assisted death.

I start with the provisions of the Bill at the moment, which, subject to the amendments to Clause 41 that I propose, require that the integrated care board, or NHS England or the Secretary of State, commission the services. A separate provision, in Amendment 753A, makes provision that, in practice, they have to be free for the person getting them.

The principle that underlies that approach—my noble friend Lady Levitt is right and this is the choice that the Bill makes—is that it will be available free to somebody who wants it and who satisfies the conditions. The reason for that is that we do not want to create a two-tier system where you can have an assisted death only if you can afford to pay for it.

In evidence to the Commons Public Bill Committee, Dr Michael Mulholland, the honorary secretary of the Royal College of GPs, said:

“Whether it occurs in the NHS is not our decision, but we would be very concerned about health inequalities creeping into any part of the health service … If the Bill comes through, we will want to make sure that there is not a differential in who is able to access it”.—[Official Report, Commons, Terminally Ill Adults (End of Life) Bill Committee, 30/1/25; col. 278.]


The amendments of the noble Baroness, Lady Fraser, do not affect that. The amendments of the noble Lord, Lord Moylan, do, and it is for that reason that I oppose them.

I will first deal with the amendments of the noble Baroness, Lady Fraser, which would restrict the model that could be used to private providers only—albeit that she is not saying that it should not be free. I agree with what my noble friend Lady Levitt has said, to the effect that the way it is delivered should not be restricted. I would therefore not be in favour of the amendments of the noble Baroness, Lady Fraser, in that respect.

Terminally Ill Adults (End of Life) Bill

Baroness Levitt Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[The Earl of Effingham (Con)]

My Lords, debate on this group, as with every group thus far in the Bill, has been extensive and in depth. We have heard from around 19 noble Lords on over 70 amendments. His Majesty’s loyal Opposition do not believe that it would be an effective use of your Lordships’ time for us to summarise the excellent contributions made across all Benches by many noble Lords. The relevant points have been highlighted. We welcome the opportunity to hear from the Minister and the noble and learned Lord, Lord Falconer, to understand their position on the proposals that we have all listened to with interest.

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, as with the groups on 27 February, I have structured this speech by grouping amendments by theme rather than taking them in order. This is in the interests of dealing with them as quickly as possible. If anything needs a longer explanation then I will take interventions, but it would be a more effective use of time if noble Lords wrote to me so that I could try to give a fuller and more detailed explanation.

I will begin with some observations about the legal implications of some of the amendments, then outline what the Government see as operational workability issues presented by some of the amendments. Finally, there will be some brief drafting considerations. I shall continue to limit my comments to amendments on which the Government have major legal, technical or operational workability concerns. I remain happy to write to any of your Lordships who have further questions relating to the workability of any amendment and will place a copy in the House Library.

The Government’s position remains that it is for Parliament to consider the policy. I will therefore not provide a government view on the merits of any proposed changes or make any observations in a personal capacity. When we were last in Committee, the noble Baroness, Lady Fox, raised how the Government plan to implement this Bill; she was not alone in doing so but she mentioned it specifically. We have not undertaken detailed implementation work as that would precede the parliamentary process. Should Parliament pass the Bill, the Government will undertake detailed work to develop a delivery model and on workforce planning, engaging with stakeholders and delivery partners, including the judiciary.

I turn first to legal considerations and specifically the compatibility of some of the amendments with the European Convention on Human Rights. The articles in question are Article 6 and Article 8. I turn first to Article 6 risk. There are four amendments in this group which, in the Government’s opinion, may interfere with a person’s right to a fair trial under Article 6. The first is Amendment 499, in the name of the noble Baroness, Lady Finlay of Llandaff, which would introduce a route to annulment of a certificate of eligibility where material circumstances have changed. However, it requires further detail about the process, so it is difficult for us properly to assess it at the moment.

The Government have concerns that Amendment 498, in the name of the noble Baroness, Lady Grey-Thompson, would prohibit any further referral to a panel where the commissioner has previously dismissed the individual’s application to review a panel decision. This has the potential to breach Article 6 in circumstances where a material change has subsequently arisen.

--- Later in debate ---

[Baroness Coffey (Con)]

The Minister will know that I will discuss later why I do not think that the legislation should apply to Wales, and that the Welsh Senedd should make the decision. I tabled the amendment because, at the moment, the judge does not have to be a judge from this country. As far as I can tell from the Bill, it could be a judge from anywhere in the world who has served under the common-law process.

[Baroness Levitt (Lab)]

I am sure that the House will welcome that clarification from the noble Baroness, but it may be that there is a drafting issue, because the amendment refers to England rather than England and Wales, and there is no such creature as a member of the senior judiciary from England only.

Finally in this group, the Government have concerns that Amendment 929B, also in the name of the noble Baroness, may have an impact on the operability of an assisted dying service by placing apparently arbitrary limits on the resourcing of the panel when the demands of that service are, as yet, unknown.

I turn now to groups of amendments dealing with assisted dying review panel proceedings and powers. Amendment 463, in the name of the noble Lord, Lord Murray, would require the commissioner to assess the procedure adopted by every individual assisted dying review panel. That would remove any flexibility for the panel to deviate from procedure, should it seem appropriate to do so for either inquisitive or compassionate reasons associated with the case.

Amendment 464, also in the name of the noble Lord, Lord Murray, would give the panel the same powers, privileges and authority as the High Court. The powers of a High Court judge are significant and wide-ranging. They are set out across statute, court rules and the inherent jurisdiction of the court. The Government think that some of them, such as the power to imprison for contempt, are not the sorts of powers that your Lordships may feel are appropriate for such a panel. Without more clarity and detail, it is impossible to assess whether this kind of extension would be appropriate, and it would be extremely difficult to apply in practice. In the view of the Government, the amendment ought to set out which powers, privileges and authorities it is intended to capture.

Regarding Amendments 495B and 941A, both in the name of the noble Baroness, Lady Maclean of Redditch, your Lordships may wish to note that requiring the panel to identify and provide a report on unmet social or palliative care needs is not within its remit, nor would the panel necessarily have the knowledge of local service provision or the expertise to make personalised recommendations on social and palliative care. Such a report therefore risks containing inaccurate or incomplete advice.

I turn to panel referrals and capacity. Amendment 445, also in the name of the noble Baroness, Lady Maclean of Redditch, seeks to ensure that the panel is independently satisfied that the person seeking assistance has continuously had capacity from the point of their first declaration. Your Lordships may wish to note that the amendment is likely to cause major workability concerns. It would be extremely difficult for the panel to determine whether the person had capacity throughout this period, rather than just at the point at which the capacity assessment is made. Moreover, it might result in people being excluded because of temporary, brief periods of incapacity. For example, a person would not have had continuous capacity if they had had an operation under general anaesthetic during this period.

On panel decisions, Amendment 496, in the name of the noble Baroness, Lady Grey-Thompson, would mean that a person cannot apply for their case to be reconsidered on the basis that the decision was irrational. That would be unusual, as the elements of the existing test under Clause 18 reflect the three primary grounds applicable in judicial review proceedings and are part of a recognised set of legal principles applicable to decision-making. If a person wished to challenge a first panel’s decision for being irrational, which is a term of art in legal proceedings, they would still be able to do so via judicial review. That would create an inconsistency in forum that would need to be justified.

Amendment 496A, in the name of the noble Lord, Lord Weir, would add failure adequately to consider evidence relating to disability-related vulnerabilities to the grounds under which, where a panel declines to grant a certificate of eligibility, the commissioner could refer a person’s case to a second panel. Your Lordships may wish to note that failure properly to consider relevant information would already be captured by the irrationality ground for reconsideration set down in Clause 18(2)(b). Similarly, a decision that was inconsistent with equality legislation already engages the first ground of challenge in Clause 18(2)(a), because it would contain an error of law.

I have taken rather longer over this than I had intended. Noble Lords will be delighted to know that I am nearly there. The final part is on drafting considerations and Amendment 490. If your Lordships support any of these amendments, the Government may need to revisit the drafting to ensure clarity and coherence with the statute book. To give one example, Amendment 490, in the name of the noble Baroness, Lady Grey-Thompson, contains some ambiguous terms that might need tightening up. In the interests of time, I will not go into more detail, but I am happy to discuss further with the noble Baroness in due course. Having taken rather longer than I had hoped, that is it from the Government on this group.

[Baroness Coffey (Con)]

Actually, I have further questions of clarity from the Government’s response. In the amendment that I tabled about His Majesty’s Counsel, the Minister mentioned workability concerns about there not being enough people. I would like to understand whether the government proposal suggested that amendment to the Bill’s sponsor. Do the Government have any consideration about alternatives I proposed during debate, where, instead of King’s Counsel, we could have people such as deputy court judges or other sorts of judges? In the two weeks since we last discussed this matter, have the Government considered that?

[Baroness Levitt (Lab)]

As a general point, the Government merely point out workability concerns and do not suggest ways in which they might be remedied. That would be a matter for the Member who tabled the amendment to discuss with the sponsor of the Bill. So no, we have not come up with any proposals because—I am sure that the noble Baroness is sick of me saying this—we are neutral on this. We just point out where we can see difficulties with the amendment as drafted.

[Baroness Coffey (Con)]

Did the Government propose, on workability grounds, the suggestion in Schedule 2 that King’s Counsel should be included? It may be that the noble and learned Lord, Lord Falconer, can answer that, but a constant theme has been trying to understand what the Government have suggested in their private workings with the sponsor of the Bill, which they will not share with the House. Did they suggest this as a way to make it workable? That is what I am trying to get to the bottom of.

[Baroness Levitt (Lab)]

I am going to have to write to the noble Baroness about this, because I do not think I can answer it. My noble friend the sponsor will deal with the question of panels. If this question is actually about the assistance given by the Government, I refer to my previous answers, but I will write to the noble Baroness on her specific point.

[Lord Falconer of Thoroton (Lab)]

My Lords, in the course of this debate, the noble Baroness, Lady Coffey, referred movingly to the death of her parents. I pay tribute to her courage and her contribution.

I will deal with the groups of amendments in themes. First, I will deal with appointments to the panels. The noble Lord, Lord Murray of Blidworth, through his Amendment 925A, said that there should be a proper appointments procedure. I agree with him that there should be a proper appointments procedure. The Bill currently places the obligation of the appointment of panel members on the voluntary assisted dying commissioner. That is in Clause 4(4)(b) and in paragraph 2 of Schedule 2. I believe that that is adequate. The voluntary assisted dying commissioner must have a proper process. I have faith that he will do that, and the law will require him to do so.

The noble Lord, Lord Murray, also proposes that the Judicial Appointments Commission make the legal appointments. Remember that one of each of the panels would have to be either a judge or King’s Counsel. I am not in favour of that. My noble friend Lady Levitt indicated that there were problems with that, but I have a more principled objection: we are dealing here not with judges but with members of a particular panel, so I do not think that this is either appropriate or necessary.