Terminally Ill Adults (End of Life) Bill

Baroness Levitt Excerpts

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.