Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, I declare my interests as chair of Team Domenica and patron of the Acorns Children’s Hospice.

In 2018, along with two other mothers of young adults with learning disabilities, I took a test case to the High Court to challenge the way in which the Mental Capacity Act was being interpreted for this cohort. Essentially, it meant that authorities had no obligation to consult us as parents on so-called “best interests” decisions for our children, because they were chronologically adults and therefore, in the eyes of the law, deemed to have capacity. The High Court judgment, although sympathetic to our case, did not radically change anything, and it is still extremely difficulty for parents to become welfare deputies of their own children.

I recall this to draw your Lordships’ attention to a particularly disturbing aspect of this Bill. Someone such as my daughter, who has Down’s syndrome, could be advised by a doctor whom she may never have met that she should consider that it would be best to have her life ended because she was deemed to have a terminal condition. Not only that, but the Bill specifically excludes any obligation to discuss this with us, her parents, or other family members. I can only imagine the fear and terror that would go through my daughter, and a total lack of comprehension. Yes, she is capable of making decisions on what to wear, what to eat and what to watch on Netflix, but when it comes to something more abstract she is, at best, extremely confused. Also, like many with Down’s syndrome, she is highly suggestible; she is anxious to please those whom she perceives to be in authority. I can clearly see where the danger lies.

It is regrettable that the other place did not find the time to discuss the amendment tabled by my right honourable friend Damian Hinds, which would have excluded any person with a learning disability from initial discussions about being given a fatal dose unless they themselves had raised it. I do not mean to cast aspersions on the medical profession—we have wonderful examples of it in this House—but there is a tendency within it to regard those living with learning disabilities as suffering. We saw that clearly in Covid with the “Do not resuscitate” notices at the end of their hospital beds. People with Down’s syndrome, for example, do not suffer; they do not have a disease.

Nor do I question the good intentions or compassion of those who have promoted this legislation, but I was startled to see in a pamphlet circulated to all Members of this House by the campaigning organisation My Death, My Decision a paragraph urging us not to contemplate any amendment that would “encourage interference from family members”. What a strange view that is to have of the very nature of what a family is. I shall certainly be putting down such an amendment.

I urge the House to consider, when voting on this Bill, the most vulnerable among us. A coalition of more than 350 disability organisations have expressed their opposition to this Bill. For parents who have spent lifetimes fighting for their children to have now to worry about them being disposed of by lethal potions is inhuman and devastatingly cruel.

Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, the Mental Capacity Act 2005 assumes capacity until proved otherwise. However, many people with learning disabilities have neither the ability nor the capacity to make life-changing or even death-making decisions. Under the Bill, because they are chronologically adults, they are not permitted to have anybody with them when the subject of assisted suicide is raised. This is something I will be discussing later in Committee.

[Baroness Hollins (CB)]

My Lords, I am glad to be able to follow the noble Baroness, Lady Monckton. I declare my interests as a past president of the Royal College of Psychiatrists, and I have a parliamentary scholar, a psychiatry trainee who is appointed by the Royal College of Psychiatrists to work one day a week with me. I was a member of the post-legislative scrutiny committee on the Mental Capacity Act. I also founded and chair a visual literacy charity called Books Beyond Words, which is relevant in a way.

I was listening to the noble Baroness, Lady Lawlor, speak about communication. It reminded me that 18% of the adult population in this country are functionally illiterate. This is really important when we think about making decisions of such importance. I have an amendment later proposing a different framework for assessing capacity, and I will obviously talk about that then, but I want to reflect on how the charity Beyond Words creates really difficult stories in pictures, without any words, to try to help people who struggle with words to understand and make decisions about such things as the care and the treatment that they might require. We currently have about 80 stories, all about the whole story that people can discuss with their peers, their healthcare professionals and their families, to help them to understand an issue, so that they will not be left out but will truly understand. It is very easy to think that somebody understands when you have explained something in words, in simple words, and that the person is compliant with it, but when you explain in pictures and enable the person to say what they have read in their own words, then you get an idea of whether they have understood.

I have been trying to think about how I would be able to create a story in pictures to explain this Bill. It would be several stories. It would take an awfully long time and an awful lot of work to be able to do it. I just wanted to respond to what the noble Baroness, Lady Lawlor, said; I thought it was very important.

Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Monckton of Dallington Forest (Con)]

My Lords, I rise very briefly to support my noble friend Lady Berridge’s Amendment 30A on EHCPs, and I declare my interest as founder of a special educational needs college. All our students have EHCPs, and all of them, in their various ways, are vulnerable. What I have learned in the years that I have been campaigning for people with learning disabilities is that they are always at the bottom of the heap when it comes to making legislation. I can only think that, once again, in drafting this Bill, this cohort has been forgotten. People with an EHCP should not be included in the Bill.

[Baroness Stroud (Con)]

My Lords, I support Amendments 22, 308 and 347, tabled by the noble Baroness, Lady Grey-Thompson. Amendment 22 rightly seeks to exclude serving prisoners and those detained by a hospital order from accessing assisted dying under the Bill. As we have heard, the Bill speaks the language of choice, autonomy and settled intention, yet this group are, in effect, the group least likely to have choice, autonomy and settled intention. Nevertheless, these are men and women living in overcrowded, often violent environments, cut off from family contact and support networks, access to services and meaningful work—those things that provide a context for someone’s life. Many are traumatised, mentally ill or struggling with addiction.

Prisoners, as we know, are an exceptionally vulnerable population. In a report published in July this year, the Prison Advice and Care Trust—PACT—warned of the mounting mental health crisis in prisons, where mental ill health is the norm and not the exception. It goes on to note that rates of self-harm in prisons have more than trebled in the last decade, from nearly 26,000 in 2014 to just over 79,000 in 2024, and reflects that recent data shows that, among prisoners, 56% of men and 74% of women report having mental health problems. In the year to June 2025, government statistics show that there were 86 self-inflicted deaths per 1,000 prisoners.

Behind these statistics lies a culture that breeds hopelessness. It is into this context that we are proposing to make serving prisoners eligible for an assisted death. I am deeply concerned that, terminal illness aside, if you design a scheme in which a person’s own sense of despair may well be a key trigger, and there is no requirement for asking someone what their motivation is for engaging in this act, those who feel most hopeless will be the most susceptible. By any objective measure, prisoners are perhaps among the most hopeless within our society.

I note that in response to a question during the Select Committee evidence sessions, the Minister of State for Courts and Legal Services, Sarah Sackman KC, MP, commented that, as we have already heard, this is a policy choice on which “the Government is neutral”. But she went on to say that much will depend on its interaction

“with the wider prison regime and some of the challenges that lie therein”,

and that there would be a need to ensure that the Bill operates in a way that

“does not lead to abuse or is not misused”.

I would like to learn from the noble and learned Lord, Lord Falconer, precisely how he intends to ensure that this is not misused within the prison system.

I wonder whether the Minister and indeed the noble and learned Lord have considered the 2021 Hospice UK report Dying Behind Bars. The authors note that

“up to 90% of older incarcerated people have at least one moderate or severe health condition, with over half having three or more”.

I have great sympathy for the comments made by the noble Baroness, Lady Fox; clearly, the state has already taken from these individuals their liberty as a punishment to protect the public. The state is of course also responsible for the delivery of healthcare within prisons. In such an imbalanced power dynamic where the state has such overwhelming power, the shift this legislation represents as drafted, whereby the state may say to a prisoner who otherwise meets the eligibility criteria, “We will help you die”, is a profound challenge. I am concerned that if we fail to exclude prisoners from the remit of the Bill, we risk undermining the comprehensive suicide prevention programmes operating in our prisons.

Providing access to assisted dying in prison sends a chilling message that where the state has failed to provide adequate care, resources or meaningful autonomy, its final offer is death, which is why I support this amendment. I am conscious of time, though, so will speak only briefly in support of Amendments 308 and 347 in the name of the noble Baroness, Lady Grey-Thompson.

Noble Lords will perhaps be aware that I ran community projects for homeless people for the better part of two decades. I will not repeat what others have said, but the complexity of the lives of people who are homeless cannot be overstated, and I am deeply concerned that the Bill fails to account for their specific needs and risk factors. People experiencing homelessness already face significant obstacles to accessing the healthcare they need. The NICE guidelines for integrated health and social care for people experiencing homelessness note:

“Barriers to access and engagement with preventive, primary care and social care services can mean that problems remain untreated until they become very severe and complex”.


It seems entirely reasonable to reflect the complexity of the lives of people experiencing homelessness, as the amendments in the name of the noble Baroness aim to do.

I accept that the legislation is based upon the premise of autonomy, but autonomy is not absolute, and we do not live as isolated individuals. It is reasonable and appropriate to ensure that this legislation is as safe as possible, with vulnerable populations in mind. To that end, I also strongly support Amendments 308 and 347.

Terminally Ill Adults (End of Life) Bill

Baroness Monckton of Dallington Forest Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

In conclusion, let us never forget that it is not just our reputation to perform our duty to scrutinise that hangs in the balance. As a result of our consideration of the Bill, the lives of people far more vulnerable than many of us will ever be hang in the balance too. Those who have no voice are depending on us, however loud the siren voices to rush our scrutiny, to subvert the transparency of the House—where, as my noble friend Lord Harper reminded us, every word spoken is on the public record—and to do grubby deals through some shady, so-called shadow usual channels process. We must not fail them. I trust that the noble and learned Lord realises that how he responds to this and other amendments will show whether he appreciates that our reputation depends on our not failing them.

[Baroness Monckton of Dallington Forest (Con)]

My Lords, all these amendments address motivation, one of the areas that the noble and learned Lord, Lord Falconer, identified as a key area in his email sent to some noble Lords on Wednesday. This therefore feels an appropriate moment to make some short observations on general matters arising from that email. My amendments focus on risks to people with learning disabilities and autism, and there is also an amendment to exclude hospices that provide palliative care, which is, I believe, true assisted dying.

As I understand it, the email’s proposal has two parts: first, that we move away from this House’s established line-by-line scrutiny and condense 74 groups into 13 areas; and, secondly, that any concessions will be limited to those areas. My question is straightforward and has been asked in various ways by my noble friends Lord Harper, Lord Deben and Lord Blencathra. When will we see the detail? What amendments will the noble and learned Lord make to address each of the areas of concern he has identified as key in the Bill? What are the terms of the noble and learned Lord’s proposals to address the concerns raised by the Delegated Powers and Constitution Committees?

We are told that amendments will be brought forward on Report to address a limited number of these concerns: advertising, independent advocates and some regulation-making powers, but we have not been told which ones. There are now 42 such powers and a further seven Henry VIII powers, but no detail has been provided. Commitments to respond to these reports were made months ago. We need to know.

The email identifies only three further changes: on the position of those aged 18 to 25, those deprived of their liberty through the Court of Protection, and the role of multidisciplinary teams. These are important but they do not go very far. Nor is there any reference to excluding hospices, as suggested in the email from the noble and learned Baroness, Lady Butler-Sloss. Finally, there is no mention at all of the serious concerns raised by five major royal colleges. They were flagged as long ago as May.

To conclude, we need answers long before Report so that all Members of this House can properly consider what is proposed.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I thank the noble Baroness, Lady Monckton of Dallington Forest, for that excellently clear way of expressing some of the discomfort and what we would like to see. I would be much happier and feel that I did not have to speak too much if I was getting reassurance and seeing on paper what exactly will address our concerns. At the moment, we are not getting that. We wish the noble Lord, Lord Shinkwin, were here. The fact that he is not is a real shame for the quality of this debate.

Inside and outside this House, I know plenty of people who support assisted dying and this Bill, inasmuch as they know the broad sense of what it is about. I try to avoid living in echo chambers. Whenever we discuss why they support the Bill, and potentially have a bit of an argument, they invariably say, in a very humane and compassionate way, that they think it will help people who are suffering, and that anyone who says they are suffering should have access to assisted dying. It is assumed, therefore, that the motivation of illness-induced suffering is at the heart of the Bill. That is what most people think. It has come up a lot in this Chamber but, ironically, suffering is not mentioned in the Bill, and neither is there any reference to motivations in the way that one would imagine. That bothers me, because the Bill checks on capacity, prognosis and residence, but it does not enforce a check on motivation. It seems to me that we should ask somebody who says that they want assisted dying, “Why?” It is a crucial absence in the Bill, and I hope that the noble and learned Lord, Lord Falconer, might rectify that or explain exactly why the Bill does not think that doctors should ask, “Why do you want assisted dying?” I think it would throw up a whole range of red flags in relation to coercion.

I have added my name to two amendments in this group, Amendment 30 in the name of the noble Baroness, Lady Foster, so ably moved by the noble Lord, Lord Weir of Ballyholme, and Amendment 56 in the name of the noble Baroness, Lady Coffey. To save time,I will concentrate on Amendment 30, which seeks to ensure that those who seek assisted dying are not substantially motivated by a number of factors. I will focus on two of those—not wanting to be a burden on others or public services, and not being motivated by mental disorder, including depression.

This week was the 29th anniversary of the death of my father, John Fox. He was only 66. He was diagnosed with cancer and given three months to live, although he actually made it for four and a half months. When he was told, the whole family was devastated, as anyone would be. The one thing that really shocked me to the core, and stays with me, was that when I had that initial, very emotional father to eldest daughter conversation, my father kept apologising. Believe me, that was not usual. In our relationship, he did not say, “Sorry, Claire” lots of times. He was so distraught. He was convinced that he would be a burden on us, and that his daughters and my mother, in looking after him, would all have to miss work and all the rest of it. He kept saying, “I’m really, really sorry”. He was worried about how we would cope. He did not want to distress others—a point that the noble Baroness, Lady Lawlor, was making on her amendment to this amendment.

I also noticed that he kept saying sorry to the nurses and the doctors. To everybody, he kept saying, “I’m really sorry for taking up your time. I’m really sorry that you’re having to give me so much attention”. There were stories in the media at the time about bed blocking. He was a vociferous reader of newspapers, and I was hiding the newspapers because I thought he would say sorry even more, convinced that he was taking up NHS resources. It took some time and determination for the family to reassure him, but I kept thinking afterwards how sad it would have been if he had been on his own or in a care home or whatever. To be honest, if a GP had suggested that assisted death was a medical option, in today’s circumstances, I think my father would have said yes—not because he wanted it but because he felt he was a burden on the family. It would not be the GP’s fault, as it is an internal feeling of being a burden. That is not the same as choice.

I was struck by a letter from Lord Sumption in the Times that is worth reflecting on. He says:

“The current bill contains a number of provisions designed to ensure that patients are not ‘pressured by any other person’ into taking their own lives”—

that was in relation to something else. He continues:

“The real problem, however, is not the pressure applied by ‘other persons’. It is assumptions which many old and ill people spontaneously make about the attitudes of the society around them. They are afraid of being an emotional or financial burden”.

That is very important.

By the way, I had better say that, in the four and a half months following his diagnosis that my father lived, we had some of the most meaningful time of our lives with him. It was through a veil of tears, but there was love, joy and reconciliation, there were conversations that would never have otherwise happened, and so on and so forth. It was a time that was important to him and to us as a family in a way that I cannot really describe.

Another motivation that I feel strongly we need to explore is on the part of those with a mental disorder. As many noble Lords have noted, a number of mental health conditions have suicidality as a feature. Again, I am sorry to do the personal stuff, but the first time I encountered that was as a young mental health community worker. I met a young man who was bipolar. I and others—psychiatric medics and social workers—worked hard not just to prevent his suicide but, using all our skills in pharmacological and psychological interventions, to alleviate the terrible “black dog” of depression and the horror of the obsessive suicide ideation that that young man had. I have to ask, then, whether the Bill would allow such a suicidal person’s depression-induced desire for death, and whether all those who had worked with him would suddenly be expected not just to welcome it if this young man made the choice of an assisted suicide but to say, “Oh, look, a perfect exemplar of autonomy and choice”.

I was therefore a little taken aback that the noble and learned Lord, in his summation of the last group on eligibility, said in relation to those with a mental disorder that it is their choice, and that if they want it and they have capacity then that is all right. I point out that, for anyone who wants to commit suicide, it is their choice and they want it, but some of us spend a lot of time asking them please not to do it, not saying, “Yippee!” I cannot think that, in that situation, if that young man had said, “I’ve got a terrible story. I’ve got a terminal illness in addition to my bipolar depression, and I want your support and help in assisted dying”, I would say that it is all perfectly fine and he should get on with it, and be delighted for him being able to show that he is a free, autonomous individual. I would say, “Please don’t”. The four and a half months that we had with my father was the kind of quality time that I would want to ensure that young man had, every day of his life, even if he was terminally ill and dying. I would want to make sure that he was not depressed or suicidal during the time he lived.