Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Baroness O'Loan (CB)]

My Lords, I declare an interest as a trustee of St John’s Hospice.

This is one of the most important Bills we will ever see. For centuries, we have protected and preserved life, which is to me, and to so many, sacred. We are now asked to change utterly and create a way to help people die. The opposition is massive, particularly among medical practitioners and their professional associations. This is a profoundly dangerous and flawed Bill. The Constitution Committee rightly affirms our right to scrutinise, amend or reject it.

The noble Lord, Lord Alton, was to speak today. He was seriously injured last week and he cannot travel. He is not permitted to speak remotely. Had he been here, he would have warned against coercion, inadequate safeguards, inevitable incrementalism and the risk posed to human rights—very important issues.

Is this Bill clear? The consequences are not known. There was no pre-legislative consultation and no proper impact assessment. The committee was selected by the Bill’s promoter. The witnesses selected largely supported the Bill. The evidence secured did not reflect a wide evidence base. Most amendments tabled on Report were not debated or voted on. Many MPs who wanted to speak were not called. The Constitution Committee said yesterday:

“The degree of deliberation, assessment and scrutiny is therefore significantly less than we would expect to see for an equivalent government bill. This is especially concerning given the subject matter of the bill”.


The Bill is a framework for assisted death, nothing more. There are 42 delegated legislative powers, including Henry VIII powers—powers which the DPRRC described as “sweeping, unspecified and unjustified”. Eligibility is very uncertain. What is a reasonably expected death? The definition of terminal illness is unclear: 36% of such diagnoses are recorded after death to be inaccurate; only 48% of prognoses are accurate at six months; and one in two prognoses will be wrong.

Is it safe? Capacity is to be assumed under the Mental Health Act. The assessment process involves two doctors, only one of whom must meet the patient. How will they determine capacity, especially in those suffering from shock, grief and depressive illness after diagnosis? How will it be assessed and monitored? Deaths may take place in hospices. Hospices have said that the Bill is not safe. In care homes, how could it be safe? In people’s homes, are doctors going to be able to manage their practices if they have to stay until the patient is dead—for up to 137 hours? What if someone does not die? It does happen.

Nobody has to check why someone wants to die. Coercion? Someone who feels they are a burden on others, or is lonely or isolated. And how will we keep our doctors and other clinicians safe? Clinicians are being asked to forget, “First do no harm”, and to provide medication to terminate a patient’s life. Many will not do it. What will be the effect of this on our doctors? Suicide rates are already higher among doctors than generally. According to the BMJ, a doctor dies by suicide every 10 days. How will we care for our doctors and keep them in practice? There is a shortage of obstetricians and gynaecologists because of the processes around abortion. The president of the Royal College of Radiologists recently said that there is

“a chronic lack of radiologists and oncologists … the outlook is bleak”.

What will be the effects of the introduction of assisted death in this situation?

Finally, is it accountable? If only 1% of people seek assisted death, that will be nearly 6,000 a year. How will the VAD commissioner find the psychiatrists, lawyers and social workers to constitute panels for 6,000 applications a year at a time when all three professions are understaffed? At only one hour a case, it would take 18,000 panel member hours a year—and, internationally, the rate is much higher than 1%.

The Bill provides little protection and no security around how death comes about. There will be no inquests. Nobody will ask about coercion, abandonment or anything else. Around 50% of those who die cannot get specialist palliative care. Why do we fund 100% of services at the beginning of life but only 30% at the end? Dame Cicely Saunders said:

“You don’t have to kill the patient in order to kill the pain”.


This Bill is ill-conceived, uncertain and unsafe. It should be rejected.

Terminally Ill Adults (End of Life) Bill

Baroness O'Loan Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness O'Loan (CB)]

I thank the noble and learned Lord for yielding. I simply wanted to say that a number of Members of the other place have said that the Bill did not receive proper scrutiny in the other place. They have also said that they expected that it would receive scrutiny in this place because that is what we do. That is profoundly important, and I do not think that what the noble and learned Lord just said is actually correct. I would also say that there were a number of amendments tabled and a number of MPs who wanted to speak who were not permitted to do so. That is reflective of the fact that the Bill did not receive proper scrutiny in the other place.

[Lord Falconer of Thoroton (Lab)]

I am grateful to the noble Baroness for her intervention. I have laid before the House the facts. I recognise that some Members of Parliament say that the Bill was not given proper scrutiny. I wonder if those were Members of Parliament who did not agree with the conclusion—I do not know. I have laid before your Lordships the time that was spent and the fact that it got more scrutiny than government Bills.

The essence of this Bill is that those who are terminally ill—and that means that they have a diagnosis that they will die within the next six months—should have the option, subject to safeguards, to be assisted to take their own life. One of the features of this debate was the personal experience that so many people have had of how, had that option been available, it would have ended terrible suffering. That suffering is not often about the pain but about the lack of dignity and the profound desire to keep control, because that is what people want.

I believe, from my own experience and from talking to so many people, that having that option is important. The points that have been made against it, which I have listened to incredibly carefully, are, in essence, not that people should not have that choice but that it brings dangers with it. The dangers are, first, that people will be overpersuaded and, secondly, that it will affect society in other ways.

On the idea that people will be overpersuaded, the Bill provides for the following: first, a conversation with the doctor in which all the options, including the palliative care options, are laid out; secondly, that a doctor decides that it is a free choice; thirdly, that a second doctor decides that it is a free choice; and, fourthly, that a panel, consisting of a senior judge or a King’s Counsel, a psychiatrist and a social worker, concludes that the person is not being coerced, that they are capable of making the decision and that it is their free choice. As it happens, that is probably the most safeguarded procedure in the whole of our healthcare system. It is certainly the most safeguarded process when compared with terminal illness Acts in other countries in the world.

I profoundly believe that people should have this choice—a profound belief that is based not on either my spirituality or my lack of spirituality, but on looking at the evidence from other countries that this will not lead to people being overpersuaded. I have in mind those countries that already have a terminal illness Act. The one that has been in force for longest is the one in Oregon, but there are many other states in the United States of America that have terminal illness Acts that have been in force for 20 years and more. They do not have those safeguards. They do have annual reports and record-keeping of the highest sort about assisted death. They show no evidence of the coercion that some noble Lords referred to in this debate.

I would have expected that, if there were real evidence of that, somebody in the course of the debate would have referred to a case from one of those countries where there is a terminal illness Act showing that there was coercion. There was none. I am convinced, first, that the Bill has had proper scrutiny in the other place and, secondly, that there is no real danger in relation to coercion. Thirdly, I completely accept the point made by noble Lords who said in this debate that they wanted more palliative care—I want more palliative care, and we should do everything we can to promote it. However, as so many people said, it is not either/or—it is both.

Some 75% of people in Victoria, Australia, who have had an assisted death came from palliative care, and 92% in Oregon came from palliative care. The Select Committee in the Commons to which I referred, which reported in 2024, said that palliative care in many jurisdictions went up in terms of its resources. In answer to the question that was raised about what the effect will be on palliative care: on the basis of other jurisdictions, it will get better. In fact, the debate here has provoked the Government to spend more money on palliative care.

Many noble Lords have talked about language. I take no point about language. I simply say this. For over 10 years of having been engaged in this debate, I have found that, for people who are terminally ill and want an assisted death, nothing upsets them more than saying that that is suicide. They hate that because of the impact it has on those they leave behind. What they feel is that they are dying anyway, and what they want is some degree of control over when and how it will happen.

I turn briefly to what happens next. I very much welcome my noble friend Lady Berger’s Motion to set up a Select Committee that can hear evidence. I very much welcome that it is time-limited, because, as my noble friend and I indicated in the letter we sent to every Peer, it allows for the Bill to go through all its phases after 7 November. I will therefore support my noble friend’s Motion to set up a Select Committee.

We have a job of work to do. I agree with everybody that, plainly, this House must give the Bill a Second Reading. We must listen to the evidence that my noble friend Lady Berger’s Select Committee will supply, and then we must do what we do so well, which is scrutinise and amend the Bill as necessary, and then send it back to the other place for a decision.

I have heard some noble Lords say, “Oh well, we can say no to this Bill”. Ultimately, on an issue such as this in our system, somebody has to decide. It is not the electorate because it is never in anybody’s manifesto, with the exception of the Greens. Therefore, Parliament has to decide. Ultimately, in our system, that means it will have to be those who are elected—not those who are unelected—who make that decision.

I end by expressing my profound gratitude to the House for the attention and quality of the debate it gave to the Bill. I commend this Bill to the House.