Terminally Ill Adults (End of Life) Bill

Baroness Stroud Excerpts

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.

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

My Lords, before we proceed, I will just say that we are getting to the point where we should begin to think about Front-Bench replies to this group of amendments so we can finish at around 3 pm. I do not want to break mid-group because that, of course, is very difficult for the House, Members and the clerks, as it will have to be recorded. Perhaps your Lordships can just bear that in mind, as I am conscious that the time now is nearly 2.40 pm.

--- Later in debate ---

[Baroness Merron (Lab)]

I am most grateful.

My Lords, I thank all noble Lords for their contributions to the debate on this group. As is my consistent introduction, my remarks will focus only on issues where the Government have major legal, technical or operational workability concerns. Many of the points that follow relate to the European Convention on Human Rights. These are risks that I am raising to inform noble Lords’ decision-making, as I said on the first group. I wish to be clear that the underlying policies are a matter for Parliament. I say to noble Lords who referred to my ministerial colleagues in the other place that it is the role of Ministers, whether in your Lordships’ House or in the other place, to flag the risks to the Bill, including potential legal challenges. As I said, policy decisions remain a matter for the sponsors. Decisions in this regard rest with Parliament.

I begin with Amendment 22, tabled by the noble Baroness, Lady Grey-Thompson, and Amendment 30C, tabled by the noble Lord, Lord Farmer. These amendments would make prisoners, a defendant on remand, a defendant on bail or those detained by a hospital order ineligible for assisted dying services, even if they have a terminal illness and meet all other criteria. Aside from the right to liberty—Article 5—the ECHR requires that prisoners, a defendant on remand or a defendant on bail should have the same rights as those who are not. The rights engaged by this amendment are Article 8 on the right to respect for private and family life and Article 14 on prohibition of discrimination. Noble Lords may wish to note the risk that making these groups ineligible for assisted dying would, on the face of it, lead to a difference in treatment, which would need to be objectively and reasonably justified in order to comply with ECHR obligations.

Likewise, making ineligible hospital in-patients who are under a hospital order would lead to a difference in treatment. Without sufficient justification for the discriminatory treatment, this may be a breach of the ECHR, which could lead the courts to issue a declaration of incompatibility.

The noble Baroness, Lady Grey-Thompson, has also tabled Amendments 24, 458, 308 and 347. The purpose of Amendments 24 and 458 is to exclude those who are pregnant from accessing assisted dying, while that of Amendments 308 and 347 is to make persons who are homeless, or living in supported or temporary accommodation, ineligible for assisted dying services. As I have previously noted, the reasons for this difference in treatment would need to be adequately justified to avoid the risk of a successful challenge under the ECHR.

[Baroness Stroud (Con)]

Can the Minister give her perspective on whether the arguments laid out today would be justifiable as reasons for a different form of treatment between the two categories: prisoners and non-prisoners?

[Baroness Merron (Lab)]

It is important I reclarify that that is a policy decision. What I am doing with your Lordships’ Committee is advising on risks, to assist noble Lords to make their decision regarding this policy.

Amendments 30A and 119A, tabled by the noble Baroness, Lady Berridge, would exclude any person with an education, health and care plan from being eligible for an assisted death, except in cases provided for in regulations made by the Secretary of State. As drafted, these amendments could impose unclear and potentially undeliverable legal duties on the Secretary of State and are potentially not aligned with how EHCPs work in practice or in law. The amendments give rise to a number of unresolved operational questions that do not work with other provisions of the Bill and they are not drafted with sufficient specificity. That could lead to confusion for those interpreting the legislation and unintended outcomes.