Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Baroness Watkins of Tavistock (CB)]

My Lords, I thank all those who have sent me opinions and information on this issue. I declare my interests as a registered nurse and a fellow of the Royal College of Nursing, which has adopted a neutral stance on the Bill, recognising the wide disparity of opinion within its membership.

The fury expressed by some people that they will be coerced into asking for assisted dying is real. The concerns are particularly strong among marginalised communities, as so amply demonstrated by the previous speaker.

Many people with severe disabilities who believe that they may become a burden to other family members, as well as those living alone who express fear about the future and the difficulties of living with a progressive condition, do not like the Bill. However, considerable safeguards in the Bill are designed to ensure that undue pressure concerning assisted dying is never placed on individuals. If a patient is given the opportunity to discuss their future options when planning the last months of their life, this should include the right to refuse further treatment and receive compassionate palliative care.

Patients must be given the chance to explore the options available to them. One of the many issues raised in this House, and in correspondence with the public, is that many people fear staying with the uncertainty about dying—not necessarily about when they will die but how their health and bodily functions, including continence and mental capacity, will deteriorate. People report being fearful of incontinence, speech difficulties and losing capacity, so that they are unable to express their wishes as they become increasingly dependent.

Let us encourage society to discuss and complete advance directives relating to future care, in the way that we are encouraged to make wills. This approach would enable those who would never want to discuss or consider assisted dying to make that clear in their personalised advance directive, and vice versa. Nurses and care workers are often those who are asked about assisted dying by patients, frequently during intimate procedures, including, for example, changing soiled bedding and washing.

I recall, when I was a district nurse, a patient saying something similar to me: “My kind husband just can’t cope with washing me, so I wait for you and I do not tell him I am dirty below but just lie here in it. He does not know, nurse, because he does not sleep in the bed with me any more. We were so happy together. We are worn down with it. Can’t you hurry it up for me?” The Royal College of Nursing has published excellent guidance on how to respond to such a request to hasten death. It states that

“nurses should acknowledge and act on all concerns raised”,

investigating and escalating them to the doctor responsible for the patient’s care and treatment.

The Bill is designed to establish a system for terminally ill adults to access assistance, yet no mention is made in it of the responsibility of health professionals to refer patients to an appropriate medical practitioner for preliminary discussion, to be recorded in the person’s notes when such requests are made.

When the process works well and advance directives have been made, agreed active treatments may be stopped and compassionate, excellent palliative care interventions accelerated. Early clarity on the patient’s position on assisted dying would be helpful to everyone. However, if the patient’s wishes have not been recorded, and they choose an assisted dying pathway in the late stages of their illness, should the Bill pass, there could be challenges from relatives who are vehemently against assisted dying for religious and/or ethical reasons.

I am broadly supportive of the Bill, but I would hope that we can consider the two issues I have raised—advance directives and other healthcare professionals’ involvement.

--- Later in debate ---

[Baroness Berger (Lab)]

I am very grateful for the intervention, and I was just about to come on to that, but I will answer that now. The answer is yes, absolutely. The intention is that all the evidence accumulated and amassed during that time will be published for everyone in the House to interrogate and consider in advance of us going into Committee of the whole House. To confirm, this Select Committee cannot take place in parallel in order that we can receive evidence on vital parts of the Bill before we go into debate, so that we are not in the unenviable position of knowing what is wrong with the Bill but being unable to amend it.

My Motion provides that a Select Committee would be intended as a focused piece of work, hearing vital expert oral evidence, as I have just set out, rather than it being a more time-intensive open exercise. It may report by simply publishing that evidence before we go into Committee of the whole House, in order to inform our detailed consideration of the Bill. As I understand it from the clerks, the revised timetable allows the committee to hold six meetings over three weeks, with two panels of witnesses on each of the days, to begin the week commencing 20 October and allowing it to conclude by 7 November. The revised timetable ensures that the Bill can progress to its next stage and maintain the opportunity for four sitting Fridays before Christmas.

We have, over the past two Fridays, shown the determination of your Lordships’ House to discuss the Bill in a considered and constructive way, and it is my strongest hope that we can continue to do that. If my amendment is accepted, I do not intend to speak on the Motion that will follow, which contains the detail that I have just set out. I am grateful to my noble and learned friend Lord Falconer of Thoroton—

[Baroness Watkins of Tavistock (CB)]

Is the list to give evidence that the noble Baroness has detailed finally determined or would it be possible for us to add the Royal College of Nursing with its 500,000 nurses?

[Baroness Berger (Lab)]

I thank the noble Baroness for her intervention. As I understand it, it is within the gift of the Select Committee to determine who will be called for evidence. I have sought to set out the key people, but of course there will be many other suggestions. Obviously, conscious of the tight timetable, we will not be able to have an extensive list, but I am sure that the chair, when appointed, will consider the suggestion that has been made.

I return to expressing my gratitude to my noble and learned friend Lord Falconer of Thoroton for being prepared to work with me to reach an agreement that would allow the House to engage carefully with the substance of what is being proposed and the powers we are being asked to bestow on Ministers. I am grateful to the many noble Lords who have already indicated in their speeches their support for my amendment and my Motion. I beg to move.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Gove (Con)]

My Lords, I support the noble Baroness, Lady Coffey, in raising this question. Whether or not the suggestion from the noble Baroness, Lady Coffey, is the right way of addressing this issue is genuinely a moot point. But she is absolutely right to raise the whole question of the fitness for purpose of the Bill, given the nature of our devolution settlement.

I speak with a modicum of experience. For just over four years, I was the Conservative Government’s Minister for Intergovernmental Relations, responsible for seeking to make the devolution settlement work at a time when we obviously had a party of one colour in government in Westminster and parties of very different complexions in Belfast, Cardiff and Edinburgh. Prior to that, as Secretary of State for Justice, Lord Chancellor and Secretary of State for Environment, Food and Rural Affairs, I had to navigate the thickets of our devolution settlement.

It requires care to make it work. In order to do so, we have to take account of conventions, of legislative competences, of precedents and, as my noble friend Lord Harper pointed out, of the interwoven nature of the lives of communities that live on our borders. It is absolutely right that we should do so, both as a revising Chamber and as a revising Chamber considering legislation of such moment.

As everyone has pointed out during the passage of the Bill, strong feelings are engaged on every side. If we are thinking about fundamentally changing the responsibility of the state and our NHS when it comes to the balance between alleviating pain, prolonging life and, in certain circumstances, ending life, then we must proceed with care.

It was the explicit wish of many in the House of Commons, including in Committee, that the Bill takes seriously the operation of the legislation—so it is not finicky, an abdication of responsibility or something to be criticised when raising these specific and precise questions. It is our role.

Of course, many of us recognise, whatever our feelings on the Bill, that the House of Commons clearly gave its express wish that those who are living with a condition that means that their life will soon end in any circumstances should be able to choose the timing and manner of their death. I respect that clearly expressed wish. Some of us may take a different view about that imperative sent to us from the House of Commons as a matter of first principle, but all of us have a responsibility to look at how the legislation operates, because we are not in the business of simply recognising and respecting a sentiment, no matter how sincere; we are in the business of introducing legislation that must work and be made to work. Therefore, it is our responsibility in the days ahead to look in detail.

That is why I make no apology for specifically referring to the operation of the Sewel convention. Introduced by Lord Sewel of Gilcomstoun, a fellow Aberdonian and a former Labour Minister, it is a convention that broadly governs how we and the Government should legislate with respect to devolved matters. The Sewel convention makes clear that the Government should not normally legislate in areas that are strictly devolved without the full consent of the devolved legislative chambers—the Senedd Cymru, the Holyrood Scottish Parliament or the Northern Ireland Assembly.

Because it is a convention, of course it is the right of Westminster—Westminster is ultimately sovereign—to legislate without that consent. But the broad convention, on which the success of our devolution sentiment rests, is that that should be exercised only sparingly. This point was made very well and repeatedly by the promoter of the Bill in this House himself, the noble and learned Lord, Lord Falconer. On a variety of occasions in the past, when the Government of which I was part sought to legislate in a way that may have caused disquiet or opposition in devolved legislatures, he has pointed out the importance of the Sewel convention, and he is not alone in doing so.

The former Prime Minister, Gordon Brown, in a report commissioned by the current Prime Minister in the other place on the operation of the Sewel convention, recommended that the Sewel convention be made justiciable and that it should be the case that it should move from a constitutional convention to be a legislative part of our constitution. The Government have not yet taken that step, but it is the stated intention and policy of the Government to ensure that, if one did choose to legislate without the consent of a devolved legislature, that would be capable of challenge in the courts, which it is not yet.

In stressing the importance of making sure that we proceed with care, I am doing no more than expressing not just my experience of how important it is to respect the devolved sentiment but my acknowledgement of the direction of travel that the Government had set out with their belief in making the devolved settlement work better.

The point has been made that our devolved settlement with regard to Wales is complex, and indeed it is, as a number of noble Lords have pointed out. Crime and justice are not devolved, but health is. But again, even in the area of crime and justice, there is no settled will.

I participated in the convention looking at the future of the constitution with regard to Welsh devolution, led by the former Archbishop of Canterbury, Lord Williams of Oystermouth—Rowan Williams. In it, he made the case—I believe it is a case that exercises the sympathy of the noble and learned Lord, Lord Thomas of Cwmgiedd—

[Baroness Watkins of Tavistock (CB)]

My understanding is that the Senedd is undertaking its usual processes around legislative consent, with reports from the health committee and the justice committee to be published soon. A date for agreeing legislative consent has not been set, but it is likely to be either shortly before or immediately after Christmas. It normally would take place before Report, so that amendments can be drafted in line with the feelings of the Senedd at the time. I wonder whether we need to look forward rather than historically.

[Lord Gove (Con)]

I am grateful to the noble Baroness for making that point, because it takes me to two of the points that I was about to make about the two committees in the Senedd that have looked at this: the Legislation, Justice and Constitution Committee and the Health and Social Care Committee. Both have explicitly raised concerns about this legislation.

The point that I was making about criminal justice is that, if there is a broad view among what one might call progressive parties in Wales—and certainly those parties that are likely to form a majority after the next Senedd election—it is that crime and justice should be devolved. That is not the case at the moment. It should not govern how we legislate in this House. But if we have to have regard to sentiment and to making the devolution settlement work, as I believe we should, we should be aware that legislating without the consent of the Senedd in areas such as crime and justice is certainly putting an additional strain on the devolution settlement. Let me put it no more highly than that.