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.

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[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.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 5th December 2025 Lords Chamber

[Baroness Berger (Lab)]

My Lords, my Amendments 4, 249, 257, 304, 337, 446 and 448 raise the eligibility for the provision of assistance under the Bill from 18 to 25.

There is no reason, either in law or in principle, why we should assume that 18 is the right age for eligibility for an assisted death. It is not only an arbitrary starting point; it is contrary to the mounting evidence of when the brain is fully formed, which I shall come to in just a moment. When I asked the Children’s Commissioner, Dame Rachel de Souza, whose role it is to promote and protect the rights of children and young people, what she thought of 18 being used as a cliff edge for eligibility under the Bill, she answered:

“The reality of life on the ground, as those of you who work with health will know, is that 18 is not really a thing … when it comes to the most vulnerable, that is extended to 25”.


She went on to say:

“I think that we are missing a trick by thinking somehow 18 is the cut-off. I really do strongly think that. I would like the committee to consider that”.


Noble Lords will be aware that there are a range of existing circumstances where 25 is already seen as a threshold to adulthood, instead of 18. This is particularly relevant when we consider vulnerable young people with a terminal illness, whom we need to consider in this legislation—lest we forget that children are not currently mentioned in the Bill.

The point was forcefully made to the Select Committee. The Children’s Commissioner said:

“They are the children I am worried about: children with special educational needs, children who are already in hospital with life-limiting diseases, children who have EHCPs—education, health and care plans—that provide support for them until the age of 25. The reason they do that is that they are vulnerable, whether it is mental health concerns, whether it is because they have had terrible lives and might have all sorts of problems, including suicidal ideation. It is a real concern”.


Noble Lords will know that local authorities are responsible for preparing and maintaining EHCPs for children and young people with special educational needs up to the age of 25. Our local authorities have a statutory responsibility for young people up to this age, particularly those in care and those with special educational needs. It was more than a decade ago that the Department of Health, in its document Future in Mind, recommended an extension of child and adolescent mental health services up to the age of 25 to end the practice of discharging young people out of mental health services at 18.

In the context of criminal justice, I am mindful of the words of the noble and learned Lord, Lord Falconer, himself, who said in his speech in 2021 on the Police, Crime, Sentencing and Courts Bill that a whole-life term should never be imposed on an offender aged 18 to 20 but only on “somebody unequivocally an adult”. I hope that he will agree with me that death is not a less weighty matter than life in prison.

We have heard concerns during the progress of this Bill from experts who work with teenagers and young adults that it will be safer and more in line with the evidence to raise the minimum age for assisted dying to 25. It is by this point that the brain is more fully developed and decision-making capabilities are more secure. In general, the brain does not finish developing until a person is in their mid-20s, which is particularly the case for the prefrontal cortex, which governs our decision-making functions and our ability to think flexibly about potential outcomes.

Noble Lords may have seen research announced only last week by the University of Cambridge which suggests that the brain is fully developed only in our early 30s. I believe that we are here to make good law, and one way we do this is to listen when experts speak and to take their counsel. The simple fact of having enabled experts to give their evidence to this House over recent months does not amount to adequate scrutiny if that evidence simply languishes on the pages of Hansard, instead of being used to shape our work.

Of course, I know that an assisted death would be available only to young people with a six-month prognosis, but we know that it is not always accurate. It is, as I have learned, particularly difficult to get right with young people, who can go on to live for years beyond an initial terminal diagnosis. In its written evidence to the other place, the charity Together for Short Lives wrote:

“We are concerned that the requirement for an accurate prognosis to be provided for a person to be considered as ‘terminally ill’ may result in ambiguity when considering the eligibility of young people with life-limiting and life-threatening conditions whose prognosis is uncertain. Whilst the majority of adults only need palliative care at the end of their lives, many young people with life-limiting and life-threatening conditions require palliative care over a much longer period, often from birth or even in the womb. During this time, it is common for their conditions to fluctuate, meaning many young people may experience relatively long periods of stability. It is therefore much more difficult to provide an accurate prognosis and identify when a young person is moving towards their end of life stage”.


Together for Short Lives also recommends that under this Bill we consider how those aged 18 to 25 with EHCPs—education, health and care plans—will be affected.

The Bill as it stands is at risk of pushing young people with life-limiting conditions into thinking that reaching the age of 18 means that they are not obliged to consider whether they should continue to live or not. What does this say about how we value their lives?

We also cannot ignore the unique responsibilities faced by young people today. We know that social media has become a powerful driver of harm. Research from the Molly Rose Foundation, a suicide prevention charity, shows that vulnerable young people are disproportionately exposed to posts that glamorise suicide or present suicidal thoughts as normal, appealing or even fashionable. Alarmingly, 68% of young people with low well-being are being served this type of content. In such an environment, how can we claim to be safeguarding young people if, beyond the hospital bed, the digital world is telling them that their lives are not worth living? If this content is impacting young people when they are well, how much more so will it play on the mind of a terminally ill young person? To allow access to assisted dying at an age when external pressures are so pervasive, and when identity and resilience are still forming, risks compounding vulnerability rather than offering protection.

When families, carers and local services should be striving to provide the very best care, we would instead be sending them the confused and dangerous message that 18 year-olds are instead now ready to choose and plan their own deaths. This is of particular concern when we consider young people with learning disabilities, and how competence should be established in those cases, particularly given the fact that young people with learning disabilities receive worse healthcare in general, as evidenced by the National Child Mortality Database. In its learning disabilities and autism study, it exposed the fact that children aged four to 17 with a diagnosed learning disability accounted for 31% of all deaths, despite only 2.5% of children in the UK having a diagnosed learning disability.

There are challenges with a health service that misses lots of health issues for this group of children and young people because of communication and advocacy barriers. The 2023 report, Learning from Lives and Deaths—People with a Learning Disability and Autistic People, found that 42% of deaths of people with a learning disability were rated as avoidable, compared with 22% for the general population.

It is in this context, and for all the other reasons I have set out, that I am strongly persuaded that raising the age of eligibility to 25 is the right thing to do. I am also haunted by the words of one child that were shared with the Select Committee. The young person said:

“I’m in care. I’ve got disabilities. The Government will pay for me to die under this Bill, but it won’t pay for me to live”.


I conclude with a final contribution from the from the Children’s Commissioner, where she said:

“I would far rather that we erred on the side of caution, protecting those who have had terrible lives, terrible experiences, have been abused, have had their families turn them out, protecting those who are suffering from extreme mental illness, protecting those with special educational needs and disabilities, protecting anorexic children who are heading into adulthood, and saying, ‘Let’s err on the side of caution and go for 25’”.


I am clear that we must continue to say to children and young people, “Yes, your life matters. Even if it will be a short life, it matters”. We must amend the eligibility for assistance under the Bill to 25. I beg to move.

[Baroness Watkins of Tavistock (CB)]

My Lords, I support this amendment in principle, based on the research in relation to cerebral development. I think it is well made and an example of something that we are really here to think through to enhance the Bill. However, I point out that the Bill excludes anybody with a lack of capacity, so several of the people that the noble Baroness referred to would not be entitled to consider assisted dying.

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[Baroness Lawlor (Con)]

I hope that noble Lords will show the customary courtesy, particularly with regard to views to which they have objections.

[Baroness Watkins of Tavistock (CB)]

Would the noble Baroness consider joining the meeting with the noble and learned Lord, Lord Falconer, to talk about her additional points? I think the majority of the Committee is keen to move on so that we can facilitate further groups.

[Baroness Lawlor (Con)]

I thank the noble Baroness for her question, and I certainly will consider it, but I think it is important that we have a discussion about what I regard as a compromise Motion, which may be useful in the discussions noble Lords have with the sponsor or those who wish to proceed in that way.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

I had thought I was implying that. I was not trying to imply some conspiratorial holding back; it is just that the noble Lord, Lord Stevens, said this was

“a dangerous reversal of the timetable we require”.—[Official Report, 8/1/26; col. 1416.]

That is the point I was really getting to. That is shocking: not because anyone is malignly behaving in this way but because the Government therefore need to commit to bringing forward that report, so it is available before we reach Report. I urge the Minister to reassure us that that is the case.

I will finish off by saying that the noble Baroness, Lady Brown of Silvertown, explained excellently that, for all of the importance of palliative care, hospices and so on, not everyone has equal access to them, which is well documented. I want to see that framework, because this is one of the chilling aspects of the Bill. For those of us who campaign to raise money for hospices, and who are desperately keen that palliative care is well resourced, to hear, as we heard earlier today, from the noble Lord, Lord Carlile, who stated baldly and perfectly reasonably that whichever choice we had in the previous group would cost a lot of money, makes me think, “Oh, spend the money somewhere else”.

[Baroness Watkins of Tavistock (CB)]

My Lords, I had not intended to speak on this group but, as the only nurse present, I want to say that nobody could deny the principles of the amendments that are being discussed today. They are right and proper in respect of good health care for the nation.

I have two concerns, however. One is that we have talked considerably about my medical colleagues, who are absolutely essential, but the vast majority of palliative care is delivered by specialist nurse practitioners. I feel that it is essential I draw the Committee’s attention to that. I want to read from the ICN Code of Ethics for Nurses, which says that nurses—and, I believe, other healthcare professionals—have four fundamental responsibilities, including

“to promote health, to prevent illness, to restore health and to alleviate suffering”.

What we are talking about today is alleviating suffering.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Carlile of Berriew (CB)]

My Lords, I will raise a practical problem, which I urge the noble and learned Lord to address, in connection with care homes and nursing homes. The problem has been drawn to my attention—and, I think, that of other noble Lords—by a letter received today from the charity Mission Care, which has 300 staff in and around London and looks after 230 residents, some of whom might wish to apply for assisted death. The point that Mission Care makes is that its staff, by reason of the fact that Mission Care is a committed Christian organisation, en bloc would not be willing to take part in assisted death under the Bill. The effect of that, says Mission Care, is that it would have to close, thereby depriving people of the quality care that they have in those institutions.

I know that the noble Lord, Lord Blencathra, has a visceral opposition to anything arising from the European Convention on Human Rights. However, I have known the noble Lord long enough, and have enough affection for him, to know that he is very practical and that if the European Convention on Human Rights will assist his argument, he will be very ready to adopt it—so I ask him to be patient with me. These amendments, particularly Amendments 110 and 112, which I support, would take the process out of nursing homes and residential homes and into the hands of outsiders.

It is not just a question of Mission Care. Among all the many residential and nursing homes up and down the country, there will be very large numbers of staff who would wish to take advantage of Clause 31(1), which says:

“No person is under any duty to participate in the provision of assistance in accordance with this Act”.


It is the opt-out, and a very important opt-out that I know the noble and learned Lord is committed to as part of his Bill.

If we find that, in nursing homes and residential homes around the country, a significant proportion of staff wish to take advantage of Clause 31(1)—or Section 31(1) if the Bill becomes an Act—it will cause real difficulties for residential and nursing homes. There will be division among their staff, and it may be that those divisions make it very difficult for them to play any part whatever in this scheme if it is made law. I invite the noble and learned Lord to consider this issue further to ensure that those staff are not put in a very difficult position in the exercise of their consciences.

[Baroness Watkins of Tavistock (CB)]

I want to draw attention to the fact that I raised this issue two days previously in Committee. It is essential that we retain staff, particularly nursing staff, who would object to anything to do with assisted dying. That can be achieved, as I said earlier, by enabling people, when they do their advance directives, to be very clear if they never want to have this discussed with them, which I think is completely fair. Nursing homes must also be able to be very clear that they want nothing to do with this in their marketing materials. That is a bit of a tough word, but I think it is real. We must respect the faith and choice of healthcare staff as well as patients or, in this case, residents and their relatives.

However, the vast majority of people who are in long-term care homes rather than nursing homes have cognitive disability, which means that they will not be eligible in this event. It is in the very high-tech nursing homes where people who have very complicated issues might want to choose assisted dying—it might be a 52 year-old with complex disease. I can see that noble Lords want me to hurry up, but I just want to be absolutely clear that we need to get this in context.

[Lord Carlile of Berriew (CB)]

I am grateful to my noble friend for that intervention. She has raised three points, and I want to answer all three quickly. On point one, I absolutely agree with her: we have to respect the views of staff, particularly views that are a combination of professional and philosophical principles. Taking this process out of the nursing home, in accordance with Amendments 110 and 112, does exactly that.

Secondly, advance directives are quite an esoteric issue. I echo what the noble Lord, Lord Deben, said, based on his experience as a Member of another place. There are a number of us here who used to go to nursing homes and residential homes at least twice a year, sometimes taking our children with us to add good cheer. We came out with very different impressions of those homes: the good, the indifferent and, in one or two cases, the really bad. We have to take that into account. In some of those homes, there is practically nobody with an advance directive. Advance directives on the whole are a middle-class thing. Probably most of us here have advance directives of some kind or another, which one has to pay one’s solicitor to produce; one has to pay a lot of money in London, happily rather less out in the provinces. Where there are advance directives, that is fine, but not everybody has them.

I have spoken to the third point, which related to the remarks of the noble Lord, Lord Deben. I repeat that I am making an extremely practical point that ought to be addressed. If this responsibility lies with nursing homes, then it will cause immense difficulty. Also, there is always the risk in the really bad residential and nursing homes that people will be subject to undue influence in the unusual atmospheres of such institutions.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 20th March 2026 Lords Chamber

[Lord Wolfson of Tredegar (Con)]

My Lords, we have focused in this debate on the role of the independent advocate, but of course many of the underlying concerns arise with regard to protections for various vulnerable groups and people in situations that expose them to coercion or abuse. It is clear that the text of the Bill as drafted does not specifically address protections for groups such as those with Down syndrome or those subject to coercion.

In fairness to the noble and learned Lord, Lord Falconer of Thoroton, he could reasonably argue that the drafting of the Bill should be wide enough to encompass all of these groups on a generic basis without specifically referencing them. If the Bill is drafted with too much specificity, almost certainly somebody will be left out and we would have to come back at a later stage. That is presumably why the noble and learned Lord has introduced his regulation-making power in Amendment 549A, which I will come back to in a moment.

That said, I would suggest that it is not enough just to say that the drafting of the Bill is broad and that, therefore, we cannot debate its impact on specific vulnerable groups. I would be interested if the Minister could take time in her response to set out how the Government have taken into account the specific needs of the groups mentioned in the various amendments. That seems to me to be part of the work to deal with the practicalities of implementing the Bill.

How, for example, in practice does a person with Down syndrome who might have both speech and hearing difficulties communicate that they wish to die? How will medical practitioners and independent advocates assess that that person has come to an informed choice that they wish to die? Assessing the true wishes of people in that situation can be exceptionally challenging, and many such people rely on loved ones or carers to interact between themselves and medical professionals. How, therefore, do these family members or carers fit into the architecture of the Bill? How do they fit in, for example, with the independent advocate? What is the relationship between family members, carers and the independent advocate within the system of the Bill? Those are general questions which I hope the Minister will be able to respond to.

There is one specific point I ask the noble and learned Lord to consider which arises from his Amendment 549A, which would introduce a new clause after Clause 22. This point was prompted by a comment made by the noble Baroness, Lady O’Loan. If one looks at subsection (2)(b), the regulations must

“require a specified person to instruct an independent advocate to represent and support a person”

if the section applies. In subsection (2)(b)(ii), it says that it applies if

“the person has not indicated that they do not want an independent advocate”.

I was just comparing that to Clause 20 of the substantive Bill, which deals with the situation of when a person who has made either a first or second declaration wants to cancel the declaration as they have decided they do not want to die. In those situations, the person

“may cancel it by giving oral or written notice of the cancellation (or otherwise indicating their decision to cancel in a manner of communication known to be used by the person)”.

On the face of it, therefore, we are requiring much more from a person—oral or written notice—to cancel if they do not want to die than what is needed if they do not want an independent advocate. If we are going to go down the route of Amendment 549A, instead of saying the person has not indicated they do not want an independent advocate, it really should be that the person has confirmed—by written notice or by some sort of firm confirmation—that they do not want an independent advocate. What does “indicated” mean? It is a very loose word and, I would suggest, a very light test. What is happening here is that a person who would otherwise have an independent advocate to protect them is now not getting one; if that person is not going to get one, then we need more than a mere indication from them that they do not want the protection because, ultimately, this is all about protecting people. The contrast with Clause 20 seems to be somewhat stark, so I look forward to the noble and learned Lord’s response.

[Baroness Watkins of Tavistock (CB)]

I just wanted to stress, particularly for Hansard, that the people we are talking about are ultimately going to die from the illness they have had. Therefore, when the noble Lord has referred to them not wanting to die, he means that they do not want an assisted death.

[Lord Wolfson of Tredegar (Con)]

We all know what we are talking about here, but yes, absolutely.

This all goes back to the fundamental point of the Bill. I am addressing this point because the hypothesis is that the person has less than six months to live but, notwithstanding that, we are making sure that this particular group of people have an independent advocate. My point is simply that, if we are going to go down this road, there needs to be consistency: if they are not going to have an independent advocate, they really need to confirm it rather than merely indicate it. I apologise for my slightly loose language; the noble Baroness was quite right to pick me up on that. I hope the noble and learned Lord will consider my point as to whether “indicating” is actually the right test in subsection (2)(b)(ii) of his proposed new clause.

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We should not allow the Bill’s six-month prognosis to become, in effect, an early death sentence. Patients do not know that the odds are not definitive and are sold misinformation by being told, “You’ve got six months to live”, when it is a bit more complicated than that.

[Baroness Watkins of Tavistock (CB)]

My Lords, we have already had extensive discussion about the multidisciplinary team involvement. In 50 years of nursing—not all in clinical—I have never heard a doctor come out with, “You’ve definitely got six months to live”. There are much more subtle conversations.

I accept that people with MAID sometimes want to discuss it and say, “If I come off the support that you’re giving me, how long would I live?” Some of the answers can be very straightforward and we still enable patients to stop treatment when they want to.

I am also delighted that the noble Lord is alive and that he clearly understands statistical formulae.

[Baroness Fox of Buckley (Non-Afl)]

I just want to ask the noble Baroness for one clarification. I agree that most doctors are not brutal and do not say, “You’ve got six months and that’s it”. I asked whether the Bill, which requires you to have a six-month prognosis to access the service, will encourage doctors to feel that they have to be more definitive to allow people to access this service.

[Baroness Watkins of Tavistock (CB)]

I do not think so. I have greater faith in the medical profession and the multidisciplinary team.

Terminally Ill Adults (End of Life) Bill

Baroness Watkins of Tavistock Excerpts

Committee stage
Friday 27th March 2026 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

I intervene on the noble Baroness’s comment about training. Everybody is, indeed, trained in abortion, for example, as they go through medical school, but by the time you are practising clinically and you are on a specialist register, you are no longer keeping up to date with those skills at all, and your revalidation depends on your keeping up to date with those skills, which is the benefit of having a specialist register.

If I might comment on the noble Baroness’s opening remarks about being worried about receiving hate mail, perhaps she might have some sympathy for those of us in palliative medicine who have been receiving a great deal of hate mail because we are known to be specialists in palliative medicine and because we have been flagging up concerns over the Bill. As for the numbers—

[Baroness Watkins of Tavistock (CB)]

My Lords—

[Lord in Waiting/Government Whip (Lord Wilson of Sedgefield) (Lab)]

I ask the noble Baroness, Lady Finlay, when she is intervening, to keep it short, and people cannot intervene on people who are intervening.

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[Baroness O'Loan (CB)]

I am not sure of the logic of what the noble Lord is saying. I apologise to the House; I am struggling slightly. We are talking about assisted dying here and nothing else. I am saying that there has to be a conscience clause: that people of faith—I do not know how many faiths are involved—must have the right not to go against their conscience. That is one of the human rights that we absolutely must have.

[Baroness Watkins of Tavistock (CB)]

My Lords, I am broadly supportive of tightening the issue of ensuring that people’s conscience and beliefs are recognised and I support people who are prepared to work with patients who are, I remind the House, terminally ill adults wanting an end-of-life story that is different from full, extensive palliative care. I am completely supportive, as is the Royal College of Nursing, of full palliative care being what the majority of people will choose. However, there is a small proportion of people who would choose the principles of the Bill because of the nature of their particular illness, or personal choice.

I have talked before about all healthcare professionals’ responsibility to try to talk with patients about the choices that are available to them. The thing that has upset me most this morning is thinking about patients whom I have worked with and done everything, together with the multidisciplinary team, to keep alive who have taken their own lives because of severe enduring mental illness. I wish that we could stop referring to this as an assisted suicide Bill. It is terribly hard on people who have relatives and friends who have died through their own hand, usually in great distress. The whole purpose of the Bill we are talking about today is to reduce stress and distress for the small proportion of people who want this as an option.

[Baroness O’Loan (CB)]

I assume that the noble Baroness is aware that one of the reasons why we need to be absolutely specific about what we are doing is that 42% of people think assisted dying is palliative care. We need to make clear what we are talking about.

[Baroness Watkins of Tavistock (CB)]

I accept that. There was a helpful article in one of the newspapers this week talking about using the term “assisted death” rather than “assisted suicide”. I am pleased that I have had the opportunity to say it in the Chamber.

[Baroness Hollins (CB)]

My Lords, I congratulate my noble friend Lady Cass on her excellent speech. I am going to speak to my Amendments 667A, 680, 681A and 848C which seek to ensure that any healthcare professional who wishes to participate in assisted dying under this Bill may do so only by formally and voluntarily choosing and training to work in this specialist area— in other words, by opting in—and being entered on a register for assisted dying held by their regulatory body.

I acknowledge that, under the Bill, no person is under any duty to participate. This is not enough. At the individual level, opting in requires an active and deliberate decision, whereas opting out relies on a preset default. The two are not ethically equivalent, despite appearing similar. An opt-out system assumes that participation is expected unless an individual takes active steps to refuse, which is bureaucratically burdensome. In the context of assisted dying, making participation the default risks signalling that it is an endorsed routine practice. Over time, this may shift social norms and create implicit pressure on those involved to participate. Because of time constraints, I am going to focus my remarks on Amendments 667A and 848C, which deal with doctors, but the principles apply to other healthcare professionals, including pharmacists and psychologists.

Some noble Lords have focused on the matter of conscience. This is important, but I suggest that it is not the only professional consideration here. If the Bill passes, assisting a person to end their life must not be regarded as part of every doctor’s ordinary professional role. The Royal College of General Practitioners has expressed concerns about the Bill as drafted and has emphasised that any assisted dying service should be separate from core general practice in both structure and resourcing. The college made clear that participation should be strictly opt-in, with no expectation placed on GPs or other healthcare professionals to take part. One reason for its position is to ensure that core general practice and palliative care are not deprioritised and that no additional demands are placed on already overstretched services.

My amendments seek to ensure that, if Parliament decides that doctors will be involved in implementing the Bill, doctors must choose to work in the service, just as they choose other areas of medicine in which they wish to practise. It follows that they must be adequately trained and registered to practise. Opt-out systems are often justified on the basis that they increase participation. They work by setting a default position where individuals are included unless they take active steps to withdraw. In practice, many people remain with that default. It reflects a well established behavioural tendency that people are more likely to stick with the pre-set option than to change it, even when there are alternatives. As a result, uptake increases not because everyone has actively chosen to participate but because fewer people opt out than would have opted in. Making participation the default may increase uptake because it is expected.

In centralised healthcare systems such as the NHS, declining participation may carry subtle penalties. I will illustrate this with the example of the Mental Health Act. In principle, a clinician may object to the compulsory detention or treatment of individuals who retain decision-making capacity about their care. However, in practice, such a position may carry consequences for training and career progression. The Mental Health Act in England and Wales sets out the legal framework for compulsory detention but does not impose a duty on individual doctors to participate. For detention and treatment, a medical recommendation is required from an approved doctor. The approval framework defines which doctors are eligible to give such recommendations but does not oblige them to do so. In strict legal terms, there is no statutory duty compelling any psychiatrist to work within the Mental Health Act framework. Instead, the Act requires that certain professionals are involved if detention occurs, but it does not compel any specific individual to act. Effectively, participation operates as an opt-in system, as psychiatrists must apply for and maintain approval status to undertake this work.

However, there is a clear distinction between legal obligation and professional and contractual expectations. Within the NHS, many consultant psychiatrist roles include Mental Health Act work in the job plan, and those taking up such posts are expected to hold relevant approval. If a psychiatrist accepts such a role, participation then becomes a contractual duty. Therefore, the system is not coercive in a legal sense, but it becomes structurally coercive in a professional sense. Without any statutory compulsion, the training pathway and the labour market strongly shape participation. This is within an opt-in system, and it raises the question of how much stronger these pressures may become under the opt-out model proposed in the Bill. I accept that it has potentially been slightly modified by the noble and learned Lord’s amendment, but I do not think it goes far enough.

My amendments in this group address the regulation of doctors who choose to participate. Just as every recognised medical specialty is regulated by the GMC, I believe assisted dying should be treated no differently. It is a completely new area of practice, requiring its own defined set of skills, competencies and training standards that fall outside the remit of any existing specialty. Accordingly, my amendments and the amendment tabled by the noble Baroness, Lady Fraser, propose the creation of a specialist register for assisted death, which would be publicly available as with other specialty registers. Participating doctors would be required to hold both their primary specialty registration and this additional registration.

Dual specialty registration is well established within NHS practice. It reflects a recognised training model in which clinicians develop advanced expertise across complementary domains to deliver specific and often more complex interventions. Dual accreditation is typically used where clinical practice spans more than one domain, as is the case with assisted dying, where unmet palliative care needs must be addressed before death is considered. Therefore, this approach is entirely consistent with existing professional standards, and no clinician should take part in any aspect of the assisted dying process unless they are appropriately registered and regulated. Requiring clinicians to specialise further reinforces that participation is genuinely opt-in. It would be difficult to argue that an individual was compelled to undertake specific training and accreditation. This would provide an additional safeguard that involvement reflects a clear and deliberate professional choice.

Any involvement should be strictly opt-in and sit outside routine professional responsibility. All those who chose to participate should be registered with their respective regulatory bodies as providers of assisted death. This supports a stand-alone, separately regulated system, with participation limited to those who have actively chosen to be involved, have received appropriate training and are properly regulated. Finally, personally, I hope that Parliament does not require doctors to participate in any way, and I support the amendments to that effect as well.