Terminally Ill Adults (End of Life) Bill

Earl Howe Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

As I have said, this also raises the issue of what we expect of medical professionals, in terms of people who want to take their own lives without assistance, and what they should do in those circumstances. I still do not understand how we are reconciling those two things. I do not understand how a medical professional can have a duty to prevent someone taking their own life in other circumstances but be expected to facilitate such a thing in these circumstances. I still do not understand how we are reconciling that in a moral, professional or legal context, so I would be grateful if the noble and learned Lord could set out how he will reconcile these things when he responds to this excellent and very helpful group of amendments.

[Earl Howe (Con)]

My Lords, the sheer number of amendments from noble Lords on all sides of the Committee that are seeking to prevent medical practitioners initiating a conversation about assisted dying with a patient demonstrates how strongly noble Lords feel about this issue. As a minimum, it is clear that many noble Lords do not feel that the Bill’s current drafting is sufficient. Although we have heard some counter-arguments during the debate, it is now incumbent on the noble and learned Lord, Lord Falconer, to set out in some detail his reasons for allowing registered medical practitioners to initiate these discussions.

Following on from that, there was one particularly moving contribution to this debate: the speech from my noble friend Lady Monckton. The case she made from her own family perspective in support of my noble friend Lord Shinkwin’s Amendment 162—to prohibit the topic of assisted dying being raised with someone with Down syndrome or a learning disability—was one I found especially powerful. I hope that the noble and learned Lord, Lord Falconer, will acknowledge that this is a particularly sensitive aspect of the issue which needs to be addressed.

There are two additional issues I should like to pick up. I was particularly interested in the amendment tabled by the noble Baroness, Lady Grey-Thompson, which requires a minimum 48-hour delay between diagnosis and any conversation about assisted dying. Given the shock that a patient will feel when receiving a diagnosis that could make them eligible under the Bill, it seems right and appropriate that they be given the space and time to process the news before facing the question of potentially ending their own life. Is the noble and learned Lord, Lord Falconer, willing to consider how that degree of sensitivity might be incorporated into the Bill—or, failing that, into guidance—to ensure that patients who receive some of the worst news they will ever hear do not immediately feel the need to address a choice as momentous and emotive as whether they wish to end their own life?

Finally, the amendments in respect of persons aged under 18 are worthy of the noble and learned Lord’s careful consideration. The Bill is designed to create a legal right for those aged over 18, not for children, so surely it follows that its provisions should not be raised with children. I therefore hope the noble and learned Lord will carefully consider the protections for children that the Bill could usefully incorporate.

[Baroness Blake of Leeds (Lab)]

My Lords, I thank all noble Lords who have contributed to this very important debate. As usual, I will limit my comments to amendments on which the Government have major legal, technical or operational workability concerns.

To begin, key concepts in Amendment 149, moved by the noble Baroness, Lady Grey-Thompson, are unclear. It will therefore be difficult to assess whether the duties have been discharged. For example, it is not clear who must co-ordinate and undertake the suggested multiagency assessment of support needs and who is responsible for ensuring that those needs are fully funded, so it may be impossible to demonstrate that these criteria have been met.

Amendment 152, tabled by the noble Lord, Lord Moylan, seeks to prohibit registered medical practitioners or any other health professionals from raising the subject of provision of assistance under the Bill. If passed, this would be inconsistent with the discretion currently afforded to the registered medical practitioner in Clause 5(2), which makes it clear that a registered medical practitioner may exercise

“their professional judgement to decide if, and when, it is appropriate to discuss the matter”.

This amendment would therefore create conflicting duties and may lead to confusion about whether a registered medical practitioner can raise the issue of assisted dying.

Terminally Ill Adults (End of Life) Bill

Earl Howe Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Lord Hamilton of Epsom (Con)]

My Lords, I would like to address the issue of mission creep. I have tabled amendments that come so late in the procedure that I do not think we will ever reach them, but I am concerned that the Bill, if it becomes an Act of Parliament, will morph into something entirely different from what we have all voted on.

I have a confession to make. I voted in the early 1980s for amendments to Lord Steel’s Abortion Bill, which went through at that stage. One of the concerns we had with that Bill was that it would morph into abortion on demand, and abortion on demand was not what we voted for in Parliament. We therefore have to be reassured that this Bill will not do the same thing. I am very concerned that, if it morphed into a euthanasia Bill, we would have a consultant in geriatrics walking through a ward saying, “I want to see those three people in those beds dead by the morning because there’s a bed-blocking issue”, and so forth. I am sure that nobody in the House wants to see the Bill become a euthanasia Bill.

Can we have an explanation from the noble and learned Lord, Lord Falconer, about what happened to the Abortion Bill and why it morphed, without Parliament having any input whatever, into abortion on demand? I am concerned that it might happen with this Bill as well, under the commissioner whom we are talking about. What checks can Parliament have to ensure that the Bill does not go down the same road as the Abortion Act?

[Earl Howe (Con)]

My Lords, I shall speak very briefly to the amendment in this group in the name of my noble friend Lord Wolfson of Tredegar. His Amendment 913A seeks to probe an issue raised by a number of noble Lords in this debate: namely, the means by which the assisted dying commissioner may be held accountable. As the Bill is drafted, and as we have heard, the commissioner is appointed by the Prime Minister. In his amendment 124, my noble and learned friend Lord Garnier would have them appointed by the Crown on the advice of the Lord Chancellor. The point that the amendment addresses is that, whoever appoints the commissioner, there ought to be a clear accountability mechanism and a process whereby concerns about the conduct of the commissioner can be investigated in response to formal representations. My noble friend suggests that representations might be made to the Prime Minister, but I would be very interested to hear from the noble and learned Lord what thought he and his co-sponsor have given to the way in which the commissioner will be held to account.

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, given the size of this group and the need to keep my remarks within the speaking limit, I have taken a rather different approach to the structure of my speech, which I hope your Lordships will find helpful. Rather than going through the amendments thematically or in chronological order, I will structure my speech by first setting out some observations about the legal implications of some of the amendments. Then, I will outline what the Government see as operational workability issues presented by some amendments and, finally, I will turn briefly to drafting considerations. Essentially, I will be flagging issues by theme, but if your Lordships have any further questions relating to the workability of any amendments, I will be very happy to write to set out the Government’s views in more detail and place a copy in the House Library. I will not comment on all the amendments. If I say nothing about a particular amendment, it is because the Government have no concerns.

As my noble friend Lady Merron, the Health Minister, and I have set out many times, the Government’s position remains that it is for Parliament to consider the policy, so I will not be providing a government view on the merits of any proposed changes or make any observations in a personal capacity.

In other debates on the Bill, your Lordships have asked how the Government plan to implement it. I will set this out at the outset. The Government have not undertaken any detailed implementation work that would precede the parliamentary process. Should Parliament pass the Bill, the Government will then undertake detailed work to develop a delivery model, which would involve engaging with stakeholders and delivery partners, including the judiciary. To answer the point made by the noble Baroness, Lady O’Loan, this relates also to NHS England and providers, although your Lordships may wish to note that the Bill does not specify where the provision of assistance may or may not take place.

A number of your Lordships, including the noble Lords, Lord Harper and Lord McCrea, the noble Baroness, Lady Finlay, and the noble Earl, Lord Howe, asked about the role of the Prime Minister. I remind the Committee that this is a Private Member’s Bill, so the proposal to designate the Prime Minister as the person who is to appoint the voluntary assisted dying commissioner was made by the sponsor, not the Government. It has nothing to do with the Government. It is up to noble Lords whether they wish to retain that provision.

The noble Baroness, Lady Finlay, asked me to confirm whether the standards in the Cabinet Office governance code would be adhered to. If it is the will of Parliament that the Prime Minister is the person who is to appoint the commissioner, the standard recruitment arrangements for prime ministerial appointments will be followed. These are made through an open, regulated appointments process, which includes selection by an assessment panel containing an independent member. Whether or not the Select Committees are involved will be a matter for the sponsor. The reason I shook my head at the noble Lord, Lord Harper—I meant no discourtesy to him as I did so—was that I thought, and continue to think, that it is a shame that he did not pass by the opportunity to make a party-political point, when, for example, his noble friend, the noble Lord, Lord Deben, was assiduous in ensuring that he did not. I felt it did not help and was not constructive, but I did not mean it discourteously.

I turn to the first of the three groups in my speech, on legal considerations and, specifically, the compatibility of some proposed amendments with the European Convention on Human Rights. The articles in question are Article 14, on protection from discrimination, and Article 6, on the right to a fair trial. On Article 14, Amendment 913 in the name of the noble Baroness, Lady Finlay, would prevent the employment of a person as commissioner, or a member of their staff, should they have links with any agency promoting assisted deaths. The Government wish to highlight that the amendment as drafted is unbalanced, creating a risk of breach of Article 14 of the convention. This would be avoided if it also prevented the employment of individuals who campaigned against assisted dying. In addition, the amendment as drafted would prevent the employment of a person in the commissioner role, or a member of their staff, should they have links with any agency that provides assisted deaths. But, if assisted dying were to be provided through the NHS, that would prevent the commissioner employing staff with relevant NHS experience.

Amendment 496C in the name of the noble Lord, Lord Weir, would involve differential treatment as between how reconsiderations of panel decisions would be made in the cases of, on the one hand, identified groups of people in the amendment and, on the other, those not belonging to those groups. If that is the intention behind the amendment, consideration would need to be given to whether the approach is proportionate and justified to avoid a risk of breach of Article 14. But if the intention behind the amendment is to afford everyone a right to hearings with the commissioner, but for only remote hearings to be permissible in the circumstances specified, then drafting changes would be needed.

Terminally Ill Adults (End of Life) Bill

Earl Howe Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

Oh, absolutely: I think pressure is something incredibly important that we have to assess. Certainly, from the huge number of disabled people I have spoken to, pressure comes in many different ways, and it is very difficult to detect. If we do not take that seriously, I think people will be coerced into thinking that this is their only option, rather than that they have a range of options. That is picked up in some of my other amendments, but I thank the noble Baroness for her intervention.

We talked about the equality impact assessment. We need to look at the impacts on the Crown Court, on health and education committees and on children with SEND, and I think we probably need another version of the equality impact assessment to enable us to make the best decision on the way forward for the Bill. I am minded to support my noble friend Lord Carlile, because I think that what he proposes is much better than the panel currently in the Bill.

Mindful of time, I will leave my last comment to the Medical Defence Union, the leading indemnifiers of UK doctors, which gave evidence to the Commons Bill Committee:

“The involvement of the judiciary is essential. Its absence leaves doctors unduly exposed. Media reports suggest that an alternative safeguard is being mooted”—


noble Lords should understand that this was the context when the evidence was given—

“No ‘independent panel’, however so constituted, can replace the legal authority of a course of action sealed and ratified by a judge. Doctors deserve that certainty when relying upon this Bill to provide the very best for their patients at the most delicate moment of their duty of care”.


This is one group we have not really heard a lot from, and we should be minded of its role in the system as well.

[Earl Howe (Con)]

My Lords, as sizeable as this group of amendments is, the key proposals embodied within it can be described in relatively brief terms. The Committee therefore owes its gratitude to the noble Lord, Lord Carlile, for having given exactly that kind of helpful summary in his opening speech, which set our debate going on a good track. In thanking him for that, what has emerged most clearly to me in this debate is the far-reaching nature of the change to the architecture of the Bill represented by his proposals. In addition, were his proposals to be adopted in their totality, they would, as I read them, have the effect of simplifying very considerably the procedures required to bring about an assisted death.

In combination, those two consequences inevitably open up a range of questions, as we have heard, about how these proposals would work, not just in theory but most particularly in practice. We have, for example, heard questions about the capacity of the family court, about its funding and about the extent of the opportunity costs which the family court would need to sustain. The noble and learned Baroness, Lady Butler-Sloss, and my noble and learned friend Lord Garnier gave us considerable reassurance on some of those issues, as did the noble Lord, Lord Carlile, himself. However, the questions that have been asked are of fundamental significance and I think the Committee should hear from the Minister how the Government view the practical effect of the proposals and their workability.

On the principle of the proposals of the noble Lord, Lord Carlile, we have heard some powerful points in their favour: for example, the established powers vested in the court; the analogous decisions which courts already have to make; the ability of the court to arrive at a reasoned judgment and to be a court of record; the fact that the court-based appeal system is well understood; and indeed the level of public confidence which the court already enjoys.

I would venture to add another, which is that the role for the court envisaged by the noble Lord, Lord Carlile, would be a substantive judicial role, in contrast to the role originally envisaged in the first iteration of the Bill. That came over to me, at least, as more of a tick-box exercise than an exercise of judicial judgment.

However, what I look forward to hearing from the noble and learned Lord, Lord Falconer, are his views on the strand of this debate brought out most ably by the noble Lord, Lord Pannick, my noble friend Lady Berridge and my noble and learned friend Lord Garnier: how he has assessed the merits of the proposals of the noble Lord, Lord Carlile, in comparison to the proposals set out in the Bill. He is on record, some years ago, as having favoured a court-based approach in this area of the law. If his view is that, on balance, he now favours the panel process, as set out in the Bill, what considerations have led him to that conclusion?

[The Parliamentary Under-Secretary of State, Ministry of Justice (Baroness Levitt) (Lab)]

My Lords, I shall respond to the amendments in the names of the noble Lord, Lord Carlile of Berriew, and the noble Baronesses, Lady Grey-Thompson and Lady Coffey. Some of your Lordships may be aware that I know the noble Lord, Lord Carlile, very well. Indeed, the convention of this House is that I refer to him as “my noble kinsman”. This has given rise to a number of jokes outside this Chamber, but there is a serious point to be made here. I reassure your Lordships that this has no effect on the Government’s neutral analysis of the workability of the amendments in question, and although I have the advantage of having advance notice of my noble kinsman’s position, I have engaged with him as to the Government’s response in no different a way from the way I would with any of your Lordships.

As this is the first time a Minister from the Ministry of Justice has spoken in this debate, I reiterate what has been said on many occasions by my noble friend Lady Merron: the Government’s position is that it is a matter for Parliament to decide the policy which underpins this Bill. It follows that I will not be providing a government view on the merits of any of the amendments, nor will I make any observations in a personal capacity.

I will, however, deal with the question asked by a number of your Lordships as to whether the Government would deliver this, were the will of Parliament to be that the general principle contained in the amendments of the noble Lord, Lord Carlile, were to be adopted. The answer is that, given our current workload, it would of course be challenging; I say this because I am in fact the Family Justice Minister, as well as the Lords Minister. But if it is the will of Parliament, then we will work with the judiciary to make sure that we have the resources in place to deliver what Parliament has decided.

This is a large group of amendments, and it is the Government’s view that—

Infected Blood Compensation Scheme Regulations 2024

Earl Howe Excerpts

Monday 21st October 2024 Lords Chamber

[Earl Howe (Con)]

My Lords, I am grateful to the Minister for introducing these regulations, which, as he has explained, fulfil one element of Sir Brian Langstaff’s carefully calibrated recommendations for establishing an infected blood compensation scheme, both as set out in his inquiry report and as amended in the light of the engagement exercise carried out by Sir Robert Francis in June. The regulations we are considering relate specifically to those individuals directly or indirectly infected by contaminated blood, blood products or tissue. Still to come at a future date, as we have heard, are regulations to extend the scheme to those who, in various ways, have been affected by the infected blood disaster; and I shall come back to that issue in a second.

Knowing, as I do, how the detailed architecture of the compensation scheme has been devised, based as it is on Sir Brian’s recommendations, and on the careful and considered advice to Ministers given by Sir Jonathan Montgomery’s expert group, I do not argue for a second with either the appropriateness of the eligibility criteria or the proposed category headings under which compensation is to be awarded. I have some questions, however.

The product of Sir Robert Francis’s engagement exercise was a total of 74 recommendations for modifying the detail of the compensation scheme, as previously announced. Of those 74 recommendations, the Government accepted 69. I have to be candid and say that I was very surprised by how high that number was, since I did not think it likely that either Sir Jonathan Montgomery or my right honourable friend the former Minister for the Cabinet Office would have neglected to take account of any aspect of harm caused by infected blood, or misjudged the appropriateness of the levels of compensation under each category of harm. However, my being surprised is not the same thing as saying that I have any issue with the Government’s decisions on this score: I am quite sure that they will have done the fair and decent thing. In an important sense, the fact that there were so many recommendations for modifying the scheme goes to demonstrate only how worthwhile the engagement exercise was. We can be glad of that.

What nags at me, though, is a worry about complexity. The Secondary Legislation Scrutiny Committee noted this complexity and criticised the Explanatory Memorandum to the regulations for what the Committee saw as a failure to explain clearly either the basis of the compensation scheme or the practical aspects of the compensation arrangements. Those criticisms are regrettable, but to my mind they highlight what I feared might be a consequence of accepting 69 modifications to the scheme, which was that these would serve only to accentuate the complexity already built into the scheme architecture. It is surely axiomatic that the more complex the arrangements, the more likely it is that accurate and timely payment of compensation will be put in jeopardy.

There is one obvious example where this might be the case. The Government have agreed that those people registered with the infected blood support scheme will continue to receive regular support scheme payments for life, running in parallel with compensation payments from the Infected Blood Compensation Authority. On the face of it, having two channels of funding as opposed to a single channel runs the risk of both error and delay in delivering to people the money due to them. What reassurance can the Minister give me on this?

There is another, quite different, example of where delay could occur. Sir Robert Francis’s recommendation 18, which the Government appear to have accepted, was that, under the injury impact award heading, not enough attention had been paid to psychological illness as opposed to emotional distress and anxiety.