Terminally Ill Adults (End of Life) Bill

Lord Ashcombe Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Ashcombe (Con)]

My Lords, this Bill raises profound concerns for me, and I wish to outline five reasons why I cannot support it in its current form. First, although many of us have faced the death of loved ones, in my case I have witnessed the extraordinary comfort that high-quality palliative care can offer, both to patients and to their families. This level of care is not universally available, as we have heard. I consider myself extremely fortunate. Far too many people, due to underfunding and limited access, are denied this vital support at the end of life. When individuals are left without access to proper palliative care, they may begin to see assisted dying not as a choice but as the only escape from suffering.

My second concern is that, as people grow older, many lose confidence and become vulnerable. This leads them to being susceptible to subtle pressures—pressures that can arise from well-meaning family members and friends. More troubling still is the potential for overt coercion, where someone may be made to feel a burden or believe that their life no longer holds value, and thus opt for a path they do not truly want. How and by whom is this being evaluated?

Thirdly, even with the strictest safeguards, we must learn from the experience of other countries. In places like Canada and the Netherlands, as we have previously heard, we have seen a gradual expansion of the eligibility criteria far beyond the original intent. What begins as a tightly controlled process can, over time, become worryingly permissive. There are reports of individuals shopping around for sympathetic doctors, even when they are not terminally ill. This risks the potential of normalising suicide as a legitimate solution to human suffering.

Fourthly, I am deeply concerned about the position in which this Bill places medical professionals. Although I acknowledge that some doctors believe that helping a patient die peacefully is, in certain circumstances, an act of compassion, there is a stark difference between that and actively participating in determining who qualifies to die. I am particularly concerned that a doctor can raise the thought of assisted death with a patient without the requirement to also discuss palliative care. This means that discussing assisted dying alone could almost be considered coercion. It also goes against the current UK medical law—and the GMC—on informed consent, which requires doctors to discuss the various treatments and options for patients and give them long enough to consider these options. This is ethically very problematic and challenges the very foundations of the medical profession, which is grounded in the preservation of life. It runs counter to modern GMC guidelines and risks turning doctors into the gatekeepers of death, not life.

Finally, I worry about the broader cultural impact. Our society is built on the principle that every life has an inherent value, from the beginning to the natural end. This Bill risks undermining that ethos. It sends a dangerous message that lives of the elderly, disabled or chronically ill may be less worth living—that they are expendable when they are no longer seen as contributing or useful. I do not deny that there are tragic cases, and we have heard some today, where medically assisted death may appear preferable to prolonged suffering. But this Bill, as it stands, is not the right instrument. Its potential consequences are too grave, its safeguards too uncertain and its impact on our societal values too profound. For those reasons, I cannot support it.

Terminally Ill Adults (End of Life) Bill

Lord Ashcombe Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

I say to the noble and learned Lord, Lord Falconer, that this debate has shown that perfectly reasonable people find a difficulty in understanding “ability” and “capability” as the same thing. If they are not the same thing, those people will want something to ensure that the narrowness of “capability” does not mean that people make decisions when they do not have the ability to do so.

[Lord Ashcombe (Con)]

My Lords, I speak definitely not as a lawyer or as part of the medical profession in any way. It appears to me that the Mental Capacity Act uses the balance of probabilities when making a decision, rather than “beyond reasonable doubt” as, in my understanding, the criminal court does. For such a definite decision as whether to end your life, the balance of probabilities is insufficient. Therefore, is the current definition of capacity in the Act sufficient for this job? I suspect not. Is “ability” the right word? I am not sure. Somewhere along this line, to the point made by my noble friend Lord Deben, there is an answer, and maybe two words is right.

[Lord Rook (Lab)]

My Lords, I will keep this brief. I was not going to share this at this point because it is quite personal and because it takes a lot for me to counter the noble Baroness, Lady Andrews, for whom I have huge respect. She was the first person to invite me to the House of Lords for tea, many years ago. I do not doubt that the Mental Capacity Act has been a huge advance in how we deal with these issues.

I accept that the noble and learned Baroness, Lady Butler-Sloss, is probably one of the few people in this place to make judgments in the courts and the Court of Appeal on mental capacity. I suspect that more of us have had to go through the process of helping a loved one through a mental capacity assessment, although I suspect that number is also still low. My father has dementia. I have had to support him through a mental capacity assessment. No matter how clear the Act or various legislations or definitions may be on paper, it is extremely difficult at times to take someone through that process. All he had to do was prove that he had capacity to instruct a solicitor, a decision far less serious and far less terminal than the one we are discussing today.

If you assessed my father’s capacity, you would find—on the comments made by the noble Baroness, Lady Hollins, about literacy and numeracy—that my father has near-perfect literacy and numeracy. We have had comments about executive function. You would find that he has near-perfect capacity for executive function to make important decisions. You would also find that he has virtually no short-term memory. He is more than capable of making a decision, but that decision is gone in 30 seconds—sometimes sooner. If you apply that to this situation, he would be able to make a decision but would not know about it at the point that decision was acted upon.

Returning to the comment from the noble and learned Baroness, Lady Butler-Sloss, about whether it is capacity or ability, I pick up on the comments from the other side of the Committee recently. There is not enough, in the way we judge capacity at the moment, to make this practicable and desirable. We certainly need more. I am not sure whether it is “ability”, but what we have at the moment is not enough to deal with this in practice.