Terminally Ill Adults (End of Life) Bill

Lord Archbishop of Canterbury Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[The Lord Bishop of London]

My Lords, as the noble Lord, Lord Kamall, has already pointed out, we in this Chamber share the same goal: for people to die with dignity and compassion. They are critical concerns for those who, like me, believe that the Bill is deeply flawed. Noble Lords will know that I am a former government Chief Nursing Officer, and I chaired the UK Commission on Bereavement. As a nurse, a priest, a daughter and a granddaughter, I have had the privilege to be with many people as they die. Most people die well although, as we have heard and will continue to hear, that is not always the case. I have known people to experience some of the most valuable days of their life as it comes to an end, including those with terminal illnesses.

As the noble Baroness, Lady May, has just pointed out, to change the law is to change society. Any law that introduces choice for a few is not limited in its effect to only those few. If passed, the Bill will signal that we are a society that believes that some lives are not worth living. The Bill would become our state-endorsed position, and our NHS would be active in its delivery. It is the role of the House to scrutinise, but there are no amendments to the Bill that could safeguard us completely from its negative effects.

I am concerned for those who will face internal and subtle pressure to end their lives in the absence of adequate palliative and social care or to avoid being a burden to their families. I understand the fear of many that they may be offered free assisted death before they are offered the care and equipment that they may live. I am concerned that we are still in the dark about how the Bill will be integrated into a struggling health and social care system, as the Delegated Powers Committee report has shown. I am concerned that the Bill is unequal to the task of preventing avoidable deaths due to the existing problems of discrimination, inequality and abuse. I am deeply concerned that so many in Parliament are not heeding the voices of professional and representative bodies that are raising the alarm. Above all, the Bill fails in its central claim that it delivers choice. A meaningful choice would see the measures in the Bill set alongside equally available, fully funded palliative and social care services. Without that being offered, this choice is an illusion.

It may not be the will of the House to take the decision on the principle of the Bill today, but I firmly hope that we will do so at Third Reading. If it is necessary, I will table the amendment myself, so the House is given the same opportunity as the other place to decide. Until then, I have no doubt that the scrutiny given to the Bill in the coming stages will make plainer its inadequacies.

As we have heard, much of the debate is about fear: fear of pain, illness, dependency, loss of control and being somehow unrecognisable to yourself and to others. The challenge, however, is that life is not something to be managed or limited when it becomes difficult. Life is often more than we can ever understand it to be. I believe in a God whose very being is life and, in that gift, we can discover meaning, dignity and innate worth, even if we are dying. To speak of God is to speak of the one who never is indifferent to human fragility, but who holds it and tends it. That is why I believe that there is always hope—hope that what looks like an ending is not the last word and hope that, with proper care, support and research, dignity and compassion are still possible. It is this firm belief that compels me to resist the Bill.

Terminally Ill Adults (End of Life) Bill

Lord Archbishop of Canterbury Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[The Lord Bishop of London]

My Lords, I will speak particularly in support of Amendments 181, 45 to 49, 58 and 222. It is a privilege to follow the noble Baroness, Lady Hollins, and the noble Lord, Lord Griffiths, whom I thank for sharing their personal stories. They are a reminder to us that this debate touches some of the deepest things within us, and not only should we be kind to each other but we ought also to be kind to ourselves.

I declare my interests as set out in the register, and particularly that I am vice-president of Exeter Hospice Care, chair of the UK Commission on Bereavement, and patron of AtaLoss. Your Lordships will know that, however many amendments there are to this Bill, I do not feel it will ever be safe. But I want to speak on this group because I believe that these amendments are at the heart of the issue of motivation. I remain concerned about the fact that there is currently no real, deep investigation of the motivation for assisted dying.

Amendment 181 is critical for us in monitoring. Even if there were no further restriction on what the motivation is for assisted dying, just knowing and recording it is extremely important because it can give us understanding of why people choose assisted dying, especially if we are serious about properly funding the care and support for people who are dying.

If we are recording the reason why people choose assisted dying, this means that we can highlight reasons why people choose it that do not fall within the aim of this Bill. For example, there is currently no mechanism in the Bill to stop someone receiving an assisted death if they are in pain because they cannot access palliative care. I hope that all of us would believe that, if somebody in that stage of their life wants to live, they should have access to the palliative and social care support that they need.

Professor Katherine Sleeman, the Association for Palliative Medicine and the Royal College of Psychiatrists highlighted the importance of identifying and addressing unmet need. We have already heard about the pressure on our palliative care service. We know that only 30% of hospices are funded by the Government. We have begun to hear about the beds that are closing and the redundancy programmes that are in place. We also know that if hospices are only 30% funded through government funding, 70% comes through voluntary giving. That is unequal across the country, and therefore palliative care services in hospices in areas that are more deprived are likely not to be as good as those in areas where there is higher socioeconomic activity. It is important for us to begin to identify whether there are reasons for people accessing assisted dying that are not within the aim of this Bill. Therefore, asking this question of a person in the preliminary discussion is the bare minimum of what is needed here.

Amendments 45, 46, 47, 48, 49 and 58 all strike at what many other noble Lords have spoken about today: that pressure, coercion, influence, encouragement, whatever word is most legally appropriate, is subtle and complex. When asked about the meaning of pressure during the Select Committee, the Royal College of Psychiatrists cited

“expectation or the worry of letting someone down”.

In a sense, for me, that gets to the heart of why it is so important that we define these feelings and decide what we think about them. We have also heard not only how hard it is to define the term we want to use but how hard it is to spot it. We heard examples of how we are not spotting coercion already today.

We have also heard how hard it is to train. Certainly, one of my concerns in the discussion of the Bill so far has been that often our focus is on medical staff, but actually people spend much more time with support assistants, with nurses, with occupational therapists and a whole range of people, not just medical staff. Often, if somebody wants to talk about dying, it is not with the doctor but with the person who has spent more time with them, and that is a whole array of people. Therefore, training is much broader than I think we often see it.

It is also true that I suspect most of us at times feel obliged to, or a responsibility for, our family. There will be some point in our life, whether through illness or otherwise, when we have felt a burden to others. The reality is that our decisions do not live within a vacuum; they are shaped by the many currents of our life, which are different at different stages. I believe that the Bill’s supporters have decided that the policy intent is that, even if somebody chooses assisted death to save their family the cost of care, that is okay as long as it is their decision and free from coercion. Amendments 47, 48, 49 and 58 demonstrate why this is not okay. They get to the heart of how subtle coercion is. It is not just personal. As we have already heard, it can be society-wide. Discrimination in healthcare provision and failure to resource palliative care or adult social care adequately are examples of this. Indeed, describing indignity as the loss of physical function, or of incontinence, or the reliance on care, is another societal example of this. We need to remind ourselves that each person is of immeasurable value which cannot be diminished by illness, disability or care costs.

I turn finally to Amendment 222, in the name of the noble Baroness, Lady Hollins. Though we have been rightly focusing on the person at the centre of making a choice about their death, as we have heard, death affects so many more people than the person who has died. The National Bereavement Alliance has said that the needs of family members, including children, both before and after death, must be considered and met. We know that people who are bereaved unexpectedly are more likely to experience complex and prolonged grief, which is associated with worse physical and mental health, including suicidal ideation. The bereavement sector forum convened by AtaLoss highlighted the risk that the kind of grief associated with assisted death is very similar. It warned that the impact of failing to address it with the right support will bring costs not just on acute services and social care but on individual people.

That complex grief is also well documented in Canada. The Bill has encouraged helpful conversation about death and dying, but we must make sure that the Bill is clear on guidance and support for many families and friends who are involved with somebody who has requested assisted dying. The work of the UK Bereavement Commission highlighted that people still do not have access today to the bereavement support that they need, and there remains a lack of understanding of the cultural and faith considerations that many communities require for death. I hope that Amendment 222 will be an opportunity for us to be proactive about making sure that family, friends and loved ones can access the bereavement support they require.

[Lord Polak (Con)]

My Lords—

Terminally Ill Adults (End of Life) Bill

Lord Archbishop of Canterbury Excerpts

Committee stage
Friday 24th April 2026 Lords Chamber

[Baroness Rafferty (Lab)]

My Lords, I speak for the first time in this debate as a nurse and former dean of the Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care at King’s College London. Our patron saints include Florence Nightingale and Cicely Saunders. It would be hard to imagine two more rigorous and formidable expert witnesses to comment on the debates that we have been having these past few weeks. Both were deeply committed Christians, driven by the alleviation of human suffering and providing the practical means to do so through nursing and palliative care. Both were accomplished scientists, Nightingale being hugely influential in public health, epidemiology, statistics and social science, as Cicely Saunders was in physiology and the psychology of pain, coining the concept of total pain to convey the holistic sense of suffering.

But both had more speculative sides to their characters. In the case of Nightingale, it was a fascination with Thomas à Kempis, Teresa of Ávila and the medieval mystics. She committed some of her thoughts to paper, consulting Benjamin Jowett, regius professor of Greek and theology at Balliol College, Oxford, who became her spiritual confessor. Cicely Saunders’s library reveals a similar quest to understand Christian ethics and the existential nature of the human condition. Both were deeply interested in, as well as troubled and possibly tormented by, the challenge of squaring the existence of a benign God with the dark side of the soul and human suffering. Perhaps the ultimate question in their minds was an eschatological one. How will it all end? How will life end and what will death be like?

In a sense, that is what we have been wrestling with over the past months, struggling to reconcile very different perspectives on how it will end for ourselves, loved ones, patients and relatives. Some of us believe in enabling people to exercise autonomy over the end of life and the nature of their deaths—to have agency over the end. We have heard testimony from people who have chosen this path, as well as from relatives and loved ones. They have spoken powerfully of the sense of freedom and relief it has provided and the physical, emotional and spiritual sense of peace for all concerned.

There are those who do not agree that this should be possible. Such views are profoundly personal. I happen to have witnessed some very difficult deaths of patients and close family members. That has convinced me that assisted dying is a positive step in easing people through to a good ending. Denying that option to people who would like to avail themselves of it, when we can offer it and international evidence demonstrates that it is safe to do so, seems not only cruel but unethical. When seen in the context of a Bill that has passed in the elected Chamber and is supported by public opinion, it seems like a dereliction of duty. It is not our job to defy or block the democratic process. I implore noble Lords: it is time to dissolve our differences and do the right thing by finding a way to pass this Bill.

[The Archbishop of Canterbury]

My Lords, I shall briefly make some reflections. It is a great privilege to follow my friend, the noble Baroness, Lady Rafferty; I thank her for her contribution. I recognise the enormous amount of work that has gone into this Committee stage. I am grateful to the noble and learned Lord, Lord Falconer, for meeting me; I thank him for the time that he has given me.

Noble Lords will know that I oppose the Bill in principle, both as a priest and as a nurse, but it is clear that some things unify us. Whether we support the Bill or oppose it, we are unified by the fact that we want people to die in a dignified, pain-free and compassionate way, with the least possible fear. I also believe that we are unified in the belief that there needs to be investment in palliative care now. I welcome the new modern framework for palliative care that the Government have introduced, but recognise that financial investment still needs to occur.

We are also unified around the fact that if this Bill or topic comes back in some form, we need to do our work differently. There is no doubt in my mind that this is one of the biggest societal shifts that we are seeing or will see. Therefore, we need to take our role seriously, as we have done. There is something about our learning for this process and looking forward to how we do it differently when it comes back. I was very taken by the view of the noble and learned Baroness, Lady Butler-Sloss, of pre-legislative scrutiny, although I do not know the details. We should look seriously at that.

We are also united in knowing that this touches some of our deepest emotions. I am grateful to those who have shared their own experiences and stories; I have felt very humbled listening to them. For me, as a Christian, this is clearly an eschatological question, as my friend, the noble Baroness, Lady Rafferty, said. Of course, for me, as a Christian, death is not the end. There is hope in death and life everlasting. As we talk about these things that touch us deeply, we need to look after each other and ourselves and recognise that this process will have impacted us, as well as those listening.

[Lord Pannick (CB)]

My Lords, I assure my friend, the noble Lord, Lord Farmer, that I shall seek to avoid pure wind. I share the disappointment of so many in this House, and indeed so many outside it, that we have not completed our task of scrutinising this important Bill. Scrutiny means not just debating seven clauses of a 59-clause Bill over 13 days; it means completing Committee and Report, going to Third Reading and voting on our differences.

There are profound differences of opinion that people can quite properly and reasonably hold, but there has to be a choice as to which side you are on. Our failure—and it is a real failure, for whatever reason—is a stain on the reputation of this House, because the issues raised by the Bill are profound. They are important to people—people who are worried about death and those who are worried that they may be coerced into agreeing to assisted dying. The issues are highly contentious, and the Bill has been passed by the other place—the democratically elected place. That does not mean that we have to agree with it, but it certainly means that we have to come to a view and vote on these matters.

I, incidentally, have no doubt whatever that if we had reached Report and Third Reading, and if we had voted on this Bill, the overwhelming majority of this House would have voted in support of the Bill, thereby rejecting the destructive amendments that were put forward. I think the opponents of the Bill know that as well.

--- Later in debate ---

[Baroness Hayter of Kentish Town (Lab)]

My Lords, the House of Commons and the public want the Bill, but the number of amendments and the length of the speeches mean that we have run out of time, so it cannot go back to the Commons. This is bad for democracy. Even more seriously, it is bad for the terminally ill—those mentally competent adults with fewer than six months to live. The Bill would offer them the choice of a more peaceful way out of this life, a way under their control, with friends and family around them, rather than an isolated and often risky suicide. A particular mum of three asked, “How dare a handful of Peers look society in the face and say they care about dying people? How dare they put their particular beliefs above the care and compassion that should be due to those facing an agonising death?”

Of course, we never heard from those affected. As my noble friend Lady Hunter said, we on the committee, where we were outnumbered by the opponents to the Bill, were denied the opportunity to hear from those facing deaths or from those bereaved, who had to watch their partner die without this help. As we just heard from my noble friend Lady Blackstone, we heard from the royal colleges, organised groups, professional bodies, social workers, the church, palliative care experts and lawyers—everyone except for whom the Bill was designed.

We have heard in the debates that the amendments are actually about improving the Bill. But I know, and I think that we all know, that some people would never have supported the Bill, even if we had accepted a thousand amendments. The most reverend Primate the Archbishop of Canterbury—although she was a Prelate at the time—admitted this at Second Reading, saying that she was going to propose a vote against the Bill at Third Reading. We heard her say today that she is against it in principle, so for some these amendments were not about improving the Bill but because they opposed it in principle.

Had we just been interested in trying to make assisted dying safer for the vulnerable groups, we would not have had to have those amendments referred to—that everyone, including a man, should have to have a negative pregnancy test before they could apply for assisted dying. We would not have had to consider the idea that some of the very people who needed this—such as those in care homes—would be denied it; that anyone being treated in an NHS hospital would have to leave for a private place with different doctors and carers if they wanted an assisted death; or, indeed, that the intimate private discussions with the panel should take place in public, so that the public can watch people talking about why they wanted to bring their deaths forward. We would not have been told in the amendments that this all costs too much, even though the estimate is the same as what the NHS spends a year after accidents caused by people wearing flip-flops—I kid you not. The cost—

[The Archbishop of Canterbury]

Will the noble Baroness confirm that while I have said very clearly that I oppose the Bill and that I would bring it to a vote on principle at Third Reading, I have not in fact tabled any amendments?