Terminally Ill Adults (End of Life) Bill

Lord Bishop of Southwark Excerpts

Friday 20th March 2026 Lords Chamber

[Baroness Fraser of Craigmaddie (Con)]

I thank the noble Lord. By probing the words “seek assistance”, I am trying to explore what assistance is provided. The noble Lord is quite right in the example of his friend. There are people who cognitively can absolutely understand what is going on. Therefore, in the context of this Bill, they would understand the assisted dying process. But they would need help with the tools by which to communicate their will, and the time and space and sometimes the vocabulary to do that. I note that, in the noble Lord’s example, his friend has only recently come to it. An issue is understanding what the right thing is for some of these people. He also said he can, at the moment, communicate only through his mother. That is my other fear. Far too often with this population, people speak for them because they know them best. I hope that clarifies my intentions.

[The Lord Bishop of Southwark]

My Lords, I support the amendments in this group, particularly Amendment 171 in the names of the noble Baronesses, Lady Nicholson of Winterbourne and Lady O’Loan.

Clause 5, as we have heard, introduces a key element in the infrastructure of assisted dying in this Bill by providing what is intended to be a safe, but not mandatory, introduction to the subject of death with the assistance of another human being. For proponents of the Bill, the advantages of such an introduction are obvious. In their minds, it will remove a good deal of unnecessary distress on the part of those who wish to proceed with such an option and on the part of those who do not. However, as we have heard from those of us who have long experience of pastoral encounters, the experience is likely to be rife with pitfalls.

This amendment and the one that follows it, about which I shall say a little and leave it to others to say more, is designed to correct some very obvious impediments to mutual understanding. A good deal of communication is picked up visually. Visual impairment requires an extra dimension when communicating. My twin brother was born with a severe hearing impairment, so I speak with lifelong experience of what it is to communicate thoughts, directions, information and feelings appropriately to someone who has a hearing impairment.

Finally and briefly, for I understand that the right reverend Prelate the Bishop of Newcastle wishes to say more, I also commend Amendment 171A. My experience of more than 40 years of ordained ministry is that there are those who purport to represent a religious or cultural identity and do so for less than an individual’s best interests. That may cut both ways in this debate.

I hope that the noble and learned Lord, Lord Falconer, will look favourably on these amendments, which are designed to provide assistance to women who may face coercion. Should the Bill become law, it will make the vulnerable more vulnerable as it currently stands. That is why so very many amendments, including this one, are so vital, although I continue to fear that assisted dying itself would make the vulnerable more vulnerable.

[Baroness Hollins (CB)]

My Lords, I commend the introduction to this group by the noble Baroness, Lady Fraser. At the end of a person’s life, clear and honest communication really matters. When my husband was dying—he had motor neurone disease—he increasingly relied on AACs to communicate. This did indeed test everyone’s patience. People who are dying must be able to understand what is happening to them and what their options are, as well as being able to say what they want and need. But this works only if people understand, and that means that communication must be accessible.

I will focus my remarks on people with learning disabilities. Around one in six of the adult population struggles with literacy—not just people with learning disabilities. That is why the Bill should not just say that “reasonable steps” must be taken; it needs to be much stronger than that. It should say that they “must provide” adjustments, whether that is interpreters, simpler language or information in different formats. In the Equality Act, making reasonable adjustments is a legal duty, not a choice. It is about making sure that everyone is heard, understood and treated with dignity when it matters most.

Clause 39 requires a code of practice to address the provision of information and support to people with learning disabilities. Clause 40 requires the Secretary of State to issue guidance on the operation of the Act and to consult people with learning disabilities prior to issuing this guidance. I have not tabled amendments about this because I cannot think of any way to make this provision robust enough. For such consultation to be meaningful, it is necessary to understand more about how assisted dying could be explained and discussed with people with learning disabilities in a way that is accessible and non-coercive.

However, currently almost nothing is known about the views, understanding and perspectives of people with learning disabilities in relation to assisted dying. Understanding how they understand and make end-of-life decisions, and who or what may influence those decisions, is crucial. There are serious questions and concerns about influence that is far more complex than explicit individual coercion. People with learning disabilities often have very limited health literacy. Many have depended all their lives on others when making decisions about their health and social care. The mere fact of someone explaining the option of assisted dying may be perceived as an endorsement of assisted dying, especially if it is someone in authority, such as a doctor, nurse or care home manager. It is true that there is now mandatory training in learning disability and autism for all health and care professionals, but this is very basic training and does not include supervised communication practice.

I have discussed these issues with Irene Tuffrey-Wijne, who is professor of intellectual disability and palliative care at Kingston University. I declare an interest as the founder and chair of the visual literacy charity Books Beyond Words, which created a word-free picture book called Am I Going to Die? The word-free narrative was co-authored by me and Professor Tuffrey-Wijne and was informed by the professor’s doctoral research, which I supervised, about the experience of death and dying of people with learning disabilities. Noble Lords may be interested to hear that a pilot study has just started at Kingston University, in collaboration with the Down’s Syndrome Research Foundation and Mencap, to explore assisted dying and end-of-life choices with people with learning disabilities. We need to wait for the results of studies such as this before concluding whether it is possible to extend the provisions of the Bill to people with learning disabilities at all.