Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Blencathra (Con)]

My Lords, I am not opposed to assisted dying in principle but I am opposed to this appallingly drafted Bill, which is a travesty of a Private Member’s Bill. It is a massive 51 pages, with 59 clauses and three schedules, and is one of the largest so-called Private Members’ Bills ever introduced in Parliament. It is larger and more controversial than many government Bills, and should have proper scrutiny. Since we need proper government Bills to make laws on prison sentences, penalties for killing with knives or dangerous driving, serious drugs et cetera, it is wrong to pass a law on how people should die through the Private Member’s Bill procedure.

The Delegated Powers Committee has issued a scathing report on the excessive 38 delegated powers, including all the Henry VIII powers, and that report alone should be enough to condemn this Bill to the scrap heap. Then yesterday, the Constitution Committee criticised it. If this Bill passes, it will not be MPs and we Peers writing the law on how we die but civil servants in the Department of Health writing up all those 38 delegated powers. Quite simply, I do not trust the Department of Health to write one word on the implementation details. The department has so far failed to implement single-sex wards for women and it failed for many years to take action on the discredited Liverpool care pathway, where 3% of patients being expedited to death actually recovered. A department that apparently cannot tell the difference between men and women is not fit to write guidance on legislation on when people should die and the drugs used to kill them.

Every year, 550,000 people die of terminal illness in the UK. From my 42 years in Parliament, I am convinced that it is impossible for Parliament to draft a general law—even with thousands of pages of regulations—which can cover every possible individual circumstance relating to those 550,000 people. We as parliamentarians have to realise and accept our limitations. I can draft a foolproof law for myself but not for any of your Lordships’ situations, nor for half a million others. The variables are simply too great. There are numerous cases of people diagnosed with terminal cancer making a full recovery and living five to 20 years longer than expected, proving correct the famous Sir William Osler, the father of modern medicine, who said:

“Medicine is a science of uncertainty and an art of probability”.


Prognostic uncertainty is one reason why the Royal College of Physicians does not support the Bill.

This Bill will give lawyers the ultimate power to make the final decisions, not the doctors. We have all seen firms of lawyers pursuing fraudulent medical negligence cases in respect of our soldiers who fought bravely in Afghanistan and Northern Ireland, and corrupt immigration lawyers running fake cases. Almost every clause in this Bill can be used by lawyers on all sides of an assisted dying application to take the case to court, and all those regulations will be a judicial review paradise for lawyers. I will trust my doctor to do what is in my best interest on my deathbed on the basis of the medical mantra, “First, do no harm”. I will be damned if I let any lawyers decide how I die.

In 2016, I tried to help pass the Medical Innovation Act, also known as the Lord Saatchi Act, which aimed to promote innovation in medical treatments in England for terminally ill patients. I recall at the time that most doctors were in favour of it, but the lawyers were opposed since it would remove their ability to sue if the treatments did not work. My perception is that most doctors have serious concerns about this Bill, but most lawyers are in favour. I do not want lawyers to come within a million miles of decisions about how people should die.

We need to start again, possibly with a royal commission led by doctors who will set out the principles and all the safeguards required. Then, there needs to be proper public scrutiny on a draft Bill that a joint parliamentary committee can consider. Finally, we need a proper government Bill and to see drafts of all the regulations that will be made. We cannot buy a “pig in a poke”, which this Bill is, and hope that the regulations will be just all right on the night.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

[Lord Weir of Ballyholme (DUP)]

My Lords, I rise to support the amendment standing in the name of the noble Baroness, Lady Coffey. Some people may detect from my accent that, although I hail from the great city of Bangor, it is not the great city of Bangor in north Wales but the great city of Bangor in Northern Ireland. I have particular empathy with the amendments that have been put forward by the noble Baroness due to my experience as a Minister in a devolved Administration. The clarity the noble Baroness seeks goes to the heart of the relationship between the devolved Administrations and Westminster, and it is of particular relevance to this Bill.

Generally speaking, a Minister in a devolved institution will face three categories of legislation. First, there will be reserved matters, which are entirely within the purview of Westminster—national issues, which I think everyone would accept. Secondly, there will be a range of issues which, although not strictly reserved, are of such obvious applicability across the United Kingdom that a legislative consent Motion should be applied. I do not see the noble Lord, Lord Foulkes, in his place, but on occasions even the SNP Government in Scotland have been prepared to sign up to legislative consent Motions. The third category—the bulk of legislation—is situations that should be decided locally, where a devolved Government and a devolved Parliament can choose whether to follow what is happening at Westminster and in England, to take a different path in seeking either to virtually replicate or to amend, or to go in a tangentially very different direction. That is at the heart of democratic accountability in devolution.

I believe that this is an issue that should be decided in Wales. It is an issue that should clearly fall into category three. We all know that we have a very unusual constitutional set-up in the United Kingdom, where devolution to Wales, Scotland and Northern Ireland is on a slightly different basis in each case. That can produce some unusual aspects. What we have today is a certain level of anomaly, because this legislation falls into what may be described as a fourth, hybrid category. As the noble Baroness, Lady Coffey, highlighted, the distinction is between the aspects that deal with criminal justice and criminal responsibility, and those that deal with health and social policy, with the former being reserved and the latter being devolved.

It is very clear that the heart of the Bill makes major decisions that impact on health and social policy. However, we are left with a situation for Wales that means, if this goes through unaltered, that the criminal responsibility will be lifted but there will be no regulations coming from this House as to how that will actually be brought about. It is the equivalent of this House saying that we are going to bring in new road safety measures, which will not apply to Wales, but if you are caught speeding on the motorway there could be no criminal sanction against you. What we have potentially arrived at for Wales is the worst of all worlds.

We need to take a step back. We need to ensure that the wishes of the Welsh people, as exercised by the Senedd—they may change over time—are respected. Rather than, in effect, imposing something that then has to be more or less corrected in Wales by way of changes to their health and social policy, we should be allowing the issue of assisted dying to be decided by the Welsh Senedd. If they decide to make those changes, this Parliament should then reflect them by way of changes to the criminal justice system, which I think would be relatively easy to do.

In the absence of that, the importance of these amendments, as outlined by the noble Baroness, Lady Coffey, is that if we cannot get things definitively the right way round, we can at least get a level of clarity over what aspects apply to Wales, rather than a potential wall of obfuscation. This is an ideal opportunity for the Government and the sponsors to highlight where exactly the demarcation is, which will be very helpful as we move through the rest of this Bill.

[Lord Blencathra (Con)]

My Lords, I support my noble friend Lady Coffey’s amendments in this group. As I looked at the title of the Bill, “terminally ill”, and then saw clause after clause talking about the patient and the doctor’s involvement, I was clear that this was a medical Bill. We had the Secretary of State for Health saying that he was in charge of it, and the Department of Health and Social Care, which seconded about 30 officials to help rewrite it, in a way taking ownership of it. Then I asked myself: why on earth are we legislating for Wales when health is a devolved matter in Wales and the Senedd is in charge of health matters? This is where it is really Pythonesque, because although this is a medical Bill in England, it is a criminal Bill in Wales, and criminal matters are not devolved to Wales. How on earth can the same Bill be a health Bill in one country of the union and a criminal Bill in another?

On 23 October last year, Senedd Members, including the First Minister, Eluned Morgan—the noble Baroness, Lady Morgan—and the Health Minister, Jeremy Miles, voted against a Motion calling for a new law to allow assisted dying in Wales and England. Miles had earlier warned of “huge ramifications” for Wales if the law changed. In total, 19 Senedd Members voted in favour of the Motion, with 26 against and nine abstentions. However, the Senedd does not have the power to change the law on assisted dying in Wales, so the vote was symbolic. The Senedd does not have the power to legalise assisted dying, but the Health Minister indicated that it is likely that future legislation will require another vote to give Parliament consent.

The Welsh NHS, which is almost totally devolved and overseen by Cardiff politicians, would be responsible for implementing the law. However, I understand that the Senedd can still vote on whether to implement the legislation, as parts of the Bill touch on devolved areas, so the Welsh Government would need to pass specific regulations and gain an affirmative vote from the Senedd before the Welsh NHS could provide the service. I am not a great fan of the devolved Administrations, but they exist and they have a genuine job to do. In Wales, this would mean that their NHS and its doctors would have implemented all the provisions of an English law, which they had no power to change. That does not seem right. If the Senedd in Wales can be trusted to run the NHS in all medical facilities in Wales, it should be trusted to make its own terminally ill end-of-life Bill.

Next year there will be Senedd elections, and on current polling there may be a large majority of Plaid Cymru and Reform Members elected. It cannot be right that they inherit a Bill relating to the deaths of about 35,000 people in Wales each year and that they have no say over how their constituents die.

Of course, the Senedd could refuse to give consent to the legislation, but I suspect it will be threatened and blackmailed into doing so. It will be told that it is the English Bill or nothing and that Wales has no power to do its own law, so the Senedd had better approve it or else. But the Senedd could do its own law; all we have to do is grant it the constitutional power to do so.

--- Later in debate ---

[Baroness Berridge (Con)]

As people around me are saying, I do not think I said that. They are neutral. The royal colleges have said that they have problems with the Bill, but they have been neutral on the principle, save for the Royal College of General Practitioners. I am sorry; I stand corrected on that. They are neutral, as is the Association for Palliative Medicine, which is not a royal college.

When one looks at the evidence that we took, of course individuals from within that group would come along whom we had to call. It was right that we did that, but one looks at a corporate view. I enormously respect Professor Sir Chris Whitty, but I heard his evidence on this and he was not the highest expert in the land. He was humble enough to write to correct himself, as he had misunderstood the Mental Capacity Act when he gave evidence in the Commons.

[Lord Blencathra (Con)]

My Lords, we should all be grateful to the noble Baroness, Lady Finlay of Llandaff, for bringing this matter before the Committee, but also to my noble friend Lord Harper, who has highlighted some of the deficiencies in in the Mental Capacity Act. Yes, it may be tried and tested in its current usage but, as we heard from many sides of the Committee, it may be inadequate for dealing with death issues.

I was going to speak in support of Amendment 2, but I might also be willing to support the potential oral amendment from my noble friend Lord Deben. When considering important decisions, particularly in the context of healthcare, it is crucial to understand the distinction between capacity and ability. This is especially relevant for terminally ill patients, as questions about decision-making may arise on treatment options, advance directives and legal matters.

I believe that we should change references from “capacity” to “ability” when discussing decision-making for terminally ill patients. The reason for this change is to ensure clarity and accuracy in describing a person’s actual situation. We should not be afraid to bring in a new word if it is more relevant than “capacity”. Although “capacity” is a legal and clinical term for specific criteria, “ability” is a broader term that may better reflect the practical realities and nuances of an individual’s situation. Using “ability” can help to avoid misunderstandings and ensure that patients are supported in ways that are appropriate to their unique circumstances.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

[Lord McCrea of Magherafelt and Cookstown (DUP)]

I do not believe that people are tabling amendments simply to wreck the Bill. That may be the noble Lord’s opinion, but he should remember that other people have different opinions. I respect the noble Lord’s opinion, but I hope that he will in turn respect my right to have an opinion. I believe that we must scrutinise this well. I noticed that the noble Baroness, Lady Hayter, objected to the fact that practically no one who supports the Bill has spoken. I know of no one supporting the Bill who has been stopped from speaking. They did not get up to speak, and therefore they were not stopped. If there are those who want to support this Bill and to get up to speak, they are free to do so. I certainly would like to hear their opinions just as well. I believe that I have an opinion that ought to be heard equally, as they have.

I come from a family that knows what the reality of suicide means and the heartbreak of suicide, where we examine and wonder whether something more could have been done before that person ended their own life in suicide. I know the pain of that and the loneliness that they went through. Therefore, I believe we must get this right.

In the domestic abuse and coercive and controlling behaviour context, a victim may, due to intimidation or trauma, deny that their actions are caused by wrongful coercion. Is the doctor supposed to be weighing the patient’s words against the very limited evidence that they can see in an examination room? Professor Jane Monckton-Smith OBE, professor of public protection at the University of Gloucestershire, emphasised in her testimony to the Select Committee the significant difficulties in relying solely on a person’s verbal denial of abuse when assessing coercion:

“I have worked in this area for a very long time. I have seen victims refuse medical help when they have been hit in the head with a hammer through fear. That is not an isolated example. If you speak to the other people here, I think they will probably agree with me. What I am saying is that coercive control is a serious social problem. It will impact on the people who are going to look to this Bill”.


Also in the Lords Select Committee evidence, Cherryl Henry-Leach of Standing Together Against Domestic Abuse warned

“the difficulty is the lack of insight into the impact of coercive control on somebody’s ability to make decisions, even though that has been enshrined in case law”.

I do not want to detain the Committee, but in over 50 years as a minister I have experienced people coming to the end of their life. I have been with them in their moments of their deepest pain, and, as a noble Lord said, was there with the families after the occasion, trying to minister to them. I also know what it is from my 25 years as a constituency Member of Parliament in the other House, and we should not close our minds to the fact that people can be coerced. Sometimes it is done very subtly and gently within family dynamics, and that is difficult for assessing doctors to detect in limited formal settings.

Therefore, I believe it is vital that the words put into this legislation, if it is passed, are the correct ones that cover all these possibilities. Remember, when the person takes that lethal injection or whatever potion they take, there is no return as far as this life is concerned, but they go to another.

[Lord Blencathra (Con)]

My Lords, I had intended to give my strong support to Amendments 3, 45 to 49, 52 and 58—a mere eight amendments out of the 21 in this massive group—but in the interests of time I will dump my notes on all those and speak merely to Amendment 58 in the name of my friend, the noble Baroness, Lady Grey-Thompson, who has made a crucial point with regard to that amendment.

Coercion and pressure do not always manifest themselves as direct, intentional acts by individuals. Instead, they can arise from broader and societal structures and conditions that constrain genuine choice. When a person facing terminal illness is subject to circumstances such as chronic poverty, social isolation or a systemic lack of quality healthcare, their options are severely limited. In such scenarios, the choice to pursue end-of-life options may not be a true expression of free will but rather the result of enduring disadvantage and unmet needs.

At Second Reading, my noble friend Lord Moylan made the telling point that many people contemplating suicide do not want to die; they just want their life circumstances to change for the better. Therefore, “structural disadvantage” refers to the social, economic and institutional barriers that systematically disadvantage certain groups. When terminally ill individuals lack access to palliative care, social support or financial resources, they may feel compelled to consider end-of-life options not out of genuine preference but because their suffering is exacerbated by these systemic failures.

Poverty is a profound social vulnerability. A terminally ill person living in poverty may fear becoming a burden to family or may lack the means to access pain relief, counselling or hospice care. The psychological and practical impact of poverty can create a sense of hopelessness, making the option of hastening death appear more acceptable or even inevitable. When systems persistently fail to address the needs of the most vulnerable, this neglect can be seen as a form of institutional or collective intent. Thus, the responsibility for coercion or pressure extends beyond individual actors to the structures that shape people’s lives and choices.

Many years ago, my illustrious predecessor in my constituency, the great Willie Whitelaw, said to me, “David, I was never interested in pensions until I turned 65”. The wonderful thing about this House of ours is that the average age in here is 71, I understand, and our average death age is 81. That, as we have heard from many noble Peers, gives us a unique insight into the sorts of infirmities that we and our close relatives suffer and the close experience of those near to us who have died from them.

We have heard from many noble Lords, including my noble friend Lord Polak and the noble Lord, Lord Griffiths, their experience of beating the odds because the prognosis was not right. I quoted in my Second Reading speech that Sir William Osler, the father of modern medicine, said, in about the 1890s:

“Medicine is a science of uncertainty and an art of probability”.


Because my noble friend Lady Berridge mentioned NICE, I am tempted to cite an example. I have experience of NICE. I am grateful to it in some ways and hate it in others. One of the side-effects of MS is that one’s feet feel nailed to the ground: they are as heavy as lead and do not move. Fifteen years ago, NICE approved an experimental drug call Fampridine. I was one of about 500 patients put on it at the National Hospital.

Fampridine is an absolutely miraculous drug. What does it do? You saw it in effect this morning. It helped me stagger from my chair to here. With assistance from my noble friends, I can manage to walk—not very fast—to the Dispatch Box. Every six months, I have to do a walking test. If my walking is not fast enough with the drug, they cut it off and I do not get it any more.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

[Baroness Falkner of Margravine (CB)]

My Lords, I wonder whether the Minister in winding up could advise us what the Companion says about Peers making speeches on the same amendment over several points of the passage of that amendment.

It is a pleasure to follow the noble Lord, Lord Deben, speaking to the amendment from the noble Lord, Lord Rook. There is a lacuna in Clause 1(1)(d), which, by requiring registration with a GP, does not cover the practical point of what happens to people who have lost contact with their GP. They may have lost contact for no other reason than being so ill, perhaps with cancer as that is the main illness that people who might be seeking assisted dying have, that they have been taken into private care—those who are lucky enough.

An increasing proportion of the population of the United Kingdom now uses private care, not least because employers provide it as part of a package. So, coming to continuity of care, if we must have the light-touch amendment of the noble Lord, Lord Rook, in the Bill, to clarify and strengthen Clause 1(1)(d), I will share with the Committee very briefly a practical experience of what it means to have advanced cancer and the interaction with the GP. My GP practice, having failed to diagnose me over six months, as I mentioned in my Second Reading speech, slipped away the moment I engaged with private care, although every single consultation with a private practitioner is sent to the GP. Nevertheless, between 30 August 2024, when I was first diagnosed, and late this September, I had no contact whatever with my GP practice. I was finally invited to come in and was told I had fallen between the cracks—it must have been a pretty large crack to have lasted 14 months.

I noticed in the equality impact assessment that 66% of the people who sought assisted dying in the two jurisdictions quoted were people who had cancer. My question to the noble and learned Lord when he winds up on this debate is therefore, what consideration has been given, in having Clause 1(1)(d) in the Bill, as to the relationship of the private oncologist who is treating that patient with the local GP, given that terminally ill people in significant enough numbers that we need to be conscious about them in the Bill may well have been—shall I say—passed on from the GP?

As a final point, once I had the diagnosis, I had the experience of requesting treatment at my local—within a walkable distance—leading cancer teaching hospital in the United Kingdom. When I rang about that after the diagnosis, I was told by my GP, “They won’t take you, because now you’ve gone private”. I leave that for noble Lords to reflect on.

[Lord Blencathra (Con)]

Before we move to the rest of the debate, could we please give way to those noble Lords who have tabled amendments? I would like to hear what they have to say.

[Baroness Grey-Thompson (CB)]

My Lords, I will speak to Amendment 21, tabled in my name, from personal experience. The richness of the debate today shows that, even in your Lordships’ Chamber, we all have completely different experiences of how we access a GP practice.

I tabled this amendment partly from personal experience, trying to look at how we provide continuous care to a patient. As for my own experience, I am disabled, not sick, but I have had some very interesting experiences of interacting with doctors. Fairly recently, I was asked by a doctor how I caught spina bifida and had to explain to him that it was congenital. As for my husband’s experience of the healthcare system, he had a spinal cord injury in 1984 and, at a recent visit, was continually asked whether it was in 1884 that he had his accident—I know he looks good for his age, but not that good. This is not to be flippant, which I have been accused of before. It is actually to try to ensure that we have proper continuity of care for a person who wishes to end their life.

My amendment is also grounded in coercion detection and the limitations of any capacity assessment. When I tabled it, I was thinking that perhaps a GP could provide extra knowledge to contribute to the decision that was made. But then I heard of the experience of my noble friend Lady Falkner, which is absolutely appalling. It shows that there is far more work we need to do, not just on the National Health Service but on making sure we provide the right care. The noble Lord, Lord Deben, talked about the NHS we wish to have. Well, this might be a chance to think about the NHS we wish to have.

I take this opportunity to welcome my new noble friend Lady Gerada and the experience she brings to the Chamber. I have to say that it has left me slightly more confused. I have amendments on data recording, which we will be debating later. Her comments show that data recording and sharing is really important. The part I got a bit confused about was that, if there is a named clinician as part of that process, does that not ultimately feed in to the points that have been made today? I would welcome the chance to discuss that with her outside the Chamber.

Continuity of care is really important, and how it relates to improved patient outcomes. In 2012, 56.7% of patients had a preferred GP, but that is declining. There is a link between your preferred GP and being able to access that GP. The decline has happened regardless of baseline continuity, rural or urban location or level of deprivation. Providing a better experience to patients will make those final weeks and months better for them. The Royal College of General Practitioners published excellent work in 2021 on why the patient’s relationship with their general practitioner is so important. Research on coercion and undue influence demonstrates that standard capacity assessments, while necessary, are not currently sufficient to identify subtle forms of coercion. That is why I tabled an amendment.

In response to the comments of my noble friend Lord Pannick, about what happens if a GP dies, I am happy to be corrected, but I thought the provision in the Bill about your doctor dying would cover a general practitioner as well as any other doctor involved in the process.

What we are talking about here are really complex decisions. Consulting an established GP or GP practice might mean that they possess the nuanced knowledge which would help somebody make a choice. The requirement that GPs confirm that they have a good understanding of the individual’s personal circumstances represents, to me, a better form of safeguard, ensuring that this knowledge actually exists. We cannot assume anything during this process. The assessment should provide abuse detection capacity unavailable in other types of consultations. For individuals whose care is family dependent, the home visit element—which I had, not so long ago—can play an important part in identifying coercion. If the debate has raised nothing else today, it is that this is a really complicated issue which needs much further work.

--- Later in debate ---

This issue illustrates a couple of things. Yes, it is down to safety, but I respectfully suggest that the fact that we are having this discussion today shows the immaturity of the Bill. We should have had a royal commission and a Government Bill, instead of trying to do it this way and negotiate on the hoof.

[Lord Blencathra (Con)]

My Lords, I did not speak last Friday, and this is the only group to which I intend to speak today. I could have spoken to the last group, as my former constituency abutted the Scottish border of Dumfries and Galloway and a mere 85 yards across the River Sark was Gretna. I was aware of our glorious 600-year history of border-raiding for cattle and women—in that order—and now it seems we can add free prescriptions to the list as well.

These amendments would strengthen the safeguards with a demonstrable, ongoing clinical relationship with a GP, reducing risk of error, coercion and administrative confusion, while supporting clinical judgment and the continuity of care. Requiring 12 months’ registration plus a minimum number of in-person contacts gives a straightforward verifiable test of recent clinical involvement. We need robust, practical safeguards and clear eligibility checks. These are essential to protect vulnerable people by evidencing local care and oversight. A sustained relationship with a local GP who has seen the patient helps ensure that the patient is informed and is acting voluntarily and free from subtle pressure. The GP’s direct knowledge of the patient’s circumstances is therefore a critical safeguard rather than a bureaucratic hurdle.

The big issue, which has already been raised today, is: who sees the same GP twice these days? I am very lucky, and perhaps some other noble Lords are as well, in that there are superb multi-disciplinary GP practices in Cumbria. I almost always see the same GP, and we can email as well. In fact, in 40 years of living that constituency, I have only ever had two GPs. However, that is not the national picture. Many patients see a different GP every time they visit. Therefore, for this part of the Bill to work, it cannot be any old GP from a practice; it has to be a GP who has treated the patient personally on a few occasions or over a period of time.

Yesterday, I had the wonderful privilege of hearing in this House from a GP who satisfied all the criteria of these amendments thanks to her deep knowledge of her patients. I was later able to congratulate the noble Baroness, Lady Gerada, a former president of the Royal College of General Practitioners, on her excellent maiden speech. I am delighted to see her here today. I understand that this morning, she was doing the day job, treating her patients in her constituency.

I know that the noble Baroness is in favour of assisted dying, but what she said in one part of her speech yesterday was directly relevant to these amendments. The noble Baroness—I am rather vexed at the right reverend Prelate the Bishop of Norwich, who stole these lines earlier this morning—said:

“I became a GP in Kennington, and I have lived and worked in the community I serve ever since … My very first patient was a young woman who suffered a stillbirth. Decades later, I look after her children and now their children too. That continuity, seeing lives unfold across time, gives general practice its unique moral and social power. It allows us to see people as whole human beings, not as isolated organs or diagnoses. We are interpreters of experience, translators of suffering and witnesses to change”.—[Official Report, 11/12/25; col. 370.]


That is exactly the sort of GP I trust to make a decision on whether a person has a confirmed wish to opt for assisted dying—not just any general practitioner, who may never have met the patient before and has just 10 minutes to form an opinion.

I would love to find a way to include that magnificent sentence about continuity and seeing lives unfold over time giving general practice its unique moral and social power; I would love to see whether we could incorporate it into the Bill, because it sets the right moral climate.

As I say, I have a GP. However, for those millions of people who are not so lucky, these amendments would balance safeguards with practicality. Setting a modest minimum of contacts is proportionate. It is enough to demonstrate an established relationship without imposing unrealistic burdens on patients or practices.

Many noble Lords have spoken of multidisciplinary teams. Can the noble Baroness tell me—indeed, can anyone tell me—how many of all the GPs in this country are still single-practice doctors? A Google search suggests that it is around 63%. That seems terribly high; there must be more multidisciplinary teams than that. There are still an awful lot of single-practice GPs. On the rare occasion when I have not seen my own GP, the other GP has had a look at the computer and read all my clinical notes. However, he does not really know who I am; perhaps that is just his good fortune.

These amendments would support patient safety and public trust in any assisted dying regime. It needs to be visible and enforceable, and it needs to have enforceable safeguards. Clinicians must be able to attest to a patient’s circumstances. I support these amendments.

May I say to the noble and learned Lord, Lord Falconer of Thoroton, that I was dismayed to read some very hostile comments about noble Lords and noble Baronesses in the weekend press? The complaint was that some Peers had tabled a large number of amendments, and that that was somehow wrong. If they were the only Peers who spoke to them, that criticism would be valid, but those noble Lords and noble Baronesses, as professionals and experts, tabled amendments to which many of us wanted to speak. We left them to do it because those Peers have experience; scores of Peers have spoken to their amendments, so they were not abusing the House. I am absolutely certain that the noble and learned Lord was not behind that bad-mouthing, because he is a gentleman as well as a Peer, but some supporters of this Bill are trying to drown out and close down any proper scrutiny in the Lords.

Lastly, I remind the noble and learned Lord and the Committee that Dignity in Dying’s website boasts that the Bill had 29 Committee sittings in the Commons and over 90 hours of consideration. Since the Bill has come to us from the Commons, we have heard devastating criticisms of it from the Constitution Committee, the Delegated Powers Committee and experts giving evidence to the noble Baroness’s Bill Committee. Today, we are on only our fourth sitting, after, I think, 18 hours of debate. So I say this to the noble and learned Lord: please tell some of the others to call off the attack dogs because this House is doing its proper job.

[Lord McCrea of Magherafelt and Cookstown (DUP)]

My Lords, like many noble Lords, I grew up at a time when the family doctor was looked upon as a family friend who could always be depended on whenever you were ill or in a time of crisis. Unfortunately, that is not the situation today. There is a major problem across the United Kingdom: patients desiring to see a GP find themselves sitting on the telephone and ringing the surgery 120 times, perhaps, but still not getting through to someone and giving up at the end of it. That is the reality of the situation in many places.

I am sorry that the noble Lord, Lord Pannick, is not here. He posed a question to the noble Baroness, Lady Lawlor, concerning what happens if your GP retires. Let me give my small experience. My GP was in his late 50s. He was an excellent GP. During Covid, unlike many other practices, he still allowed patients to come to his surgery. Whenever elderly patients could not come, he went out to their houses and visited them in their own homes—unlike many other practices and GPs. Unfortunately, he got cancer and, in his late 50s, just recently, he passed away.

We were left with a practice in our town with several thousands of patients but nobody to take it over. So what happened to us? Our GP died, and so, without any consultation whatever, we were all farmed out to seven or eight practices around the countryside, some of them not even close—just to whoever would take us. It is unrealistic to imagine that somehow a new doctor would have any knowledge of the pressures, the problems or the complex challenges that his new patient was facing; he would not have any continuity of care whatever.

It was even worse than that, because it was several months before the notes went to the next practice that you were farmed out to. You were allotted a practice but the notes concerning any illnesses of the patients did not immediately follow; it was several months before they arrived. What has been suggested in these amendments today strengthens safeguards. Therefore, they are worthy of the support of noble Lords in this House.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I have added my name to two amendments in this case.

[Lord Blencathra (Con)]

My Lords, could we please first hear from those noble Lords who have tabled and signed amendments before the rest of us speak? I apologise if the noble Baroness is a signatory, but I did not think she was.

[Baroness Fox of Buckley (Non-Afl)]

I have my name on a number of amendments. I did not know that those rules applied—anyway, they do not.

I have added my name to a number of amendments from the noble Lord, Lord Carter of Haslemere, in this group.

In general, I am glad to support many of the amendments on palliative care in this group. The Bill asks us to accept that assisted dying is a medical intervention, albeit an irreversible life-ending one, which is something I am not entirely happy with. It seems obvious to me that there must be guaranteed input from the best-placed medical experts in end-of-life care: that is, palliative care specialists. That is essential for the informed consent of the patient.

I imagine and hope that the noble and learned Lord, Lord Falconer, is very sensitive to the importance of palliative care. I know that he is in the much-cited Demos Commission, which I will not bother quoting again, and I am hoping that he has not changed his mind. I think the noble Lord, Lord Carter, made a very important point earlier to the sponsor of the Bill about the number of amendments, for which we have all been chastised and finger-pointed at and tut-tutted at. I kept my patience last night, although my blood pressure did go up.

None the less, I genuinely think that the number of amendments could be really slimmed down if the sponsor of the Bill were to go through, for example, all the amendments on palliative care and say to us, “I accept the principle of this and I will come back with my own amendment” or what have you. We would then not have this issue. We are not an organised political grouping; people table amendments and add their names to them in good faith, which is what I have done, and they then speak in good faith. We are not trying to repeat things for the purpose of delaying the Bill but because we think that it matters and is important. That is what we are doing here.

On this group, and the concept of 10 important themes, we need an assurance that real choices will be offered to a patient with a terminal illness and they will be given the option of a palliative care assessment and, hopefully, then, possibly palliative care. That safeguard would really reassure us, and it is a key theme, and so on. One of the reasons why I say that is, under the Bill, GPs can mention palliative care to a patient. I am a great fan of GPs; they are fantastic generalists who do a good job. But very often they do not have all the expertise of a palliative care specialist in knowing how precisely medical intervention can improve a patient’s condition, or indeed change their will to live.

It is important for the Committee to note that research has shown that those who wish to hasten their own death often change their mind when they receive more information. Palliative care can mean that people who want to die then want to live, and that is important if we are going to talk about choice. It is possible that you might want to die, that you are determined you want to die in assisted death terms, having had your terminal diagnosis. But why is it that you want to die? That is the motivation behind the discussion in this group.

One of the things that happens is that many people are frightened and fearful, and one of the things they are fearful of is pain and terrible symptoms, which by the way are often graphically described by supporters of the Bill, and I think that they can scare people. It is the idea that your pain and symptoms cannot be controlled. When I talk to supporters of the Bill—some of my friends, colleagues and members of the public—they are completely compassionate in talking about how the Bill will help people who are suffering intolerably and in excruciating pain. None of us wishes that on anyone—or, indeed, on ourselves. It is a frightening prospect.

That is actually often a fear and a dread that the right kind of care can mean will not be realised. Patients are understandably frightened of being in that kind of pain, so they need to know that. Toby Porter, the CEO of Hospice UK, summed up the way I feel about this. He said:

“An outcome in which someone chose an assisted death because of a real or imagined fear that they could not get pain relief or other symptom alleviation, or because their family would not get support through their illness, would clearly be a moral and practical disgrace to any country”.


That is absolutely right.

We all know family and friends and so on who have died and who have had terminal illnesses. People will say that morphine is simply not enough to control the pain. That is the kind of thing that I would say, because I know nothing about medicine. So, it is a great relief to discover that palliative medicine resident doctors say that morphine is the tip of the iceberg for pain management. There are countless other options available, but to know this requires training and experience, which I have not got. When you are having a chat in the pub with mates—or indeed, when I was in hospital pumping in the morphine—it is good to know that somebody, somewhere, has got the experience. That is the palliative care specialist and every terminally ill patient should at least be offered the option to go to see one. This is a modest but meaningful addition to the Bill and I hope that the noble and learned Lord, in the spirit of listening, accommodating and compromise that we heard about last night, will make changes to the Bill accordingly.

There is also a question for the Government and the Minister here. The noble Baroness, Lady Smith of Newnham, explained this very well. In relation to the point made by the noble Lord, Lord Stevens, yesterday, it was a shocking revelation that the Minister responsible for palliative care said that the Government would not publish their modern framework until after the Bill had passed through Parliament. The noble Lord, Lord Stevens—

--- Later in debate ---

[Lord Harper (Con)]

No, I am sorry, there is no requirement in the Companion that you can speak in a debate only if you have tabled an amendment. If we want to finish at 3 o’clock, we can either go slightly past 3 o’clock or we can stop at 3 o’clock and resume this group next week. I wish to make one point that has not yet been made and which I think is pertinent to the debate, and I believe I am perfectly in order doing so.

The point is this. Two Members have raised the valuable contribution made in yesterday’s procedural debate by the noble Lord, Lord Stevens of Birmingham—a man who knows what he is talking about on the NHS, as he ran it for a number of years—about the timetable for the Government to publish their modern framework for palliative medicine. He said that, at the moment, that framework is likely to be published after Parliament has considered the Bill, and he felt that that was the wrong way around. The reason that matters is that the Government have published a 10-year plan for the NHS, and nothing in that plan will significantly change the provision of palliative care in England.

We know that only about half the people who require specialist palliative care are able to get it, and that the Bill’s sponsor, the noble and learned Lord, Lord Falconer of Thoroton, believes—or believed and still believes—that good palliative care is a prerequisite for there to be assisted suicide, so I think it very important that the Minister answers the question and confirms that the Government will at least think about publishing the modern framework for palliative care before we get to Report on the Bill, so that this House can make a properly informed decision about the amendments before it on palliative care.

[Lord Blencathra (Con)]

My Lords, this is a self-regulating House, and that does not mean that a Government Whip can regulate who can speak and who cannot. I echo the point made by my noble friend. If the only way one can speak in these debates is to sign amendments, I know what to do in future.

I spoke for five minutes on the Friday before Christmas and said not a peep in the debate earlier today because it was not my speciality. I have been waiting here for two hours to make a speech on palliative care, and we seem to have been refused the right to do so because the Government Whip wants us not to say anything so that we can finish at 3 o’clock. I agree that we can finish at 3 o’clock—it is a simple matter for the House to adjourn and come back to polish off this matter next Friday morning—but it would be absolutely outrageous for noble Lords who have not had a chance to speak at all on palliative care to be refused the right to do so because the Government have imposed an arbitrary timetable on us.

[Baroness Wheeler (Lab)]

My Lords, it is not an arbitrary timetable. Many people have spoken on palliative care both at Second Reading and today, and I respect that totally. I am just saying that we need to respect the rules of the House to be able to adjourn. It is better if we finish this amendment so that we can start the next session with a new debate.

--- Later in debate ---

[Lord Blencathra (Con)]

Why must we finish this group and start the next session with a new amendment? In Committee, we often adjourn at 10 pm when we are half way through a large group, and we come back and polish it off the next day. Nothing in the Companion suggests that we are honour-bound or duty-bound to finish a group on a certain timescale. There is no problem with coming back and completing it then.

[Baroness Hayman (CB)]

The noble Lord is of course completely correct that there is nothing in the Companion. It is however difficult for many Members, when they have spoken in a debate, not to be able to hear from the Front Benches because they have arrangements for another occasion. I say gently to the last two speakers that we are not talking simply about the Companion; we are talking about last night’s decision and the mood and concern of the House that we make progress. It is very unfair to attack the Government Whips on this when they are trying to work their way through the input of last night’s decision.

[Lord Blencathra (Con)]

I respect what the noble Baroness has said, but it is also the case that it is disrespectful to Members who have prepared speeches, wishing to say something on palliative care, and who deliberately stayed quiet in previous debates so that they could make a point on a subject in which they are interested. They are now being deprived of the opportunity to do so.

[Lord Kamall (Con)]

My Lords, one reason I was reluctant to get up is that I believe very strongly that all who want to speak in these debates should be allowed to do so, but I ask noble Lords to please bear in mind that there are many others who may want to speak to the group, and we should not make Second Reading speeches. We should repeat what the Chief Whip reminded us of a number of times: please can we speak to the amendments and keep to the point? I will try to do so in summing up very quickly.

It is quite clear that these amendments relate to palliative care and whether people who seek assisted dying services are offered a meaningful choice—not just a choice in theory or on paper because it says it somewhere in the current version of the Bill but a very real choice. I pay tribute to the noble Baroness, Lady Finlay. When I was the Minister taking the Health and Care Act 2022 through the House, she came to speak to our officials in the Department of Health and Social Care who did not know as much as her. She held a teach-in. She did not have to do that, but many officials in the department said that they welcomed the opportunity to learn from such expertise. That is why I think it is important that we learn from all noble Lords, whatever their expertise. We should also thank everyone, especially specialists, currently working in the palliative care sector, which is under pressure.

This refers to a point made early on at Second Reading, when the noble Lords, Lord Hunt and Lord Stevens, said that we know how government works and how money is shifted around government. I do not want to argue about the merits of the Bill—personally, I am torn on it at the moment and am listening to the debates to make up my mind—but the noble Lords said that, if it goes through, the money has to come from somewhere. They feel, having been in government—one having run NHS and one having been a Health Minister—that that money will come at the expense of palliative care. I think that that concern is behind many of the amendments in this group.

It seems that the principle is that anyone who is making that decision, or who seeks that help, should make a meaningful choice, so I welcome the intent of all those who laid amendments in this group—I will not waste time by naming them all; they know who they are, and I thank them. But I point out to them that, as some noble Lords have said, palliative care is mentioned in the current version of the Bill. We see it in Clause 5, on preliminary discussions with registered medical practitioners; in Clause 12, on doctors’ assessments; in Clause 39, on codes of practice; in Clause 40, on guidance about the operation of the Act; in Clause 47, on reporting on the implementation of the Act; and in Clause 50, on review of the Act.

Surely, the crucial question at this stage to both the sponsor of the Bill—the noble and learned Lord, Lord Falconer—and the Minister, are whether they believe that these clauses in the current version of the Bill, as entered this House, address the concerns raised by the many probing amendments discussed in this group. That is the crucial question to the sponsor of the Bill and the Minister.

I have a further question for the Minister, and I know that it is a little unfair because it is probably more a question for the Department of Health and Social Care and perhaps the Treasury, so if the Minister does not have the answer to hand, we understand that she will write to us and place a copy in the Library. Are the Government confident that palliative care will be sufficiently funded so that those who seek assisted dying services are offered a real as opposed to theoretical choice on palliative care, so they can make a more informed decision, understanding what is available to them? I recognise that that may be a difficult question and may put the Minister on the spot, but I hope that she can go back to the Government and ask for an answer that can be shared with your Lordships.

I look forward to the answers from the Bill’s sponsor and the Minister.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 16th January 2026 Lords Chamber

[Lord Blencathra (Con)]

I want to speak briefly in firm support of this suite of amendments, because they do not obstruct compassion but restore clarity and protect the vulnerable. As many noble Lords have said, the Bill leaves crucial decisions to discretion and delegated guidance. As my noble friend Lord Deben said, it is not precise.

Where I slightly disagree with my noble friend Lord Harper is that I am worried not about the judges moving the goalposts on the main Act of Parliament but because I believe that there will be more than 40 regulations, of which we have seen neither hide nor hare. We will not even see a draft before the Bill becomes law, and every single one of those regulations will be wide open to judicial review. That is where the judges will not have to move goalposts but have to fill in gaps on issues that neither House of Parliament has considered. They will have to decide whether the goalposts are for rugby or football, which neither House will have determined. I am deeply concerned that the Bill is not precise enough on the details that noble Lords have specified.

That imprecision leaves a big legal vacuum, where the most sensitive judgments about life and death can be initiated or driven by others, where serious mental illness can be overlooked and where people in care homes or in poverty can be pushed towards an irrevocable choice without robust, statutory safeguards. The amendments in this group are practical, proportionate and targeted fixes to those gaps.

First, the amendments make it clear that only the person themselves may initiate a request and that lasting powers of attorney cannot be used to start the process. That is essential, and I believe the noble and learned Lord, Lord Falconer of Thoroton, agrees. If he does, let us put it in the Bill. The law must not be ambiguous about agency of any sort. Where the law is silent, pressure and expediency will fill the silence. We have seen in other jurisdictions how a third party can accelerate a fatal outcome; the Bill must not replicate that risk.

Secondly, the amendments addressing severe mental health are not an attack on autonomy; they are recognition of clinical reality. A person can meet the narrow legal test of capacity while still having a treatable or episodic mental disorder that drives suicidal ideation. Excluding those with a history or pattern of suicidality from eligibility, or at least requiring a specialist psychiatric assessment, protects people whose wish to die is a symptom rather than a settled, autonomous decision.

Thirdly, the Bill must provide an independent, neutral route for information. Many doctors will rightly decline to participate. Patients must not be left to navigate a black box where the only signpost is a clinician who may be unwilling or conflicted. An independent local service or register would ensure that information was unbiased and accessible, and that the pathway into assessment was not covertly steered by those with other motives.

Fourthly, care home residents deserve heightened safeguards. Undiagnosed dementia and fluctuating capacity are common in residential settings. A single visiting doctor cannot reliably detect these risks in one brief encounter. Requiring a specialist assessment for care home residents is a modest, necessary step to prevent tragic mistakes.

These amendments would not create delay for those who are clearly eligible. They would create clear, statutory thresholds and processes so that clinicians, patients and families knew where they stood. They would reduce litigation risk, prevent inconsistent local practice, and ensure that the law aligned with the seriousness of the act that it permitted. If this House is to legislate for assisted dying, we must do so with precision. These amendments are not obstructionist; they are the scaffolding of a safe, humane system. I urge noble Lords to support them so that the Bill protects autonomy while safeguarding those most at risk of being failed by ambiguity, poverty or untreated mental illness.

I conclude in a more inadequate way than my noble friend Lord Deben did, on the point that he also made to the noble and learned Lord, Lord Falconer. If he cannot produce an assurance of amendments on the Bill that will implement some of the concerns of the royal colleges and of the three Select Committees of this House, some will be left with the impression that his strategy is not to accept amendments but to beg for more time and drive through the Bill, line by line unamended. That would be unacceptable. I hope that that is not the noble and learned Lord’s intention, but he could reassure us all by coming forward with revisions to the Bill and amendments that seek to implement the safeguards for which many organisations outside the House have been calling.

[Baroness Grey-Thompson (CB)]

My Lords, I shall speak to three amendments in this group—Amendment 38, in the name of my noble friend Lady O’Loan, to which my name is attached, and Amendments 39 and 68. Amendment 38 seeks to address the challenges of those who have bipolar disorder, borderline personality disorder or other conditions associated with episodic suicide ideation, who face a higher baseline risk of self-harm and suicide. Research indicates that suicidal thoughts and behaviours are significantly more prevalent among people with these diagnoses, even without terminal illness, as reported by NICE in 2022 and Public Health England in 2021. Critically, evidence also shows that suicidal ideation tends to increase following a terminal diagnosis, so without the safeguard of this amendment, the Bill risks enabling assisted dying decisions to be influenced by pre-existing mental health vulnerabilities exacerbated by the receipt of a terminal diagnosis.

I support calls in the Chamber today to look at the benefits system. It is a really complicated process, whether you have a terminal diagnosis or not. It is important to learn from other jurisdictions. The 2024 Oregon official report cited that 9% of those who requested to end their lives did so for financial reasons and 42% requested it because they were felt a burden. I think it has already been quoted that in 2011, the noble and learned Lord, Lord Falconer, with the Demos report, said that no remedial mental health condition should be eligible for assisted suicide. I do not expect an answer in the Chamber on this question this afternoon because it might take a long time—I am very happy to meet outside—but I am interested to understand what has changed from his view in 2011 to thinking that this would work in the Bill now.

Many of the amendments talk about a settled wish. I could almost see how somebody could try to justify that, for someone with a terminal condition and suicide ideation, requesting assisted dying might be a form of suicide prevention. I feel like I am tying myself in knots with this argument, but I think when we hear the argument that people are already dying, we need protection for those groups of individuals. The noble Baroness, Lady Jay, who I do not think is in her place—I am sorry, I do not have my glasses on—raised evidence given in the Select Committee and talked about paternalism. My personal experience is that I do not see much paternalism in the health service. What I do see is an awful lot of ableism, and I think that if we are talking about paternalism, we should be talking about ableism as well. From a disabled person’s perspective, this recognises the intersection between disability, chronic illness and mental health vulnerability.

The panel has already been raised in the Chamber this afternoon. The panel is a really important part of the eligibility determination and deciding whether somebody can go forward. I think that one of the only things that the noble Lord, Lord Winston, and I could agree on today is that words are important. This relates to the place of the panel. I draw your Lordships’ attention to the clarification statement that was issued by the Association for Palliative Medicine this week. Because words are important, I am going to read it. It states:

“In Friday’s … debate (9/1/26), Lord Falconer cited, and misrepresented, expert evidence presented to the Terminals Ill Adults committee last year by the Association for Palliative Medicine … Crucially, panel members would not be required to meet the patient. They would, therefore, have no individual clinical perspective to bring to bear on the person applying for an assisted death. This renders the panel a mere administrative review, stripping it of the very nuance and human understanding that defines robust, compassionate decision-making at the end of life”.


This is why these amendments are even more important in terms of what we are trying to do.

I have previously discussed suicide among unpaid carers and the pressure on them. In Canada, there is a case of a man who had carer burnout and arranged for an urgent assessment for his wife. She died that day. That is listed in the Ontario coroner’s report. There is also written evidence to show that two men who had caring responsibilities for their partners ended up doing a mercy killing, which is often, strangely, very sympathetically portrayed in the media.

Amendment 39, in my name, is about recognising where an assisted death could take place and who will be most directly affected. The settings that could be affected include care homes or nursing homes—communities that care for those living with dementia, frailty, disability or advanced illness, where dependency is a condition of daily life rather than an exception.

It is important to recognise that a significant proportion of people living with dementia or cognitive impairment remain undiagnosed until the later stages of the disease. On average, people with dementia live with symptoms for three and a half years before receiving a diagnosis. Current NHS England and Alzheimer’s Society data show that only about two-thirds of those with dementia receive a formal diagnosis. The diagnosis rate in Wales is even lower. This further underscores the need for a specialist clinical assessment before any conclusion about capacity is reached. If one in three people with dementia are never diagnosed, one in three potential applicants under the Bill may have an unrecognised impairment in capacity. This is not a margin of error that any legislator can reasonably accept.

A recent report by the whistleblower charity Compassion in Care further illustrates the heightened vulnerability of care home residents. Based on evidence submitted by over 1,000 care workers who called the charity’s helpline to express their concerns about the Terminally Ill Adults (End of Life) Bill, the most predominant issue raised in 97% of cases was that of fluctuating capacity, which is common among those residing in care homes. The British Geriatrics Society, which gave evidence during the Select Committee, estimates the prevalence of delirium among care and nursing home residents to be as high as 60%.

Amendment 68 is about protecting autonomy. It would ensure that the right to request assistance to end one’s life remains solely with the individual who is terminally ill. It would prevent any surrogate, family member or medical professional making that decision on their behalf. By explicitly prohibiting third-party decisions, we safeguard vulnerable individuals from coercion or misinterpretation of their wishes.

Finally, I would like to ask the noble and learned Lord a few questions. How will he specifically seek to protect those who are in care homes or who may be vulnerable? How will the Bill protect those individuals who have had previous suicide ideation? Where does the Bill seek to understand the intersection of those with suicide ideation who then receive a terminal diagnosis and whether this is a genuine, settled wish? How, through the Bill, will we be able to offer protection to those who have a previous history of self-harm?

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 23rd January 2026 Lords Chamber

[Lord Goodman of Wycombe (Con)]

The noble Baroness, Lady Berger, is quite correct. That is exactly what happened in the Select Committee. For my sins, I sit on a surfeit of committees, including the Delegated Powers Committee, which drew attention to this very deficit in the Bill. So the question for the noble and learned Lord, Lord Falconer, is: since the Minister was questioned in the Select Committee by the noble Baroness, Lady Berger, in the weeks that have followed, has he had any guarantee from the Government that they will ensure that the Secretary of State by regulation ensures that the NHS delivers voluntary assisted dying services? When the Minister replies to the debate, can she cast some light on this matter so that we know whether or not the proposal that the noble Lord, Lord Birt, has put forward and my noble friend has opposed really has any basis in reality?

[Lord Blencathra (Con)]

My Lords, I was delighted to hear the noble Baroness, Lady Fox of Buckley, hit every nail on the head of everything that is wrong with the amendment moved by the noble Lord, Lord Birt. I shall speak to the amendments in the names of my noble friends Lord Mackinlay of Richborough and Lord Harper, and I have signed some of them. I have done so because the Bill as drafted, and as now proposed to be amended by the noble Lords, Lord Birt and Lord Pannick, promises choice while quietly engineering speed, centralisation and a single-minded pathway to assisted death. That is not a neutral design choice. It reshapes incentives, shifts resources and narrows real options for people at the end of life.

I will give three short examples of why the amendments proposed by the noble Lord, Lord Birt, are wrong, and end with a direct challenge to the noble and learned Lord, Lord Falconer of Thoroton.

First, the amendments would turn life and death decisions into a fast-track process. From first declaration to possible assistance, the clock can run down to 30 days, or as few as 18 days if death is deemed imminent. Panels must decide within 48 hours of referral. Reports are forced within 24 hours. Reflection periods can be cut to 24 hours. That is extraordinary. Courts take months to resolve urgent life issues. Prognoses measured in months are notoriously unreliable. Rushing assessments in this way risks premature deaths, misdiagnoses and inadequate exploration of reversible causes of despair. My noble friends’ amendments, including the ones that I have signed, push back against that compression.

Secondly, as others have pointed out, the assisted dying help service and the personal navigator create an asymmetric system. The navigator is designed to shepherd people quickly through the assisted dying pathway. There is no equivalent statutory guarantee that a person will get timely access to palliative care, hospice support, social services or mental health interventions. In practice, a patient could reach assisted death faster than they could gain access to pain control, a care package, meaningful social intervention or, as the noble Baroness said, a GP appointment these days. That is a perverse allocation of scarce resources and a distortion of choice. When one option is actively facilitated and the others are not, choice becomes a funnel.

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[Lord Birt (CB)]

I do not think it for us, in framing in principle amendments, to deal with that level of issue, but the noble Lord is right—that is exactly what the body should do. We are talking about highly distressed people, and it should facilitate different kinds of response and reaction to their difficulty.

[Lord Blencathra (Con)]

If I heard the noble Lord correctly, he said that anyone going to A&E gets a navigator. He was challenged by the noble Baroness, Lady O’Loan, but he did not hear her question. She said that she never experienced that in her life and neither have I. If any noble Lord has, I would be grateful to hear it. If you go to St Thomas’, the first people you meet are two security guards who are there to keep people out.

[Lord Birt (CB)]

Plainly, the NHS is a very large organisation and it offers a variety of different kinds of experience. I hope none of us uses A&E very often but, like everybody else, I have used it and, in my experience, I have found it very efficient indeed at handling everything.

As I have said already, there are many issues and if anybody wants to talk to me and the noble Lord, Lord Pannick, about them, please do. I end with a very simple point, and I address this particularly to the noble and learned Lord, Lord Falconer. I am utterly convinced that this needs a proper organisational framework. You cannot throw this complexity of issues at the National Health Service. It also needs a more flexible process than currently exists to deal with the complexity that I have outlined, which comes out of the Australian experience. Both those things need to be in the Bill, and the noble Lord, Lord Pannick, and I will be returning to these issues on Report with, I hope, as much help from across the Chamber as possible. In the meantime, I beg leave to withdraw the amendment.

--- Later in debate ---

Moved by

[Lord Blencathra]

39A: Clause 1, page 1, line 14, at end insert—
“(1A) Assistance may be provided only under this Act where the person has demonstrably understood—(a) their diagnosis,(b) their prognosis,(c) their treatment options, (d) any inherent uncertainties in the assisted dying process, and(e) any known risks and likely complications of the approved substance.”Member’s explanatory statement
This amendment seeks to strengthen the Bill’s informed consent requirements by ensuring that a patient’s understanding must be demonstrated, rather than assumed.

[Lord Blencathra (Con)]

My Lords, I will move my Amendment 39A and speak to my Amendments 238B and 553G. The purpose of Amendment 39A is to require that the patient’s understanding is demonstrable, not assumed.

Before I continue, I wish to thank the Chief Whip for his very wise decision to have a 40-minute lunch break but, as the average age of this House is 71, it was more like a loo break. It was very convenient, whatever it was. I move on to the subject of the amendment.

This amendment goes to the heart of autonomy. The Bill repeatedly invokes autonomy as its moral foundation, yet it does not require that the patient’s understanding be demonstrated. In every other area of medicine, informed consent requires evidence that the patient has actually understood the information. Here, where the outcome is irreversible, the evidential threshold should be higher, not lower.

The Bill currently requires doctors to “explain” and “discuss” certain matters, but it nowhere requires confirmation that the patient has absorbed or understood them. That is a fundamental flaw. NICE guidance, GMC guidance and the Montgomery judgment all emphasise that consent is valid only when the patient understands material risks, uncertainties and alternatives. The Bill omits these requirements.

International comparators—Oregon, California and Victoria—all require explicit discussion of risks and complications. England and Wales would be an outlier if we did not require demonstrable understanding. This amendment simply aligns the Bill with established medical ethics and legal precedent.

My final point on this amendment is that it protects clinicians. Without a demonstrable understanding requirement, a doctor could comply with the Act while failing to meet professional standards. That is a recipe for litigation, confusion and moral hazard.

My Amendment 238B would introduce a safeguard that is standard in every jurisdiction where assisted suicide is legal. A written acknowledgement would ensure that the patient has been informed of the risks— including prolonged dying, vomiting, seizure or failure of the drugs—and that they understand them. Without this, the Bill creates a parallel medical system where the usual rules of consent simply do not apply.

The Bill currently requires doctors to discuss

“the nature of the substance”

and what to do in the event of “complications”, but it does not require doctors to explain that complications may occur or what they are. That is a glaring omission. A patient cannot meaningfully consent to a life-ending drug without knowing that it may not work as intended.

Those noble Lords who have experienced cancer treatment or chemotherapy know that, before one gets it, one has to spend about an hour with a clinician or the oncologist ticking boxes on a form, explaining and saying that they understand all the potential downsides. I recall having to complete a seven-page form to do so. It is important that patients consent.

This amendment would also protect clinicians. The Bill grants civil liability exemptions for doctors acting in good faith but, without a written acknowledgement, there is no evidential record that the patient was informed of the risks. This exposes clinicians to professional risk and undermines public trust. Finally, this amendment is modest, proportionate and entirely consistent with the principle of autonomy.

I turn to my Amendment 553G, which is a Montgomery compliance clause. It would require doctors to apply the principles of Montgomery v Lanarkshire when informing patients of material risks. The amendment would embed that leading case on informed consent into the Bill. Montgomery requires doctors to inform patients of material risks and reasonable alternatives. The Bill does not currently require this. That omission is extraordinary in a process that ends in death. Without this amendment, the Bill creates a parallel medical system where the usual rules of consent do not apply. That is ethically indefensible. If anything, the standard should be higher than in ordinary medicine, not lower. This amendment would also protect clinicians by ensuring they are not forced to choose between complying with the Act and complying with their professional obligations. Finally, I believe that this amendment would align the Bill with international best practice.

These three amendments together would make the policy clearer, leaner and fairer. By tightening rules and strengthening enforcement, amendment 1 would remove ambiguity and speed decisions, reducing disputes and legal exposure. My amendment 2 would lower operational friction and cost by streamlining processes and clarifying responsibilities, which would improve efficiency and predictability during implementation. My third amendment would enhance fairness and future readiness by embedding equitable principles and scalable mechanisms, increasing stakeholder buy-in and adaptability as circumstances evolve. The result would be a more enforceable, cost-effective framework that better serves stakeholders today while remaining flexible for tomorrow. These amendments are practical, complementary—

[Lord Falconer of Thoroton (Lab)]

The noble Lord referred to amendment 1, amendment 2 and amendment 3. I apologise, but I did not know which his amendment 2 was.

[Lord Blencathra (Con)]

I realise that I should not have said that. When I spoke to my amendment 1, I meant Amendment 39A. I shall rephrase that: my Amendment 39A would remove ambiguity and speed decisions; my Amendment 238B would lower operational friction and costs by streamlining processes; and my Amendment 553G would enhance fairness and future readiness by embedding equitable principles and scalable mechanisms, et cetera. I believe that those three amendments would result in a more enforceable, cost-effective framework that would better serve stakeholders today while remaining flexible for tomorrow. The amendments are practical, complementary and strategically aligned to deliver measurable improvements in performance, compliance and stakeholder confidence. I commend them to the Committee and to the noble and learned Lord, Lord Falconer of Thoroton. I beg to move.

[Baroness Coffey (Con)]

My Lords, I tabled Amendment 43, to which Amendments 312 and 340 are consequential, and Amendment 188A, so I will speak to those. Amendment 43 would bring in the term “demonstrably”. I appreciate that noble Lords may think that this is dancing on the head of a pin, but it is my understanding that the use of “demonstrably” is well known in legal practice, and it effectively requires evidence. I appreciate that there are other aspects of the Bill, when it was first introduced, that were set out in specific forms, but they have been replaced by a variety of regulations and other powers, so I think we just need to be clear about what that really means.

Being informed conceptually is meaningless unless we can establish that the person can demonstrate to healthcare professionals and others that they understand assisted dying, they understand the process and they are absolutely committed to this journey on which they go. The Bill currently requires that certain matters be explained and discussed, but it does not require evidence that the patient has understood them. I appreciate that one of the things about the current Clause 3 of the Bill is that the Mental Capacity Act 2005, which is at the MoJ level but is used in the NHS, requires in effect only a balance, rather than something much firmer, in terms of probabilities of understanding.

It is important to understand the impact of the lethal drugs that people are going to be given, and my noble friend referred to international examples. In Victoria in Australia, and in Oregon in the USA, there are firmer elements of how it can be demonstrably identified and verified that this decision is being made. It should also be recognised that we need to make sure that the doctors setting this out may say, “Your death is actually going to be quite straightforward. It may take longer, but it may not be as painful”. I accept that people on this journey are close to dying, but they need to understand the risks and how that comes about. We have not yet got into the detail of understanding which drugs are going to be used in this process.

One of the reasons I tabled the amendment on Montgomery compliance is that there was a significant ruling to do with liability and negligence. Back in 2015, the Supreme Court effectively made sure that a patient-centred focus became the norm. There was a more recent ruling in the case of McCulloch in 2023. In 1985 the House of Lords judges spoke about the professional basically making the decision, whereas the key ruling in the 2015 case, and the principles behind it, show that case law has helped to evolve what has ended up becoming guidance. We should be clear in this Bill about the exact approach that we want to have. I appreciate that this may seem a bit nebulous to the Minister, but I tabled it as a probing amendment.

In the case of McCulloch, the NHS basically said, “We’re more or less back to Bolam”, which was the original test. I know that the noble Baroness, Lady Freeman of Steventon, had to leave early, but this is one of her key areas of expertise; she teaches this in different places around the country, including in the NHS. One of the presentations that she shared with me shows that the director’s advisory role involves dialogue, the aim of which is to ensure that there is an understanding of the seriousness of a condition. The information provider has to be comprehensible. The doctor’s duty is therefore not fulfilled by bombarding the patient with technical information that they may not reasonably be expected to grasp, let alone by routinely just demanding a signature on a consent form.

I am trying to make sure that, instead of just relying on case law that may change, we end up being very clear about the need for a patient-centred focus and the principles on which we expect this process to happen. The other aspect, which we will get into a bit later, is that I am just trying to explore what this looks like for the person involved, at a pretty scary time of their lives, if we go down this route. I am afraid I have seen it happen too often with things such as DNR: patients are not necessarily given good advice and are told that the doctor knows best. I want to be crystal-clear that somebody who is going through a difficult moment needs to be aware of not only options but risks, and what the balance might be on whether to go with a lethal dose of certain drugs or to take a different route in order to end their life in a good way. That is why I have proposed these amendments.

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[Baroness Hayter of Kentish Town (Lab)]

Can I put it on record that I am not shaking my head? I think it was made clear that the power of attorney could not be used for this purpose.

[Lord Blencathra (Con)]

This has been another interesting debate. Possibly more important than the speeches that we all made at the beginning has been the last 40 minutes of real debate and interchange with the noble and learned Lord. I am left with the feeling that many colleagues in the Committee feel that there are a lot of unanswered questions and some uncertainties that we may need to return to.

However, I will follow the instructions of the Companion and the Government Whips, and I will not seek to respond in any detail to the many good points raised by noble Lords. I merely wish to remind the Committee that in the debate we heard from the noble Baronesses, Lady Coffey, Lady Lawlor, Lady Hollins, Lady Berridge, Lady Finlay of Llandaff and Lady O’Loan. We also heard from the noble Lords, Lord Empey, Lord Harper, Lord McCrea, Lord Carlile of Berriew, Lord Wilson of Tredegar and Lord Mawson. What they all had in common was that they were deeply concerned that the definition of informed consent is not strong enough in the Bill and something more needs to be added.

I think that the noble and learned Lord relied on Clause 12(2)(c)(iv). The doctors have to discuss

“the nature of the substance that is to be provided”

and, in Clause 12(2)(d),

“discuss with the person their wishes in the event of complications”.

However, there is nothing in there to say that they have to discuss the complications with them or the possible side effects. The noble and learned Lord may pick me up on this if I put the wrong words into his mouth, but I think that he said that explaining the nature of the substance could possibly—I think that he used that word—include discussing the possibility of complications and side effects.

[Lord Falconer of Thoroton (Lab)]

If the noble Lord is suggesting that I said “possibly”, meaning that you might have to say what the complications were, if there were complications or the threat of complications, I did not say that. I said that if there was the prospect of complications, you would have to say.

[Lord Blencathra (Con)]

I think that I will have to check the record, as I firmly remember the noble and learned Lord using the word “possible”; it will be “possible” to discuss this. I think that most noble Lords who have spoken do not want the possibility of it being discussed but the certainty of it being discussed, and that may require an amendment to this part of the Bill.

Many noble Lords made the point that you cannot get any NHS treatment or any medical treatment these days unless the doctor takes elaborate steps to explain the consequences, the downsides and things that could possibly go wrong. That extends through all aspects of health. Two days ago, I went down Victoria Street to buy a packet of Night Nurse in Boots. I was interrogated: “Have you taken this medication before, are you taking other medication with it, are you aware it can make you drowsy?”—they were practically asking, “Are you going to fly a jet plane after this?” It goes to that extent in selling drugs. Noble Lords were concerned that, when people are getting treatment to help cure them, they get every single thing explained, but they would not get it explained to them in detail if it is a treatment to kill them.

Some may say, “What does it matter? If you’re going to take a drug that will kill you, why do you need to know the side-effects?” Well, you do not need to know the long-term side-effects, of course, but you do need to know any side-effects the drugs may have. As the noble Lord, Lord Goddard, said, NICE guidelines say that no drug can be supplied unless it is approved by NICE. But NICE approves drugs to treat you; it does not approve a lethal dose. We have seen in the United States death row places where people are given a cocktail of drugs. In the old days, it was straightforward: it was a drug that could kill you. Now, they are given drugs that, taken individually, can help your life, but, when given in combination to put someone to sleep, slow the heart and all the other things, those cocktails eventually kill them. We have heard horrendous stories of the cocktails not working and the person waking up. Noble Lords have raised questions about what would happen if a patient who is given a lethal cocktail or drug wakes up; we just do not know what the consequences would be.

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Moved by

[Lord Blencathra]

39B: Clause 1, page 1, line 14, at end insert—
“(1A) A person is only eligible for assistance under this Act if their wish to end their life is principally attributable to the symptoms, suffering or prognosis of the terminal illness.”Member’s explanatory statement
This amendment seeks to narrow eligibility for assistance to illness-related motives.

[Lord Blencathra (Con)]

My Lords, I will speak relatively briefly to the amendments in this group. I degrouped them for a technical reason. They are quite narrowly drawn. I know there is a group coming up, led by the noble Baroness, Lady Berger, that is wider ranging and more important than mine. If any noble Lord wishes to speak on the principle of these amendments, they might be better off waiting for the noble Baroness’s group.

The purpose of my Amendment 39B is to ensure that a person who wishes to die is driven by their illness, not by poverty, loneliness, lack of care or other remedial pressures. This would restore the link between the justification for the Bill and its operation. The political case for assisted dying has always been framed around unbearable physical suffering caused by terminal illness, yet the Bill contains no requirement that the person’s motivation must arise from that illness. Without this amendment, the Bill becomes a general choice in adversity scheme, where any reason—financial distress, lack of care, fear of being a burden—can drive the decision.

The noble and learned Lord has now explicitly said:

“I am strongly against saying poor people should not have that choice”.—[Official Report, 16/1/26; col. 2020.]


That is an admission that the Bill permits assisted death for reasons of poverty. My amendment would correct that. It would ensure that the motivation must be principally attributable to the illness itself, not to the state’s failure to provide care, housing or support. This is not about denying autonomy; it is about ensuring that autonomy is real. A decision driven by poverty or abandonment is not a free choice. The amendment would ensure that the Bill remains what the public believe it to be: a response to suffering caused by terminal illness, not a response to social failure.

My Amendment 39C would draw a clear line: financial distress, lack of housing or lack of social support cannot be the primary motivations for an assisted death. Without this safeguard, the Bill risks becoming a mechanism by which poor and unsupported people are offered death instead of help. The Bill is presented to the public as a response to the unbearable physical suffering caused by terminal illness, yet it contains no requirement that the person’s motivation must arise from that illness. Without these amendments, the Bill permits assisted death for a whole host of reasons that Parliament never intended, such as loneliness, poverty, lack of housing, lack of care or feeling like a burden on the state or your dependants.

The noble and learned Lord has now accepted that these motivations are valid choices. That is a dramatic shift from his own 2012 commission, which said that motivations were never legitimate and that safeguards must prevent them. Peers are entitled to ask what has changed other than the political need to keep the Bill workable. International evidence shows that non-medical motivations dominate assisted dying requests. Pain is not the primary driver. We hear that being a burden is a driver, as is the loss of autonomy. Parliament must decide whether it is comfortable legislating for that.

Finally, these amendments ensure that asking “why” has consequences. If the answer is poverty, loneliness or lack of care, the response should be support, not a lethal prescription. These amendments restore coherence, safeguard autonomy and prevent the Bill from becoming a general choice in adversity scheme. I beg to move.

[Lord Kamall (Con)]

In the interests of being brief, rather than repeating everything that my noble friend said, I look forward to the answers from the sponsor of the Bill and from the Minister.

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[Lord Falconer of Thoroton (Lab)]

My Lords, I am grateful for how this has been dealt with. We have discussed this a lot, at Second Reading and in Committee. I have made clear that, while suffering may very often be the cause of somebody wanting an assisted death, it is not the trigger for it as a legal requirement. Why people want to end their life in the context of a terminal illness is for them to decide. The effect of these amendments is that a person is entitled to an assisted death only if the reasons for them wanting the assisted death are the symptoms, suffering or prognosis of the terminal illness. I am not in favour of inquiring as to precisely what is the cause. Severe misery may well be the cause in the context of a terminal illness. In my view, this provision would unduly limit the entitlement to an assisted death, so I am against these amendments because they go right against the principle of the Bill.

[Lord Blencathra (Con)]

My Lords, I think that the noble and learned Lord is utterly wrong in his last pronouncement. Misery should not be a reason for an assisted death. The misery might be able to be removed. At Second Reading, my noble friend Lord Moylan stated that many people do not actually want to die; they want the things that are causing the feeling to be removed. They want better housing, they want better relationships with their family, they wish their love life was better or they want out of total misery. The noble and learned Lord is utterly wrong in seeming to extend the reason for dying beyond the severity of the terminal illness.

We will probably discuss this better and in more detail in the next group of amendments, so I beg leave to withdraw my amendment.

Amendment 39B withdrawn.

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[Lord Hamilton of Epsom (Con)]

I am very grateful to the noble Baroness. That just illustrates my point that misdiagnosis can very easily be done, and we are putting an enormous weight on it in this Bill and it can so often be wrong. We should be very disturbed and concerned about that because it means that we may be passing legislation which is based on faulty information.

[Lord Blencathra (Con)]

My Lords, this may be a convenient point to speak to two amendments in my name in this group. My Amendment 320ZA complements Amendments 39B and 39C, which I briefly touched on in the last debate, by making explicit that non-medical motivations cannot drive an assisted death. It draws a distinct line between medical suffering and social abandonment. International evidence shows that non-medical motivations dominate assisted dying requests. In Oregon, “being a burden” is cited by nearly half of all applicants. Parliament must decide whether it is comfortable legislating for that. This amendment ensures that England and Wales do not drift into a model in which existential distress, loneliness or, in the words of the noble and learned Lord, “sheer misery” or lack of care become accepted reasons for state-facilitated death. It also responds directly to the Equality and Human Rights Commission, which warned that subtle pressures from lack of services can drive people prematurely towards death. This amendment ensures those pressures are addressed, not endorsed.

My other Amendment 332AA operationalises the “ask why” concession. The noble and learned Lord, Lord Falconer, said he is “attracted” to requiring clinicians to ask why a person wants to die but unless the answer has consequences, the question is meaningless. This amendment ensures that when the answer is, “I am a burden” or “I cannot afford care,” or “I am alone”, “I am fed up” or “I am miserable”, the process pauses and support is provided. It reflects the evidence from the Royal College of Psychiatrists and British Geriatrics Society, both of which emphasise the need for holistic assessment. It ensures that treatable depression, unmet care needs or social pressures are addressed before an irreversible decision is made. This is safeguarding, not obstruction. It ensures that assisted death is not used as a substitute for care.

My amendments matter because, first, they protect genuine choice. A decision driven by lack of heating, housing or social care is not the same as one driven by intractable physical decline. These amendments stop the law becoming a backdoor response to social failure.

Secondly, I believe they are a practical safeguard, not a veto. This is not a blanket ban; it is a procedural pause to address fixable problems—social support, benefits, palliative referrals—before a final medical judgment is made. Thirdly, clinicians need clarity. Doctors must be able to ask why and act on the answer. These amendments would give them a clear statutory duty to do so, reducing moral and legal ambiguity. If the noble and learned Lord, Lord Falconer of Thoroton, truly believes this Bill is about free, informed choice, will he oppose leaving people to die because the state failed to provide basic support or will he back these modest, targeted safeguards?

[Lord Markham (Con)]

The main point here is that, by definition, you are eligible for assisted death only if you have been diagnosed to be within six months of the end of your life through a terminal illness. That is the reason that you are applying for an assisted death. That is motivation for doing it, because clearly it is not like those people want to die. We have talked to many people, and I am sure a lot of people have, and they desperately do not want to be in this situation.

Terminally Ill Adults (End of Life) Bill

Lord Blencathra Excerpts

Committee stage
Friday 30th January 2026 Lords Chamber

[Lord Evans of Rainow (Con)]

My Lords, I will speak to my Amendment 376. It is a pleasure to follow the noble Lord, Lord Empey. Last Friday, like many of your Lordships, I sat here all day and did not say a word. My amendment was in the following group, but sadly we did not get to it. However, there was an excellent discussion, and I want to pay tribute to some of the contributors: my noble friend Lord Deben, the noble Lord, Lord Mawson, and indeed the noble and learned Lord, Lord Falconer.

The noble and learned Lord said something that rang a bell; he referred to studied diligence, and how healthcare professionals and the whole system will study how best to conduct these assessments. When he said “studied diligence”, it reminded me of some experiences that I had as a Member of Parliament in helping people in very distressing circumstances with the healthcare of loved ones and trying to navigate the system. The thing that struck me was studied neglect. Studied neglect is quite difficult to detect, because it is not always obvious.

Many of us in this House have a routine, which is what makes us get up every day, and as you get older, that routine becomes very important. You have a good night’s sleep, you wake up in the morning, you shower, you clean your teeth, you exercise and you go to work, or to functions in the community. You eat well—you eat healthily. You can lead a normal life, as many of us do in this House, but something may happen to you—you may slip, trip and fall, and you may find yourself in hospital. That is when things can go wrong, because you are out of that routine of a good night’s sleep and getting up in the morning. For every week that you lie in bed, you lose 10% of your muscle strength. You do not get up, you do not do your routine, you do not shower and you do not clean your teeth. Things start happening to you, and you can go downhill very quickly.

Those things can happen through daily life—but the thing that really concerns me about this Bill, and the reason why I tabled this particular amendment insisting on face-to-face diagnosis from the healthcare professionals having to make this decision, is based on my experience as an MP. Close family and friends can have a malign influence by slowly but surely—this is why I referred to it as studied neglect—not encouraging a loved one to get out of bed in the morning, so that routine declines. They stop showering in the morning; they do not go for their manicure or pedicure or to get their hair done, and they start to decline. People who we always regard as very smart for their age can decline very quickly. The loved ones around them can engineer that, so that when social workers and healthcare professionals meet those people, it is not obvious what is happening. They are not sleeping properly, not looking after themselves properly and not eating properly, and therefore they decline. Nutrition is very important. You also have medication, and there can be no clear care plan; as one grows older, we take lots more medication, and that medication can be increased when it does not need to be increased or indeed not given at all.

That is why I am using the phrase “studied neglect”, to the “studied diligence” of noble and learned Lord, Lord Falconer. We really have to look very carefully at the malign forces that, I am afraid, are out there in society. They look at granny and, as my noble friend Lord Deben says, the £2 million house sitting there, and can slowly but surely—but still relatively quickly—see the demise of granny and realise those capital assets. That is the reason why I put this amendment forward.

Crucial steps in the assisted dying process should be undertaken with direct, in-person interaction, to increase the likelihood that the individual’s request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly through face-to-face contact, is driven by the importance of rigorous safeguards and scrutiny, and of upholding patient autonomy in a process that culminates in an irreversible outcome, called death. I could use many more examples but, in the interests of time, I beg to move this amendment.

[Lord Blencathra (Con)]

My Lords, I will speak to my Amendment 320B and three others in my name in this group. The first clinical gateway in this Bill is the most important moment any of us will ever legislate for: the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care; it should not be reduced to a convenience-driven video call.

My amendment is simple and proportionate: it creates a presumption that the co-ordinating doctor’s first assessment takes place in person, and it asks only that, if the presumption is displaced, the doctor records why an in-person meeting was not possible for medical reasons. That is not micromanagement; it is common sense. It is the minimum standard of human contact that we should expect before opening a pathway that is irreversible.

Why does this matter? First, capacity and voluntariness are relational judgments. Clinicians do not assess capacity from words alone: they read people’s faces; they notice the hesitation; they observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide: a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception.

Secondly, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons. It recognises that there will be rare cases where a patient is too frail to be seen in person; in those cases, the co-ordinating doctor must set out the reasons. That requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels, the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside.

Thirdly, the evidence is clear: leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible. Telemedicine studies and the experience of courts show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Some will say that this amendment would delay access or over-engineer the process, but I disagree. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay. If the system cannot, then speed is being prioritised over safety, and that would be a real problem.

Finally on this amendment, will the noble and learned Lord, Lord Falconer of Thoroton, accept that a life-ending pathway should begin with human contact, with a clinician who has seen the person in the flesh—smelled the room, so to speak—and observed the context in which that wish has arisen, or does he prefer a default of pixels on a screen? When the outcome is death, convenience must never trump clinical rigour. I urge the Committee to support my Amendment 320B.

My Amendment 347A would ensure that the second assessment—the final medical safeguard—is conducted in person. The Bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life-ending decision. Experts told the House of Lords Select Committee that assessing capacity remotely is, as I said, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person. Remote assessment hides the environment. Who is in the room? Who is influencing the patient? What pressure are they under? Kim Leadbeater MP herself said she was uncomfortable watching Oregon’s remote assessments, describing them as “tick-box”. If the sponsor is uncomfortable with death by Zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding.

If remote assessments are permitted at all, my Amendment 406A would introduce the bare minimum safeguards: the doctor must verify that the patient is alone and speaking freely. Coercion, as we know, is often silent. Abusers can sit off-camera, and patients are coached. A Michigan prosecutor famously spotted a domestic abuse victim being coerced during a Zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? My amendment would not ban remote assessment but simply prevent the most obvious and dangerous form of abuse. Without it, the Bill’s coercion safeguards are meaningless.

My Amendment 415B would ensure that remote assessments are tightly controlled, used only when appropriate and subject to independent oversight. The Bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the commissioner would ensure consistency, transparency and accountability. It would prevent remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest, the Bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible.

In summary, my four amendments form a single, focused package of safeguards to ensure that human judgment, not administrative convenience, governs a life-ending pathway. Amendment 320B would make the first assessment face to face by default—the minimum human contact needed to test capacity and spot coercion. Amendment 347A would extend that presumption to the independent second assessment so that the final clinical check is equally robust. Amendment 406A would require a simple verification when assessments are remote—a recorded confirmation that the patient is alone and speaking freely. Amendment 415B demands a statutory protocol for remote or pre-recorded assessments so that exceptions are tightly controlled and independently verified.

These are modest, proportionate measures. They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequence is irreversible. If this Bill is to be the safest system in the world, will the noble and learned Lord, Lord Falconer of Thoroton, accept these targeted protections so that speed and convenience never replace clinical judgment and human scrutiny? I urge the Committee to support my amendments.

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[Lord Falconer of Thoroton (Lab)]

Obviously, you cannot ask questions under subsection (6), so it is exactly the same point. The point being made in subsections (5) and (6) is that the panel recognises that there are circumstances in which questioning is not possible. I do not know what additional point the noble Lord was making.

[Lord Blencathra (Con)]

I am grateful to the noble and learned Lord. I acknowledge that he has accepted that something else needs to be added to the Bill, possibly along the lines that I was suggesting. That comes on top of the dozen new clauses that he is already planning to add to the Bill, so I ask him to help me understand something. If the noble and learned Lord is therefore admitting that the Bill is fundamentally flawed, to a greater or lesser extent, and that it needs to be amended, how on earth can he reconcile that with what he said a couple of days ago? He said that he would seek to drive the Bill through, unamended from the House of Commons—the Bill that is so fundamentally flawed that he is now trying to move amendments to correct it. That said, I am grateful for his concession this morning.

[Lord Falconer of Thoroton (Lab)]

I would not look a gift horse in the mouth if I were the noble Lord. First, I do not regard accepting amendments in Committee of the House of Lords as indicating that a Bill is fundamentally flawed; I regard it as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for this to happen through the Parliament Act. I want this House to do the job that it is supposed to do, which is do scrutiny and then send it back to the Commons.

In the debate on 8 January 2026, I gave in detail the reasons why I thought we were not going about it properly, and I thought that the House agreed with me when it said that we needed to move quicker. The problem is not that everybody does not have good ideas; the problem is that it is taking not just far too long but disproportionately long. My experience of the Lords is that we can do this, and we can do it much quicker than we are doing it and there still be quality. That was the point I made on 8 January and that I understood the House to have accepted.

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[Lord Jackson of Peterborough (Con)]

My Lords, I beg the indulgence of the Committee to raise what I think is an important point; I hope the Committee does not think it pedantic. I had not intended to speak but was prompted to by the excellent speech of the noble Baroness, Lady Falkner, and by my noble friend Lady Coffey’s reference to the lack of insight provided by the Government—I will not criticise the sponsor, the noble and learned Lord, Lord Falconer of Thoroton. This—our deliberations, scrutiny and oversight of the Bill—is a moveable feast, so we need information in real time.

My specific point is not just about freedom of information but about Written Questions that the Government have received and not answered. On 1 December 2025 my noble friend Lord Kempsell asked His Majesty’s Government a very reasonable Question. He asked, with regard to the Bill and its impact assessment,

“what assessment they have made of the effectiveness of judicial approval as a safeguard in countries with assisted suicide regimes, including the proportion of applications refused in those countries and the reasons for refusal”.

Two months on, that Question has not been answered. That is unacceptable, because scrutiny and oversight require us to have all the information in our hands, including comparative legal, regulatory and medical regimes.

By comparison, the very sensible Question from the noble Viscount, Lord Stansgate—I do not want to embarrass him because he is in the Chair—about the use of the Parliament Act was asked on 26 January and answered promptly on 29 January. The point is that there should be equality and a level playing field on Questions asked, irrespective of the position on the Bill of the noble Lord asking it.

[Lord Blencathra (Con)]

I am another Member who had not intended to say a single word on whether the clause should stand part; I am rather relaxed about it. The Government Whips must blame their noble friend Lord Rooker, who provoked me into commenting because I agree, once again, with every single wise word he said.

The noble Lord referenced the Delegated Powers Committee, of which he was a distinguished member at one point. I was the chair of the committee when we produced the Democracy Denied? report. It highlighted the fact that every Government over the past 30 years—Tory, Labour, Conservative-Lib Dem and Conservative again—took more and more powers away from Parliament via delegated powers. The delegated powers in the Bill are excessive and have rightly been criticised.

The noble Baroness is also right that no Government in any democracy in the world can function unless there are delegated powers; not everything can be in Bills. The questions here are: how many delegated powers are appropriate; and what will they contain? The trouble is that we have more than 40—48, I think—possible delegated powers, including Henry VIII powers. That seems excessive.

I pay tribute to the noble and learned Lord, Lord Falconer, for producing some amendments that would implement the delegated powers recommendations, but I think he knows that if he did not produce them, this House, on Report, would implement every single one of the delegated powers recommendations; we would gut those bits of the Bill that did not implement them. So, although he has generously provided some amendments regarding the delegated powers recommendations, he knows full well that this House will implement all of them in any case.

That is all I want to say on the Bill. Delegated powers under all Governments have been increasing and ought to be diminished. Although I have some concerns about the contents of the Bill, I have many more concerns about the 48 powers that will be written by civil servants in the Department of Health. At the moment, they are unable to tell the difference between a man and a woman; I do not want them writing up how I will die in future.

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[Lord Hendy (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Sandhurst, and I am particularly grateful to the noble Lord, Lord Harper, for advancing Amendments 70 and 78, which I drafted. Unfortunately, I was unable to be here last week when I thought they would be debated. I disagree with nothing that the noble Lords, Lord Harper and Lord Sandhurst, said.

The purpose of Amendments 70 and 78 was to broaden the definition of “disease” to include “injuries”. It is completely illogical that people who are facing death within six months because of some untoward event, such as contracting an illness, being hit by a car or suffering an injury at work, should not be in the same position. One thinks about injuries at work, in particular: if inhalation of asbestos fibre, silica or cotton results in asbestosis, silicosis, byssinosis or mesothelioma, they would be covered by the legislation currently proposed. But inhalation of a poisonous gas at work, causing an injury that is likely to result in death within six months, would not be covered. There does not seem to be a logical distinction there.

The law also does not regard there being a distinction. The common law of negligence requires one not to harm someone else, whether by an injury or causing that person to contract an illness. That is particularly evident in the field that the noble Lord, Lord Harper, developed; namely, injury at work. The Health and Safety at Work etc. Act 1974, the Workplace (Health, Safety and Welfare) Regulations 1992 and the common law of workplace negligence all require that the employer keeps the workplace safe and they make no distinction between whether the danger arises from a risk of injury, such as getting an arm mangled in a machine, or the risk of disease, by the inhalation of noxious particles causing lung disease. There is no logical distinction to me and it would be right for the Bill to extend the scope of “disease”—illness and disease are not defined in the Bill—to cover “illness” as well.

I turn to the main point that the noble Lords, Lord Harper and Lord Sandhurst, developed. The risk, as the noble Lords, Lord Sandhurst and Lord Carlile, put in their explanatory statement and which the noble Lord, Lord Sandhurst, developed, is that the dependants

“will probably lose their right under the Fatal Accidents Act 1976 to sue the alleged tortfeasor said to have caused the disease, unless the Bill specifically provides otherwise (which currently it does not)”.

I agree with his legal analysis. It is likely that insurers will say, “No, the cause of death here was not the underlying mesothelioma. It was the fact that this person opted for an assisted death”.

The noble Lord developed the consequences for the family. I just want to add: what about the consequences for the injured person? Are they going to think to themselves, “Well, if I opt for an assisted death, I’m going to deprive my family of extensive damages that they will not enjoy”? Of course there will be considerable pressure on that person to say, “I’m going to put up with the suffering as long as I can until I die to make sure that my family get the money”. I do not want to be rude to insurance companies, but they have to do what they can to safeguard their assets and avoid paying out what they do not need to pay out; they will fight these cases. Therefore, it seems important that the Bill, to quote those words, “specifically provides otherwise”, which it does not currently.

I am very grateful for the interview that I had with my noble and learned friend Lord Falconer and the noble Lord, Lord Sandhurst, to discuss these matters a week or so ago. I had mistakenly thought that the power of my oratory was such that my noble friend was convinced by my argument, but he was not. It is quite clear from his Amendment 718C, which he has tabled today, that he does not accept that the Bill should provide a measure that would protect the victim in the circumstances that we are discussing.

The noble Baroness, Lady Finlay of Llandaff, and I tabled Amendment 717, which is obviously not before the Committee today, which seeks to redress this by requiring that the coroner records that the cause of death was the underlying disease, while noting that the death was one by assisted dying. I do not know whether that would go far enough to protect these victims from the insurers who claim that the death was not caused by the underlying disease, but it goes a bit further than the amendment proposed by the noble Lords, Lord Sandhurst and Lord Carlile. In my view, it is essential that the Bill protects against the danger that I have outlined.

[Lord Blencathra (Con)]

My Lords, I am very concerned by my noble friend Lord Harper’s amendment to extend the Bill’s definition of terminal illness to include simply the one word, “injuries”. I agree entirely with my noble friend Lord Sandhurst and with what the noble and learned Lord, Lord Falconer, may propose to ensure that those who have suffered an industrial injury are not deprived of their rightful compensation. I support entirely what the noble Lord, Lord Hendy, said on that, but I disagreed with his general thesis that the Bill should be extended to include all other injuries, because that could take us in a rather dangerous direction.

We all know that some injuries are awfully catastrophic, relentlessly painful and leave no prospect of meaningful recovery. For those individuals, the desire for control over the timing and manner of their death is understandable and deeply felt. If the law permits assisted death for terminal illness, it is in some ways emotionally coherent to ask why a grievous and irreversible injury that will inevitably lead to death should be treated differently. I think the amendment from my noble friend and the suggestion of the noble Lord, Lord Hendy, is born of a humane impulse: to extend compassion to a group whose suffering can be as severe as that of the terminally ill. However, compassion must be married to clarity and caution when Parliament contemplates measures that permit an irreversible outcome. Extending the definition to “injuries” raises serious legal, clinical and ethical problems. I will set out the principal flaws and risks that I see flowing from the proposed change.

First, the term “injury” is legally and clinically vague. What counts as an “injury”? Does the word encompass acute trauma, chronic sequelae, surgical complications, other serious harm, or the long-term consequences of an earlier wound? Without precise limits, the category could sweep far beyond the narrow cohort the amendment’s proponents intend. Vagueness at this threshold invites inconsistent application and litigation.

Secondly, I suggest that the proposed threshold—that the injury be “reasonably expected to result in death”—is problematic. Prognosis after severe injury is often uncertain, as it is with terminal illnesses, and can change with treatment, rehabilitation and time. Modern trauma care, reconstructive surgery and rehabilitation can alter trajectories in ways that are difficult to predict at the bedside. Using “reasonably expected to result in death” without a clear evidential standard hands clinicians wide discretion and risks premature decisions made on the basis of an evolving clinical picture.

Thirdly, there is a real danger of premature decisions in acute settings. Many catastrophic injuries occur in emergency contexts where prognosis is evolving and where immediate stabilisation, surgery or intensive rehabilitation may change outcomes. Allowing assisted death on the basis of an early prognosis risks decisions taken before full treatment options have been explored and before the patient has had the opportunity to adapt to new circumstances or to benefit from specialist rehabilitation.

I will not talk about civil law and compensation, because that has already been expertly covered by my noble friends and the noble Lord, Lord Hendy. My noble friend also mentioned the coronial and investigatory consequences which arise, so I will not elaborate on those.

There is a “slippery slope” argument here. Once “injuries” are included—just that one, simple word—pressure may grow to widen eligibility further to chronic disability, psychiatric consequences or non-combat trauma. Experience from other jurisdictions shows how initial expansions can lead to broader reinterpretation over time. Parliament must be wary of opening a door that cannot easily be closed.

The clinical complexity of catastrophic injury demands multidisciplinary expertise. This is not one GP giving an opinion here. Assessing such cases properly would require trauma surgeons, rehabilitation specialists, pain teams, psychiatrists and a whole range of different medical specialities. The Bill’s processes must ensure that such expertise is mandatory before any irreversible step is taken, otherwise we risk decisions being made without the full range of clinical knowledge that these cases demand.

In conclusion, if Parliament is to consider injuries within scope, it must do so with surgical precision, so to speak. It needs narrow definitions, higher evidential standards, mandatory specialist review, and explicit protections for families and compensation rights; only then can we balance mercy with the safeguards that such irreversible decisions demand. I urge the House to reflect carefully on the human impulse behind this amendment and on the legal and clinical realities that make adding it to the Bill as currently drafted—with just one word, “injuries”, as my noble friend proposes—deeply problematic.

[Lord Carlile of Berriew (CB)]

My Lords, I return us to Amendment 829, to which I put my name and which was moved by the noble Lord, Lord Sandhurst. I added my name because I share experience with the noble Lords, Lord Hendy and Lord Sandhurst. We have all seen cases in which a potentially huge claim arises under the Fatal Accidents Act which will provide a family with a payment for their dependency on the deceased for many years to come, so these are very substantial claims.

Probably all three of us have done cases for both claimants and trade unions on the one side, and for insurance companies on the other. Insurance companies are very business-like and accurate, but they are not social services organisations. One question they ask their counsel—particularly their leading counsel, their KC—in such cases is, “Are we liable to pay? Is there a point we can make, saying that it does not arise because the death was caused by some other means?” There have been many cases in which novus actus interveniens, which the noble Lord, Lord Harper, referred to earlier, has been cited as a reason for not paying.

--- Later in debate ---

[Lord Carlile of Berriew (CB)]

Well, there we are: we know that the noble Lord adheres to the cab rank rule.

We have heard three very cogent speeches from the noble Lords, Lord Frost, Lord Carter and Lord Taylor, about the suffering point. If we look at the discussion we have had this afternoon, we now have a clear and stark difference between assisted suicide based on suffering and assisted suicide based on choice. I agree entirely with the noble Lords, Lord Frost and Lord Taylor: the public expect this Bill to be dealing with suffering. The public understand this Bill to be dealing with great suffering. They understand that the choice to have one’s life ended is based on great suffering, although it does not say so in the Bill. That must be clarified by the sponsor.

On the other side of the argument, we heard a very eloquent speech from my noble friend Lord Pannick, with whom I have a lot of sympathy. It is not generally known that, as he said, he has very personal experience of the issues arising from this Bill. However, the choice he is suggesting comes very close to being a choice for anyone who is seriously ill, not just someone who is seriously ill with an expectation of death within a certain limited period, whatever that happens to be. I fear that those of us who, like the noble and learned Lord the sponsor, are trying to reach the end of our process in the House of Lords on the basis that there will be a Bill, so it must be the best it can be, are not focusing on what choice really means.

We are talking about informed choice, accurate choice, if we can achieve it. I bear in mind very much what my noble friend Lady Finlay said. We are talking about a protective choice: the duty of the state to protect the citizen, even when they are making a choice. We do not, as citizens, have unlimited free choices in what we do; therefore, protection is important. It must be a morally sound choice, because that is part of our polity. We do things that are morally sound, and the Government protect us from those which may not be. It must be a choice founded on medical and scientific integrity: and there is the rub, going back to the points my noble friend Lady Finlay made about the uncertainty of the scientific and medical integrity of what is proposed.

For those reasons, I support the amendments that are focused on choice. I will mention three other amendments that I also support. The first is Amendment 76, which is not in my name but in that of the noble and learned Lord, Lord Garnier, but he is not able to be here for the latter part of today’s proceedings and I agreed to mention it at his request.

Amendment 76 would do something very simple. In Clause 2(1)(b), it would add one word, “direct”, so that a person is terminally ill if, in the amended paragraph (b), their death as a direct

“consequence of that illness or disease can reasonably be expected within six months”.

It may not be the perfect word, but it is about facts and the consequences of those facts. I agree very strongly with the noble and learned Lord, Lord Garnier, that if there is to be a death of someone through the assistance of a third party, which is what the Bill is fundamentally about, then it cannot be just a consequence, or one of the many consequences, of the illness. It has to be the, or at least a, major consequence of the illness. That is the purpose of that amendment: there has to be a bond, as it were, between the illness or disease and the death which ensues.

The next amendment is Amendment 93. It suggests leaving out Clause 2(3) altogether as it lacks clarity as to when an assisted death would be permitted. The subsection says that

“treatment which only relieves the symptoms of an inevitably progressive illness or disease temporarily is not to be regarded as treatment which can reverse that illness”.

What if the relief that is provided for an inevitably progressive illness provides not only relief from the symptoms but extra time to the person who is suffering from the illness or disease? I argue that if it allows extra time, the individual concerned will be having a new experience: they will be seeing what can happen if their symptoms are relieved. They need to discuss with their medical advisers whether they can have that relief of their symptoms again and whether it will prolong their life if they do. The relief may cause a fundamental change of heart by the individual. Therefore, I do not believe that there should be any possibility of the six-month period being elongated in any way by that relief. Indeed, I believe that the period should start again if such relief is given so that the person concerned can have an informed choice.

The third amendment is Amendment 96, which suggests leaving out Clause 2(4), which says:

“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both)”,


followed by an important further sentence that I will not read out because of time. This subsection fails to deal with the proportionality between the disease, which is the terminal illness, and the disability or mental disorder, or both, from which that person also suffers. It is a complex little conundrum, but a very important one. I believe that proportionality needs to be clarified so that the Bill can be the best possible Bill we can have.

We have much still to learn about the issues that have been under discussion. I invite the noble and learned Lord, Lord Falconer, to consider these carefully and present some draft amendments to us before we meet again in a week’s time.

[Lord Blencathra (Con)]

My Lords, I seek a cast-iron assurance from the Government Whip that those of us whose speeches will be delayed till next Friday are recorded by the Government and will be allowed to speak. That is all I want to say at this stage. We want an assurance that we will be allowed to speak next Friday if we delay our speeches from today.

[Baroness Wheeler (Lab)]

I will shortly make an announcement to that effect.