Terminally Ill Adults (End of Life) Bill

Lord Carlile of Berriew Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Lord Harper (Con)]

I am going to limit my remarks to a couple of process points, which think are important. I have listened very carefully to those with considerable expertise on the clinical issues raised by these amendments, and I just want to cover these points.

The noble Baroness, Lady Parminter, has just made the point that this loophole has been well understood for some time and was not dealt with in the House of Commons, although it could have been. I gently say, because there is some frustration from the supporters of this Bill about the time taken to scrutinise it, in repeating what I have said before—it is part of the reason why noble Lords are having to table significant amendments and debate this Bill at length—that there are considerable gaps in the Bill that have been known for some time and have not previously been dealt with. The noble Baroness, Lady Parminter, was exactly right to point out that it is this House that will have delivered an amendment to make that considerable improvement, which has been argued for by a number of people for some time. We are doing good work here, whatever people may think of the principle of the Bill, in improving the drafting.

The noble and learned Lord, Lord Falconer, referred at the beginning to whether the Committee would accept this change to the Bill. I make a clear distinction here—and I am going to be very supportive of his position—between this debate and the earlier debate on what he described as drafting amendments. Many of us considered that they were not drafting amendments but quite significant changes, and we made it clear that, if he pressed them, we would oppose him. In this case, his Amendment 87, as amended by Amendment 87A, clearly resolves one issue in the Bill, and that is welcome. I would certainly have no objection if the noble and learned Lord pressed the amendment, and I hope the Committee would accept it, because there is general agreement that it would improve the Bill.

Finally, as has been said by the noble Baronesses, Lady Parminter and Lady Berger, the noble and learned Lord’s amendment fixes one problem. I am not at all an expert in this area, but I understand from those who are that it deals with the issue of anorexia but leaves other eating disorders such as bulimia unresolved, as the noble Baroness, Lady Berger, said. There are other amendments in this group that raise those issues.

I hope for two things. When the Minister responds, I hope that she can commit at a later stage to setting out that, in the view of the Government and the Department of Health, with regard to the span of eating disorders, the Bill will actually deal with them when we have made some more progress on it. That is a factual point, not an expression of a policy position. When the noble and learned Lord responds, as well as pressing Amendment 87 as amended by Amendment 87A, I hope that he can say something positive about what work he will conduct with the Department of Health on drafting some later amendments on Report to deal with the other eating disorders that have been explained, so that we can make sure that there are no loopholes covering any of these eating disorders. As we have heard, they affect a very significant number of people, particularly younger people, and particularly younger women. I want to make sure that we properly protect them as this Bill proceeds through your Lordships’ House.

[Lord Carlile of Berriew (CB)]

My Lords, I signed the noble and learned Lord’s amendment, and I thank him very much for introducing it. In my view, it is a very important amendment. Noble Lords who have seen a serious eating disorder at close quarters will know that it not only disturbs the person who suffers from that eating disorder, but dramatically affects everybody around them. It is all too easy to be fatalistic about it, not challenge it and try to make one’s way through it.

It is a condition that, in my view, produces three possible outcomes. One, in all too many cases, as we have heard, is suicide. For some, indeed in quite a number of cases, there is recovery. However, perhaps most people who suffer from anorexia, particularly at a young age, learn to live with it. It is that living with it that, in my view, is the most important reason for ensuring that it plays no part in the outcomes envisaged in this Bill. For everybody who suffers from an eating disorder—this perhaps particularly needs to be said to teenagers who suffer from eating disorders, whether boys or girls—the important thing is that there is hope of some kind of good recovery, even if it is just learning to live with it. Something that offers such hope should not, in my view, be part of anything remotely resembling this Bill.

[Lord Deben (Con)]

My Lords, I wanted to say, as I have several times pointed out, that one reason why this Bill has taken so long is that the proponents have not been willing to make some of the changes that many of us feel would be perfectly sensible. I therefore thank the noble and learned Lord for this amendment. I think he must also agree that the debate that has followed has brought to the surface a number of issues that need to be considered, and no doubt will be when we get to Report.

However, the reason I rise is just to say to him that I find it pretty unacceptable, when I have sat through almost every moment on this Bill and have learned so much from the discussions that have taken place, for him to suggest that somehow or other we ought to do it more quickly. The fact is that this is a very badly produced Bill. It is opposed by every single organisation representing the people who have to actually do it and by every single representative of disabled people. If this House is not here to go through the details that others have raised outside, I really do wonder what the House of Lords is supposed to be. The noble and learned Lord ought to give some of us credit for the fact that, whatever we think about the Bill, we want to make it as good as it can be. That means we have to discuss it properly.

--- Later in debate ---

It is now nearly 4.50 pm. I will have to leave very shortly to catch my plane, because it is the only plane I can catch. Obviously, I want to stay to hear the Minister’s response to the observations I made and, indeed, to hear the contributions of any other noble Peers. I apologise to the Committee that I cannot do so. Again, it is inappropriate that so many of our colleagues have had to leave for similar reasons.

[Lord Carlile of Berriew (CB)]

My Lords, I will raise a practical problem, which I urge the noble and learned Lord to address, in connection with care homes and nursing homes. The problem has been drawn to my attention—and, I think, that of other noble Lords—by a letter received today from the charity Mission Care, which has 300 staff in and around London and looks after 230 residents, some of whom might wish to apply for assisted death. The point that Mission Care makes is that its staff, by reason of the fact that Mission Care is a committed Christian organisation, en bloc would not be willing to take part in assisted death under the Bill. The effect of that, says Mission Care, is that it would have to close, thereby depriving people of the quality care that they have in those institutions.

I know that the noble Lord, Lord Blencathra, has a visceral opposition to anything arising from the European Convention on Human Rights. However, I have known the noble Lord long enough, and have enough affection for him, to know that he is very practical and that if the European Convention on Human Rights will assist his argument, he will be very ready to adopt it—so I ask him to be patient with me. These amendments, particularly Amendments 110 and 112, which I support, would take the process out of nursing homes and residential homes and into the hands of outsiders.

It is not just a question of Mission Care. Among all the many residential and nursing homes up and down the country, there will be very large numbers of staff who would wish to take advantage of Clause 31(1), which says:

“No person is under any duty to participate in the provision of assistance in accordance with this Act”.


It is the opt-out, and a very important opt-out that I know the noble and learned Lord is committed to as part of his Bill.

If we find that, in nursing homes and residential homes around the country, a significant proportion of staff wish to take advantage of Clause 31(1)—or Section 31(1) if the Bill becomes an Act—it will cause real difficulties for residential and nursing homes. There will be division among their staff, and it may be that those divisions make it very difficult for them to play any part whatever in this scheme if it is made law. I invite the noble and learned Lord to consider this issue further to ensure that those staff are not put in a very difficult position in the exercise of their consciences.

[Baroness Watkins of Tavistock (CB)]

I want to draw attention to the fact that I raised this issue two days previously in Committee. It is essential that we retain staff, particularly nursing staff, who would object to anything to do with assisted dying. That can be achieved, as I said earlier, by enabling people, when they do their advance directives, to be very clear if they never want to have this discussed with them, which I think is completely fair. Nursing homes must also be able to be very clear that they want nothing to do with this in their marketing materials. That is a bit of a tough word, but I think it is real. We must respect the faith and choice of healthcare staff as well as patients or, in this case, residents and their relatives.

However, the vast majority of people who are in long-term care homes rather than nursing homes have cognitive disability, which means that they will not be eligible in this event. It is in the very high-tech nursing homes where people who have very complicated issues might want to choose assisted dying—it might be a 52 year-old with complex disease. I can see that noble Lords want me to hurry up, but I just want to be absolutely clear that we need to get this in context.

[Lord Carlile of Berriew (CB)]

I am grateful to my noble friend for that intervention. She has raised three points, and I want to answer all three quickly. On point one, I absolutely agree with her: we have to respect the views of staff, particularly views that are a combination of professional and philosophical principles. Taking this process out of the nursing home, in accordance with Amendments 110 and 112, does exactly that.

Secondly, advance directives are quite an esoteric issue. I echo what the noble Lord, Lord Deben, said, based on his experience as a Member of another place. There are a number of us here who used to go to nursing homes and residential homes at least twice a year, sometimes taking our children with us to add good cheer. We came out with very different impressions of those homes: the good, the indifferent and, in one or two cases, the really bad. We have to take that into account. In some of those homes, there is practically nobody with an advance directive. Advance directives on the whole are a middle-class thing. Probably most of us here have advance directives of some kind or another, which one has to pay one’s solicitor to produce; one has to pay a lot of money in London, happily rather less out in the provinces. Where there are advance directives, that is fine, but not everybody has them.

I have spoken to the third point, which related to the remarks of the noble Lord, Lord Deben. I repeat that I am making an extremely practical point that ought to be addressed. If this responsibility lies with nursing homes, then it will cause immense difficulty. Also, there is always the risk in the really bad residential and nursing homes that people will be subject to undue influence in the unusual atmospheres of such institutions.

[Baroness Finlay of Llandaff (CB)]

My Lords, I would like to provide some information to the Committee which I think supports these amendments quite well. Care England, which has 122 care providers, consulted its care providers some weeks ago. It found that:

“84% have not been consulted on the Bill or its implications. 24% said staffing would become very difficult due to conscientious objections, with a further 16% expressing similar concerns. Only 14% reported staff being willing to participate in the whole procedure … Only 13% said they could manage assisted dying in their Homes. Only 27% reported 24/7 access to specialist palliative care support on site”.


This demonstrates that the care home sector itself has been very worried about how it would cope with this. Sadly, it also demonstrates just why not having specialist palliative care in scope on this Bill has created quite so many problems.

--- Later in debate ---

[Baroness Merron (Lab)]

It would not be possible in any case to stop it in that way, because it would not invalidate legislation. I am just drawing the Committee’s attention to the fact that it would require further work. As the noble Lord will know, if a court finds that primary legislation is incompatible, it may make a declaration of incompatibility. As I said, although it does not invalidate legislation, it is usual practice for the Government to consider and address these matters.

[Lord Carlile of Berriew (CB)]

I am afraid that the Minister is between a rock and a hard place here. If these amendments are not passed, she might find that the Government are in breach of Articles 9, 10 and 11. I would be grateful if she could consult her lawyers in relation to that matter.

[Baroness Merron (Lab)]

I will consult my lawyers with pleasure.

Lastly, all the amendments in this group address complex issues and, if they were passed, considerable further policy and drafting work would likely be required.