Terminally Ill Adults (End of Life) Bill

Lord Carter of Haslemere Excerpts

2nd reading
Friday 12th September 2025 Lords Chamber

[Lord Carter of Haslemere (CB)]

My Lords, the noble Baroness, Lady Merron, stated in this House on 4 September last year, that the Government’s commitment is

“to ensure that any debate on assisted dying … will take place in a broader context of access to high-quality palliative and end-of-life care”.—[Official Report, 4/9/24; col. 1151.]

Well, here we are having that debate. Has access to palliative and end-of-life care improved so much in the past few months? The experts say not. We have heard—but it bears repeating—that the evidence shows that 100,000 people die each year in the UK with unmet palliative care needs. Fewer than 50% have input from a specialist palliative care team in their last three months of life.

The Bill sidesteps this crucial issue because, as was pointed out by the noble Lords, Lord Lamont and Lord Grabiner, it contains no requirement that a person who is suffering from a terminal illness must also be suffering intolerable pain. Under the Bill, anyone given a prognosis of six or fewer months to live would be eligible for assistance to die, regardless of whether they are experiencing pain. Some of these people will require palliative care in any event, but if the focus of the debate were instead on relieving intolerable pain and suffering, then it would be more apparent that we should be legislating for wider access to higher-quality palliative care, not a state-assisted death regime.

As the Health and Social Care Committee heard, patients in countries with assisted dying who request help to die frequently change their mind if provided with proper palliative care. Evidence from Oregon, for example, showed that 46% of patients who received substantive palliative care changed their minds about an assisted death, compared with just 15% who did not receive such palliative care. Yet the Bill does not require a person to receive palliative care before electing an assisted death, merely that they be given the opportunity to discuss it. There is therefore a strong case for the huge sums that would be spent on state-assisted deaths to be spent instead on improving access to specialist palliative care.

Yet the intention seems to be quite the opposite. The impact statement sets out the tens of millions of pounds currently spent on care, state pensions and benefits that would be saved if this Bill were enacted. Is this really a relevant consideration? If so, we need to re-examine our priorities here. We should be encouraging those who are ill, depressed or struggling in any way to believe that life is a precious gift and worth living. We should be treating them as individuals who never cease to be important, even in frailty or decline, and that they deserve to have a dignified life in all its seasons by being cared for to the end, with the state meeting the full costs of that.

In speaking on this Bill, each of us will individually have searched our consciences, which is exactly how it should be. In searching mine and taking the line that I have, I have been guided by my Christian beliefs on life and on how life comes to an end.

Terminally Ill Adults (End of Life) Bill

Lord Carter of Haslemere Excerpts

Committee stage
Friday 12th December 2025 Lords Chamber

I want to reiterate the question: are we keeping our prison population in mind as a vulnerable group in the Bill? Particularly when our prisons are overcrowded and, to be extremely frank—although I think the noble Baroness, Lady Fox, was franker—the desire to remove people from the system is high. I fear how the Bill could play out among the prison population and hope that noble Lords will give further consideration to this important issue.

[Lord Carter of Haslemere (CB)]

My Lords, I want to make a very brief intervention in relation to the prison population. It is only the second time I have spoken on the Bill. I declare an interest as a trustee of the Prison Reform Trust.

The suicide rate among male prisoners is four times as high as that of the general population. In the year to 2024, 89 male prisoners committed suicide. The Prison Service has a duty of care towards the prison population to protect them from committing suicide—to stop it. The Government run the Prison Service, so they must have a view on what to do about a prisoner whose suicide the Prison Service has correctly thwarted under its duty of care but who then requests an assisted death under the Bill. How will the Government balance those two conflicting things?

That is my short intervention—to ask that question. I wholly support all the comments made by the noble Baroness, Lady Fox, the noble Lords, Lord Moore and Lord Farmer, the right reverend Prelate the Bishop of Gloucester, and others on this crucial issue. I am genuinely interested to know what the noble and learned Lord, Lord Falconer, makes of this dilemma for the Prison Service and the Government.

[Lord Deben (Con)]

My Lords, the moments in the Bill that most concern me are when it gets nearest to saving money. There are several occasions on which that appears to be the case, particularly when talking about people for whom many have no sympathy at all, and when you are talking about a service in which we all know we are failing. It cannot be true that any Member of this House believes that our prisons are as they should be. Yet we imprison more and more people. We imprison twice as many people as the French or the Germans. I still do not understand why we cannot take this seriously, but we still go on doing it.

First, can one really think that someone in prison circumstances finds it possible to make the same kind of decision as people who are not? Just simply, those circumstances are the pressures, the crowding and the fact that you are not in any company that you would have chosen. I do not believe that those are the circumstances in which the Bill’s proponents meant for decisions of the sort we are talking about to be made.

The second issue is: what about the pressures there? We have been talking about the concerns of those who find themselves under pressure. Do we really believe that there will not be many prisoners for whom the whole issue will be presented as, “You will be better off and we will be better off if you make this decision”?

The third issue is surely this: we know that prisoners have much worse healthcare than people outside prison. Therefore, the fact that they are told that they have but six months to live is much more difficult than it would be if they were in normal circumstances. I put it no more sharply than that, but it does seem to be true.

Fourthly, earlier on, we were talking very strongly about the difficulty that the Government are willing to fund this when they are not funding palliative care for very large numbers of people in the country. I therefore come back to my deep concern that it will become so much easier for people to die than to continue.

The right reverend Prelate, whose experience is remarkable and whom I admire enormously for her work in the prisons, has reminded us of how old the prison population is and how much older it is becoming. I just do not think that those of us in this House who really believe that our major job in this Bill is to protect the vulnerable can possibly agree that people in prison should be included under the Bill. We should take them out.

--- Later in debate ---

[Baroness Merron (Lab)]

First, I am referring to the amendments before us. Secondly, I am advising on risk and workability, again for the assistance of your Lordships’ Committee, which, as is correct and proper, will make the decision.

These amendments appear to treat people with EHCPs differently from those who do not have them. This could give rise to potential incompatibility with Article 14 of the ECHR, when read with Article 8, and would require reasonable justification for differential treatment.

Finally, as noble Lords will be aware, the amendments in this group have not had technical drafting support from officials, so the way they are drafted means that they may not be fully workable, effective or enforceable. However, as I have said, the issues raised are rightly a matter for noble Lords to consider and decide.

[Lord Carter of Haslemere (CB)]

My Lords, the Minister referred to a number of articles of the ECHR, but she has not referred to Article 2, which is the duty on a state to protect life. That is why the courts have imposed a duty of care on the Prison Service and the Government to protect prisoners from committing suicide. My question goes back to what I said earlier: how do the Government reconcile that duty with a vulnerable prisoner applying for an assisted death? How does that square with the duty under Article 2 and the duty of care to prisoners?

[Baroness Merron (Lab)]

I refer the noble Lord to the provisions within the Bill. His earlier question was very much about policy. I am sure that my noble and learned friend will also refer to this, but this is a matter of policy and therefore it is for Parliament to decide.

Terminally Ill Adults (End of Life) Bill

Lord Carter of Haslemere Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Lord Carter of Haslemere (CB)]

My Lords, I speak to the six amendments in my name in this group. I do not need to explain what they say because they are all replicated by other amendments in the group, so I can be very brief. All these amendments are intended to ensure that a person seeking assistance to end their life first be referred to a registered medical practitioner who specialises in palliative, hospice and other care for the purpose of a full assessment—the operative word being “assessment”, not necessarily treatment. The Bill currently requires merely that a medical practitioner “offer” a referral to a specialist palliative care practitioner. This is inadequate in relation to such critical decisions as choosing whether to live or seek a state-assisted death.

It is important to note that all these amendments are based on evidence. In countries with assisted dying—Oregon has been referred to—experts say that patients who request help to die often change their minds if provided with proper palliative care. Yet the Government’s impact assessment confirms that fewer than half of dying people have input from a specialist palliative care team in the last three months of their life. It seems hard to dispute the case, therefore, for the Bill requiring that persons seeking a state-assisted death be given a full palliative care assessment, with the opportunity to choose to experience modern specialist palliative care at its very best. It is about doing everything humanly possible to keep people alive with as little pain and suffering as possible, and giving priority to life over death wherever possible.

Recalling our debate yesterday about which amendments the noble and learned Lord, Lord Falconer, might be prepared to accept, the amendments in this group are, like the previous group, pivotal to the decision a dying person will have to make if this Bill is enacted. It would save much time on Report if the noble and learned Lord could indicate now whether he can accept one or more of them. The Government would then have a responsibility to ensure that adequate palliative care specialists are available.

I recall, as I did at Second Reading, the wise words of the Minister, the noble Baroness, Lady Merron, who, in answer to an Oral Question in this House on 4 September 2024, said that the Government’s

“commitment is to ensure that any debate on assisted dying … takes place in a broader context of access to high-quality palliative and end-of-life care”.—[Official Report, 4/9/24; col. 1151.]

The amendments in this group would help to ensure that a person at least has a real choice of whether to access that palliative and end-of-life care or whether to seek a state-assisted death.

[Baroness Brown of Silvertown (Lab)]

My Lords, my Amendment 51 and others would require the providers of assisted dying services to ensure that all persons seeking such services have discussed the range of end-of-life options available to them with a palliative care specialist.

The Government and proponents of the Bill have promised that end-of-life care will not suffer in order to accommodate assisted dying. I have significant reservations about whether this would be possible, and I fear a push factor, particularly for those who are vulnerable, those who are without family and, to be absolutely frank, those who are poor and cannot fund their own care. When done right, as we know, palliative care can provide a dignified end of life and alleviate the desire to hasten one’s death. Equitable access to options for end-of-life care must be a cornerstone for this Bill, which is why I have laid these amendments. I want to ensure, as far as humanly possible, that all people have and know that they have equal access to palliative care, to treatments that may extend life and to specialist teams to manage the symptoms and pain and to provide dignity.

This Committee must accept that equal access to these services, as for many public services, is not guaranteed and is rarely delivered. I give just one example, due to time. A Liverpool resident with the terrible asbestos-related mesothelioma cancer can undergo a specialist injection that has a high chance of abolishing the pain, whereas a resident of the Midlands, who may be unfit to travel to Liverpool, simply cannot because there are so few specialists trained to take this work on. Therefore, access is obviously limited.

Clauses 5 and 12 require doctors to have discussions about disease prognosis, treatments and symptomatic alleviation with patients. Clause 5 includes an offer to refer them to a specialist. Although these are important discussions, which must be had, they have to be conducted by somebody properly trained and experienced in such matters. For conditions that are specialist care cases, such as motor neurone disease, most doctors will have minimal involvement in the management of that condition and will likely not have the skills and training to adequately fulfil the duties that the Bill places on them. A specialist referral is absolutely necessary to that ensure patients are able to reach an informed decision about their care with somebody who properly understands the disease, how that disease will progress and what can be put in place to alleviate their distress and pain.

A person seeking assisted dying will be worried about their future, losing their independence and dignity and placing a huge burden on their families. A dedicated palliative care specialist would have the expertise, skill and training to provide the highest level of information and support, tailored to the individual needs of each patient, and have specialist knowledge of the condition that the patient is experiencing. Clause 1 requires that a person

“has a clear, settled and informed wish to end their own life”.

I believe that you can ensure a settled and informed wish and reach an informed decision only after properly exploring all available care and treatment options with dedicated palliative care specialists and having those options available to you. My amendment would therefore create a duty on all people involved in the provision of assisted dying services to ensure that those discussions have occurred, covering care options including symptom management and home care provision.

I welcome the amendments tabled by other colleagues that would ensure a dedicated palliative care assessment is part of the assisted dying process and I believe that my amendment can work alongside theirs. My amendment would also cover consultations with palliative care specialists that occur prior to a person seeking assisted dying, providing they cover the criteria outlined in the amendment. You can reach a clear, informed decision to end your own life only after having the advice and support to truly be able to weigh your options. That guarantee should absolutely be in the Bill.