Terminally Ill Adults (End of Life) Bill

Lord Deben Excerpts

Friday 13th March 2026 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I oppose the view of the noble Baroness, Lady Finlay, that we should have a completely separate service. That would target and isolate people who are dying. They will wish to be supported by the people who they have known through the course of their illness, so it is crucial that they be seen and examined by those people and not moved to another place. Yes, there will perhaps be separate people who take on this role, and they should be properly qualified and discuss it with the panel, but it is utterly crucial that, when patients are in the process of dying, we do not separate and reject their carers, who should be part of the palliative care provided to them.

In other countries, assisted dying usually happens as part of a palliative care service. That is how it is done, very successfully, in Oregon and Washington. We should not separate carers who are there to support patients during this process. These little nitpicking changes to the Bill will just make it worse.

[Lord Deben (Con)]

My Lords, I was not going to speak on this, but the last speaker has led me to do so. To describe the care with which this proposal has been put forward as “nitpicking” is frankly unacceptable. The noble Baroness should not have said that. The reason why this has been brought forward is that many of us feel that we should take seriously the pressures on the people who will have to carry out these arrangements, all of whom, either in principle or because of the nature of the Bill, have objections to the Bill, so one tries to find answers.

One of my sadnesses is that the sponsor of the Bill has so far not met the questions put forward by the Royal Colleges or—I say this to the noble Baroness—the committees of this House, which have suggested that the fact that this Bill is so unclear on so many things makes it unacceptable legislation, and that we need to be much more precise and much less vague.

[Baroness Murphy (CB)]

The fact of the matter is that many of the things we are discussing would, in normal medical and social legislation, be contained in codes of practice. They will certainly need to be worked up in great detail for some of these issues to be covered, but it is not necessary to put them in primary legislation. For example, the carting of medication around between a pharmacy and a doctor is in a code of practice that is quite straightforward. I agree that that needs to be done in detail so that it can be monitored and practitioners who are implementing the legislation can do it with confidence. There is no good in putting it in primary legislation that will inevitably change when processes and habits change.

[Lord Deben (Con)]

That may well be the view of the noble Baroness, but it is not the view of the Royal Colleges, and it is not the view of the Select Committees of this House that have looked at this. It is perfectly reasonable for me to suggest that there is an alternative, and I am suggesting an alternative to the noble Baroness. I am still sorry that she should think the word “nitpicking” a suitable phrase to describe people who have spent their lives working on these issues and are trying to find answers to the problems that have clearly been raised by this Bill. Most of us who have views on this subject have been extremely careful in the language that we have used. We have respected the views of those with whom we fundamentally disagree, and we have done so with great care.

I will explain why I think we should consider these amendments very carefully. I am not expert enough to say that this or that bit is the right answer to this, but this is precisely the kind of information that ought to be in the Bill, but which is not. These are the answers that most people who are expert in this matter, and have given evidence to the various Select Committees, have asked for. This should not have been needed as an amendment; it should have been presented by the noble and learned Lord and those who are putting forward this Bill, because we need to know this before we vote on it, not afterwards. That is the problem that the noble Baroness is avoiding. We are being asked to pass a Bill and leave so much to things that will be done in a way we have absolutely no knowledge of.

There is a second reason why it is important to take very seriously these amendments: the relationship between patient and doctor. My one expertise is from having spent nearly 40 years as a Member of Parliament, representing a constituency. It is all very well for those who are perhaps removed from the generality of the population, but one thing you learn in your weekly surgery, and from going around your constituency, is the degree of fear that people have of doctors and hospitals. Anyone who is concerned about this from a pastoral point of view—here is a non-religious element for bishops and ministers of all sorts—knows very well that this is a fundamental fact that you find everywhere. One problem, even for those who are in favour of the principle of the Bill, is that it increases that fear among many people. Therefore, it is hugely important to ensure that there is a service that is clearly separate from and unconnected in any way—except that necessary connection to which the noble Baroness pointed—with the care that has taken place.

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[Baroness Murphy (CB)]

My Lords—

[Lord Deben (Con)]

I will give way in a moment but I wish to finish my sentence—and to being a society that cares for people right to the end of their lives. I know what sort of society I want to live in: one that looks after the most vulnerable at their most vulnerable time. If they are to be given that alternative, it is clearly unconnected with the fundamental moral duty of a society: to look after those who cannot look after themselves.

[Lord Pannick (CB)]

How are we looking after the most vulnerable at the most vulnerable time of their life if we isolate them from those who have given them care in the most difficult time of their life, when they are about to die?

[Lord Deben (Con)]

The proposal here is not isolating them in all the things that matter; it is doing something quite different. It is saying that those who are looking after them continue to look after them and give the information that is necessary for those who will make judgments to make those judgments. It is making a distinction between care—that is, the people we are talking about—and a decision about life and death. That decision should not be made by the people who are looking after them, but the people who are looking after them should provide information to those who are making an objective decision. That is why putting carefulness at the heart of what we do, and putting the rest to one side, is a proper way of dealing with it.

[Lord Markham (Con)]

The noble Lord was at pains to say that he felt that assisted dying was somehow not a compassionate part of care, but will he accept that, for some people, it is the true definition of compassion? Noble Lords have heard me say on many occasions that, when my mother was terminally ill and it was suggested that we might help her take an earlier train home, that was absolutely the compassionate thing, which she and others wanted. For all the supporters of assisted dying in this House and in this country, which is about 70% of people of every religion and including those with a disability—every group we talk about—it is because they believe that that is the most compassionate thing they can do: to give the person the autonomy of their own choice of how they want to end their suffering.

[Lord Deben (Con)]

One problem with using the word “compassionate” is that it is a mechanism for suggesting that one’s own answers to these issues are compassionate and other people’s are not. I happen to think that the most compassionate way of dealing with this is, first, to have a society in which we have palliative care of the highest standard for everybody. Then, if you have that, it may be that some would believe that it would be better for them to make a choice to kill themselves. This is what we are debating: not the principle but how you do this. I have given a clear statement of what my principled views are, but I am talking now about the facts of this issue. First, you have to show that you have proper palliative care. Secondly, you have to accept that there will be, in accordance with the Bill, the opportunity for people to decide. Who should make that decision? The problem is that, if you have proper palliative care, that will continue—or it ought to continue. All the information that those people have should be given to the people who are making that decision.

My noble friend is absolutely right: there are those who feel that this is a compassionate answer. I suggest that, if they feel that, the opportunity to make that choice should not be in the hands of people who are actually looking after them. I have tried to explain that, first, it makes many people more frightened of hospitals; secondly, it confuses their relationship with doctors; and, thirdly, it is very difficult to see that all those people who are looking after people will want to be involved in this. Fourthly, this begins to get closer to what the people who support the Bill demand should be carried through. We are trying to find an answer and, if the sponsors of the Bill do not like this particular answer, perhaps they can come forward with a proper programme for how to do this, instead of leaving it to the vagueness which our own Select Committee said was unacceptable.

[Baroness Jay of Paddington (Lab)]

My Lords, it seems to have become a regular feature of these Committee sittings that the noble Lord, Lord Deben, and I disagree—but I think we disagree with courtesy, and I hope we disagree on the basis of real understanding. However, it is extraordinary that we have got to this stage in the Bill and he does not seem to accept that those on this side of the House—or rather, those of us who support the Bill, as it is not an “on this side of the House” issue—are in favour of palliative care. We have always been in favour of palliative care and have always said that the two go together.

I have not had the honour of serving in the other place, as the noble Lord has done, but I have had experience of sitting on other Select Committees of your Lordships’ House on this particular matter—not the immediately past one, but on others—where we looked in detail and travelled to those places where assisted dying is in place. There is absolutely no evidence that assisted dying, when introduced, does anything other than improve palliative care, because it improves the understanding that people have of discussions about end-of-life care, death and the general issue, which can be debated more openly.

I am not trying to take the point made by the noble Baroness, Lady Murphy, any further, but one of the things that has concerned us in this Committee is that there is so much emphasis in so many of these amendments on the detailed administration—the noble Baroness used the word “nitpicking”, which noble Lords did not like—and the very small print, and so much less focus on those people who are actually going to hope to take advantage of this legislation: patients and people who are dying, and people who are reaching the end of their life. I remember that in a previous debate my noble friend Lady Hayter said this, but I have been rather shocked by the emphasis, for example, on the bureaucracy and structure of the commission and so on, which has not emphasised the position of those people who are dying.

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[Baroness in Waiting/Government Whip (Baroness Blake of Leeds) (Lab)]

My Lords, I thank all noble Lords for taking part in the debate so far today. As we know, this group of amendments focuses on two core subjects: first, adding a new multidisciplinary panel process into the Bill, tabled by the noble Baroness, Lady Finlay, and secondly, amendments in relation to approved substances. This is a large group of amendments. As ever, my comments will be limited to amendments where the Government have major legal or technical workability concerns.

On the suite of amendments tabled by the noble Baroness, Lady Finlay, it is the Government’s view that, logically, these amendments stand or fall together, as they are a systemic change to the Bill. The amendments would introduce a new system of “assisted dying panels”, distinct from the existing assisted dying review panel in the Bill. These panels would receive and consider requests for assistance as part of the first declaration process, replacing the role of the co-ordinating doctor. The amendments would also introduce the concepts of “licensed assisted dying services”, “navigators for assisted dying”, and “designated” pharmacies. These are rightly policy choices and matters for the sponsor and for Parliament to decide on.

However, noble Lords may wish to note that it is the Government’s view that this package of amendments would lead to major technical, legal or operational workability concerns. The amendments introduce new concepts that would require significant further work to ensure that the policy intent was clearly understood and could work with the rest of the Bill.

[Lord Deben (Con)]

The point about the drugs and their control will surely have to be dealt with by the Government, whatever happens. What assessment have they made—surely they ought to make it in any circumstances—about how that should be done, what it would cost and how one can protect people from dangers which have happened? It seems to me that that is not a policy matter but a practical matter which we ought to understand from the Government.

[Baroness Blake of Leeds (Lab)]

I can only refer the noble Lord to previous comments that the details around these matters will be considered when progress is made. It is not appropriate for those matters of detail to be considered now. The noble Lord is shaking his head, but I think we are very clear about the responsibility of government at this moment in time, and it will be for my noble and learned friend to respond to the detail of policy as we go forward.

[Lord Deben (Con)]

If the Minister does not mind me saying so, this is a real problem. If we do not know—because only the Government can tell us—what the mechanism whereby drugs would be dealt with would be, how can we make decisions about this? We really need to know from the Government, under the present Bill, what in general the way in which they will deal with this is, otherwise we will have to put it into the Bill because we do not know. It really is important for the Government to help us.

[Baroness Blake of Leeds (Lab)]

I completely recognise the noble Lord’s strength of feeling, which he has expressed on many occasions. However, I just reaffirm that we would go through a process for determining the mechanism around the matters that he raises should the Bill progress, and that is a clear point from the Government in response to his—

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[Lord Falconer of Thoroton (Lab)]

I accept what my noble friend says. I hope she has read my note to the committee, which it published, in which I accept that further work is required, in particular on Clause 37. I accept in principle that I have to come back with further amendments in relation to Clauses 27 and 37.

The noble Baroness, Lady Hollins, has made a series of creative suggestions. She is addressing this in a way that is separate from the proposal from the noble Baroness, Lady Finlay of Llandaff. She says that her proposals on substances should apply irrespective of which scheme it is. I need to consider some of them in detail. My noble friend Lady Blake has indicated why some are difficult to integrate into substances for assisted dying. I am particularly interested in the relationship between the Medicines and Healthcare products Regulatory Agency and the approval of these drugs; that needs further thought on the sponsor’s part. In addition to the amendments that I am proposing to Clauses 27 and 37, I should consider them as I think they are valuable.

For the reasons given by my noble friend Lady Blake, I do not support the amendments proposed by the noble Baroness, Lady Grey-Thompson, in relation to clinical trials. Although the MHRA has a part to play, I also accept the limitations on that put forward by my noble friend Lady Blake.

I have seven amendments in this group: Amendments 624A, 708A, 708B, 710B, 862B, 877B and 878A, all of which relate to limiting the power in Clauses 27 and 37, and include a requirement for consultation in respect of the Minister. I do not think that they are contentious, although I accept that people think that I should go further. In the respect that I have mentioned, I am more than willing to think about going further. If and when we reach those amendments, I expect the Committee to agree to them.

I deal finally with the question from the noble Lord, Lord Empey, in relation to Northern Ireland. He asks why the Bill extends the power of the drug regulator in this respect to Northern Ireland. The noble Lord will know that drug regulation is a matter for the whole of the United Kingdom so must be dealt with by a statute in this House. We are not suggesting that Northern Ireland should change its current law, but if there was a law change then there would be no reason why the drugs authorised in whatever process the Secretary of State agrees to should not apply to Northern Ireland. That is why it refers to Northern Ireland.

[Lord Deben (Con)]

Does the noble and learned Lord agree with the noble Baroness, Lady Murphy, that assisted dying is part of palliative care?

[Lord Falconer of Thoroton (Lab)]

Assisted dying is about giving somebody a good death. Palliative care is about exactly the same thing.