Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

2nd reading
Friday 19th September 2025 Lords Chamber

[Lord Empey (UUP)]

My Lords, I have been shocked at the inaccuracy of the parliamentary process applied to the Bill. It has lacked the detailed scrutiny that such a major piece of legislation requires, as confirmed in recent devastating reports by committees of this House. Despite all the hype in the Commons, it failed to gain the support of a majority of MPs.

Let us be clear what the Bill does. It authorises medical professionals in the employ of the state to introduce and ultimately provide the means by which an individual in the care of the NHS can be assisted to commit suicide, and to observe and supervise that process. The Bill also gives unprecedented powers to the Secretary of State. The Bill is not fit for purpose, and I am not convinced that it can be adequately reformed. As a member of the Presbyterian Church in Ireland, I accept my Church’s teaching on the principle of the Bill, but I am also a legislator, and that confers its own distinct obligations and responsibilities.

In my family’s case, we were faced with the illness of my late wife, Stella. She suffered from complicated medical conditions. In January 2023, she was very unwell—to the extent that the consultant called the family together and said that she was not going to pull out of it this time. Had he been asked whether she was terminally ill and would die within six months, he would have said yes. Would he have signed off as expecting her death in six days? I believe so, as that is what we were told. Nine months later, I was still taking her out most days, and she was able to enjoy that time with our children and grandchildren. I am also aware that she felt she was impacting on the ability of our children to get on with their careers. I could sense the anxiety she felt at impacting on our lives. This is the pressure point that is glossed over in the Bill and the discourse around it.

Doctors do not get it right all the time, and this arbitrary six-month timescale is a dangerous nonsense. The Bill would fundamentally change the relationship between the medical profession and patients at all levels. Gone would be the days of “do no harm”. Doctors could be seen not only as healers but as instruments to end the life of a patient in hospital, maybe spurred on for financial reasons. Families are not always welcoming environments. They can be toxic with competing pressures, especially over money. It is in these circumstances where subtle pressures to end a life can be generated.

Some of the basic practicalities have not yet been investigated because of this mad dash to get the Bill through. I know that all of us in this Chamber want the same thing: to reduce and minimise suffering. None of us knows how our days will end, but I believe that we are adding to suffering by introducing massive anxiety to patients at the most vulnerable time of their lives.

Our mailbags have been characterised by messages from disabled people, the elderly and others who feel a sense that they are no longer valued by society, surplus to requirements and mere cost centres. I know this is not the intention of the sponsors, but that is the inevitable outworking. To involve the entire NHS and turn its ethos upside-down is a serious mistake. People may also be afraid to present themselves to doctors for fear of getting a one-way ticket. Those of us with the financial means to get the best advice can do so, but for those without the resources it is the NHS or nothing.

It is time to think again. We have underinvested in palliative care for years, thus reducing rather than enhancing choice. Surely it makes sense to follow that route, as emphasised by former Prime Minister Gordon Brown, rather than risking the nearly 80 years of the embedding of a life-saving NHS in our nation’s DNA.

Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 14th November 2025 Lords Chamber

As I said at the beginning of my remarks, I am not yet convinced that the amendment in the name of the noble Baroness, Lady Coffey, is the right way to address this gap, but gap there is. Unless the Government come forward with a clear proposal that addresses the concerns expressed by the First Minister of Wales, the Senedd, both the Senedd Select Committees, the leader of Plaid Cymru and in Committee in the other place, we risk doing real damage to the devolution settlement and to confidence in the capacity of Westminster to legislate in this area, and doing real injustice to those in Wales, who deserve better palliative care and better mental health care than would be the case if this legislation were to pass as it stands.

[Lord Empey (UUP)]

My Lords, the noble and learned Lord, Lord Thomas, said that some people were suffering from insomnia. I think this House is suffering from collective amnesia. All of a sudden there is a great hurrah about the Sewel convention and respecting devolution. I gently remind this House that it had no hesitation whatever in legislating over the heads of the Northern Ireland Assembly against the expressed wishes of that Assembly on abortion, for instance, and on other matters. So, if we have suddenly decided that we are going to respect these settlements, it is a Damascene conversion, and I hope that it is perfectly obvious that there are huge holes in where this legislation is taking us, as has just been ably pointed out by the noble Lord, Lord Gove. Like him, I leave it open as to whether this is the right amendment, but I just gently remind everybody that we in this House are not scoring very high on consistency.

[Lord Tyrie (Non-Afl)]

I will be brief—everybody will be delighted to hear that. I should say that I am a supporter of the intentions of the Bill, and I agree with what the noble and learned Lord, Lord Thomas, said, particularly when he suggested that the Government will need to be involved in sorting out some of these problems.

What concerns me is that we are now going to try to improve a Bill, which is demonstrably flawed, with 900 amendments—many of which seem to make sense to me—on the Floor of the House between now and Christmas. Surely the Government should now be listening, and grasping that they need to take the Bill in themselves. They need to consult nationally and widely, to try to find as much consensus as possible, and then in a considered way they need to come back to the House. To attempt to deal with these 900 amendments in this way will end up with the Bill being talked out, with us being in a place we do not want to be—at least those of us who want to see progress on the Bill—and we will end up in a worse place than we would have been had the Government done the sensible thing at the beginning and taken the Bill in, as they did with Private Members’ Bills such as the Suicide Act.

--- Later in debate ---

[Lord Gove (Con)]

My Lords, I speak briefly in support of the point made by the noble Baroness. I entirely understand why many Members of the Committee regard the suggestion to replace “capacity” with “ability” as wholly inadequate. The challenge that has been made by my noble friend Lord Markham and others is entirely fair enough, but the definition of “capacity” in the Bill itself is inadequate.

It is the case that the Mental Capacity Act was not designed for this purpose and that this legislation has been retrofitted to use the Mental Capacity Act because inadequate effort was put into defining the ability of an individual to make this decision in an appropriate way. It is the case that the Office of the Parliamentary Counsel has made it clear that the effort to put this Bill together was “done on a shoestring”. It is also clear, as the noble Baroness pointed out, that the Royal College of Psychiatrists—the people who are responsible for addressing mental capacity—said that assessing a person’s mental capacity to decide to end their own life is an entirely different and more complex determination requiring a higher level of understanding than assessing capacity for treatment decisions, which is the purpose of the MCA.

We have been told by those responsible for the mental health of vulnerable people that the safeguard that we are about to legislate for is inadequate. More people will be placed at risk by its inadequacy. We may feel that the noble Baroness, Lady Finlay, in putting forward “ability”, is failing to meet the needs of the legislation. However, it is not her responsibility, but our collective responsibility, the promoter of the Bill’s responsibility and the Government’s responsibility to ensure that psychiatrists and this House can be satisfied that the threshold is sufficiently high.

We all recognise that, while this Bill may be about respecting personal autonomy, personal autonomy is not sovereign. We recognise that there may be circumstances in which that right cannot and should not be exercised. The promoters of the Bill have been very clear that they want to draw the lines narrowly to ensure that this is available only to people who are consciously capable at a time when their life will automatically end within a certain period.

[Lord Empey (UUP)]

Does the noble Lord agree with me that one of the issues, which has been sporadically mentioned, is the inconsistency of capacity or ability brought about by the interaction of certain drugs on an individual? They may be lucid at a particular point in time, but not lucid at another. Under our current proposals, the people who would be making that judgment do not even have to know or to have treated that person. Surely that has to be dealt with in any definition.

[Lord Gove (Con)]

The noble Lord is absolutely right. Again, there has been some debate about the evidence from psychiatrists and the reasons why they expressed doubts, but that evidence is plentifully available to Members of this House.

As a number of Members have made clear, the work of Alex Ruck Keene KC and the Complex Life and Death Decisions group of King’s College, which is available to this House and was examined in the Select Committee, makes it clear that the Mental Capacity Act is inadequate. It is inadequate to deal with the concept of suicidal ideation that occurs. It is inadequate to deal with the fact that capacity fluctuates, and that fluctuation can be affected by mental health and well-being in its broadest sense, as well as by other syndromes and conditions.

The psychiatrists would not have intervened as they did if they had felt that this was a matter that could be left to one side, a matter that was entirely, as it were, within the scope of parliamentarians or legislators to shrug their shoulders and to accept. They have sent a message to us that the Bill as framed endangers those who are most vulnerable. Can we really proceed on the basis of the MCA, a piece of legislation conceived at a different time for a different purpose and rendered in the eyes of the professionals as not the correct way to go forward?

Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 21st November 2025 Lords Chamber

In conclusion, the proposed amendments—adding “influenced or encouraged”, clarifying “pressured” as “externally or internally”, and broadening “person” to encompass corporate and institutional actors—would significantly enhance the safeguards in the Bill. Also, broader structural disadvantages which may persuade a person to end their life, such as poverty, need to be taken into account. These changes would help ensure that decisions to end life are made with the highest standards of voluntariness and autonomy, free from all forms of undue influence, pressure or encouragement, whether from individuals, organisations or internalised feelings. I support all these amendments.

[Lord Empey (UUP)]

My Lords, there is one aspect of coercion that we have not so far discussed. It was mentioned tangentially by the noble Baroness, Lady Hollins. It is institutional coercion. As somebody who has unfortunately had to bring a loved one into hospital to be treated and discharged on a large number of occasions in recent years, I have become familiar with the process called “clerking”, where an individual is brought into the hospital, the paperwork obviously has to be brought to bear, the healthcare staff have to fill it in and so on.

If this legislation gets on to the statute book, in whatever form, it has to be translated into paper that the health service will have to deliver when a patient is brought into a hospital. We already have the “Do not resuscitate” aspect of an induction, and we will now have to have another set of paperwork. I have seen how it works frequently: the pressure that the staff are under from time to time, and the fact that the people coming and going and dealing with a patient are frequently different and they change at 8 am in the morning and 8 pm in the evening. That paperwork has to be done by an individual, sometimes a relatively junior member of staff, and all these things have to be translated into a box that has to be ticked.

How is that to be done? The actual process that one has to go through, particularly dealing with somebody who is seriously ill, is challenging in itself, and when you have to ask the person, “Do you want me to tick the box that says, ‘Do not resuscitate’?”, that is a big thing to do, and the person needs to be coherent, informed et cetera. We are moving things to a stage well beyond that.

I had the experience of being in a hospice and, while it was not an issue with pain that was the problem, when the consultant comes along and says to your loved one, “Have you considered the D-word?”, that sobers you up. Somebody who was perfect intellectually, who had the ability and the capability, shut down completely and could not cope with, “Have you considered the D-word?”. So, I say to noble Lords, these are emotional things, coercion is a very hard thing to define, but I have to say to the noble Lord, Lord Pannick, that the difference between his scenario and what we are facing is that the state is co-operating, providing the mechanism and delivering the mechanism for a person to end their life. That is the antithesis of what the medical profession and the National Health Service have stood for since its inception.

With regard to how we treat things in this House, when Bills come to us, of course we have a view on whether we are for them or against them. I remember when the Brexit legislation came before this House and I gently remind the noble Baroness, Lady Hayter, that she was not running to try to improve it so that she could get into the Content Lobby. It is the way things are. On an issue such as this, we have to be driven by our conscience, not by our parties or anything else, but let us remember that this will have to be translated into the room where the patient is sitting. What box is a junior nurse or a junior auxiliary going to be asked to tick? What is the question? Who is going to fill it out?

As the noble Lord, Lord Hunt of Kings Heath, said, if we had had a royal commission and a proper government Bill, we could have answered these questions, instead of having to sit here and go through the whole process again. I just ask the noble and learned Lord, Lord Falconer, to bear these things in mind. These are gaps in the system which the staff are going to have to face. There will be shifts coming on and there will be some members of those shifts who will refuse to participate. What kind of chaos is that going to create? These things need to be thought through and they are not thought through.

[Baroness Hayter of Kentish Town (Lab)]

I just remind the noble Lord, Lord Empey, that of course I did vote for the Brexit legislation and in fact led the Labour Party into the Lobby to support the final agreement on Brexit.