Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 6th February 2026 Lords Chamber

[Baroness Keeley (Lab)]

My Lords, I am speaking on behalf of my noble and learned friend Lady Scotland, who made clear last Friday that she could not attend today’s Committee debate. I very much appreciate what my noble and learned friend Lord Falconer has just said, but it is worth me explaining Amendment 87A a little and making another couple of points.

The purpose of Amendment 87A is simple—to retain a safeguard that prevents a person becoming eligible for assisted dying by choosing to stop or limit their drinking. We have heard about what happens around that.

I certainly welcome the intention behind Amendment 87, which rightly seeks to protect people with anorexia nervosa, whose restricted intake cannot truly be considered voluntary. On that point, there is welcome consensus. But there are some points that are still worth making.

As drafted, Amendment 87 would inadvertently dismantle another essential safeguard that would ensure that people who are not terminally ill cannot make themselves terminally ill by deliberately ceasing food and fluids. This issue is entirely distinct from anorexia. The other place added Clause 2(2) specifically to prevent that.

Amendment 87A restores that protection so that Amendment 87 would safeguard both groups—those whose mental disorder limits eating and drinking and those who might deliberately restrict intake. This is not a theoretical concern. The case of Cody Sontag in Oregon shows us that what we fear may happen is already happening in one of the jurisdictions that we keep hearing has not experienced significant challenges with assisted dying. Cody was a woman with mild cognitive impairment who feared future cognitive decline after watching her father die of Alzheimer’s disease. After being advised by an end-of-life organisation that by voluntarily stopping eating and drinking she could bring herself within the eligibility for an assisted death without a waiting period, she did so. Within five days, her doctor concluded that she was terminally ill due to dehydration. Two days later, she died by assisted death.

The American Academy of Aid-in-Dying Medicine acknowledges that this loophole is a legal grey zone. I am sure that noble Lords agree there must be no grey zones when dealing with irreversible decisions about life and death.

Even if amended by Amendment 87A, Amendment 87 would not fully protect people with eating disorders, because many people with eating disorders do not restrict their eating and drinking. For example, people with type 1 diabetes and an eating disorder will manipulate insulin, and people with bulimia binge and purge. Both behaviours can be life threatening—particularly where treatment is refused or unavailable—despite being treatable conditions. Under Clause 2(1), such individuals could still meet the definition of terminal illness.

Throughout the Bill’s passage, as my noble and learned friend Lord Falconer acknowledged, concerns about protecting people with eating disorders have repeatedly resurfaced. Concerns were raised repeatedly in the other place, in oral evidence, in line-by-line scrutiny on Report, and at Third Reading, and we are raising them again here. It is abundantly clear that we have not yet got this right, so my noble and learned friend’s comments about accepting Amendment 87A are very welcome.

The Bill does not yet protect this vulnerable and growing group of people, illustrating how easily complex conditions can fall outside intended protections. For that reason, I support Amendment 101 in the name of the noble Baroness, Lady Parminter, which would explicitly rule out the physical effects of any mental illness, including eating disorders, from qualifying the person for assisted dying.

Evidence from other jurisdictions shows that more than 60 people with eating disorders have already died by assisted death—all women, and the majority aged under 40. We must not repeat those mistakes here.

I also support Amendment 92 in the name of my noble friend Lady Debbonaire, which addresses the serious risk posed when someone with a treatable condition refuses or withdraws consent to treatment. Long, difficult treatment journeys can leave people despairing. Under the Bill as drafted, refusal of treatment would become a straightforward route to eligibility. The amendment from the noble Baroness, Lady Parminter, would close that loophole for eating disorders, and Amendment 92 would extend protection to all treatable conditions. We should adopt both. This is fundamentally a matter of sequencing.

Someone who is terminally ill and chooses an assisted death is entirely different from someone who makes themselves terminally ill by refusing treatment due to suicidal feelings. The Bill was never intended to allow the latter.

Our purpose is to make the Bill safer, and adopting all these amendments is essential to doing so. There can be no grey areas in matters of life and death and the protection of vulnerable people.

[Lord Empey (UUP)]

My Lords, I will speak to Amendment 89. I think that everybody in the Committee is more or less on the same page in what we are trying to achieve here. This amendment would add,

“or withdrawing medication, hydration, or life-sustaining devices”

to Clause 2(2). This has perhaps been forgotten about, but people sometimes rely on ventilators and other equipment to sustain their lives, so it is not a big leap forward to add this to the legislation. It is simple and straightforward, and amending Clause 2(2) seems to make sense. I cannot think of any reason why the noble and learned Lord should not adopt the amendment as a sensible way forward. It indicates—we have had this conversation a number of times, but we have to bear it in mind—that there are still significant weaknesses. We have to make the Bill safe.

On the hostile reaction to what we are trying to do here, I gently remind the Committee that when we last discussed this subject on 22 October 2021, at the Second Reading of the Assisted Dying Bill that Baroness Meacher brought forward, her Private Member’s Bill had 10 pages and 13 clauses. The Bill before us has 51 pages and 59 clauses. People have to understand that this is a massive Private Member’s Bill and is not normal in terms of how we deal with such Bills—it is much bigger. With that, I hope that the noble and learned Lord will have no difficulty in accepting Amendment 89.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, I will speak to my Amendment 103. I thank the noble Baroness, Lady Hollins, for adding her name to it. It is a modest amendment simply seeking to ensure that a person is not categorised as terminally ill if they have refused life-saving treatment because they are influenced by a mental disorder. The noble Baroness, Lady Keeley, was perceptive in addressing some of the issues that concern me and are why I tabled this amendment.

We are talking about any individual who, in effect, voluntarily brings themselves within the definition of terminal illness as defined in the Bill. As we heard on the previous group, supporters of the Bill often present the six-month prognosis as clear-cut and argue that we all know what we mean by terminal illness. In public discussions, the example given is usually cancer, which again seems fairly clear-cut. But we heard on the previous group that life and death and diseases are rather more complicated. The noble Lord, Lord Moylan, raised some very thought-provoking issues around that.

I want to make a bit more concrete what terminal illness would mean in the examples that I talk about. I have noted that the noble Baroness, Lady Coffey, started this theme in the previous group, and I was very affected by the moving speech made by the noble Lord, Lord Farmer, which also pertains to this. Where someone suffers a serious depressive episode, perhaps related to a debilitating physical illness that is difficult but none the less treatable, what would happen if, in a temporary period of despair, they refuse treatments such as dialysis or HIV antivirals, therefore potentially leading them to a terminally ill prognosis? Would they be eligible for assisted death in that instance?

Or let us take the case of a suicidal person, perhaps a prisoner suffering mental distress, who has attempted to take his own life several times before but suicide prevention policies have saved him. I think in particular of prisoners I have long campaigned for who are on IPP sentences. Tragically, suicide figures among that group of prisoners are very high and suicidal ideation is a real factor for those prisoners. Our imagined prisoner is not just mentally disturbed but physically dependent on insulin for diabetes and needs to take it to remain alive. If that person refuses to take that treatment and becomes seriously ill, bringing upon himself the inevitability of having a progressive disease and it becoming terminal, would he be eligible for assisted death under this Bill?

This example would seem to contradict the slogan of many of the Bill’s supporters, which we frequently hear: “They’re dying anyway”. As it happens, it is a phrase that I find particularly chilling, but, in this instance, they would not be “dying anyway”; they would be dying in a self-induced way. How will the idea of terminal illness in such instances be weighed up? In the case of our IPP prisoner refusing to take treatment such as insulin—perhaps even refusing to eat or drink—this could lead to an inevitable assisted death, because he would meet the physical criteria of terminal illness when, actually, the root cause was not inevitably progressive.

I like to imagine that we as parliamentarians, along with campaigners, will be successful in ensuring that IPP prisoners are freed from the hopelessness of an abolished prison sentence that psychiatrists uniformly and consistently say is a major factor in making people suffer mental illness in prison. If the IPP was ended, that prisoner could resume their medical treatment and their mental ill-health would have changed because the social circumstances would have changed. Therefore, they could resume their treatment, start engaging again, feel that they have a reason to live and become treatable, with recovery possible—but not if it is too late as they have already had an assisted death. In other words, terminal prognosis is not inevitable in that instance but self-induced, driven by a disturbance of the mind.

The noble and learned Lord, Lord Falconer, has some insight into the issues in this amendment, as he has explained. He has tabled an amendment and talked about any disease caused by a person not eating or drinking when that occurs as a result of mental disorder. Obviously, the focus there is on anorexia and eating disorders, but is this not a similar example?

I raise these issues because this is a loophole that has been nagging at me. I cannot see anywhere in the Bill where safeguards exist to prevent such undoubted unintended outcomes. Without those safeguards, the drafting of the Bill could inadvertently incentivise self-destructive choices about treatments for illnesses that are treatable, and lead to irreversible early death facilitated by state medical services when life-saving medical treatments could have ensured that people lived and were not categorised as terminally ill. It is this confusion—about who defines terminal if you put yourself into that category—that I would like the noble and learned Lord to reassure me about and clarify.