Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 13th March 2026 Lords Chamber

[Baroness Berger (Lab)]

The noble Baroness, Lady Grey-Thompson, made some important points, as have been made by other noble Lords, about the drugs. Given the context of this debate, as we deliberate these amendments and later amendments, it is worth sharing that the Delegated Powers and Regulatory Reform Committee of this House, in its important report about the extension of delegated powers in the Bill—of which there are now 48—had specific concerns about substances, drugs and the detail missing from the Bill. In fact, the two specific themes that are relevant are the lack of specification of approved drugs and the lack of regulation of approved substances. The Bill currently uses two delegated powers for something that would usually be described in the Bill, but it is instead in delegated legislation. That perhaps provides some context as to why these amendments have been put forward.

[Lord Empey (UUP)]

My Lords, I want to deal with probing Amendments 887A and 888A, in my name. Throughout the process there has been a potential clash between what decisions might be made here and what decisions might be made in the devolved nations. In the other place, an amendment was introduced by the sponsor of the Bill as it progressed to extend certain parts of it to Northern Ireland and Scotland, as well as England and Wales. My colleagues at the other end tried to put an amendment down to probe why this was done. Unfortunately, it was not taken, so the matter was never really debated.

I remind the House that Clause 37 deals with the regulation of approved substances and devices for self-administration. It says that:

“The Secretary of State must by regulations make provision about approved substances”,


and that has the extent of the entire United Kingdom. These regulations also deal with

“the supply or offer for supply, or administration, of approved substances … the transportation, storage, handling and disposal of approved substances”,

and

“keeping records”.

It says provisions must be made

“about the manufacture, importation, preparation or assembly of approved substances … or in connection with the monitoring of matters”

and so on,

“requiring persons specified in the regulations, in specified cases, to give information to the Secretary of State”.

As things stand at the moment, there is no plan by the Northern Ireland Executive to introduce an assisted dying Bill, and there is no Private Member’s Bill currently in the Chamber. Some of these regulations would, in my view, cut across the role that is currently played by devolved Ministers and devolved departments.

This is what I am trying to get at and to probe. It does not, incidentally, confine the extent to Clause 37. In fact, other clauses extend the Bill’s extent as well—Clauses 43, 54, and 56 all apply to the whole of the United Kingdom. I do not understand that. If the noble and learned Lord could enlighten us, that would be most helpful. As I said, they are probing amendments. The point I am trying to tease out in Committee is why that was introduced if it was not in the original Bill and why that extension was made, because, as things stand, there are no plans for an assisted dying Bill in Northern Ireland—not from the Executive and there is no Private Member’s Bill currently.

I totally accept that this Parliament has the right to legislate for the entire United Kingdom, irrespective of devolution. But, at the end of the day, the Bill says:

“The Secretary of State must by regulations make provision about approved substances”.


There is no argument about it—this has to happen. The extent of those regulations would be the entire United Kingdom. Whether Northern Ireland and Scotland want it, it is going to happen, according to this clause. Why is that the case? If there is no assisted dying available—and in many cases, it would be a devolved matter anyway—why are we regulating for the provision of these substances in all parts of the United Kingdom? That is what I want to know, and I will be grateful for the noble and learned Lord’s contribution in the wind-up.

--- Later in debate ---

[Lord Falconer of Thoroton (Lab)]

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

[Lord Empey (UUP)]

I thank the noble and learned Lord for his explanation. However, I said that it was a probing amendment. Other clauses are also extended to Northern Ireland, not simply Clause 37. Because it was just probing, I reserve the right to reflect on that and perhaps come back at a later stage.

[Lord Falconer of Thoroton (Lab)]

It is my fault for not dealing with it adequately. Of the two other clauses that apply, one is about advertising and is concerned with advertising into England and Wales. Nobody wants the advertising of assisted death services. We have drafted it on the basis that if you do it from Northern Ireland into England and Wales then there should be a means of enforcing that. The other is detriment to employment rights. Employment law covers the whole of the United Kingdom, which is why this applies to that one as well.

--- Later in debate ---

[Lord Jackson of Peterborough (Con)]

My Lords, I think the debate that we have had for the last two and a half hours shows this House in a very positive light. It goes to the very essence of what some of us who are sceptical about the Bill believe to be the most crucial issue: how the Bill will impact the most vulnerable people in society. I say in passing how moved I was by the wonderfully powerful and emotional speech from my noble friend Lady Monckton, as well as by my noble friend Lord Shinkwin’s speech on his amendment.

Noble Lords might ask a rhetorical question: why are we spending so much time on this particular group? I will offer an anecdote to your Lordships on why it is important that we have spent this time talking about people with disabilities and learning disabilities, and particularly people with Down syndrome. In the summer of 2024, my 91 year-old father was admitted to Peterborough hospital and spent a number of hours in what is euphemistically called “ambulatory care”—which is the back of an ambulance—before being able to access a trolley for a number of hours. As it happens, he was terminally ill. He died a few weeks later from bladder cancer that had metastasised to the rest of his body, but he did not have a diagnosis of terminal illness.

When I reached the hospital, his belongings were adjacent to where he was. At the bottom of the Sainsbury’s carrier bag that held all his personal belongings was a “Do not resuscitate” form that had been filled in. In fact, I think it was what they call—again, euphemistically—a “respect form”. It had been countersigned by a doctor without any discussion with myself or my two brothers. As your Lordships know, none of us are shrinking violets. My brother is a decorated police officer and my other brother is a world-leading scientist and a professor of psychology. We are all quite smart people, but this form had been completed without any discussion with the family.

Indeed, it was alleged that my father had had capacity to sign that form and had agreed to it being countersigned by a doctor. That was a very significant development. I found myself having to front up a difficult conversation with the clinicians in accident and emergency and the geriatrician who was on duty that day. I thought to myself: what if my father had a learning disability? What if he could not read or write properly? What if he was anxious about dealing with bureaucracy and professional people? I thought about how much more difficult it would have been if he did not have a family: if he had not had three sons watching out for him and protecting his interests. How much difficulty would there have been in him challenging the professional bona fides and authority of a clinician—a medic who is well educated and articulate and knows their profession.

I posit that that is the reason we have spent so much time debating these issues. It is not for people such as my father, who, as I say, was terminally ill, but for the many people who have great difficulty: people who are already in a position where they are sad, lonely, depressed, bereft and distraught after a diagnosis of a terminal illness. Those people need assistance in primary legislation to protect their interests, because otherwise no one else will look out for them. That is not to say that those doctors were in breach of the Hippocratic oath, or that they were not compassionate, empathetic, caring and feeling for my father and many thousands of other people in similar situations, particularly old people. Nevertheless, they are busy and stressed and that form was filled in in good faith.

[Lord Empey (UUP)]

In the modern NHS—not the NHS of five, 10 or 20 years ago—a patient can be in the back of an ambulance for hours outside the hospital, and then be put in a corridor before they get to a ward; and they might see a consultant on the ward round only once or twice a week for a few minutes, if they are lucky, and may not see the same consultant again for weeks. That fundamental change in the nature of our health service over recent years, with the huge additional pressure and demand, makes these protections all the more important.

Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 27th February 2026 Lords Chamber

[Baroness Grey-Thompson (CB)]

My Lords, the noble Lord, Lord Moylan, and the noble Baroness, Lady Fraser, raised some interesting points in this group of amendments. I do not have the noble Lord’s experience of local councils—I declare that I am president of the LGA, but that is largely an honorary role—but I have a lot of experience of wheelchair services. I also declare that I am president of the Wheelchair Alliance.

A service that should be incredibly easy to provide has become one of the most complex parts of NHS funding. In the good old days, when I was a child, there were two choices of chair: a small one and a large one. These days, because we want to provide better wheelchairs for people, which is a good thing, the commissioning and provision of those services has become complicated, and in different areas different prices are paid for exactly the same chair. My concern is that, if we cannot do that for something as simple as wheelchair services, how are we going to do it for this process? Many wheelchairs should be provided within 18 weeks, but I know cases where it has taken years to provide a chair for a child. We should learn from previous experience.

Some noble Lords have mentioned the potential competition that could come from funding for this service and the challenges for palliative care. However, the consensus among several professional bodies, including the Royal College of General Practitioners and the Association for Palliative Medicine, is that assisted dying should have distinct funding. Others have mentioned the way that palliative care is currently funded in the UK, but Nancy Preston, who gave oral evidence as well as written evidence co-written with a professor at Lancaster, Suzanne Ost, expressed concern that it would communicate the wrong symbolic message.

I am one of the seven Peers who were in the Observer for my number of amendments. I am receiving lots of emails telling me I need to uphold the will of the people, but I am not sure the people have been asked how they would like to reprioritise the funding of the NHS. I accept that lot of people think the service is needed, but are they being given the choice of what else they might lose? The comments by Stephen Kinnock, who said there needs to be reprioritisation, were interesting. We need to be really clear what we are going to lose out on. The noble Lord, Lord Markham, made some interesting points about savings and cost, but for me that is more about how you schedule the payments and work through it.

I am more concerned about the comments made by the noble Baroness, Lady Finlay, about the incentive to encourage people to go down this route. In Belgium, the service is paid for through the national health and the doctors receive a fee of €180. The cost of the procedure in Canada is $2,327, and it is estimated that they spend about $22.3 million a year to put this service in place. They save $149 million, but for provincial healthcare that is a negligible saving—it is 0.08% of their budget.

Stephen Kinnock talked about doctors receiving a reasonable expense. I have raised the issue of “reasonable” in terms of the Equality Act before. What actually is it reasonable for a doctor to be paid? In Australia, 27% of the doctors were unpaid while 32% got direct state government reimbursement, but a conversation is going on there at the moment about whether clinicians should have to be altruistic to provide this service. Doctors are already talking about having a standardised price for a voluntary assisted dying assessment of $860 as an out-of-pocket expense. That is important because a lot of assumptions are being made about where this service is going to be provided. The reality is that if we are going to give people a choice, we need to give them a real choice.

This is probably going to come up in later groups as well, but I have also noticed a shift in the language, which originally talked about doctors and now we are talking about medical practitioners. Does this mean it could be physician assistants? Could it be nurses? Could someone else be trained to do this? Could there be a career path in this service? Might people think this a good step in their career? The reality is that somebody always pays: the question is just who and when.

[Lord Empey (UUP)]

My Lords, to some extent this group of amendments goes to the core of a lot of the potential downsides of this Bill because, whether we like it or not, it is going to be a source of coercion.

If we go back a few weeks to the issue that was drawn to our attention by the noble Lord, Lord Stevens, concerning the role and the purpose of the National Health Service, clearly, that would need to be changed because we are talking here about a mechanism for ending life rather than a service that does its best to preserve life. To anybody who has had to spend a lot of time around hospitals—be it as a consumer of, or a relative of a consumer of, NHS services; or if you have had any role in government, even at regional level, dealing with health services—it is inconceivable that looking at the balance sheet is not going to be an issue for a clinician and a trust. That is the nature of the beast if you are the finance director of a trust and it is over budget, as they nearly all are. In Canada, we see that some people are boasting about the money they have saved by providing assisted deaths. I do not believe for one moment that that factor can be airbrushed out of this equation as far as this legislation is concerned. While I do not necessarily accept or agree with every amendment in this group, it draws our attention to the principles at stake.

It is in those circumstances that we have got into the habit in this debate of euphemisms. We call one thing by a certain name, but we know it actually means something else. In that regard, I draw the attention of the Committee to a debate on assisted dying that took place during the last iteration of this Bill, proposed by Lady Meacher, on 22 October 2021. This is the point I want to try to get across. Incidentally, that Bill had 13 clauses and 10 pages, compared to the 59 clauses and 51 pages we are looking at today. After Lady Meacher proposed her Bill at Second Reading, the noble Lord, Lord Winston, who I think is not in his place, spoke. He said that the Bill should refer to “euthanasia” rather than “assisted dying” as the Bill’s title did not represent what was intended. He went on to provide the Greek definition of what the word “euthanasia” means.

These amendments go to the core of a couple of issues. The first is the rationale behind the National Health Service in the first place, and how it would be changed and turned if it is carrying out a service which is anything but—

[Baroness Royall of Blaisdon (Lab)]

My Lords, the point that the noble Lord is making is very interesting, but he may have heard my noble friend Lord Winston say previously in the debate on the current Bill that he has changed his mind. He may well have changed his mind about the words that we use in relation to assisted dying.

[Lord Empey (UUP)]

I accept that that may well be the case. I am simply referring to what was in Hansard in 2021. The noble Lord may have changed his mind, as we all do over our lifetime, and rightly so—if you have a completely solid view of everything throughout your life, it is not a good thing. I am not in any sense trying to demean his position in any way; he is a very highly respected member of your Lordships’ House. My point is that his reference to the euphemism is still valid in my view.

Coming to the nuts and bolts of how things would work in practice, at Second Reading of this Bill, and indeed in previous iterations in which I have had any role, I drew attention to one of the key issues: changing the nature of the service that we are funding. If we decide as a Parliament to make assisted dying, or whatever phrase one wishes to use, a legal activity, that does not necessarily mean that the National Health Service has to pay for it. Can you imagine the finance committee of a trust discussing its budget and getting into an argument? The sums may be modest, but to even put something such as that in this context, when we are talking about life and death, is fundamentally flawed, morally and in every other way. The noble and learned Lord needs to reflect on some of these matters.

[Lord Harper (Con)]

I am grateful to my noble friends Lord Moylan and Lady Fraser for tabling these amendments. They have put forward some important questions which are worth raising explicitly with the sponsors of the Bill, so that we can hear what their intentions are and how they have reached those conclusions.

I have a number of concerns in this area, which I will set out. On a previous day, the Minister currently on the Front Bench confirmed, when we were debating resources, that if Parliament were to pass this Bill then the Government would ensure that all the requirements in the Bill were funded. That is perfectly right and proper. It was clear from that debate that there was no guarantee of any extra resources and that therefore money would be reprioritised—not just in the National Health Service but in the courts’ budget, given the impact that this Bill would have on the courts. That has clearly been reflected by what Stephen Kinnock said in evidence and by the Health Secretary, who commented on the need for prioritisation.

I do not make as much of the cost of this as some people, because I accept what the noble and learned Lord, Lord Falconer, said on a previous occasion. Compared with the NHS’s overall budget, the cost of providing this service is relatively modest. I have a different concern, which is twofold. First, as has been raised already in the debate, it would be perverse if Parliament were to pass this Bill and the taxpayer were to fully fund an assisted suicide service when it only partially funds palliative care. That would set out a very weird set of priorities and choices to the country—that the taxpayer should fully fund helping to kill people and not fully fund helping them to live well.

My question to the Minister—which does not trespass on the Government expressing a view on the Bill—is, in the event that Parliament passes the Bill, and the Government rightly ensure that it is funded, will the Government ensure that palliative care is fully funded by the taxpayer? This is not a question about taking a view on the Bill; rather, it is about making sure that when the Government publish in the autumn—this is why doing it in this order is not helpful, because we are not going to hear about palliative care services until the autumn—they will fully fund those services so that the taxpayer will ensure that any individual facing a choice has a proper choice and, if they choose palliative care, they will have care fully funded by the taxpayer in the same way that they would have a fully funded assisted suicide. If you do not fund it on that basis, you are not providing people with a proper choice. That is a question for the Government to answer.

Terminally Ill Adults (End of Life) Bill

Lord Empey Excerpts

Committee stage
Friday 9th January 2026 Lords Chamber

[Baroness Coffey (Con)]

Yes, I will. I am just saying that it is really important that we get statistics, and that this becomes the premise of the Lord Chancellor. This will be critical to making sure that we have confidence going forward and I will have to work out a way to reassess these amendments in future groups.

[Lord Empey (UUP)]

My Lords, I am indebted to the noble Lord, Lord Carlile, for bringing to a head one of the critical issues in this legislation. As one of the diminishing number of people in this House who is not a lawyer, I say that we have to find our way through this labyrinthine structure where we have chambers and all sorts of things. Without legal experience, it is difficult even as a legislator to navigate through this.

The point I want to make at the outset is that this significant piece of legislation started off in the other place with the legal process as a fundamental part of the architecture. That was subsequently changed more than half way through its process in the other place, and now we are trying to re-inject it into the system. I would ask the sponsor and indeed the Minister to respond to this. There are so many issues that have been raised already this morning about the consequences of making this change, for which we have absolutely no information whatever.

I remind colleagues that, on our last Friday, there were five separate issues—I repeat, five—to which no response or answer was provided. They were: the issue between England and Wales, the issue between England and Scotland, the issue of pregnant women, the issue of homeless people, and the issue of prisoners. There is no clarity on any of that.

The noble Lord, Lord Carlile, and his co-signatories are attempting in these amendments to at least make the legislation, as the noble Baroness, Lady Finlay, said, less unsafe. The stage we are at in this legislation is probably 75% or 80% of the way through the process and, as with a Meccano set, we are still bolting bits on and taking bits off.

All of this could have been avoided if we had had the proper process of a Royal Commission and a government Bill. This is Heath Robinson-type legislation on such a serious issue. I have to say to the sponsors that, instead of battling this out for the next few months, they would be far better to go to the Government and ask them to appoint a commission and get on with it. Then we would not have to fight our way through this morass.

Not being a legal person myself, I ask the noble Lord, Lord Carlile—given the pressures that we understand are applied to the courts and the Family Division—whether there is a case for the creation of a special chamber for people who are dedicated to this, with the training that would be required. Or, with the pressures that the family court is under, could it be that comparatively junior people end up being designated to hear these cases? Because you are talking about a huge gap in knowledge and experience on a life and death issue.

Maybe these questions cannot be answered now—maybe we will get answers when we come to Report—but the fact is that we are having to ask all these questions and we have no information, no numbers and nothing in front of us. I do not believe that that is a coherent and sensible way to go forward.

The noble and right reverend Lord, Lord Harries of Pentregarth, made a very valid point about the general public’s confidence in who makes such decisions. While I can see the merits, as the noble Lord, Lord Pannick, pointed out, of having a panel with different disciplines, the fact of the matter is that persons who are on that panel have to be appointed by somebody. Is there confidence in the people who appoint them? The court system, however, has a level of public confidence miles above any alternative.

All of these things need to be sorted out. They should have been sorted out before we had this debate today and they have not been. That is where we are. I think that the noble Lord, Lord Carlile, is attempting to put a foundation under this legislation. Leaving issues of principle out of it for the moment—we are legislators and sometimes we have to do things that we do not want to do personally—we are obliged to undertake this process. I assume that he is trying to put a foundation underneath this legislation that would command confidence among the general public, or at least a higher level of confidence than, I suspect, the panel process has. The fact that we have had this change and this flip-flop is very concerning.

I conclude by asking the noble Lord, and indeed, necessarily, the Minister: if these amendments were to be accepted by the sponsor, what would be the Government’s response? The noble Lords, Lord Harper and Lord Gove, have raised this, as have others. I understand that Ministers are in a difficult position. They are technically dealing with a Private Member’s Bill, whatever some of us think about that. Without having knowledge of what the state is going to do, we are legislating for the state to intervene to allow a person to end their life, which is against other legislation that we have already passed. So it is important that the Government should let us know what their responses will be in these various scenarios and I do hope that, when we come to the wind-up of this debate, we will get some clarity.

[Baroness Grey-Thompson (CB)]

My Lords, I speak to Amendment 67 in my name, in which I have sought to bring back the role of the High Court judge. The complexity of this group of amendments is shown here, but I thought that it could be done with one amendment rather than the number of amendments that my noble friend Lord Carlile had to table.

I think that this debate shows many different things. Not least, we have heard quotes about how the noble and learned Lord, Lord Falconer, has changed his mind over time. Others in the Chamber have done so as well, depending on the situation and the specific piece of legislation.

We need to give much more consideration to how this Bill will work in practice; this is one of the fundamental issues. I was disappointed when the High Court judge was removed from the process, because that had given me a level of reassurance. I felt that it gave authority and integrity to the process.

On where we are now, as other noble Lords have said, the toing and froing of this part of the Bill is very difficult. In another place, two-thirds of the debates on the Bill took place with the High Court judge as part of the process. If the noble and learned Lord was minded to bring that back in, it would yet again change a huge part of the Bill.

I thank the noble and learned Lord for meeting me before Christmas, when we had a very interesting discussion on one of the areas I am very concerned about, which is coercion, specifically coercion of disabled people. I am not minded to think that the panel is strong enough to cope with not just the number of cases that they may have to deal with but actually being able to spot some of the things that we have talked about. I have amendments on coercion; I also have amendments on the appointment process of those panel members, which I will not debate now. I know that the noble and learned Lord and I disagree on whether this is the safest Bill in the world. This is not the time for me to ask who has provided independent verification of that, apart from the Bill’s sponsors, but one thing we have to talk about is how we can make the Bill safe.